Leiomyoma characteristics and risk of subsequent surgery after myomectomy.

OBJECTIVE: Evaluate the association between leiomyoma characteristics at myomectomy with subsequent surgery risk. METHODS: A population-based nested case control study from a cohort of women at a large HMO, identified as having had a myomectomy was performed; 82 cases had subsequent uterine surgery; 82 controls, frequency matched for age and date of first surgery, did not. Medical records were abstracted; follow-up was 18-128months. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. RESULTS: Women without subserosal myomas were more likely to have a second surgery as compared to women with at least one subserosal myoma, aOR=4.1(95% CI 1.5-10.9). Size of myomas did not predict subsequent surgery in subanalyses by type of surgery. Number of leiomyomas was not predictive of a subsequent uterine surgery overall or in subgroup analyses. CONCLUSION: Myoma location, but not number or size, impacts the risk for subsequent leiomyoma uterine surgery.

Hemodynamically stable upper gastrointestinal bleeding.

This article is a prospective evaluation of 38 patients presenting to an emergency department (ED) with hematemesis but who were otherwise hemodynamically stable. Four patients were admitted, only one because of the development of hemodynamic instability. Thirty-three patients were discharged; on follow-up there was no evidence of major morbidity or mortality. Two patients were lost to follow-up, one who left against medical advice and one who lived in a county outside the service area of our hospital. Patients with hematemesis can be safely discharged from the ED after observation for 6 hours if they: (1) lack orthostatic vital sign changes; (2) lack associated significant underlying disease; (3) have a hemoglobin concentration greater than 10 gm/dL; (4) are less than 60 years of age; and (5) are thought to be reliable and compliant.

Metastatic colorectal cancer: radioimmunoscintigraphy with a stabilized In-111-labeled F(ab')2 fragment of an anti-CEA monoclonal antibody.

Metastatic colorectal cancer was detected with stabilized F(ab')2 fragments of ZCE-025, an anti-carcino-embryonic antigen (CEA) monoclonal antibody (MoAb). The fragments were prepared by cross-linking Fab' with a bifunctional cross-linking agent, bis-(maleimido)methyl ether. The authors labeled 2 mg of ZCE-025 with 5 mCi (185 MBq) of indium-111 and injected the material intravenously, either alone or with unlabeled F(ab')2, into 16 patients. Lesion detection, pharmacokinetics, and relative body distribution were evaluated and compared with those of the intact immunoglobulin (IgG1) antibody. Stabilized F(ab')2 fragments were more useful than the intact antibody in detection of lesions: Overall sensitivity of F(ab')2 fragments for all the patients was 79.4%, whereas overall sensitivity of the intact IgG1 antibody was 32%. This anti-CEA-stabilized F(ab')2 fragment may be a powerful diagnostic tool that can achieve higher sensitivity at smaller protein doses than the intact IgG1 antibody.