Latest Articles
- Surgeon’s Skill Key to Ovarian Cancer Management
No good screening test exists for ovarian cancer, yet women are being advised to demand screening.
- Noninfectious respiratory disease in pregnancy
BACKGROUND Pregnancy increases the risk of many noninfectious respiratory conditions.
OBJECTIVE To review the clinical presentation and management of a variety of noninfectious respiratory conditions in pregnant women.
SUMMARY Asthma, aspiration pneumonia, venous air embolism, adult respiratory distress syndrome, pulmonary embolism, and deep venous thrombosis may have unique features in pregnant women.
CONCLUSIONS Evaluation and treatment of these diseases and conditions requires an understanding of the normal physiologic alterations that accompany pregnancy and an awareness of the risks of medication use during pregnancy and in the postpartum period.
- Noninvasive risk assessment after myocardial infarction
BACKGROUND Mortality from acute myocardial infarction is substantially less than it was two and even one decade ago. This improvement in both short-term and postdischarge outcome results both from early interventions to restore myocardial perfusion and mitigate expansion and remodeling, and from later assessment and management of functional status at the time of hospital discharge.
OBJECTIVE Recent studies suggest that invasive evaluation of the patient who has had a myocardial infarction (MI) should not be recommended on a routine basis. This review provides an approach to the noninvasive assessment of the patient.
DISCUSSION Stress testing to ascertain post-MI ischemia, ejection fraction determination to evaluate ventricular volumes and function, and ambulatory electrocardiographic monitoring, electrophysiologic study, and signal-averaged electrocardiography to assess presence and type of ventricular ectopy are discussed.
CONCLUSION The approach to the post-MI patient offered herein is felt to be medically sound and cost-effective. Refinement and alterations in this approach will be necessary as outcomes in specific patient groups, such as thrombolysis patients, women, and the elderly, become clearer.
- Acquired immunodeficiency syndrome: case reporting at a university hospital
BACKGROUND Planning and allocating resources for care of patients with acquired immunodeficiency syndrome (AIDS) requires accurate assessment of disease incidence.
OBJECTIVE To assess the accuracy and completeness of AIDS case reporting at our institution, we reviewed all inpatient and outpatient records of patients with AIDS seen at University Hospitals of Cleveland, Ohio, between January 1983 and July 1990.
METHODS The patients were identified through review of hospital discharge summaries, ambulatory clinic listings, and laboratory identification of opportunistic infections.
RESULTS We found that 24 of 291 AIDS cases (8%) seen at this institution had not been reported to state health departments. Of the 24 patients with unreported AIDS, 16 had received an AIDS diagnosis at other institutions, 11 had never been hospitalized at this institution, and 2 had used pseudonyms.
CONCLUSIONS Review of AIDS case reporting can ascertain the magnitude of underreporting; the profile of patients who were unreported may be used to evaluate the accuracy of reporting elsewhere and to identify systematic problems in case reporting methods.