Deep endometriosis transvaginal ultrasound in the workup of patients with signs and symptoms of endometriosis: a cost analysis.

OBJECTIVE: Deep endometriosis transvaginal ultrasound (DE TVS) is accurate in the detection of ovarian endometriosis and DE; however, realisation of its full potential and utilisation remains variable. As such, patients may require a two-step surgical approach (diagnostic followed by therapeutic laparoscopy) or experience incomplete surgical treatment. Besides the clinical implications, the economic impact of a two-step approach to diagnosis and treatment on the healthcare system is likely to be significant. We aim to compare the economic costs of two diagnostic models of care for patients with potential endometriosis. DESIGN: Cost analysis using Markov model with 12-month time horizon comparing the economic costs of two diagnostic models. SETTING: The study used a hypothetical population of 1000 women visiting a public tertiary gynaecology clinic. POPULATION: Women with potential endometriosis. Estimates for endometriosis prevalence and severity were drawn from local Australian hospital data. METHODS: The conventional model (M1) includes the basic TVS and diagnostic laparoscopy. The novel model (M2) includes the DE TVS. Probabilistic sensitivity analysis was conducted to capture the uncertainty in the information used to populate the models. MAIN OUTCOME MEASURE: Changes to government, health-service and patient costs with the adoption of the DE TVS compared with standard diagnostic methods. Costs are given in Australian dollars (AU$) and also in pound sterling (£). RESULTS: The total annual cost of the novel model (M2) is AU$12,547,724.03 (£6,826,673.63), cheaper than the conventional model (M1), which cost AU$13,472,161.67 (£7,329,620.15). CONCLUSIONS: For a population of 1000 women, the integration of the DE TVS may save healthcare costs of AU$924,437 (£502,946.17) annually. TWEETABLE ABSTRACT: An endometriosis-focused ultrasound may negate a two-step surgery pathway, including diagnostic surgery, and save healthcare money.

Bronchoalveolar lavage cell data in amiodarone-associated pneumonitis. Evaluation in 22 patients.

To assess the value of bronchoalveolar lavage (BAL) for diagnosis, understanding, and treatment of amiodarone-associated pneumonitis, we examined the results of BAL total and differential cell counts and phenotyping of lymphocytes in 22 patients with this lung disorder and in 33 normal subjects. Overall, the total cell count was found to be almost the same as that seen in control subjects; the macrophage population was significantly reduced, and the lymphocyte, neutrophil, and eosinophil populations were increased in absolute number and percentage. When results were analyzed individually, BAL data appeared to be distributed according to two patterns. In the first pattern, there was no abnormal lymphocytosis. In the second pattern a lymphocyte alveolitis was found in percentage and in absolute number. This lymphocyte alveolitis was present either alone or associated with neutrophil alveolitis or with eosinophil alveolitis. In the first pattern, despite the normal level of the lymphocyte population, the percentage of CD4 T-lymphocytes and the CD4:CD8 T-lymphocyte ratio were significantly lowered. In the second pattern the CD8 T-lymphocyte count was increased in absolute number and percentage, with a low CD4:CD8 ratio. In six patients relavaged two to four months after amiodarone withdrawal, there was a significant fall in alveolar lymphocytosis, but the progressive increase in the neutrophil population over time seemed to be associated with the seriousness and progression of the disease. Finally, these findings closely resembled those obtained in patients with hypersensitivity pneumonitis due to inhalation of organic dust and suggest that an underlying immunologic cell-mediated mechanism may play a role in this iatrogenic pulmonary disease.

Farmer's lung presenting as respiratory failure and homogeneous consolidation.

A 40-year-old woman who worked on a farm and was exposed to moldy hay presented with acute respiratory failure requiring mechanical ventilation and homogeneous radiologic consolidation. Treatment with steroids produced rapid improvement. These features of presentation of hypersensitivity pneumonitis with acute respiratory failure and homogeneous consolidation are rarely encountered.

Electromyographic study of lumbar back muscles during locomotion in acute high decerebrate and in low spinal cats.

The electromyographic (EMG) activity of the lumbar back muscles (multifidus, longissimus and iliocostalis) was investigated during treadmill locomotion in acute high decerebrate and in low spinal cats. During alternate stepping (0.7-2.0 m X s-1) in high decerebrate cats, the back muscles have two bursts of activity per step cycle. On the average these EMG bursts last about 170 ms and start some 25 ms before the onset of each vastus lateralis (VL). The two bursts in any one back muscle may have a different duration, the shortest burst on one side coinciding with the longest burst of the homologous contralateral muscle. There is often an overall asymmetry in the discharge wherein the bursts of activity in both ipsi- and contralateral muscles are longer at the onset of one of the VLs. Correlation analyses of several timing parameters of the bursts as a function of walking speeds were made. Different patterns of correlation were identified and it was found that, in most cases, the end of the bursts (with respect to the onset of VL activity) was best correlated with the speed of walking. During gallop, the back muscles activity is a single burst of about 200 ms duration which starts some 75 ms before the onset of VL. In low spinal cats walking after an injection of clonidine, the double burst pattern of EMG activation may be present if there is adequate weight support. However, when the animal steps with the hindlimbs extended and with insufficient weight support, these muscles have a tonic activity uncorrelated with the rhythmic activity of hindlimb muscles.

Interaction between forced grasping and a learned precision grip after ablation of the supplementary motor area.

Monkeys were trained to compress and release a force transducer held between the thumb and forefinger. Immediately following ablation of the contralateral supplementary motor area a grasp reflex produced a disturbance of the learned precision grip characterized by an increase in mean grasping force, an increase in the rate of prehensile force application and the inability to release the strain gauge. No change was observed in the same learned grip with the ipsilateral hand.

The effects of storage times, temperatures and container types on the accuracy of atomic-absorption determinations of Cd, Cu, Hg, Pb and Zn in whole heparinized blood.

The concentration changes of five different heavy metals in whole blood were tested under a variety of storage conditions. Changes were observed for hourly, daily and weekly periods at four temperatures (-70, -10, 4 and 22 degrees C) and in six different container types, (pyrex and soda glass, two polyethylene, polypropylene, polystyrene and polycarbonate). Rapid, direct-dilution, heated graphite furnace atomic absorption (AA) techniques were developed for analysis of cadmium, copper, lead, and zinc, while mercury was analyzed by the cold vapor flame atomic absorption spectroscopy (FAAS) method. The levels of all metals changed significantly in one week at almost all temperatures in all containers. Concentrations of cadmium, copper and zinc increased probably through leaching processes while lead and mercury decreased through probable hydrolysis and vaporization, respectively. Commercially cleaned polypropylene tubes did not perform significantly better than acid washed vessels. In the absence of better vessels, storage must be as short as possible for meaningful metal concentration determinations.

Perinatal mortality in Southland.

A review of Southland's perinatal mortality was undertaken from 1971 to 1977 and included 237 deaths with a post mortem rate of 90 percent. During this period, the perinatal mortality rate fell to below the national average. Prematurity remains the most important single factor. Seventy-four percent of confinements are attended solely by general practitioner obstetricians. Fetal monitoring of high risk pregnancies in labour markedly reduces the intrapartum death rate of mature babies.