Surgical removal of a gigantic abdominal mass: a multidisciplinary approach.

BACKGROUND: Ovarian cystadenomas are common benign ovarian neoplasms that rarely present as gigantic abdominal masses. A variety of intraoperative and postoperative challenges may be encountered in the removal of these masses. CASE: We review the case of a 45-year-old woman who presented with massive abdominal swelling that was later identified as two distinct bilateral serous cystadenomas with a combined weight of approximately 107 kg. A multidisciplinary team including gynecology, plastic surgery, anesthesiology, and the operating room staff convened before surgery to discuss surgical technique, physiologic considerations, and logistical issues. CONCLUSION: A multidisciplinary approach had an integral role in intraoperative safety and successful recovery of our patient from this surgery.

Flow cytometric methods for prenatal and neonatal diagnosis.

Flow cytometry offers a promising alternative to the current methods of amniocentesis or chorionic villus sampling (CVS) for fetal cell sorting for prenatal diagnosis. While flow cytometric methods have been greatly improved to be more sensitive at detecting fetal cells within the maternal circulation, there are still several challenges that need to be overcome before application in prenatal diagnosis. However, flow cytometry is a powerful tool that can be used to enhance molecular testing and other diagnostic testing modalities in prenatal and neonatal diagnosis. It remains the gold standard to identify cellular immunodeficiencies and, for some immunological disorders with established biomarkers, flow cytometric assays can be used to make a definitive diagnosis. In this review, the advantages and disadvantages of using MACS and FACS analysis for fetal cell sorting are discussed. This review also includes an overview of the current flow cytometric assays and biomarkers that may be used for prenatal and neonatal diagnosis of common immunological and hematological abnormalities and the role of flow cytometry in treatment monitoring after bone marrow and stem cell transplantation.

Do we practice what we preach? A review of actual clinical practice with regards to preconception care guidelines.

OBJECTIVES: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. METHODS: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. RESULTS: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. CONCLUSIONS: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.

The business case for preconception care: methods and issues.

Only a limited number of economic evaluations have addressed the costs and benefits of preconception care. In order to persuade health care providers, payers, or purchasers to become actively involved in promoting preconception care, it is important to demonstrate the value of doing so through development of a "business case". Perceived benefits in terms of organizational reputation and market share can be influential in forming a business case. In addition, it is standard to include an economic analysis of financial costs and benefits from the perspective of the provider practice, payer, or purchaser in a business case. The methods, data needs, and other issues involved with preparing an economic analysis of the likely financial return on investment in preconception care are presented here. This is accompanied by a review or case study of economic evaluations of preconception care for women with recognized diabetes. Although the data are not sufficient to draw firm conclusions, there are indications that such care may yield positive financial benefits to health care organizations through reduction in maternal and infant hospitalizations. More work is needed to establish how costs and economic benefits are distributed among different types of organizations. Also, the optimum methods of delivering preconception care for women with diabetes need to be evaluated. Similar assessments should also be conducted for other forms of preconception care, including comprehensive care.

The history of preconception care: evolving guidelines and standards.

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail.

Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care.

This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives.

Cloning and stem cells: processes, politics, and policy.

The creation of good science policy requires an understanding of the scientific technologic processes as well as an appreciation of the "politicization process" and contemporary politics. This article encompasses a review of nuclear transfer and stem cell technologies and advances against a backdrop of the politicization of science. The combination of these forces has rendered it almost impossible to develop true consensus on what any national policy regarding nuclear transfer should look like. Careful consideration of the multidimensional nature of these technologies and the myriad of social, economic, and cultural factors they will impact demands, however, that, at the very least, a national dialogue be instituted in an effort to frame good policy pertaining to nuclear transfer and stem cell research.