Tubal ectopic pregnancy: a histologic, morphometric, and statistical study.

Pathologists are occasionally asked for medicolegal reasons to estimate the gestational age of an ectopic pregnancy based on morphologic findings. We evaluated the correlation between the gestational age and the maximal diameter of the resected fallopian tube, the average diameter of chorionic villi, the number of chorionic villi per square millimeter of the microscopic section, the number of degenerated villi per square millimeter, the number of syncytial knots per square millimeter, and the average number of layers of cytotrophoblastic cells covering the villi. There was a significant correlation between the diameter of the fallopian tube and the gestational age, with a correlation coefficient of 0.41 and a P value of .05. There was no significant correlation of the gestational age with any of the microscopic parameters measured. The findings indicate that an approximate estimation of the gestational age of tubal ectopic pregnancies may be made using the diameter of the resected fallopian tube.

Reading deficiencies in older patients.

To participate effectively in their health care, older patients often are expected to read a wide variety of materials, including written instructions, brochures, and consent forms. This study quantitates the reading ability of older patients and compares it to that of younger patients. Two hundred seventy-two patients 30 and older were selected from five outpatient clinics at a public teaching hospital and tested for objective reading ability using the Peabody Individual Achievement Test--Revised. The 76 patients 60 and older read significantly worse (grade level 2.9) than the 196 patients younger than 60 (grade level 5.8) (P < 0.0001). Older patients also completed significantly fewer years of school than younger patients (7.3 years versus 10.6 years). Analysis of variance for age categories 30-44, 45-59, 60-74, and 75 and older confirmed declining reading ability and educational status with advancing age. Multiple regression analysis helped show that an equation could be derived to predict reading ability from age, educational status, race, and sex, but the coefficient of determination was so low (r2 = 0.39) that it cannot be considered clinically useful for individual patients. In this study, older patients read significantly worse than younger patients, and a formula that combines age, race, sex, and educational status cannot reliably predict reading ability for individual patients. Most older patients read on a level so low that they cannot be expected to read most commonly used written materials. Routine testing of reading ability may allow more appropriate design and use of written materials.

Assessment of hypoxemia in patients with sleep disorders using saturation impairment time.

A method of recording cumulative nocturnal oxygen desaturation was utilized to develop a quantitative index of nocturnal hypoxemia (SIT index) to provide reference values and distributional properties for apneic and nonapneic sleep-disordered patients. The SIT indices were compared in patients with varying degrees of obstructive sleep apnea (OSA) as determined by traditional methods of counting apneas and hypopneas. We studied 298 patients who were divided into five groups based on the presence and frequency of apnea or sleep-related respiratory deterioration. SIT indices for patient groups and individual patients were compared with the respiratory disturbance index (apneas + hypopneas x 60/total sleep time = RDI) using scatter plots, Kruskal-Wallis analysis of variance, and Mann-Whitney U tests. The OSA and non-respiratory-impaired patient groups had mean SIT values that were significantly different (p < 0.05). Subjects with severe apnea differed (p < 0.05) from subjects with mild and moderate apnea at SIT index thresholds < baseline, < 90, < 80, and < 70% SaO2, but subjects with mild and moderate apnea did not differ statistically from each other at any threshold. In individual patients with similar RDI values, considerable variation in SIT index can be seen, and the reverse is also true. This suggests that using both RDI and SIT may provide complementary information in assessing the severity of OSA.

Timing and dosage of postoperative radiotherapy for squamous cell carcinoma of the upper aerodigestive tract.

Seventy patients who received postoperative irradiation (PI) after curative surgery for stage III or IV squamous cell carcinoma of the upper aerodigestive tract were studied retrospectively to compare the rate of local and regional recurrence (LRR) and the effect of total dose on LRR rate in patients irradiated timely (n = 40) with those who were not (n = 30). Overall, the LRR rate was higher when PI was delayed than when timely (37% vs 20%). No advantage resulted from increasing total dose when PI was delayed; the LRR rate in the primary site and upper neck was 18% with less than 60 Gy and was 26% with 60 Gy or more; the LRR rate in the lower neck was 13% with 50 Gy or less and was 14% with more than 50 Gy. These data seem to corroborate the findings of other investigators regarding the importance of initiating timely PI, but not the observation that a pronounced delay is not detrimental provided higher tumoricidal doses are used.

Characteristics of indigent women with ruptured and unruptured tubal pregnancies.

The diagnosis of tubal pregnancy, whether ruptured or unruptured, often requires a surgical procedure, such as laparoscopy or laparotomy, for confirmation. We compared women with ruptured and unruptured tubal pregnancies to determine whether the clinical presentations, morbidity and surgical complications in the two groups were significantly different. We compared the demographic characteristics, clinical presentations, laboratory findings, morbidity and complications from surgical management in the two groups. Women with ruptured tubal pregnancies had a higher incidence of abdominal pain lasting less than 24 hours, adnexal tenderness and positive culdocentesis from hemoperitoneum as compared to women with unruptured tubal gestations. Abnormal uterine bleeding was observed less frequently in women with ruptured tubal pregnancies as compared to women with unruptured ones despite similar gestational ages at presentation. All the patients with a tubal pregnancy were managed surgically. The morbidity and surgical complication rates in the two groups were not significantly different.

Clomiphene-dexamethasone treatment of clomiphene-resistant women with and without the polycystic ovary syndrome.

We used clomiphene and dexamethasone in 40 infertile women to treat chronic anovulation resistant to the use of clomiphene alone. Eighteen (45%) of the women had the polycystic ovary (PCO) syndrome; the remaining 22 (55%) had clomiphene-resistant anovulation from idiopathic causes. Both groups of women were similar in regard to age, parity, duration of infertility and absence of other causes of infertility besides chronic anovulation. Ovulation could be induced in approximately 90% of the women in each group. Altogether, 19 of 36 women (52.8%) conceived without any side effects or complications. The cumulative probability of conception at nine months of treatment was 87.5% in PCO patients and 46% in the non-PCO group. Clomiphene plus dexamethasone was highly effective in the treatment of clomiphene-resistant anovulation associated with infertility in women with and without the PCO syndrome.

Patient reading ability: an overlooked problem in health care.

Health care workers often assume that patients who have completed a certain grade in school can read at that level. This study examines the relationships between patient reading ability, the last grade completed, and the reading ability necessary to comprehend commonly used written materials. We tested 528 patients during regular visits to seven outpatient clinics serving a predominantly indigent population. In addition, we analyzed the readability of 280 brochures and consent forms used in these clinics. Most patients had reading abilities on a level far below their last grade completed, while almost all materials tested were written on a level far above average patient reading ability. We conclude that patient reading ability should be routinely tested and that written materials should be developed on a level commensurate with patient reading ability.

Rapid assessment of literacy levels of adult primary care patients.

Health education materials, medical instructions, consent forms, and self-report questionnaires are often given to patients with little regard for their ability to read them. Reading ability is rarely tested in medical settings. The Rapid Estimate of Adult Literacy in Medicine (REALM) was developed as a quick screening tool to assist physicians in identifying patients with limited reading skills and in estimating patient reading levels. This information can be used to tailor materials and instructions to patients' abilities. The REALM and the reading sections of the Peabody Individual Achievement Test-Revised and the Slosson Oral Reading Test were used to test reading ability in 207 adults in six public and private primary care clinics. REALM scores correlated highly with those of the standardized reading tests. The REALM, which takes three to five minutes to administer and score, appears to be a practical instrument to estimate patient literacy in primary care, patient education, and medical research.

Use of psychoactive substances by medical students: a survey.

The use and abuse of alcohol and other psychoactive substances is of concern to the medical profession and to medical educators. Sixty-eight members of the sophomore class at LSU Medical Center in Shreveport participated in a substance use survey. Ten students (14.7%) described themselves as abstainers from alcohol consumption. Although none described themselves as heavy or abusive drinkers, 9 (13.2%) drank 6-10 alcoholic beverages on a weekend if there was no examination scheduled for Monday or Tuesday, and 3 (4.4%) consumed more than 10 alcoholic beverages on such a weekend. At a large school social event, 9 students (13.2%) drank 6-10 alcoholic beverages and 3 (4.4%) drank more than 10 alcoholic beverages during the event. Nine students (13.2%) used marijuana at least 1-3 times per year. Tobacco was used by 17.6% of the students sampled. Only 4 students (5.9%) avoided caffeine completely. Twelve students (17.6%) drank 5-10 caffeinated beverages daily. The use of cocaine (2.9%), amphetamines (4.5%), and unprescribed sedatives (6%) was small in this student sample. More education concerning effects of psychoactive substances is encouraged.

Childhood depression: an overlooked problem in family practice.

To investigate the incidence and correlates of childhood depression in a family practice clinic, Kovacs Childhood Depression Inventory (CDI) was administered to 64 patients, aged 6 to 12 years. Accompanying parents completed the short form of Beck's Depression Inventory (BDI) and reported on the children's behavior problems. One half of the children studied scored within the depressed range on the CDI. Thirty-nine percent of the parents scored at least mildly depressed on the BDI. Depression appeared to cluster in families. Every parent who scored in the severe depression range was accompanying a child who rated himself or herself as depressed. All parents who scored above the cutoff for mild depression rated their children as having behavior problems. Children's self-reported depression was also related to negative parental rating of the children's behavior.

Screening depression in primary care: back to the basics with a new tool.

Two depression inventories were used to screen 377 family practice patients. One, the Self-Rating Depression Scale (SDS), assesses major symptomatology; it is the depression inventory most frequently used in family practice. The other, the Depression Adjective Checklist (DACL), assesses mood only and has not been previously reported in the family medicine literature. Forty-one percent of the patients who completed the SDS rated themselves at least mildly depressed; 37% scored in the same range on the DACL. Four percent of the patients scored in the severe depression range on the SDS, while 15% scored in the severe depression range on the DACL. Residents treating these patients, however, failed to diagnose depression in more than 85% of the patients who had rated themselves as at least mildly depressed on either inventory. The residents also failed to diagnose depression in more than 70% of those who had rated themselves as severely depressed. Teaching and research implications are discussed.

The effect of antimotion sickness drugs on habituation to motion.

The effect of antimotion sickness drugs on habituation was studied. Subjects were rotated once a day for 5 d to the malaise III end-point after receiving placebo, 1 mg scopolamine, 10 mg d-amphetamine, or the combination of 0.6 mg scopolamine with 5 mg of d-amphetamine. The placebo scores had a Spearman coefficient of correlation of 0.88 with the initial untreated tests. This demonstrated a high reliability for the M-III end-point and that little habituation resulted from the test design. The combination of 0.6 scopolamine with 5 mg amphetamine produced the fastest rate of habituation closely followed by the dose of 1 mg scopolamine. 10 mg of d-amphetamine also produced an increase in habituation over placebo scores. When the medications were discontinued on day 5 a rebound in sensitivity to vestibular stimulation occurred with scopolamine and scopolamine with d-amphetamine. The increased habituation appears to be due to the greater exposure to vestibular stimulation permitted by the medications.

Pursuit Meter II, a computer-based device for testing pursuit-tracking performance.

The Pursuit Meter II, a microcomputer-based device developed for the quantitative determination of human pursuit-tracking performance, is described. Computer-generated moving patterns are displayed on a high resolution color video monitor. For the subject the task is to attempt to superimpose a red line presented on the screen, the vertical location of which he controls with a steering device, over a blue line the computer generates as the problem. Both lines, each composed of 279 segments, are generated at the same rate, left to right on the monitor. The individual differences between the subject's response and the problem are summed and stored by the computer as an error score which correlates inversely to the subject's ability to perform the task. Three Pursuit Meter II problems were presented to 26 male college students. Our data demonstrated that different levels of performance to the problems resulted and that the Pursuit Meter II can be used to quantify human pursuit-tracking performance.

Correlation of fluid exchange in the microcirculation and macrocirculation.

Accurate, quantitative information relating to hydraulic conductivity (Lp) of the capillary wall in any organ of tissue is essential as the first step toward understanding fluid homeostasis. Any perturbation which permanently alters fluid balance will ultimately lead to death and destruction of tissues in the living organism. This report summarizes some recent information relating to Lp measurements in single capillary and whole organ experiments. It is shown that the single capillary and whole organ methods do not yield similar quantitative information and some possible reasons for this are discussed. It is hypothesized that capillary membrane permeability is governed by dynamic processes which may change in response to both the metabolic requirements of the organ tissue cells and overall metabolic homeostasis of the organism. It follows from this hypothesis that fluid balance in tissues is a passive process determined solely by the Starling forces, the functional significance of which is to provide an aqueous medium to aid the diffusion of nutrient substrate from blood to tissue cells.