Estrogen replacement therapy in endometrial cancer patients: a matched control study.

OBJECTIVE: To determine if estrogen replacement therapy, in women with a history of endometrial cancer, increases the risk of recurrence or death from that disease. METHODS: Two hundred forty-nine women with surgical stage I, II, and III endometrial cancer were treated between 1984 and 1998; 130 received estrogen replacement after their primary cancer treatments and 49% received progesterone in addition to estrogen. Among this cohort, 75 matched treatment-control pairs were identified. The two groups were matched by using decade of age at diagnosis and stage of disease. Both groups were comparable in terms of parity, grade of tumor, depth of invasion, histology, surgical treatment, lymph node status, postoperative radiation, and concurrent diseases. The outcome events included the number of recurrences and deaths from disease. RESULTS: The hormone users were followed for a mean interval of 83 months (95% confidence interval [CI] 71.0, 91.4) and the nonhormone users were followed for a comparable mean interval of 69 months (CI 59.1, 78.7). There were two recurrences (1%) among the 75 estrogen users compared with 11 (14%) recurrences in the 75 nonhormone users. Hormone users had a statistically significant longer disease-free interval than nonestrogen users (P =.006). CONCLUSION: Estrogen replacement therapy with or without progestins does not appear to increase the rate of recurrence and death among endometrial cancer survivors.

The capture rate of at-risk term newborns for early-onset group B streptococcal sepsis determined by a risk factor approach.

OBJECTIVE: Currently, the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommend that health care providers for pregnant women implement 1 of 2 strategies for the potential prevention of early-onset neonatal group B streptococcal sepsis. Both algorithms recommend intrapartum antibiotic chemoprophylaxis for patients delivered of their neonates at <37 weeks' gestation. The basic difference lies in the management of the term pregnancy. One protocol suggests treatment of all patients with term pregnancies with a positive culture for group B Streptococcus obtained at 35 to 37 weeks' gestation. The second approach recommends treatment on the basis of risk factors of membrane rupture of >/=18 hours' duration or intrapartum temperature of >/=38 degrees C. The capture rate of at-risk neonates determined by the risk factor strategy is quoted as being approximately 70%; however, the basis for this percentage was from studies that used slightly different definitions than the current guidelines and never separated the term from the preterm newborn. Our objective was to prospectively collect every case of blood culture-proven early-onset neonatal group B streptococcal sepsis and determine whether risk factors, as currently defined, were present that might have warranted maternal intrapartum antibiotic chemoprophylaxis. STUDY DESIGN: A prospective study was initiated on July 1, 1987, and completed on December 31, 1996. Every patient that was delivered of a neonate in whom early-onset group B streptococcal sepsis developed was analyzed in detail for possible intrapartum risk factors. RESULTS: A total of 49 cases of early-onset group B streptococcal sepsis occurred in 46,959 deliveries. Of these 49 newborns, 9 (18%) were delivered at <37 weeks' gestation. The remaining 40 newborns were delivered at term, and only 12 (30%) were delivered with an intrapartum risk factor of either membrane rupture of >/=18 hours' duration or temperature of >/=38 degrees C or both. CONCLUSIONS: On the basis of the data from this study and the current literature, the risk factor approach with the current guideline recommendations would capture <50% of the term newborns in whom sepsis develops.

[Ethnography of acute respiratory infections in a rural zone of Mexican highlands]. / Etnografía de la infección respiratoria aguda en una zona rural del altiplano mexicano.

OBJECTIVE: To identify the terms used by mothers to refer to diseases, signs and symptoms related to acute respiratory illnesses (ARI), alarming signs which should motivate them to seek medical attention, and to describe common home practices of disease care and treatment. MATERIAL AND METHODS: An ethnographic study was performed in six rural communities of the Mexican central highlands. Interviews were collected from 12 key informers, six mothers of children who had died from ARI and 24 mothers of children younger than five years of age, with several ethnographic techniques to complement information ("triangulation"). RESULTS: The most commonly identified diseases were cold, sore throat, cough, bronchitis, pneumonia and "bronchopneumonia". Key signs to establish diagnosis included nasal discharge, sore throat, cough, head and body ache, fever. "bubbling" chest, general malaise and shortness of breath. Tachypnea was referred to as "strong breathing", "much breathing", "rapid breathing" or "sizzle"; intercostal depression as "the chest sinks", stridor as "chest moan or chest snore", sibilance as "chest snore" and cyanosis as "he turns purple". Home treatments include herbal teas, lemon, green or red tomato or potato applied to the throat externally, as well as creams applied to chest or back. Antibiotic prescription was not common, contrary to antipyretics. Most mothers recognized mild illnesses: severe illnesses were recognized less frequently. When faced with a severe ARI, mothers sought attention firstly at the project clinic, second in frequency with a private physician in the capital of the province and then at the Health Ministry of the district. The reasons to choose these possibilities were mainly proximity and lower costs. CONCLUSIONS: This information can be useful to improve communication with mothers.