RESUMEN
Computerized data management technology for clinical decision making is a key to optimizing the performance of programs serving the most severely disabled and treatment-resistant patients.
Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Sistemas de Información en Hospital , Hospitales Psiquiátricos , Hospitales Provinciales , Planificación de Atención al Paciente/organización & administración , Análisis Costo-Beneficio , Humanos , Trastornos Mentales/terapia , Evaluación de Necesidades , Terapia Asistida por ComputadorRESUMEN
OBJECTIVE: To determine the incidence of false positive malignant peritoneal cytology and psammoma bodies associated with benign gynecologic disorders. STUDY DESIGN: Pelvic peritoneal fluid was prospectively collected for cytologic examination from 119 women undergoing laparoscopy for benign conditions (infertility, 67; pelvic pain, 35; elective sterilization, 17). The median age was 30. No patient had laparoscopic gross cancer or histologic evidence of cancer. RESULTS: The peritoneal cytology of 2 of 119 cases (2%) contained cells with features suggestive of malignancy, and 6 of 119 cases (5%) contained psammoma bodies. Both cases of false positive peritoneal cytology and four of six with psammoma bodies were associated with endometriosis. All cases were followed for a minimum of two years, and no patient had developed cancer. CONCLUSION: Peritoneal fluid from cases of benign gynecologic disorders, especially endometriosis, can contain psammoma bodies and cells suggestive of malignancy.
Asunto(s)
Líquido Ascítico/patología , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/diagnóstico , Neoplasias de los Genitales Femeninos/patología , Cuerpos de Inclusión/patología , Adulto , Diagnóstico Diferencial , Endometriosis/diagnóstico , Endometriosis/patología , Reacciones Falso Positivas , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The peritoneal washings obtained at diagnostic laparoscopy of two women with suspected endometriosis contained cells with cytologic features of adenocarcinoma. Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic washings confirmed endometriosis with no evidence of cancer. At 1.5-year and 4.0-year follow-up, respectively, cancer had not developed in either patient. The authors report what they were able to find in the literature regarding false-positive assessments of malignancy obtained by cytologic examination. They also outline steps to be taken should a diagnosis of malignancy arise in a woman with endometriosis who desires pregnancy.
Asunto(s)
Endometriosis/diagnóstico , Enfermedades del Ovario/diagnóstico , Lavado Peritoneal , Adenocarcinoma/diagnóstico , Adulto , Diagnóstico Diferencial , Errores Diagnósticos , Endometriosis/cirugía , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Neoplasias de los Genitales Femeninos/diagnóstico , Humanos , Laparoscopía , Persona de Mediana Edad , Enfermedades del Ovario/cirugía , Pelvis , Valor Predictivo de las PruebasRESUMEN
Loss of vision is a common physical impairment in America today. Comprehensive low vision rehabilitation programs can have dramatic results in increasing the independence and productivity of affected persons. Rehabilitation efforts must be tailored to the type of vision loss and to specific functional implications. Every effort should be made to enhance the residual vision. Activities of daily living, orientation and mobility, and psychological concerns must be addressed.
Asunto(s)
Baja Visión/rehabilitación , Actividades Cotidianas/psicología , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Anteojos , Femenino , Humanos , Masculino , Baja Visión/psicologíaAsunto(s)
Células Sanguíneas/trasplante , Trasplante de Células Madre Hematopoyéticas , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades de la Médula Ósea/inducido químicamente , Enfermedades de la Médula Ósea/terapia , Trasplante de Médula Ósea , Granulocitos , Hematopoyesis , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Megacariocitos , Trasplante AutólogoAsunto(s)
Trompas Uterinas/inmunología , Gonorrea/inmunología , Linfocitos/inmunología , Antígenos de Diferenciación/análisis , Separación Celular , Trompas Uterinas/citología , Femenino , Humanos , Inmunoglobulina A Secretora/metabolismo , Inmunoglobulina G/metabolismo , Linfocitos/citología , Neisseria gonorrhoeae , Neisseria meningitidis , Técnicas de Cultivo de Órganos , Receptores de Antígenos de Linfocitos B/metabolismo , Componente Secretorio/metabolismoRESUMEN
In an investigation of the possible role of IgA1 protease in the initial encounter of Neisseria gonorrhoeae with human genital mucosa, the pathogenicity of an isogenic, piliated, wild-type gonococcal clone was compared with that of its IgA1 protease-deficient mutant in organ cultures of human fallopian tubes. The fallopian tube mucosa released IgA into the organ culture medium throughout the course of the infection; the rate of release was substantially higher in gonococcus-infected organ cultures. The wild-type gonococcus but not the IgA1 protease-deficient mutant elaborated IgA1 protease into the medium. The rate and extent of attachment, damage, and invasion of the fallopian tube mucosa by the IgA1 protease-deficient mutant were indistinguishable from those by the parental clone. These data are compatible with the hypothesis that, in the initial encounter with previously uninfected human genital mucosa, the production of IgA1 protease is not critical to the ability of the gonococcus to act as a mucosal pathogen.