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PubMed1984

Response of patients and doctors to the 1983 'pill scare'.

The immediate response of patients and doctors to the recent adverse publicity about the combined oral contraceptive ;Pill' were studied in two separate locations: a major family planning clinic and a large provincial health centre. Consultations arising from anxiety about the Pill were less than the general practitioners had anticipated but extra sessions were required at the family planning clinic to cope with the increased demand. Differences in the responses of doctors were observed both within and between the two locations. Doctors at the family planning clinic were more likely to change the brand of Pill, whereas doctors at the health centre were more likely to offer reassurance only. The respective roles of primary care teams and family planning clinics in the provision of a comprehensive contraception service to the community are discussed.

Attitude↗
PubMed1984

Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old.

Over a ten-year period, fifty-one congenitally dislocated hips in forty-one patients, whose ages ranged from twelve to thirty-six months, required open reduction. Supplemental procedures such as derotational osteotomy, pericapsular (Pemberton) osteotomy, and femoral shortening were performed as necessary. All of the patients have been followed for at least two years (average, 6.1 years). No patient had a significant limp, Trendelenburg gait, or avascular necrosis. Using Severin's classification of radiographic evaluation, twenty-nine hips (57 per cent) were rate as excellent and eighteen hips (35 per cent), as good. In our experience, open reduction of the hip together with correction of acetabular and femoral deformities affords the patient in the one to three-year-old age range an excellent chance of obtaining an anatomically satisfactory hip.

Age Factors↗
PubMed1983

Abdominal myomectomy and subsequent fertility.

The role of myomectomy in subsequent fertility was evaluated. Of 50 patients undergoing myomectomy, 25 subsequently conceived. The most important correlation with subsequent fertility was surgical indication, 68 per cent of the women who underwent exploration for a pelvic mass having conceived, whereas only 16 per cent of women with a normal infertility evaluation conceived. In addition, women more than 30 years of age who became pregnant had fewer and smaller fibroid tumors than those who did not. It is concluded that myomectomy itself may decrease fertility, probably on the basis of adhesion formation and may be unjustified in women with otherwise negative infertility evaluations.

Age Factors↗
PubMed1978

General-practice teaching in Australia.

There have been several important changes in the aims and organization of general-practice teaching in Australia in recent years. During a visit to Australia I had the opportunity to see many of these and to discuss others. This report describes the features I found of most interest.

Australia↗
PubMed1978

Patients admitted to the new central hospital in Bhutan.

A new 100-bedded hospital was opened in Thimphu, the capital of Bhutan, in 1974. The hospital serves a large district, and also acts as a referral hospital for the rest of the country. This study analyses the first complete year of running the hospital with a full medical staff.

Adolescent↗
PubMed1995

The effect of redeepening incisions on radial keratotomy outcome.

BACKGROUND: Patients scheduled to undergo radial keratotomy in both eyes received redeepening incisions in one eye and single pass incisions in the other. Eye and order of surgery were assigned randomly and surgical parameters were otherwise identical in the two eyes. METHODS: This study was designed to measured the improvements in myopia obtained by radial keratotomy, with and without redeepening incisions. RESULTS: There was a greater decrease in spherical equivalent manifest refraction in the redeepening group than in the control group at 1 week (0.41 D) and 1 month (0.36 D) after surgery, as measured by keratometry. The difference in change between groups was 0.41 D at one week, 0.36 D at 1 month, and 0.26 D at 3 months. Change in spherical equivalent was significantly more in the redeepened group at 3 months after surgery (0.37 D); however, the improvement constituted only 8.8 percent of the decrease in myopia achieved by radial keratotomy without redeepening (3.87 D). CONCLUSIONS: Although redeepening yields an incremental effect in the correction of myopia, the technical difficulties of redeepening and the increased chance of perforation of the cornea with redeepening outweigh the benefits of the procedure.

Adult↗
PubMed1994

Candidate tumor-suppressor genes MTS1 (p16INK4A) and MTS2 (p15INK4B) display frequent homozygous deletions in primary cells from T- but not from B-cell lineage acute lymphoblastic leukemias.

Using a Southern blot approach, deletions of MTS1 (multiple tumor-suppressor gene 1) and MTS2 (multiple tumor-suppressor gene 2) candidate tumor-suppressor genes have been studied in primary neoplastic cells from 55 acute lymphoblastic leukemia (ALL) patients. Homozygous MTS1 deletions were found in 20 of 24 T-ALL cases and in only 2 of 31 B-lineage cases (P < .001). The deletions involved MTS1 and MTS2 in most cases. Homozygous MTS2 deletions were observed in 16 of 24 T-ALL cases and in 1 of 31 B-lineage ALLs (P < .001), all of them displaying homozygous MTS1 deletions. In 5 cases (4 T and 1 B), deletions involved MTS1 but spared the MTS2 gene, showing that one deletion breakpoint was located between the two genes within a 25-kb region. In 1 T-ALL case, an MTS1 gene rearrangement has occurred downstream to exon 2. Possible hemizygous deletions were found in 6 cases, 4 of them of the B-cell lineage. In 7 ALL cases, cells obtained at presentation and at first relapse were studied and identical results were observed in 6 cases. In 1 B-lineage case, a germline pattern was found at presentation and a possible monoallelic MTS1/MTS2 deletion was observed at relapse. The high frequency of MTS1 and MTS2 homozygous deletions in T-ALLs supports the view that inactivation of these genes plays an important role in the pathogenesis of this type of human leukemia.

Adolescent↗
PubMed1995

Variability of day 3 follicle-stimulating hormone levels in eumenorrheic women.

OBJECTIVE: To assess the intercycle variability of early follicular follicle-stimulating hormone (FSH) and estradiol (E2) levels in eumenorrheic women according to age. STUDY DESIGN: Forty-eight female volunteers with regular menstrual cycles were studied. Serum samples were obtained on cycle day 3 in multiple cycles over a one-year period. Serum was also obtained on consecutive cycle days 2, 3 or 4 in a single cycle in 20 participants. All samples were assayed for FSH and E2 by radioimmunoassay. RESULTS: In women under 40 years of age, all initial day 3 FSH levels were < 20 mIU/mL, and 15% of subjects had a subsequently elevated day 3 FSH level (> or = 20 mIU/mL) within the year. In eight women 40-44 years of age, 75% had an initial day 3 FSH level < 20 mIU/mL, but half of them subsequently had an elevated level, > 20 mIU/mL, within the year. Between cycle days 2, 3 and 4, FSH (coefficient of variation [CV] = 14.8%, 95% confidence interval (CI) = 11.4-18.3%) varied less than E2 (CV = 31.1%, 95% CI = 21.5-40.6%). CONCLUSION: A single day 3 FSH level < 20 mIU/mL is highly predictive of all subsequent values within a year and occurred only in women under 40. An FSH level drawn on cycle day 2 or 4 will probably be within 18% of the day 3 value, but the E2 level may vary by up to 40%.

Adult↗
PubMed1996

Office carpal tunnel release with wrist block and wrist tourniquet.

Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. Over the past 5 years we have performed carpal tunnel releases in the office setting using wrist block anesthesia and a wrist tourniquet. There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.

Ambulatory Surgical Procedures↗
PubMed1998

Clinical outcomes of the Otago-Southland Breast Cancer Screening Programme 1991-1996.

AIM: To document the clinical outcome of the Otago-Southland Breast Cancer Screening Programme through its first two rounds of screening, from 1991-1996. METHODS: Review and analysis of clinical and pathological records. RESULTS: In the first round of screening, 13,876 women were screened, giving 75% uptake; 12.2% were referred for assessment and 126 cancers detected, 9.1 per thousand women screened. For the 9946 incidence screens in the second round, 3.9% of women screened were referred to assessment and 50 cancers detected, 5.0 per thousand women screened. The uptake and cancer detection rates exceed the targets and exceed other published results; the size distribution of the cancers detected was comparable to the Swedish two-counties study, showing that the results should produce an ultimate mortality reduction. The referral rate to assessment was higher than expected in the first round of screening, but within the targeted range in the second round. The benign to malignant ratio for all biopsies was 1.4:1 for the prevalence screen of the first round and 1.2:1 for the incidence screens in the second round, both exceeding the targets set. CONCLUSIONS: The results show that the uptake and clinical results of the programme exceed expectations and that a large number of small invasive tumours have been successfully detected. These results are comparable to the best of overseas studies, and give confidence that mortality reductions will ultimately occur.

Aged↗