The impact of hoist sling fabrics on interface pressure whilst sitting in healthy volunteers and wheelchair users: A comparative study.

AIM OF THE STUDY: To evaluate the effect of three sling fabrics on gluteal interface pressure whilst sitting in a population of wheelchair users and to compare these to data previously collected in a pilot study with a healthy population. MATERIALS AND METHODS: A repeated measures experimental design was used with 32 adult wheelchair users (15 women, 17 men). Healthy population pilot study consisted of 61 participants (51 women, 10 men) recruited from staff and students at The University of Salford. METHODS: Gluteal pressures at six pressure zones were recorded using the X-sensor PX100 pressure sensor at 30 s intervals for 10 min. Data were collected in 4 conditions with participants seated in a standardised chair, followed by the chair with slings made of three different fabrics. RESULTS: The spacer fabric reduced the mean gluteal pressure more effectively than slipfit and polyester (p = 0.014 and p = 0.01 respectively, 95%CI) and reduced peak pressure at the left ischial tuberosity and coccyx when compared to the slipfit (p = 0.003 and p = 0.005) with the wheelchair users. When comparing data with the pilot study, the mean gluteal pressure and peak pressures at the ischial tuberosities and coccyx were significantly higher in the wheelchair user group (p < 0.005). CONCLUSION: The fabric identified as the most effective in reducing mean and peak pressures in both groups was the spacer fabric, suggesting that a spacer fabric sling is more likely to reduce the risk of pressure ulcer development. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Survey of monitor specification and viewing conditions in breast screening units in the North West of England.

INTRODUCTION: Monitor specification and viewing conditions are important factors affecting image assessment in mammography. This survey evaluates the different viewing conditions and monitor specifications that exist in acquisition and reporting rooms in UK breast screening units. METHODS: Static (n = 10) and mobile (n = 2) breast screening units were evaluated in North West England. Room illumination levels were measured in 3 locations for each room using a calibrated Lux meter and the specification of 122 monitors recorded. Room layout, wall colour, location and number of doors, windows and light sources were recorded. RESULTS: In reporting rooms, 90/91 of monitors had similar technical specifications and were compliant to guidelines. The ambient light levels ranged from 10 to 25.8 lux. The mean illuminance was 12.32 ± 4.6 lux. In acquisition rooms, great variances appeared in monitor specification and ambient light levels. The majority of monitors (24/34) had 3 megapixel (MB) optimum resolution but the ambient light level ranged from 10 to 1020 lux. The mean illuminance was 105.3 ± 178.8 lux. The mobile units were consistent with each other and compliant with guidelines. CONCLUSION: A lack of consistency and great variances appeared in terms of ambient light levels and monitor specifications in the image acquisition rooms. However, there was excellent consistency among the illumination measurements and the monitors' technical specifications in the reporting rooms. IMPLICATIONS FOR PRACTICE: This research demonstrates, for the first time, the need for further research and specialised guidelines for acquisition rooms.

A systematic review of viewing conditions and monitor specifications in mammography.

OBJECTIVES: The purpose of this systematic review was to establish the current status of recommended monitor specifications and viewing conditions in mammography for image acquisition and reporting rooms. A literature search was completed between August 2018 and March 2019 using ScienceDirect, PubMed, Web of Science and MEDLINE databases. An additional manual search was performed to identify relevant guidelines to support the review. Only articles and guidelines written in English were included. KEY FINDINGS: Results were selected according to the following criteria; articles detailing (i) monitor specification and, (ii) viewing conditions in mammography acquisition and reporting rooms. Twenty-one studies met the inclusion criteria. Six papers described monitor specifications, five described viewing conditions and ten guideline documents were identified from the UK, Europe and the US. Common outcomes were that monitors with 3 or 5 MP resolution seemed to be preferred and at the same time higher illumination levels (>15 lux) were found to decrease the luminance of the monitors and negatively impact the assessment of image quality. Contrary to this, the majority of guideline documents recommended illumination levels above 20 Lux. Finally, there is a lack of guidance for viewing conditions in acquisition rooms. CONCLUSION: This review did not reveal any strong evidence for the proposed room illumination levels in acquisition rooms. In reference to monitors specifications, there is preference for using higher resolution displays (3 and 5 MP) but again, the evidence is not strong. Moreover, variance exists in the guidelines and that promotes inconsistency in mammography departments. IMPLICATIONS FOR PRACTICE: This review highlights the lack of standardised guidelines and the need for further research on the viewing conditions and monitor specifications for the acquisition rooms in mammography.

Explantation and subculture of epithelial cells from human uterine ectocervix.

Human ectocervical explant cultures were grown in medium with D-valine substituted for L-valine. Pure epithelial cell monolayers were obtained with both dialyzed and undialyzed fetal calf serum. Epithelial cell explant colonies grown in D-valine medium supplemented with undialyzed serum could routinely be subcultured if plated at a density of 1.5 x 10(4) cells/sq cm or higher. Such cultures could be passaged at least three times and could yield up to 21 population doublings per culture lifetime. Contaminating fibroblastic colonies were never detected in these cultures, which were free of surface-associated fibronectin as revealed by immunofluorescent tests. Both primary and passaged epithelial colonies retained many characteristic morphological features of ectocervical epithelium when examined by light and electron microscopy. Such cultures may be of use in investigating the action of viral and chemical carcinogenic agents upon epithelial cells in vitro.

Adverse effects of intraperitoneal fluorouracil in patients with optimal residual ovarian cancer after second-look laparotomy: a Gynecologic Oncology Group Study.

Twenty-seven patients with ovarian cancer who had failed combination chemotherapy were offered intraperitoneal (IP) fluorouracil (5-FU) as salvage therapy in an attempt to ascertain the efficacy of such a therapeutic method. All patients had minimal residual epithelial cancer. The median number of treatment cycles was six. Major problems with dialysate inflow and egress occurred in ten patients and required discontinuation of therapy. An additional ten patients experienced hematologic toxicity with a median nadir WBC of 2,300/microL. Therapy was altered but not discontinued because of this complication. Other adverse sequelae, such as abdominal pain, were manageable with medication. IP 5-FU is technically feasible on a multiinstitutional basis in residual ovarian cancer, but its therapeutic role remains to be defined.

Depression in a sample of 9-year-old children, Prevalence and associated characteristics.

We investigated the prevalence of depression in a sample of 9-year-old children from the general population being studied longitudinally. Current point prevalences of major and minor depressive disorder were estimated at 1.8% and 2.5%, respectively. A comparison of children with depression and a nondepressed group disclosed no significant differences by sex, nor any significant association between depression and socioeconomic status, teacher reports of behavior problems, and cognitive or motor development. The children with current depression were reported by a parent to have had a history of more behavioral problems, had been referred more often for assessment or treatment of behavioral or emotional problems, and had more negative self-perceptions of their academic ability. The results suggested that parents may be more sensitive than teachers to the behavior problems exhibited by depressed children.

Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers.

Although epidemiological studies suggest that cigarette smoking is a risk factor for cervical cancer, further evidence is required to document the biological plausibility of this relationship. This study obtained cervical mucus, using a cervical flush technique, from 50 patients in a neoplasia clinic. Nicotine was detected in the cervical mucus of all 25 smokers and cotinine in the mucus of 84% of the smokers; nicotine and cotinine levels were correlated (P < or = 0.10) with both the number of cigarettes usually smoked and the number smoked in the last 24 h. Nicotine and cotinine levels for passive smokers and nonexposed women were much lower than for women who currently smoked, with little difference found between the nonsmoking women who did and did not report passive smoke exposure. In the one woman who reported smokeless tobacco use, both nicotine and cotinine were detected at much higher levels than for other nonsmoking women. These results indicate that tobacco constituents do indeed reach the uterine cervix, suggesting that they could play a causal role in the development of cervical cancer.

Intraperitoneal radioactive phosphate in early ovarian carcinoma: an analysis of complications.

Intraperitoneal radioactive chromic phosphate was administered to 69 patients with Stage I and II ovarian carcinoma who had undergone comprehensive surgical staging. Intestinal obstruction requiring surgical intervention occurred in four patients and was the most severe complication. Abdominal pain was the most common post-therapy complaint. Attention to time and technique of drug administration could minimize complications.

1000 cGy single dose palliation for advanced carcinoma of the cervix or endometrium.

Between January 1980 and the present, 42 patients with symptomatic, incurable gynecologic malignancies were treated at the University of North Carolina with 1000 cGy in a single fraction to the pelvis, repeated once or twice at monthly intervals as necessary. Of patients with adequate follow-up, total cessation of bleeding was seen in 18 of 30 (60%), complete pain relief in 2/9 (22%), and complete tumor eradication in 7/28 (25%). These palliative benefits were permanent in approximately half of the patients. Five serious treatment complications have been documented, four occurred more than 10 months after treatment. We conclude that 1000 cGy single-fraction whole pelvis treatment can be an effective means of palliating advanced gynecologic cancer provided the patient has a life expectancy of less than 1 year. Patients with a longer life expectancy are at risk for both recurrence of symptoms and for treatment related complications.

Carcinoma of the cervix stage IB: results of treatment with radiation therapy.

An analysis has been made of 101 patients treated with radiation therapy for epidermoid carcinoma of the cervix Stage IB (FIGO) from January 1970 through December 1976. The patients were treated with a combination of intracavitary therapy and external beam therapy delivering a total combined dose of 8000 rad to the paracervical areas (Points AR and AL) and 5500 rad to the pelvic lymph nodes (Points IR and IL). The cumulative, disease-free survival at 2, 3 and 5 years was 89%, 87% and 84%. Sixteen failures were recorded in this group of patients, of which 3 were a result of loco-regional disease, 5 loco-regional disease plus distant metastasis and 8 distant metastasis only. The failure rate was greater among the patients who had lesions 4 or more cm in diameter and in patients who received doses of external beam therapy to the whole pelvis of 4000 rad or more. Eighteen patients developed complications; however, one patient had a recto-vaginal and a vesico-vaginal fistula; thus 19 complications were recorded. The complications were divided according to their severity into three groups: Grade I (mild), Grade II (moderate) and Grade III (severe). There were 10 Grade I, 4 Grade II and 5 Grade III complications.

Oral contraceptive use and cervical intraepithelial neoplasia.

To explore the somewhat controversial relationship between oral contraceptives and pre-invasive cervical cancer, 103 cases of biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or CIN III were compared with 258 controls who had normal cervical cytology. Cases were slightly less likely than controls to have ever used oral contraceptives; the odds ratio, controlling for age, socioeconomic status, barrier method use, smoking history, age at first sexual intercourse, number of sex partners, current marital status, and number of Pap smears, was 0.7 (95% CI 0.3-1.6). Recency, latency, duration, and age at first oral contraceptive use were evaluated and in no instance was oral contraceptive use positively associated with CIN. This study adds to the body of knowledge that oral contraceptives are not associated with pre-invasive cervical cancer. Further, if oral contraceptive users continue to be regularly screened, their risk of developing the more invasive lesions should be very low.

PIP: Between September 1987 and November 1988, 103 University of North Carolina Hospitals (UNCH) Dysplasia Clinic patients with newly diagnosed, biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or CIN III were enrolled as cases. They were 18-45 years old, black or white, nonpregnant North Carolina residents. 40 cases were CIN II and 63 cases were CIN III confirmed histologically. The controls were 258 UNCH Family Practice Center patients with normal cervical cytology. All subjects participated in a 15-minute structured interview. The Hollingshead Index was used as a proxy for socioeconomic status (SES). Known risk factors for cervical neoplasia were found to be risk factors for CIN II and CIN III. Compared with controls, cases were younger (odds ratio [OR] = 3.4 for those under 25 years of age), less educated (OR - 13.3 for 13 years), and of lower SES. Cases were more likely to have been divorced (OR - 2.7), to be cigarette smokers (OR = 3.4), to have ever been pregnant (OR - 2.6), to have had more than 2 sex partners (OR = 5.0), to have reported having had a sexually transmitted disease (gonorrhea, chlamydia, herpes, venereal warts, or pelvic inflammatory disease) (OR = 2.9), and to have had at least 3 Pap smears in the 5 years prior to study recruitment (OR = 1.7). Cases were less likely to have used a barrier method of contraception (OR = 0.3). 80.6% of cases and 81.0% of controls had ever used oral contraceptives (OCs); thus, the crude OR was 1.0. Adjustment of the OR for all confounders (age, SES, ever-use of barrier methods, smoking history, age at 1st sexual intercourse, lifetime number of male sex partners, current marital status, and number of Pap smears) reduced the OR to 0.7 (95% confidence interval 0.3-1.6). Recency, latency, duration, and age at 1st OC use were compared without finding any positive association between OC use and CIN.

Intestinal anastomoses after radiation therapy by surgical stapling instruments.

The use of automated stapling instruments in 17 patients requiring intestinal surgery following irradiation therapy for gynecologic malignancies has been reviewed. Fifteen of these patients also had other medical problems thought to inhibit optimal anastomotic healing: malnutrition, persistent intraabdominal cancer, uremia, hypoalbuminemia, and recent antineoplastic chemotherapy. Although these conditions severely test a method of intestinal anastomosis, no patient had a complication involving the intestinal anastomosis. The use of these stapling instruments reduced both the operating time and the contamination of the peritoneal surfaces by bowel content, thereby improving the postoperative recovery of these patients. The favorable results and the secure anastomoses justify the continued use of stapling instruments in gynecologic oncology patients with prior irradiation therapy.

Morbidity of lymph node sampling in cancers of the uterine corpus and cervix.

To assess the morbidity of lymph node sampling, medical records were reviewed for all patients with cancers of the uterine corpus and cervix who underwent primary surgical therapy between January 1, 1980 and December 31, 1986. Five hundred fifty-four patients were identified. Of the 292 patients with corpus cancer undergoing total abdominal hysterectomy, lymph node sampling was performed in 65.4%. Operative blood loss, transfusion requirements, and length of hospital stay were not increased significantly (P greater than .05) in women having node sampling. Of the 262 patients with cervical cancer, 72 underwent abdominal hysterectomy, 111 underwent radical hysterectomy, and 79 underwent staging laparotomy, with lymph node sampling performed in 82, 100, and 92% of these groups, respectively. The incidence of perioperative complications in this group was similar to that in the corpus cancer group. Vascular injuries, hematomas, and lymphocysts were more frequent after lymph node sampling. One postoperative death was attributed to complications from node sampling, but there were no other long-term sequelae. The low overall risk associated with lymph node sampling supports its inclusion in the surgical evaluation of gynecologic malignancies.

Cryosurgical treatment of early cervical intraepithelial neoplasia.

Two hundred forty patients, ages 12 to 54 years, with biopsy-confirmed early cervical intraepithelial neoplasia (CIN I) treated by cryosurgery were reviewed. CIN I has been viewed historically as having high rates of remission or stabilization. The initial cure rate was 89%, with a 97% cure rate after retreatment of failures. All failures were confirmed histologically. The initial cure rates are no better than those for higher grades of CIN. Thus, CIN I should be viewed with the same seriousness as CIN II or CIN III.

Cryosurgery for the treatment of cervical intraepithelial neoplasia during the reproductive years.

Cervical intraepithelial neoplasia (CIN) is so rampant that simpler, effective, and less costly methods of therapy are being evaluated to replace the aggressive surgical therapeutic measures of the past. Cryosurgery is one alternative method. A review is presented of 152 patients in the childbearing age group with biopsy confirmation of CIN II (moderate dysplasia) and CIN III (severe dysplasia and carcinoma in situ). The persistence of CIN 3 months after therapy was deemed a treatment failure. Initial failure rates (24.2% for CIN II and 31.6% for CIN III) were high by this stringent definition. However, follow-up smears, further treatment, and a review of the literature definition of "treatment failure" lowered the failure rate to acceptable levels such that cryosurgery should be utilized in the therapy of cervical intraepithelial neoplasia.

DNA content in cervical neoplasia and its relationship to prognosis.

Aneuploidy is commonly associated with malignancy and certain premalignant conditions. Recent studies have demonstrated an association between prognosis and the presence of aneuploidy. In this study, flow cytometry was used to determine the deoxyribonucleic acid (DNA) content of tissues with cervical intraepithelial neoplasia or invasive cervical carcinoma. Of 41 evaluable patients with cervical intraepithelial neoplasia, aneuploidy was demonstrated in the specimens of three of ten patients with cervical intraepithelial neoplasia II and six of 13 with cervical intraepithelial neoplasia III. No specimens with cervical intraepithelial neoplasia I, with condylomata, or without pathologic diagnosis contained aneuploid populations. Of the 22 evaluable specimens with invasive cervical carcinoma, 13 contained aneuploid populations. In stage I cervical lesions, aneuploidy appeared to be a poor prognostic factor with an overall survival of two of five patients with aneuploid tumors versus five of five patients with diploid tumors.

Noninvasive papillary serous carcinoma of the endometrium.

OBJECTIVE: To determine the clinical course of noninvasive uterine papillary serous carcinoma and whether it indicates advanced metastatic disease. METHODS: We reviewed the charts of women with noninvasive uterine papillary serous carcinoma who were treated at our institution and abstracted surgical stage, sites of metastases, disease progression, and length of follow-up. RESULTS: There were 595 cases of endometrial adenocarcinoma between January 1990 and February 2000, 69 of which had papillary serous histology. Sixteen were noninvasive tumors. Six were confirmed stage IA by complete surgical staging and ten were associated with metastasis at staging. Two of the six women with stage IA tumors had disease recurrence. CONCLUSIONS: Noninvasive papillary serous carcinoma is often widely metastatic. In our experience, approximately two thirds of patients had metastasis, indicating the need for complete surgical staging. Even in those with disease limited to the endometrium, a significant percentage will have disease recurrence.

Use of the APACHE II scoring system to determine mortality of gynecologic oncology patients in the intensive care unit.

OBJECTIVE: To determine if an elevated score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is associated with mortality of acutely ill gynecologic oncology patients. METHODS: Gynecologic oncology patients admitted to the surgical intensive care unit (ICU) were identified from the ICU data base. Their admission APACHE II score and type of gynecologic cancer were also extracted from the data base. Charts were reviewed to determine the disease status and reason for admission to the surgical ICU. Patient mortality was correlated with APACHE II scores. RESULTS: Forty-five gynecologic oncology patients were admitted to the surgical ICU from June 1988 to January 1992. They had a mean age of 62 years and various cancers: ovarian (24), cervical (16), and endometrial (five). The mean APACHE II score was 12 (range 2-26). Eight of 45 (18%) patients died. There was a significant correlation between APACHE II scores and mortality; patients with an APACHE II score of 20 or greater had a 78% risk of death compared to a 3% risk if the score was less than 20 (P < .001, chi 2 test). CONCLUSION: Elevated APACHE II scores are associated with mortality in acutely ill gynecologic oncology patients.

Steroid receptors in endolymphatic stromal myosis.

Endolymphatic stromal myosis is a neoplasm derived from the endometrial stromal cell. As such it should respond to hormonal manipulation. Reported are positive estrogen and progesterone cytosol receptors in three cases of endolymphatic stromal myosis with disease regression following progestational therapy. Estrogen and progesterone receptor studies are recommended in all cases of endolymphatic stromal myosis. When positive, progestational therapy is appropriate.

Adenoid cystic carcinoma of the Cervix. Report of 9 cases and a reappraisal.

The clinical and pathologic findings of 9 patients with adenoid cystic carcinoma of the cervix are presented. A review of the literature identified an additional 29 cases. The tumor was usually associated with adenocarcinoma or squamous cell carcinoma of the cervix. Adenoid cystic carcinoma of the cervix appears to be an aggressive type of tumor; of the 38 cases reported in the literature lung metastases have occurred in 18 (47.4%), and of these, 14 patients are known to have died of the cancer.