Abdominal wall implantation of an endocervical-like mucinous borderline tumor.

We present the case of a 21-year-old woman in whom development of a bulky abdominal wall metastasis in a laparotomy scar led to discovery of bilateral endocervical-like mucinous borderline tumors in normal-sized ovaries. Tumor implants were also present in the mesosalpinx and a pelvic lymph node. We hypothesize that the abdominal wall metastasis resulted from seeding at the time of a prior exploratory laparotomy for trauma, before the ovarian tumors were discovered. We present evidence to support our theory of mechanical implantation of borderline tumor and explore other mechanisms leading to extraovarian mucinous neoplastic involvement.

Accurate coronary calcium phosphate mass measurements from electron beam computed tomograms.

Precipitates of calcium phosphate in coronary arteries always indicate the presence of atherosclerosis. The mass of these precipitates is related to the severity of atherosclerosis. To determine the accuracy of electron beam computed tomographic (CT) mass estimates, we imaged 21 human hearts inside an anthropomorphic chest phantom using an Imatron C-100 electron beam CT scanner (Imatron, San Francisco, CA). We then incinerated the 63 imaged coronary arteries and weighed the mineral ash. We calculated the mass estimates from the images using an algorithm derived from a model that assumes simple radiographic properties of the coronary arteries. We also calculated the currently used coronary calcium score for each artery. Although both the mass estimates and the scores correlated with the actual mass of the incinerated specimens (r = .97 and r = .93), the correlation with the mass estimates was better (P = .02; William's test). The regression equation relating the actual mass to the mass estimates was y = 1.37 x + 14, indicating that the CT mass estimates consistently underestimate actual coronary calcium phosphate mass. We conclude that relative mass estimates using electron beam CT scanning are accurate and that both these and the currently employed calcium scores reflect the actual mass of precipitated calcium phosphate in diseased coronary arteries.

Xerophthalmia in urban Bangladesh. Implications for vitamin A deficiency preventive strategies.

Eight per cent of children attending a nutrition unit in urban Bangladesh had the eye signs and symptoms of vitamin A deficiency. About 1 in 10 of children with xerophthalmia and moderate-to-severe protein-energy malnutrition (PEM) had corneal involvement (X2,X3A/B): seasonal variation in prevalence was striking. Xerophthalmia was commonest in the 2-3 years age group and was associated with gastro-enteritis and measles. Breast feeding rates were low for PEM children with or without xerophthalmia. Poverty and overall shortage of food are the common denominators for both PEM and xerophthalmia. Effective vitamin A deficiency preventive strategies in urban Bangladesh will need, therefore, to include a broad range of measures such as the present limited distribution of high potency vitamin A capsules (200 000 IU) to children aged 0-6 years, food subsidies and food fortification if the most vulnerable children in the slums are to be reached.

Use-effectiveness of standard-dose and low-dose oral contraceptives in Dacca.

Five hundred women accepting oral contraceptives at an urban clinic were alternately prescribed standard-dose (50 microgram of estrogen) or low-dose (30 microgram of estrogen) combined pills. Life-table continuation rates at 12 months were approximately 40% for both groups, with no significant differences between or within the two groups after controlling for sociodemographic variables and nutritional status. Approximately three fifths of those who discontinued using both formulations cited medical reasons, especially dizziness. The low-dose oral contraceptive appeared to be as acceptable to these urban Bangladeshi women as the higher-dose pill.

PIP: Results of an urban comparative study of continuation rates and reasons for discontinuation of standard-dose and low-dose oral contraceptives are presented. 500 females were alternately given standard-dose (0.5 mg of DL-norgestrel with 50 ug of ethinyl estradiol) or low dose (0.15 mg of levonorgestrel with 30 ug of ethinyl estradiol) pills. Nutritional status was measured according to Huffman's method. 110 women were excluded from the analysis for various reasons, leaving 192 standard-dose and 198 low-dose acceptors. Cumulative life-table rates show a slightly higher, but statistically insignificant continuation rate for low-dose acceptors at 3, 6, 9 and 12 months (40% for both groups). When age, parity and nutritional status were controlled, no significant differences in continuation rates were observed either between or within the 2 groups. Medical reasons, especially dizziness, accounted for nearly 1/2 of standard-dose discontinuation, and for about 1/3 of low-dose discontinuation. Low-dose pills were just as acceptable as the standard dose in this urban setting.

Fertility and contraceptive practice: Bogota, 1964-74.

The results of a 1974 survey of 6,692 Bogota women aged 15-49 conducted by the Colombian Association for Population Studies show that, in the last decade, approval of family planning practice increased 34 percent, contraceptive practice nearly doubled, and fertility declined by over 45 percent. Life-table analysis shows unusually high continuation rates for Bogota women. Data concerning crossovers between Bogota's three family planning programs and the commercial sector indicate that the manufacturers of contraceptives benefit from program activities. The study demonstrates, for the first time in Latin America, the feasibility of using a probability sample of the general female population to evaluate family planning programs.