Emergency medicine in the wilderness. Part Two.

The guiding tenet of field trauma, as in all of medical or dental treatment, is "first, do no harm". A common sense approach to the whole patient followed by a careful examination of the area of injury will provide outstanding outcome. A few simple techniques of wound care judiciously applied will likewise provide an opportunity for excellent functional status.

A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community.

OBJECTIVE: To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS: From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS: Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION: The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

Neuroblastoma.

Neuroblastoma, a tumor of the sympathetic nervous system, accounts for 8 percent of all pediatric tumors and causes 11 percent of all deaths from cancer in children. Patients with this tumor usually present with symptoms before four years of age; neuroblastoma rarely occurs after 14 years of age. Clinical manifestations vary, depending on tumor site and extent of the tumor. The case described here illustrates the main features of presentation, diagnosis and treatment.

Basic review: endocrinology of the normal menstrual cycle.

(1) The normal menstrual cycle depends on hormonal relationships between the hypothalamus, pituitary, and ovary. The mechanisms of hormonal control involve both long-looped feedback control (i.e., E2 feedback to the hypothalamus) and local control (i.e., internal ovary). A hormone may have different effects depending on concentration and timing of appearance during the menstrual cycle. (2) There is a single gonadotropin-releasing hormone that governs both FSH and LH release from the pituitary. FSH and LH release is governed by both the concentration and timing of the hypothalamic-releasing factor, GNRH. (3) The follicular or proliferative phase of the menstrual cycle is characterized by the selective development of a dominant follicle. The follicular phase biochemistry is notable for increasing estradiol production, which inhibits GNRH secretion but increases the gonadotropin pool and prepares the follicle for LH influence by stimulating LH receptors. (4) Ovulation occurs secondary to LH surge triggered by increasing levels of E2 acting in a positive feedback loop on the pituitary. (5) Corpus luteum development is signaled by increasing serum progesterone and is largely an autonomous ovarian phenomenon not subject to a great deal of control by hypothalamic or pituitary hormonal controls, because high levels of progesterone inhibit GNRH and gonadotropins.

Indochinese refugee health assessment and treatment.

Many Southeast Asian refugees have resettled in the United States. This report reviews data from 426 refugees who underwent comprehensive examination and treatment at the Mayo Clinic. Health problems identified were primarily selected contagious illnesses and stress syndromes with functional complaints. Counseling was necessary in 17 percent of adults for psychosomatic problems or psychiatric disorders. When family-planning issues were applicable and addressed, 80 percent of women chose some method of contraception. The prevalence rate of intestinal parasites was 82 percent, and pathogens necessitated persistent treatment and follow-up. Tuberculosis skin-sensitivity testing was positive in 54 percent; the risk of active disease warrants prophylactic treatment until age 35 years. Hepatitis antigen was positive in 13 percent; precautions should be taken for potentially exposed professionals. Hematologic genetic disorders were very common and accounted for most of the 25 percent incidence of microcytosis. Physicians should become aware of cultural attitudes and treatment acceptance among Indochinese patients and should carefully investigate for infectious diseases.