Surgical Treatment of Suspected Meningioangiomatosis in the Thoracolumbar Spinal Cord.

A 5 yr old male neutered Labrador retriever was evaluated for an 8 wk history of a slowly progressive abnormal hind limb gait that did not respond to treatment with nonsteroidal anti-inflammatories. Initial examination findings were mild pelvic limb ataxia and moderate right pelvic limb lameness. A computed tomography with a myelogram was performed and showed a suspected intramedullary spinal mass. MRI was conducted and supported the computed tomography with myelogram findings of a possible intradural spinal mass at L1. A left-sided hemilaminectomy followed by a durotomy at L1 was performed and a firm, tan mass was removed. The histopathologic findings indicated a vascular proliferation most suggestive of a rare proliferative disorder of leptomeningeal blood vessels termed meningioangiomatosis. Although the dog's signs initially worsened after surgery and he was nonambulatory with marked paraparesis, he regained ambulation within 3-4 wk after the operation. Eighteen months after surgery, he was ambulatory with mild hind limb ataxia with no progression of signs. This case suggests that surgical resection of lesions of suspected meningioangiomatosis can result in improvement of clinical signs with a good long-term prognosis.

A 21st-Century Public Health Approach to Abortion.

In the United States, groups advocating for and against abortion rights often deploy public health arguments to advance their positions. Recently, these arguments have evolved into state laws that use the government health department infrastructure to increase law enforcement and regulatory activities around abortion. Many major medical and public health associations oppose these new laws because they are not evidence-based and do not protect women's health. Yet state health departments have been defending these laws in court. We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically, we apply the Centers for Disease Control and Prevention's 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women's ability to obtain an abortion in the state and county where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services.

Mixed-methods investigation of women's experiences with second-trimester abortion care in the Midwest and Northeast United States.

OBJECTIVE(S): We studied women's experiences seeking and receiving second-trimester abortion care in two geographically and legislatively different settings to inform ways to improve abortion care access and services. STUDY DESIGN: We conducted in-depth interviews with women who obtained second-trimester abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received second-trimester abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. RESULTS: We interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. CONCLUSION(S): Women seeking second-trimester abortion in these locations reported positive abortion experiences. However, they had to overcome significant obstacles to obtain care. IMPLICATIONS: This is the first study to systematically research women's second-trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with second trimester abortion care.