Translocation t(5;12)(q31-q33;p12-p13): a non-random translocation associated with a myeloid disorder with eosinophilia.

A t(5;12)(q33;p13) translocation has been detected in two patients with myeloid disorder and eosinophilia. Six other patients with haematological disease with eosinophilia with similar translocation have been published previously. The existence of a new entity, a myeloproliferative disorder with eosinophilia and t(5;12) (q31-q33;p12-p13), is suggested by the results of the present study.

[Role of the titration of anti-neutrophil cytoplasmic antibodies in therapeutic follow-up of patients with systemic vasculitis]. / Place du titrage des anticorps anticytoplasme des polynucléaires neutrophiles dans le suivi thérapeutique des patients atteints de vascularite systémique.

We studied clinical and biological data of 18 patients presenting ANCA associated diseases for 16 months at least. Five relapses were preceded by ANCA elevation, 1 relapse was not. Four transient elevations were noted without any clinical event. We think ANCA level elevation by itself is not enough for deciding therapy intensification, clinical data are necessary for doing so.

[Oral contraception with Moneva: findings of a cohort study of 6000 women]. / Contraception orale par Moneva: resultats d'une etude de cohorte portant sur 6.000 femmes.

PIP: Between the fall of 1991 and the fall of 1992, 1500 physicians from throughout France followed 5989 women, 13-56 years old, using the combined oral contraceptive (OC) Moneva (30 mcg ethinyl estradiol and 75 mcg of the new generation progestogen, gestodene) for 3-6 months for a total of 29,000 cycles. Moneva was prescribed in 60% of the cases because the women did not tolerate a previous OC. Moneva effectively prevented pregnancy. It reduced the rate of abnormal cycles (5.4% of cycles vs. 0.9% at 3 months and 0.6% at 6 months). Intermenstrual bleeding also decreased in frequency from 13.8% to 6.1% at 6 months. Amenorrhea occurred less often with Moneva (2.8% vs. 1.1% at 3 and 6 months). Moneva also reduced the length of the menstrual period (20.7% of women with long period vs. 3.3% at 6 months) and excessive menstruation (1.4% vs. 0.2% at 6 months). Pain during menstruation, breast tenderness, and secondary effects occurred less frequently as well (37.1% vs. 13.5% at 3 months and 9/7% at 6 months, 13% vs. 7.9% at 6 months, and 15.1% vs. 11.1% at 3 months and 9% at 6 months, respectively). Secondary effects included headaches, nausea, and heavy legs. Moneva did not affect body weight or arterial blood pressure. 95% of women who took Moneva for 6 months were satisfied with it. 83.8% said that they would continue to use it. In conclusion, Moneva is an effective, safe, tolerable, and acceptable OC for women of all ages.^ieng

[Generalized status epilepticus after ingestion of ibuprofen (Brufen), disclosing systemic lupus erythematosus]. / Etat de mal comitial généralisé après prise d'ibuprofène (Brufen), révélateur d'un lupus érythémateux disséminé.

We report a case of aseptic meningoencephalitis induced by ibuprofen (Brufen) in a 24-year old unmarried woman with unrecognized systemic lupus erythematosus. The neurological manifestations induced by ibuprofen revealed the systemic disease. Clinicians confronted with aseptic meningitis or meningoencephalitis developed after treatment with a non-steroidal anti-inflammatory drug, notably ibuprofen, should investigate for systemic disease.

Sentinel health events as indicators of unmet needs.

It is vitally important to be able to assess the impact of the health care system on the populations it serves. This paper explores whether sentinel health events--negative health states, such as death, disability, and disease, that might have been avoided given current medical and public health knowledge and technology--can be used as sociomedical indicators to assess levels of unmet needs and to evaluate health system performance. Using hospital discharge data, the occurrence of sentinel health events in New York State and differences among population subgroups are examined. Among hospitalized residents of New York State in 1983, more than 17,000 deaths occurred that were possibly avoidable. More than 336,000 instances of disease were found that were potentially preventable. Significantly higher rates and ratios for many sentinel events were found among blacks, Medicaid recipients, and users of public hospitals than were found for comparison groups. The sentinel events approach proved to be useful and practical. However, refinements and adaptations of the sentinel events method are needed, including the development of one or more smaller sets of indicators--tracer sentinel events--that can be used to profile aspects of health status and the health system.

Measuring avoidable deaths and diseases in New York State.

The measurement of sentinel health events--avoidable deaths and diseases--is a practical and valuable method for assessing the state of the community's health and the performance of the health system in meeting the needs of the population. A comprehensive framework for identification of sentinel health events has been defined by the Working Group on Preventable and Manageable Diseases. The Working Group developed lists that include more than 120 medical conditions for which death or disease is deemed to be potentially avoidable through primary prevention activities or timely and appropriate treatment. Hospital discharge abstract data offer a unique perspective for examining these potentially avoidable negative health outcomes. Such data, available in New York State through the Statewide Planning and Research Cooperative System (SPARCS), are a source of detailed and accessible information on a wide range of morbidity-producing conditions and associated deaths. Among the findings of this sentinel health events study, based on an analysis of SPARCS data, are the following: Among hospitalized residents of New York State in 1983, more than 19,000 deaths occurred that were potentially avoidable. More than one-third of these deaths occurred among persons under age 65. More than 336,000 instances of disease were found that were potentially preventable, amounting to 123 disease occurrences per 1,000 discharges. In the category of sentinel events where each event may be avoidable, only three conditions alone were associated with 75 percent of the deaths and 60 percent of the disease occurrences--malignant neoplasm of the trachea, bronchus, and lung; emphysema or chronic obstructive lung disease(s); and malignant neoplasm of the bladder. In the category of events where some proportion of events may be avoidable, one diagnosis--vascular complications associated with hypertensive disease(s)--was linked with 45 percent of the deaths. Significantly higher rates and ratios for many sentinel events were found among blacks, Medicaid recipients, and users of public hospitals than were found for comparison groups. For example, among patients hospitalized for colon and related neoplasms, black patients were more than twice as likely to die than white patients.(ABSTRACT TRUNCATED AT 400 WORDS)

New York's role as a center for health care: an analysis of nonresident patients served by New York City hospitals.

Patients who reside outside of New York City have long been an important segment of the patient population at New York City hospitals. Each year, as far back as systematic data are available, approximately 10 percent of all patients at New York City hospitals have been non residents. Increasing competition and changing reimbursement policies compel hospitals in New York City to assess their role in caring for these patients and its economic implications. This report provides a comprehensive assessment of the characteristics of nonresident patients and their significance to the city's hospitals. Using data from all New York City hospitals, the report analyzes the demographics, insurance coverage, and case-mix characteristics of nonresident and resident patients. And, using more detailed data from New York University Medical Center and Columbia-Presbyterian Medical Center, it addresses the financial and reimbursement policy questions posed by the care of nonresident patients. The key findings of the report are as follows: A total of 115,307 nonresidents were hospitalized in New York City in 1982; this figure represents 10.4 percent of all patients in city hospitals. Over 80 percent of nonresident patients come from 14 counties surrounding New York City. Nonresident patients are a crucial component of the patient population at six hospitals that are the principal affiliates of a medical school and the six specialty hospitals. At academic health centers, nonresidents represent 25 percent of all inpatients; at the specialty hospitals, they represent 36 percent. Manhattan hospitals account for 69 percent of all nonresident discharges in the city. Outside of Manhattan, only Montefiore Medical Center and Long Island Jewish Medical Center have substantial numbers of nonresident patients. Among nonresident patients, 75 percent of admissions are scheduled in advance and 72 percent of hospital stays are for surgical procedures. In contrast, among resident patients, only 50 percent of admissions ares scheduled and 52 percent are for surgical procedures. Almost two-thirds of nonresident patients are covered by private insurance, compared to one-third of residents. Nonresident patients require more hospital resources on average than residents do. The average Diagnosis Related Group (DRG) weight, a measure of expected resource intensity, is 22.5 percent higher for nonresidents than for residents. However, nonresidents also come to New York City hospitals for relatively routine care. For example, the most common diagnoses among nonresidents and residents are uncomplicated deliveries and abortions. At New York University Medical Center and Columbia-Presbyterian Medical Center, nonresidents have higher average charges than residents, but the charge differences are much smaller than the DRG weight differences. Thus, within a given DRG, nonresidents consume fewer resources than residents. Under Medicare's Prospective Payment System bases on DRGs, nonresidents appear to be financially attractive to New York hospitals, based on the experience of New York University Medical Center.