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Biomedical subjects

C B Hammond

Publications and source records attributed to C B Hammond.

At least 19 recordsLinked to original sources
PubMed1992

Acute childbirth morbidity: its measurement using hospital charges.

OBJECTIVES: An analytic descriptive analysis of acute childbirth morbidity was carried out at Duke University Medical Center, comparing patients delivered by primary cesarean section with those delivered vaginally. STUDY DESIGN: All primary cesarean deliveries and vaginal deliveries from July 1, 1981, through June 30, 1986, were combined with maternal and infant charge data. A total of 7256 patients were analyzed. A description of the charges for the associated diagnoses was carried out. A morbidity index was used to identify differences in predicted median hospital charges with 95% confidence intervals. RESULTS: The ratio of mean primary cesarean delivery to mean vaginal delivery total charges was 2.5:1. The magnitude of the mean hospital charges was inversely related to the frequency of the indication with the lowest charges associated with dystocia and the highest with multiple pregnancy. Antepartum risk factors (increased maternal age, patient referral) were associated with increases in maternal and infant morbidity as measured by the morbidity index. Chronic maternal hypertension resulted in decreased maternal morbidity but increased infant morbidity when primary cesarean delivery was used. Although preterm delivery was associated with large increases in charges, it was not significantly altered by using primary cesarean delivery. Risk factors associated with the management of abnormalities of labor were associated with decreases in maternal and infant morbidity when primary cesarean delivery was used. CONCLUSION: Analysis of acute childbirth morbidity, as measured by hospital charges, showed marked variation of diagnosis and risk-specific charges for patients delivered by primary cesarean section.

Adult↗
PubMed1990

Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center.

Between 1968 and 1985, 28 patients with recurrent gestational trophoblastic disease (GTD) were treated at the Southeastern Regional Trophoblastic Disease Center. Sixteen patients received primary therapy at this center and had recurrence diagnosed by re-elevation of human chorionic gonadotropin (hCG) levels after three consecutive negative levels: five (2.5%) of 204 patients with nonmetastatic GTD, three (3.7%) of 81 with good prognosis metastatic disease, and eight (13%) of 61 with poor prognosis disease. The remaining 12 patients were referred for therapy after receiving primary therapy elsewhere. All episodes of recurrence were observed within 36 months of remission with 50% and 85% before 3 and 18 months, respectively. Fourteen (56%) of 25 patients who achieved secondary remission developed a second recurrence and five (45%) of 11 surviving a second recurrence developed one or more further episodes of recurrent GTD. Nineteen patients (68%) have sustained remission 18 months following therapy for recurrent GTD. Factors relating to development and survival of recurrent disease include: poor prognosis metastatic disease, inadequate initial staging and therapy, lack of adequate maintenance chemotherapy beyond the first negative hCG level, and prolonged intervals between cycles of chemotherapy. Recent regimens introduced have contributed to an increasing salvage rate: 15 of 18 patients treated since 1978 are without evidence of disease whereas only four of ten treated prior to 1978 are currently in remission (P = 0.03).

Chorionic Gonadotropin↗
PubMed1989

Estrogen replacement therapy: what the future holds.

Although hormonal replacement therapy has proved beneficial for many postmenopausal women, several issues remain to be resolved through future research. Improved combination therapy, better delivery systems, and optimal dosing may enhance compliance, which is essential for maximum benefit from therapy. Epidemiologic studies are necessary to clarify the role of estrogen in osteoporosis and cardiovascular disease. Additionally, the contribution of hormonal replacement therapy to the development of breast and endometrial cancers needs to be clarified.

Cardiovascular Diseases↗
PubMed1989

The risks and benefits of oral contraceptives.

Although OCs are frequently perceived as offering no health benefits other than enabling a woman to control the timing and size of her family, it is obvious from this review that substantial protection from a variety of conditions is conferred by OC use. Future studies, however, may delineate a subpopulation of women at risk for cervical neoplasia who should not use oral contraception. When OCs are prescribed for only those women for whom they are appropriate, using the lowest dosage of estrogenic and progestogenic agents necessary to control fertility and prevent irregular bleeding, then morbidity and mortality from cardiovascular events can be avoided while allowing the largest number of women to benefit from their protection from neoplasia, infection, and benign breast disease.

Contraceptives, Oral↗
PubMed1988

Case-control study of gestational choriocarcinoma.

A multicentered case-control study of 75 women who had had gestational choriocarcinoma was conducted to investigate the role of reproductive and fertility factors as well as other potential risk factors in the development of this disease. Control women, identified through random digit dialing, were individually matched to cases by year of pregnancy, age at pregnancy, and geographical proximity of residence. Choriocarcinoma risk was decreased significantly as body mass index increased (P for trend = 0.03). Cases reported low-calorie dieting significantly less frequently than controls [odds ratio estimate (OR) = 0.50, P = 0.05] and were significantly less likely to participate in regular exercise (OR = 0.38, P = 0.004). Compared to women with a heavy menstrual flow, those with light menstruation had significantly elevated risk (OR = 6.69, P = 0.01). Menarche after age 12 was also associated with elevated risk of this disease (OR = 2.89, P = 0.003). There were significantly more pairs of dizygotic twins born to cases and their first degree relatives than to controls (12 case families with 13 sets of twins versus 3 sets in control families, OR = 6.36, P = 0.009). Cases were more likely to have married more than once (OR = 13.0, P less than 0.001), and infrequent intercourse was a significant risk factor (OR for weekly or less often was 3.00, P = 0.04). Risk estimates for postmolar choriocarcinoma were not significantly different from those for all other cases. These observations and some descriptive features of the disease suggest that hormonal factors, specifically below normal estrogen levels, may be associated with a disruption of normal ovulation and thus predispose to choriocarcinoma.

Adult↗
PubMed1988

Uterine hemangioma associated with infertility.

An infertile woman with an enlarged uterus was thought to have leiomyoma. At laparotomy two large, vascular uterine tumors were removed; the remainder of the uterus was preserved. Evaluation of histologic sections with antibody to human factor VIII and electron microscopy were necessary to confirm the diagnosis of hemangioma.

Adult↗
PubMed1988

Are estrogens indicated for the treatment of postmenopausal women?

A woman in the U.S. can now expect to live for 30 years or more past the menopause in a state of estrogen deprivation. Hypoestrogenic-associated conditions can be managed by a variety of medical regimens and lifestyle changes, but estrogen replacement therapy (ERT) is the most specific and universal treatment for all of the above conditions. Although concern for potential risks has limited its acceptance, the benefits of ERT extend beyond the amelioration of estrogen deprivation symptoms. Evidence is accumulating that ERT may offer protection from cardiovascular atherogenic disease. Several of the risks that have been associated with continuous ERT, such as endometrial cancer and breast cancer, are significantly reduced with the use of cyclic progestogens. Moreover, any concern arising from the use of conjugated estrogens and synthetic progestogens are being addressed by the recent introduction of orally active natural estrogen and soon, progesterone. With the demonstrated efficacy and safety of ERT, such therapy should be considered for all postmenopausal women.

Aged↗
PubMed1988

Metastatic gestational trophoblastic disease: prognostic factors in previously untreated patients.

From 1966-1982, 138 previously untreated patients with metastatic malignant gestational trophoblastic disease received primary chemotherapy at the Southeastern Regional Trophoblastic Disease Center. Fifty-six (41%) had poor-prognosis metastatic gestational trophoblastic disease, and 51 (91%) of these patients were initially treated with multiagent chemotherapy. Sustained remissions were achieved in 128 patients (93%). Patients who had metastatic involvement of more than one anatomic site, disease duration of greater than four months, antecedent nonmolar pregnancy, or clinicopathologic diagnosis of choriocarcinoma were at significantly increased risk for failure to achieve sustained remission compared with patients who lacked these clinical features. Initial human chorionic gonadotropin level and site of metastasis had no significant effect on survival in these previously untreated patients. Patients with disease duration of greater than four months who had an antecedent nonmolar pregnancy were at significantly increased risk, with only 12 of 20 (60%) surviving, versus all of 85 patients with short duration of disease and antecedent molar pregnancy, and 32 (94%) of 34 patients with other combinations of these factors (P less than .001). Initial therapy for patients with metastatic gestational trophoblastic disease should be selected on the basis of prognostic factors that predict a high probability of failure with single-agent chemotherapy alone. Patients with prolonged duration of disease and nonmolar antecedent gestation are at high risk for failure using traditional forms of methotrexate and actinomycin D-based combination chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Renal metastases of gestational trophoblastic disease: a report of eight cases.

Between 1968-1984, eight women with renal metastases of gestational trophoblastic disease were treated at the Southeastern Regional Trophoblastic Disease Center. Two (1.3%) of 154 patients referred for primary therapy and six (14%) of 42 patients referred for secondary therapy of metastatic gestational trophoblastic disease had renal metastases. All eight had coexistent pulmonary metastases. Four had central nervous system and other systemic metastases. All had high-risk metastatic gestational trophoblastic disease by assessment of individual risk factors and analysis of a prognostic index score. Three women with limited systemic tumor burden are alive after receiving multiagent chemotherapy and nephrectomy.

Female↗
PubMed1988

Nonmetastatic gestational trophoblastic disease.

Nonmetastatic gestational trophoblastic disease encompasses a variety of related neoplasms of the human placenta. With the advent of effective chemotherapy, nearly all of these patients can be cured using a variety of regimens with acceptable toxicity. Hysterectomy is useful in selected patients to decrease the amount of chemotherapy required to produce remission and to salvage patients who have failed initial chemotherapy. The majority of patients can retain child-bearing capacity and often have normal pregnancies after therapy.

Combined Modality Therapy↗
PubMed1988

Changing rates of cesarean delivery: the Duke experience, 1978-1986.

There was a steady increase in the yearly cesarean delivery rate, from 14.0 to 24.8%, between July 1, 1978 and June 30, 1986 at Duke University Medical Center; this was associated predominantly with an increase in the rate of primary cesarean deliveries. The three most frequent major diagnoses associated with primary cesarean delivery changed significantly over the study period. Fetal compromise became the most commonly associated diagnosis (from third), dystocia second (from first), and maternal disease third (from second). The categories of fetal positional abnormalities (fourth), abnormalities of placentation (fifth), and multiple pregnancy (sixth) did not change in rank. Primary cesarean delivery patients were compared with patients who delivered vaginally using odds ratios, prevalence, and population-attributable fractions. The risk factors of nulliparity, gestational age less than 37 weeks, late decelerations, and referral had the largest impact on the primary cesarean rate. Decreases in rates related to an increased tolerance of abnormalities of labor were overshadowed by the effects of increased concerns related to fetal health.

Academic Medical Centers↗
PubMed1987

Total parenteral nutrition in poor prognosis gestational trophoblastic disease.

From 1978 through 1984, 35 women received therapy for poor prognosis gestational trophoblastic disease (GTD) at Duke University Medical Center. Total parenteral nutrition (TPN) was utilized in nine patients (26%) for reasons including inadequate oral intake, nutritional depletion, and/or bone marrow suppression. Overall survival with follow-up ranging from 12 to 78 months was 88% for the TPN group and 70% for the non-TPN group (P = 0.38). Median duration of TPN therapy was 4 weeks (2-46 weeks). Intensity of therapy was comparable between the groups. Median weight gain of 0.15 kg/week for the TPN group was significantly greater than the 0.18/kg/week weight loss in the non-TPN group (P less than 0.001). Severe nutritional depletion represented by both low serum albumin (less than or equal to 2.5 gm/dl) and weight loss greater than or equal to 10% had a higher mortality rate than when only one of these factors existed (P = 0.006). Future studies need to further define the proper role of TPN in patients with poor prognosis GTD especially in those with severe nutritional deficits.

Adolescent↗
PubMed1987

Role of surgical therapy and radiotherapy in gestational trophoblastic disease.

Surgical procedures and radiotherapy continue to play a significant role in the management of gestational trophoblastic disease (GTD) despite continuing advances in chemotherapy. Suction curettage and hysterectomy are preferred techniques for evacuation of hydatidiform mole. Although primary chemotherapy alone is usually successful in women with nonmetastatic or good-prognosis metastatic GTD, hysterectomy is useful in selected patients to decrease the amount of chemotherapy required to produce remission or as salvage therapy in patients who have failed primary chemotherapy. Even among patients with poor-prognosis metastatic GTD, such adjunctive surgical procedures as hysterectomy, thoracotomy and craniotomy may be useful. Whole brain and liver irradiation is employed as adjuvant therapy to reduce hemorrhagic complications of brain and liver metastases.

Brain Neoplasms↗
PubMed1987

Urogenital atrophy.

Urogenital atrophy in the postmenopausal or castrated woman is common with a multifactorial etiology and a varied clinical presentation. The effects of age and estrogen deprivation are, at times, poorly separable. Estrogen replacement may be used to significantly alleviate symptoms due to atrophy but must be used with appropriate surveillance to avoid potential adverse consequences.

Aging↗
PubMed1986

Hepatic metastases of choriocarcinoma: a report of 15 patients.

The presentation of illness, response to treatment, and complications of therapy of 15 patients with hepatic metastases of choriocarcinoma are analyzed. The majority of patients received multiagent chemotherapy concomitantly with whole-liver irradiation. Two patients are now in sustained remission. Hepatotoxicity of this combined treatment regimen directly contributed to only one death in the 13 nonsurviving patients. The diagnosis, management, and prognostic significance of choriocarcinoma metastatic to the liver are discussed.

Adult↗