The LSUMC-S Rural Infant Care Project to reduce infant mortality.

The Louisiana State University Medical Center-Shreveport (LSUMC-S) Rural Infant Care Project (RICP) was initiated to reduce infant mortality in a five-parish, rural target area over a four-year period by improving the coordination of maternal and infant care providers. Three process measure based evaluation approaches were used. One approach examined cohorts of women attending clinics in parish health units. A second approach looked at hospital obstetric charts, and the third approach looked at admission and discharge data, as well as cost figures for NICU admissions from the target area. Results indicate improved coordination among providers and are linked to a national, outcome measure based evaluation for the national program, of which this project was one of nine. Problems of local evaluation efforts are also discussed.

Carcinoma of the cervix in young females (35 years, and younger).

This retrospective study involved 55 patients, 35 years old or less with invasive carcinoma of the cervix. There were 49 squamous carcinomas, 3 adenocarcinomas, and 3 unusual varieties. Thirty-five patients had stage IB disease; 4 had stage IIA disease; 6 had stage IIB disease; 5 had stage IIIB disease, and 3 had stage IV disease. Treatments employed were either radical hysterectomy and node dissection, irradiation, or irradiation followed by radical surgery. Our overall 5-year disease-free survival among young females with stage IB disease was observed to be only 43%; stage IIA only 25%; stage IIB only 17%, and no survivors in more advanced stages.

Morbidity in obese and nonobese patients following gynecologic surgery for cancer.

Meager information exists regarding the morbidity of cancer surgery in obese patients, and it is generally assumed that surgery in the obese patient is attended with increased complications over those found in nonobese patients. A retrospective evaluation was undertaken at the Louisiana State University Medical Center to ascertain the morbidity of cancer surgery among 97 patients. In comparing the obese with the nonobese group of patients, the former was more often found to have complications of postoperative wound disorders that frequently required secondary operations, and a greater incidence of diabetes. The risk of postoperative complications among obese patients undergoing cancer surgery did not otherwise appear to be greater than that of nonobese patients.

Acquired aganglionosis.

A documented case of acquired aganglionosis is presented in which transrectal biopsies taken 4 mo apart first showed the presence then subsequently the absence of ganglion cells. Colostomy followed by a Soave procedure was curative.

A controlled trial of the differential effects of intrapartum fetal monitoring.

A controlled prospective study of the differential effects of intrapartum fetal monitoring on mothers and infants has been conducted at Denver General Hospital, Denver, Colorado. A total of 690 high-risk obstetric patients in labor were randomly assigned to one of three monitoring groups--auscultation, electronic fetal monitoring alone, or electronic monitoring with the option to scalp sample. There were no differences in immediate infant outcomes in any measured category (Apgar scores, cord blood gases, neonatal death, neonatal morbidity, nursery course) among the three groups. There were no differences in rates of infant or maternal infections. The cesarean section rate was markedly increased in the electronically monitored groups, especially in the electronically monitored alone (18%) as compared with the auscultated (6%) (P less than 0.005). In this controlled trial electronic monitoring did not improve neonatal outcomes and the mothers were at increased risk of cesarean section.

Priapism and multiple myeloma. Successful treatment with plasmapheresis.

Priapism was associated with multiple myeloma and hyperviscosity in a sixty-year-old black male. Plasmapheresis treatment of the hyperviscosity corrected his priapism, and chemotherapy for the underlying multiple myeloma prevented the recurrence of priapism after a chronic intermittent history of seventeen years.

Value of ultrasound as a presurgical diagnostic tool in Obstetrics and Gynecology.

Although relatively new, diagnostic ultrasound is an important part of the surgeon's armamentarium in preoperative diagnosis and patient preparation. In the field of gynecology, it is possible to differentiate between solid and cystic tumors, measure the extent of tumors in the pelvis and abdomen, define normal structures in relationship to pathologic changes and diagnose and follow patients with malignant disease. In obstetrics, ultrasound has proved effective in the evaluation of the fetus and detection of obstetric problems such as estimation of fetal weight and gestational age, diagnosis of placenta previa, hydatidiform mole and missed and incomplete abortions.

The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy.

Intrapartum electronic fetal heart rate monitoring of the high-risk obstetric patient is thought to improve the perinatal outcome. A prospective randomized study of 483 high-risk obstetric patients in labor was carried out comparing the effectiveness of electronic fetal monitoring with auscultation of fetal heart tones. The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity. There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group. The cesarean section rate was markedly increased in the monitored group (16.5 vs. 6.8 per cent in the auscultated patients). The presumptive benefits of electronic fetal monitoring for improving fetal outcome were not found in this study.

FDA obstetrics-gynecology device classification report.

PIP: A tentative classification of obstetrical and gynecological devices, proposed by the Panel on Review of Obstetrical and Gynecological Devices of the Bureau of Medical Devices and Diagnostic Products of the Food and Drug Administration, is presented. The devices are classified, for regulatory purposes, under 3 general categories (scientific review, specific standards, and general control) as diagnostic, surgical monitoring, prosthetic, and therapeutic devices. The development of the categoreal scheme is discussed. Comments from obstetrician-gynecologists and concerned individuals are invited.^ieng

The intrauterine device and tubo-ovarian abscess.

During the past 4 years, 16 patients have been seen who developed a unilateral tubo-ovarian abscess while wearing, or soon after removal of, an IUD. None of the patients had gonorrhea. There appears to be a prodromal syndrome before abscess formation of 2 to 5 weeks during which the patient complains of vague lower abdominal pain, pelvic tenderness, and dyspareunia. A few patients had a rapid onset of symptoms. The device should be removed when prodromal symptoms arise and the patient should be treated with antibiotics. Should a tubo-ovarian abscess develop, surgical intervention is necessary.

Diagnosis of early pregnancy with A-mode ultrasound. A preliminary report.

An A-mode ultrasonic analyzer was used to detect pregnancy and to determine gestational age in 102 patients, 77 of whom were pregnant and 25 of whom were not pregnant. All pregnant patients were in the first trimester. Polaroid photographs were taken of the echo pattern display and diagnosis was compared with that of the clinical examination. Results indicate, using only the Polaroid photograph of the patient's A-scope echo pattern, it is possible to (1) diagnose pregnancy with an accuracy rate of 87.2% and (2) estimate the week of gestation, within a tolerance of 21 days of the clinical examination, with an accuracy rate of 84.5%.