Maternal HIV Status and Infant Feeding Practices among Ugandan Women

To describe the infant feeding practices in the general population in Uganda; and to assess the impact of maternal HIV status on these practices; a questionnaire was administered to women attending the follow-up clinics for child vaccination. Among the mothers who were still breastfeeding at the time of interview (N=838); 61.4of the HIV-infected women had planned to breastfeed for a maximum of 6 months; compared with 12.1of the HIV-uninfected women (p0.001). Among the women who were not breastfeeding at the time of interview (Nof the HIV-infected women had stopped breastfeeding within 3 months; compared with 23.5of the HIV-uninfected women (p0.001). Only 2.1of HIV-infected women seen up to 14 weeks postnatally practised mixed feeding; compared with 23.6of HIV-uninfected women (p0.001). After 6 months; however; 30of the HIV-infected women and 55of the HIV-uninfected mothers were using mixed feeding; with no significant differences. Programmes for the prevention of motherto- child transmission of HIV should re-enforce counselling activities to address the issue of early weaning by HIV-infected women; and to support safe breastfeeding up to 6 months

Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis.

Bowel obstruction is the most common complication in patients with ovarian cancer. Management of this situation is controversial. The aim of our retrospective study was to determine the best approach for managing bowel obstruction in recurrent ovarian cancer. A retrospective analysis of data on 47 patients with intestinal obstruction by ovarian cancer was performed. Twenty-seven patients were submitted to surgery, with 21 intestinal procedures performed, 2 gastrostomy tubes placed, and 4 patients deemed inoperable. Twenty patients were managed medically with Octreotide (mean dosage of 0.48 mg/day), of which 1 patient required a nasogastric tube. Age, performance status, diagnosis of tumor to occlusion time, obstruction site, previous chemotherapy or radiotherapy, presence of ascites, or palpable masses were the variables analyzed. Student's t-test and Pearson chi-square test were used to compare the two different groups of treatment (surgical vs medical therapy). Disease-free-survival curves were plotted according to the Kaplan-Meier method and analyzed by the log-rank test. Cox's proportional hazards model was used for multivariate analysis. Values less than or equal to 0.05 were considered significant. The mean age of the patients was 58.7 years. Perioperative mortality and morbidity were both 22%. All patients died with minimal distress. Performance status results were significantly different between the patients submitted to surgery and patients treated with Octreotide (P= 0.03). No significant differences were found in the other variables analyzed. In multivariate analysis, only type of treatment emerges as a strong predictor of poor outcome (P < 0.001). Both surgery and Octreotide therapy are able to control distressing symptoms in end-stage ovarian cancer. Survival was significantly longer in the surgical group, and surgical palliation should be considered first in patients with good performance status.

Metastatic placental site trophoblastic tumor. Report of a case with complete response to chemotherapy.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasia, commonly insensitive to chemotherapeutic agents. CASE: We report on long-term remission in a patient with metastatic PSTT after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine combination chemotherapy. The 27-year-old patient with metastatic lung PSTT was alive, without evidence of disease, > 40 months after treatment. CONCLUSION: Treatment with multiagent chemotherapy can produce long-term remission, even in patients with metastatic PSTT.

Cranial computed tomography findings in children with acute lymphoblastic leukemia at diagnosis.

Forty children newly diagnosed with acute lymphoblastic leukemia (ALL) were examined by computed tomography (CT) of the central nervous system (CNS) on hospital admission before any medication was started. The results of the CT scans were defined as normal, borderline (slight or moderate dilatation of the ventricular system and/or basal cisterns and/or convolutional sulci), or pathologic (severe cerebral atrophy). The mean age of the patients was 5.8 years (range 1.7-15 years). Sixteen of the 40 patients (40%) had CT scan abnormalities with 14 patients having borderline scans and two patients pathologic scans. No child presented with neurologic symptoms or CNS leukemia. These data suggest that CT abnormalities of the brain are common in children with ALL at diagnosis and may represent clinically unsuspected lesions secondary to leukemia.

Correlation between cranial computed tomographic scans at diagnosis in children with acute lymphoblastic leukaemia and central nervous system relapse.

145 children with acute lymphoblastic leukaemia (ALL) were evaluated over a period of 3 years in a multicentre study in which serial cranial computed tomographic (CT) scans of the brain were done. All patients were symptom-free. CT scans were graded as normal, borderline (slight or moderate cerebral atrophy), or pathological (severe cerebral atrophy). 62% (90/145) of children had CT scan abnormalities at diagnosis. After a median follow-up of 24 months (range 6-36) 12 of 108 evaluable patients had central nervous system (CNS) relapses (6 isolated relapses and 6 combined with relapse at another site). All patients with CNS relapse had an abnormal CT scan at diagnosis (8 pathological and 4 borderline). No relapses were observed among the 42 patients with a normal cranial CT scan at diagnosis. A significantly higher proportion of severe cerebral atrophy, both following CNS prophylaxis and after the discontinuation of treatment, was found among patients with a borderline CT scan at diagnosis than among patients with a normal CT scan at diagnosis. Thus an abnormal cranial CT scan at diagnosis in children with ALL seems to have prognostic significance.