High-risk endometrial cancer in young indigent women

OBJECTIVE: The aim of this study was to evaluate a different prevalence and clinical pattern of high-risk endometrial cancer in an indigent population of young women. METHODS: Charts of 71 consecutive patients, treated for endometrial adenocarcinoma during a 6-year period, were reviewed. The patients were divided into two groups contingent upon age--(i) those who were below 40 years and (ii) those who were over 40. Based on histological type, grade, and stage, both groups were subdivided into a low, intermediate, or high-risk cancer category. RESULTS: Of the 13 (18.3%) patients in the younger age group, five patients (38.4%) had high-risk endometrial cancer, compared to only eight patients (13.8%) in the older age group. CONCLUSION: In contradiction to previous reports, our results show that a higher proportion of young indigent women diagnosed with endometrial cancer have a high-risk cancer. Delay in diagnosis can explain only some of the discrepancies in the special clinical pattern of endometrial cancer among this population. Other possible explanations include nutritional differences, genetic susceptibility, immunological status, and high-risk behavior. More epidemiological studies are needed for complete understanding of the unfavorable outcome of endometrial cancer in these young women.     

Combination of ABO blood group incompatibility and glucose-6-phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia

The incidence (%) of hyperbilirubinemia (serum bilirubin ≥257 μmol/l) was similar in neonates with a combination of ABO incompatibility and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (45%), with ABO incompatibility (54%) or G-6-PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 ± 0.32%, 0.82 ± 0.29%, 0.76 ± 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO-incompatible/G-6-PD-deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.     

Investigation of age as a prognostic factor in early stage invasive cancer of the cervix. Implications for nursing

A retrospective study was conducted investigating the relationships between age and length of survival, and between age and the prognostic factors of disease stage, tumor size, histologic grade, and hematocrit. The subjects consisted of all of the women with early-stage invasive squamous cell cancer of the cervix, treated with radiation therapy alone in the Department of Radiation Oncology at the State University of New York-Health Science Center at Brooklyn between January 1, 1980, and December 31, 1986. The 105 eligible subjects were divided into two groups: those 39 and younger (n = 22) and those older than 39 (n = 83). Length of survival was significantly shorter for the younger group (p = 0.0009). Of this group, 50% had died from disease compared with 23% of the older group. Tumor size was also significantly greater in the younger group (p = 0.038). Further study is needed to determine the contributing risk factors for cancer of the cervix in young women and to develop a comprehensive gynecologic nursing assessment tool for identifying those at increased risk for this disease. In terms of developmental psychology, the young women fit into the stage of early adulthood. Knowledge of the tasks of this stage would facilitate the development of primary cancer prevention programs for this group.     

Subject review with case study: Pseudotumour cerebri risk for cognitive impairment

Does increased intracranial pressure in patients with pseudotumour cerebri PTC result in cognitive impairments The results of previous investigations have not clarified this question It may be that there is a subgroup within those diagnosed with PTC that does experience cognitive decline with increased intracranial pressure However elevated intracranial pressure headache and emotional distress also can contribute to reduced cognitive performance and increased self monitoring As a result of the lack of clarity regarding the impact of PTC on cognition clinicians are left with no empirically derived practice guidelines A case study demonstrates subjective complaints of concentration and memory deficits in a depressed patient with PTC whose neuropsychological stores except Seashore Rhythm Test were in the normal range     

Hemodynamics and survival of patients with portopulmonary hypertension.

It is not known whether patients with pulmonary arterial hypertension associated with portal hypertension (portopulmonary hypertension (PPHTN) have different disease characteristics from those of patients with other forms of pulmonary arterial hypertension. We performed a retrospective cohort study of patients with PPHTN and patients with pulmonary arterial hypertension that was idiopathic, familial, or associated with anorexigen use (IPAH) to determine whether hemodynamics or survival were different between these groups. We included consecutive patients who underwent initial pulmonary artery catheterization and vasodilator testing at our center between January 1997 and May 2001 and who were followed until January 2004. Patients with PPHTN (N = 13) had a higher cardiac index and lower pulmonary vascular resistance than patients with IPAH (N = 33) (P < or = 0.001). Right atrial pressure and pulmonary artery pressure were similar between the groups. Patients with PPHTN had a higher risk of death in multivariate analysis (hazard ratio: [HR] = 2.8, 95% CI 1.04-7.4; P = 0.04). These findings were not affected by adjustment for differences in laboratory values, hemodynamics, or therapy. In conclusion, patients with PPHTN have a higher risk of death than that of patients with IPAH, despite having a higher cardiac index and lower pulmonary vascular resistance. Future studies of the specific mechanisms of and therapy for pulmonary arterial hypertension should focus on the distinctions between the different forms of this disease.     

Biochemical markers of compliance in the Physicians' Health Study

The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial using a 2 x 2 factorial design to test the effects of low-dose aspirin on risk of cardiovascular disease and beta-carotene supplementation on the incidence of cancer. To evaluate self-reported compliance with assigned treatment, we measured serum thromboxane B2, which is decreased after aspirin use, and plasma beta-carotene in samples of study participants drawn from three geographic locations in three different time periods. Thromboxane B2 levels were markedly lower in those assigned to aspirin (median = 63.5 pg/mL) than in those given aspirin placebo (median = 3,600 pg/mL, P less than .0001). Similarly, those assigned to beta-carotene had significantly higher levels (median = 1,176 ng/mL) than those given placebo (median = 306 ng/mL, P less than .0001). In addition, there was a highly significant positive correlation between levels of these biochemical markers and the self-reports of compliance (r = 0.65 for thromboxane B2 and r = 0.69 for beta-carotene, P less than .0001). These findings support the validity of the self-reported compliance in the Physicians' Health Study.