A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study.

OBJECTIVE: Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms. STUDY DESIGN: A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991-2017 in a tertiary medical center. Kaplan-Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders. RESULTS: During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16-1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03-1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14-3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies." When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01-1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9-2.8; p = 0.103). CONCLUSION: Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.

Prehospital use of heparin locks: a cost-effective method for intravenous access.

Intravenous (IV) infusions were ordered in nearly 95% of paramedic runs called into a busy base station hospital. Most of the patients received IV lines for either prophylactic access or administration of single or multiple bolus medications. In this group of patients, the application of a heparin lock injection port directly to the IV catheter, followed by the injection of 10 units of heparin, was evaluated. Of 102 consecutive patients treated in the field, 98 (97%) were treated with heparin locks only. The total number of patients requiring an IV infusion drip (either by paramedics or in the emergency department of the receiving hospital) was 20 (20%). If all 102 patients had received conventional IV drip infusions, the total patient equipment charges would have been $4,610.40. The actual charges for all patients in this series, either with heparin locks or IV infusion sets, was $1,846.14--a 60% savings. The results of the study indicate that the heparin lock is a safe, convenient, and cost-effective method for maintaining IV access in the prehospital environment.

Roller skating injuries.

An increasing number of patients who have sustained injuries while roller skating are being seen in emergency departments; more can be expected. One hundred consecutive charts of patients who presented to the emergency department after roller skating accidents were reviewed. Sixty-five percent of patients had sustained a fracture or dislocation. The areas most commonly injured were the wrist, elbow, and ankle. Those who attempt to roller skate should use proper equipment and be familiar with proper techniques for falling.

Spontaneous hemothorax.

A 31-year-old man presented to the emergency department with dyspnea and pleuritic chest pain resulting from a spontaneous hemothorax. A tube thoracostomy was performed on the left side and 700 cc of blood removed. Another 1800 cc of blood oozed from the chest tube. Open thoracotomy was performed in the operating room. There were approximately 1 to 2 liters of blood and clot in the chest cavity. Multiple bleeding points in the apex were ligated and wedge resection was done. Spontaneous hemothorax may represent a form of spontaneous hemopneumothorax or it may be a complication of a variety of situations. Open thoracotomy may be necessary for definitive diagnosis and treatment.