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Data were recorded on mental function, urinary continence, ability to dress, falls, mobility, and vision in 340 patients aged 75 and over on admission to a medical department. Three months later, 213 patients had been discharged, 41 were still in hospital, 64 had died, and 22 had been transferred to another hospital or returned to a nursing home. Impairment of any of the functions tested, except vision, was associated with prolonged length of stay. Only two of 135 patients with no disability were still in hospital after three months, while for patients with three or more disabilities the number was 15 out of 56. Increasing age was associated with a tendency to prolonged length of stay. No such tendency was found among those who lived alone.

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PIP: A case of primary ovarian pregnancy involving a Copper 7 (Cu 7) IUD is described, and the pertinent literature is reviewed. A 29-year old white woman, gravida 2, para 2, presented with nausea and fatigue of 1 months' duration and severe bilateral upper abdominal pain with radiation to both shoulders of 1 day's duration. Her menstrual cycles for the previous 4 months had been irregular and her last menstrual period started 35 days prior to admission. She was known to have had a Cu 7 IUD in situ for 26 months. On admission, the patient was in moderate abdominal distress. Direct and rebound tenderness with some voluntary guarding was found in the upper abdomen, with minimal lower abdominal tenderness. Pelvic examination was normal, except for slight tenderness. Pelvic examination was normal, except for slight tenderness in the right adnexal area. No vaginal bleeding was observed. Serum pregnancy test (RIA) was positive. Sonogram of the abdomen showed the IUD in situ, free fluid in the peritoneal cavity, and a mass in the right adnexal area containing fetal parts and a fetal heartbeat. Dilation and curettage after removal of the IUD obtained a minimal amount of tissue. Laparotomy revealed 500-600 ml of blood. The uterus, both fallopian tubes, and the left ovary were normal. A hemorrhagic cystic area at the distal pole of the right ovary was actively bleeding. Wedge resection of the right ovary was performed. The patient recovered well and was discharged from the hospital 4 days after the operation. The hemorrhagic ovarian mass measured 6.0x4.5x3.0 cm. Section demonstrated at 3.0 cm cavity filled with clear fluid. The cavity was lined with a smooth membrane and contained a 1.6 cm embryo. A corpus luteum, 1.5 cm in greatest dimension, was adjacent to the cavity. Microscopic sections showed an edematous stroma and an area of implantation with vascularized chorionic villi adjacent to a corpus luteum. Hemorrhage extended from the area of implantation to the ovarian surface. Sections of the fetus were histologically normal. The diagnosis was ovarian pregnancy. Available data allow an approximation of the proportion of woman years of IUD use that involve the Cu 7 IUD in the US since 1966, which is calculated to be 28%. This calculation agrees with the observed 27% of the cases of ovarian pregnancy with an IUD in situ that involved the Cu 7 IUD reported in the US literature. This comparison suggests that the Cu 7 does not increase or decrease the risk of ovarian pregnancy relative to inert plastic IUDs. Clinicians should be aware of the possibility of ovarian pregnancy in patients who use the IUD.^ieng

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10 adults with bacterial meningitis were given 1.5 g cefuroxime intravenously 4 time daily in addition to the normal antibiotic treatment. CSF levels of cefuroxime ranged from 1.5 to 13.5 mg/l (mean 6.0 mg/l) in the aucte stage of the disease. In the convalescent stage, the cefuroxime levels in the CSF varied from less than 1 to 7.5 mg/l (mean 3.2 mg/l). The CSF levels of cefuroxime in all but one measurement, by far exceeded the MIC values reported for the vast majority of strains of the pathogen commonly associated with meningitis.

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Hepatitis B surface antigen (HBsAg) was detected by solid phase radioimmunoassay (RIA) in mixed saliva of 15 out of 50 antigenemic patients. The salivary antigen was present in low titers for a short period of time in the acute stage of illness. Occult blood was detected in most mixed saliva samples. In parotid saliva neither HBsAg nor occult blood was found. Salivary HBsAg is probably due to admixture of blood or exudate.

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Because the rate of malignancies in young women exposed in utero to diethylstilbesterol (DES) is low, appropriate population screening methods have not been established. A case is presented that is believed to represent the first reported instance of a DES-exposed daughter who developed clear cell adenocarcinoma of the vagina after initially negative examinations. The patient was followed with Papanicolaou smears, pelvic examinations, and colposcopy every 6 months for 2 years prior to the discovery of malignancy. Initially negative, Papanicolaou smears successfully predicted the presence of an early adenocarcinoma. Palpation aided by colposcopy allowed directed biopsy of the small asymptomatic lesion. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Colposcopy is indicated to direct biopsies when an abnormal cytologic smears is reported or when abnormal bleeding or discharge occurs. Biopsy of any palpable lesion is mandatory.

PIP: The value of frequent routine screening of in utero diethylstilbestrol-exposed women has not been established because of lack of documented reports of patients with initially negative examinations who later developed malignancy. LB, a 19-year-old nulligravida with a history of drug exposure in utero, was 1st evaluated for vaginal adenosis at age 15. The patient was followed with Papanicolaou (Pap) smears, pelvic examination, and colposcopy every 6 months for 2 years before malignancy was discovered. After initially negative Pap smears, the patient's smears were classified as Class III 2 years later, and she was referred to the hospital where colposcopy revealed a cervical collar and extensive columnar ectopy covering the entire cervix. A transformation zone, extending onto the upper third of the vagina, showed epithelial and vascular changes characteristic of immature squamous metaplasia. A directed biopsy (aided by palpation) of the area uncovered a clear cell carcinoma. Reactive hyperplasia was present in multiple lymph nodes, and surgery (radical hysterectomy, total vaginectomy, and vaginal reconstruction) was performed. At 24 weeks postoperation, the patient was sexually active and orgasmic, and 1 year postoperation was clinically free of disease, asymptommatic, and enrolled in college, where follow-up continues. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Biopsy of any palpable lesion is mandatory.

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