[Comparative assessment of efficacy of tissue plasminogen activator and streptokinase in the treatment of patients with acute myocardial infarction]. / Sravnitel'naia otsenka éffektivnosti tkanevogo aktivatora plazminogena i streptokinazy v lechenii bol'nykh ostrym infarktom miokarda.

AIM: To compare results of treatment of patients with acute myocardial infarction with tissue plasminogen activator (TPA) and streptokinase. MATERIAL AND METHODS: TPA (100 mg intravenously) and streptokinase (1500000 U intravenously) were used for thrombolytic therapy of acute myocardial infarction in 114 and 118 patients, respectively. RESULTS: TPA treated compared with streptokinase treated patients were characterized by less frequent serious cardiac rhythm and conduction disturbances and hypotension during thrombolysis (p<0.05), as well as less frequent pathological Q-waves formation (p<0.001). More than 50% lowering of initially elevated ST-segment by 90-th minute occurred more often in TPA treated patients (p<0.001). Differences between TPA and streptokinase treated patients in mortality (3.5 and 7.6%, respectively), reinfarction rate during first 24 hours (3.5 and 5.1%, respectively), aneurysm formation (9.1 and 14.7%, respectively), and heart failure development (4.5 and 11.0%, respectively) were not significant. CONCLUSION: The use of TPA for thrombolytic therapy of patients with acute myocardial infarction gave better results than the use of streptokinase.

Options for measuring unintended pregnancy in cycle 6 of the National Survey of Family Growth.

PIP: The National Survey of Family Growth staff contracted with researchers for an improved measurement of unintended pregnancy for Cycle 6 in the year 2001. There is a need for additional data related to unintended pregnancy for individuals practicing contraception, and for individuals who wanted to be pregnant but are not using any method. Substantive additions for the study include motivation desire to avoid pregnancy, ambivalence, and reasons for unintended pregnancy. Moreover, the introduction at the beginning of the "intendedness" series is to know about the feelings of a woman right before she becomes pregnant. A question is asked on the method or methods used in the month of conception. The impact of the question on the respondents needs to be assessed.^ieng

Chronic plasma cell endometritis in hysterectomy specimens of HIV-infected women: a retrospective analysis.

OBJECTIVE: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients. METHODS: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surgical indication, and history of gonadotropin-releasing hormone (GnRH) use. Cases were evaluated for the presence of plasma cells and assigned a grade between 0 and 3. RESULTS: Indications included cervical dysplasia (4), carcinoma in situ (2), abnormal uterine bleeding (3), and adnexal mass (3). Some degree of abnormal uterine bleeding occurred in all cases. Plasma cell endometritis was twice as common in HIV-infected women compared to HIV-negative specimens (11/11 versus 11/22) (P < 0.05). Plasma cell endometritis was also of a higher grade in specimens from HIV-infected women than in controls (P = 0.001). CONCLUSION: Chronic endometritis was common and of a higher grade among HIV-infected women requiring hysterectomy in our series. Diagnosis and treatment of endometritis should be considered in HIV-infected women with uterine bleeding and/or tenderness. We speculate that antiretroviral and/or antimicrobial treatment for endometritis may effectively treat endometritis and eliminate the need for surgery in some HIV-infected women. We suggest that consideration and treatment of endometritis in HIV-1 infected women being evaluated for possible hysterectomy has the potential to reduce costs and morbidity for patients and providers who may be exposed during surgical procedures.

Women's efforts to prevent pregnancy: consistency of oral contraceptive use.

CONTEXT: An understanding of determinants of inconsistent pill-taking could be useful to service providers who are trying to help women prevent unwanted pregnancy. This article explores the predictors of inconsistent use in a nationally representative sample of U.S. women aged 15-44. METHODS: Data on 1,485 pill users participating in the 1995 National Survey of Family Growth are used to describe users' characteristics, and logistic regression analyses are conducted to identify factors that predict inconsistent use (defined as missing two or more pills in a three-month period) among both users of the pill only and dual method users. RESULTS: While 85% of pill users rely solely on the pill, 15% also use another method. Overall, 16% of users are inconsistent in their pill-taking (16% of those using the pill alone and 20% of dual method users). Among users of the pill only, Hispanic and non-Hispanic black women have a significantly increased likelihood of inconsistent use (odds ratios, 2.5 and 2.1, respectively), as do those who recently began use (2.7) and those who have had an unintended pregnancy (1.6). For dual method users, the odds are significantly elevated among women whose income is less than 250% of the federal poverty level (4.3) and among new users (4.5). CONCLUSION: Service providers may need to better address consistency of pill-taking among women who have characteristics associated with inconsistent use.

Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth.

OBJECTIVES: This report shows data on a wide range of topics from the 1995 National Survey of Family Growth (NSFG), including: pregnancy and birth, marriage, divorce, cohabitation, sexual intercourse, contraception, infertility, use of family planning and other medical services, and health conditions and behavior. METHODS: The data in this report are based on in-person interviews with a national sample of 10,847 women 15-44 years of age. The interviews lasted an average of 103 minutes. The response rate was 79 percent. The sample data are adjusted for nonresponse and are national estimates. RESULTS: Following large increases in the 1970's and 1980's, the proportion of teenagers who have ever had sexual intercourse decreased slightly between 1990 and 1995; condom use, both at first intercourse and currently, has increased markedly since the 1970's. These changes may have contributed to the decreases in the teen birth rate observed in the 1990's. For all women 15-44 years of age, the number whose partner was currently using the condom (at the date of interview) increased from 3.6 million in 1982 to 5.1 million in 1988 and 7.9 million in 1995. About 8 percent of women reported that their first intercourse was not voluntary. This result is consistent with an earlier national survey. About 20 percent reported that they had been forced by a man to have intercourse at some time in their lives. About 10 percent of births in 1990-95 were unwanted by the mother compared with 12 percent in 1984-88. The decrease in unwanted births was particularly large for black women. It appears that the prevalence of pelvic inflammatory disease (PID) and vaginal douching have both decreased since 1988.

The epidemiology of morphea (localized scleroderma) in Olmsted County 1960-1993.

OBJECTIVE: To determine the incidence, prevalence, survival rates, clinical manifestations, and longterm outcome of patients with morphea (localized scleroderma) and its subtypes over a 33 year period in Olmsted County, Minnesota. METHODS: We used the unique data resources of the Rochester Epidemiology Project to review all Olmsted County medical records with any potential diagnosis consistent with morphea (including plaque, generalized, bullous, linear, and deep entities) from 1960 through 1993. RESULTS: We screened 1030 medical records and identified 82 (59 female; 23 male) cases of morphea first diagnosed between 1960 and 1993. All cases were followed until death or migration from Olmsted County, a total of 754 person-years of observation. The annual age and sex adjusted incidence rate per 100,000 population was 2.7 (95% confidence interval 2.1, 3.3). The incidence rate increased significantly over the 33 years (p = 0.0037) on an average of 3.6% per year. The prevalence (estimated using cumulative incidence) at 80 years of age was about 2/1000. 50% of the patients had a cutaneous softening or evidence of disease resolution by 3.8 years' duration. The shortest active disease duration was found in the plaque group (50% resolution or skin softening by 2.7 years) compared to 5.5 years in the deep group. Arthralgias, synovitis, uveitis, and joint contractures were more frequent in the linear and deep categories. Although 9 patients (11%) developed some disease related disability over the followup period, this was common (44%) in the deep group. No case of morphea developed severe internal organ involvement and none progressed to systemic sclerosis. The survival rate was not significantly different from the general population (p = 0.409). CONCLUSION: Morphea, and its subtypes, are more common than previously recognized, and can lead to important disability.

Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthritis: a controlled, population-based study.

OBJECTIVE: The goal of this study was to evaluate the physical and psychosocial impact of juvenile rheumatoid arthritis (JRA) among a population-based cohort of adults who had the disease during childhood, compared with a control cohort of subjects with no history of JRA. METHODS: The Rochester Epidemiology Project database was used to identify all cases of JRA (based on the American College of Rheumatology [formerly, the American Rheumatism Association] 1977 criteria) among Rochester, Minnesota residents first diagnosed between January 1, 1960 and December 31, 1993. Controls were age- and sex-matched to the cases as of the date of diagnosis of JRA. A pretested postal survey was mailed to all adult cases (whose date of birth was before December 31, 1975) and matched controls from the same population, to obtain information on socioeconomic issues and functional status (using the Health Assessment Questionnaire and the Health Status Questionnaire). The complete medical records of all cases and controls were reviewed to obtain information on demographics and clinical manifestations of JRA. RESULTS: Of the 50 eligible cases, 44 (88%) responded to the survey. There were 102 age- and sex-matched controls (2-3 per case) who responded to the survey. Seventy-three percent of the cases had pauciarticular-onset JRA, 16% had polyarticular-onset JRA, and 11% had systemic-onset JRA. Average followup was 24.7 years and 24.5 years after the index date for cases and controls, respectively. Greater disability (P = 0.0002), more bodily pain (P = 0.0002), increased fatigue (P = 0.0112), poorer health perception (P = 0.0004), and decreased physical functioning (P = 0.0002) were reported by the cases compared with the controls. JRA cases reported significantly lower rates of employment (P = 0.015) and lower levels of exercise (P = 0.0002) than did controls. Level of educational achievement, annual income, health insurance status, and rate of pregnancy and childbirth were similar for both cases and controls. CONCLUSION: Adults who have had JRA during childhood experience long-term physical and psychosocial impairment.

SLE nephropathy in a patient with HIV infection: case report and review of the literature.

We describe a 39-year-old bisexual man with clinical category B2 human immunodeficiency virus (HIV) infection who subsequently developed systemic lupus erythematosus (SLE). SLE was diagnosed on the basis of a clinical presentation of malar rash, polyarthritis, membranous glomerulonephritis, and characteristic serology. To our knowledge, this is the fourth reported case of a patient with HIV infection to develop SLE and the second adult patient with HIV and coexistent SLE nephropathy.

Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology changing?

OBJECTIVE: To examine trends in the incidence and prevalence of juvenile rheumatoid arthritis (JRA) in Rochester, Minnesota, over 33 years. METHODS: The diagnostic retrieval system of the Rochester Epidemiology Project was utilized to screen medical records of all Rochester residents with any potential diagnoses of JRA from 1978 to 1993 (based on the American College of Rheumatology 1977 revised criteria). In addition, all cases of JRA from our previously identified cohort from 1960-1979 were verified, and the 2 data sets were combined, resulting in an incidence cohort spanning 33 years (1960-1993). RESULTS: Of the 1,240 medical records screened, we identified 65 cases of JRA diagnosed between 1960 and 1993 (48 females, 17 males). The average followup for cases was 12.7 years (range 0-34 years) for a total of 833 person-years of observation. A bimodal distribution of age at diagnosis was observed, with peaks between 0 and 4 years and 9 and 15 years. Seventy-two percent of patients had pauciarticular-onset, 17% had polyarticular-onset, and 11% had systemic-onset disease. Progression of pauciarticular to polyarticular disease occurred in 11% of the cases. The overall age- and sex-adjusted incidence rate was 11.7 per 100,000 population (95% confidence intervals 8.7, 14.8). The incidence rate per 100,000 population was 15.0, 14.1, and 7.8 for the time periods 1960-1969, 1970-1979, and 1980-1993, respectively (P = 0.024). A 3-year, centered, moving average, which was used to display time trends in incidence, suggested a cyclical pattern, with incidence peaks in 1967, 1975, and 1987. CONCLUSION: An overall decrease in the incidence rate over the last decade was observed, most marked in the pauciarticular- and systemic-onset subtypes. This decrease, along with the observed cyclical pattern, suggest that environmental factors may influence disease frequency.

Classification of morphea (localized scleroderma)

OBJECTIVE: To classify and describe morphea (localized scleroderma). DESIGN: A review of morphea and its subtypes is presented. RESULTS: The current classification of morphea is incomplete and confusing. As knowledge of the spectrum of disease continues to evolve, the controversy and confusing nature of its multiple subtypes present a challenge for the physician who encounters a patient with this condition. Thus, we propose that morphea be classified into the following five groups: plaque, generalized, bullous, linear, and deep. This classification, based on clinical morphologic findings, will simplify the diagnostic and therapeutic approach. CONCLUSION: Morphea represents a wide variety of clinical entities that seen to be on the opposite end of the scleroderma spectrum from systemic sclerosis. The cutaneous lesions eventually evolve from a sclerotic stage to a nonindurated stage, and residual hypopigmentation or hyperpigmentation follows. The histologic pattern in patients with morphea is similar to that in patients with progressive systemic sclerosis. Although treatment is nonstandardized, hydroxychloroquine sulfate may be beneficial.

Cytologic features of adenoid basal carcinoma of the uterine cervix. A case report.

The cytologic features of a case of adenoid basal carcinoma of the cervix included large numbers of three-dimensional, somewhat-discohesive groups of intact cells with overlapping nuclei, a moderately high nuclear/cytoplasmic ratio, occasional peripheral palisading, finely granular chromatin, mild hyperchromasia and small nucleoli. The differential diagnosis with other entitities, including reactive endocervical cells and low grade adenocarcinoma of the cervix, is discussed. The acini, rosettes, pseudostratified nuclei with bare, "feathered" nuclei and columnar configurations seen in well-differentiated endocervical adenocarcinoma were absent. The distinction from reactive endocervical cells was difficult; adenoid basal carcinoma showed more numerous groups of cells, a higher nuclear/cytoplasmic ratio, palisading and more three-dimensional groups with a "windswept" appearance as compared to those with reactive atypia.

Solitary colonic metastasis from renal-cell carcinoma 17 years after nephrectomy. Report of a case.

Late recurrence of renal-cell carcinoma can present many years after nephrectomy. To the best of our knowledge, we are reporting the first known case of solitary metastatic renal-cell carcinoma to the colon occurring 17 years after nephrectomy.