RESUMEN
PURPOSE: After chemotherapy for breast cancer, most women will recover some ovarian function, but the timing and extent of this recovery are poorly understood. We studied post-chemotherapy ovarian recovery in women with and without a history of ovarian suppression during chemotherapy. METHODS: Reproductive age breast cancer patients who were seen prior to chemotherapy for fertility preservation consult were consented for follow-up ovarian function assessment (every 3-6 months after chemotherapy) with antral follicle count (AFC) in this prospective cohort study. We restricted our analysis to those with menses present after chemotherapy. Box plots were used to demonstrate the change in follow-up AFC versus time elapsed after chemotherapy. A mixed effects regression model was used to assess differences in AFC. RESULTS: Eighty-eight patients with a history of newly diagnosed breast cancer were included. Forty-five patients (51%) had ovarian suppression with GnRH agonist (GnRHa) during chemotherapy. AFC recovery appeared to plateau at 1 year after completing chemotherapy at a median of 40% of pre-chemotherapy AFC. After adjustment for age, initial AFC, cyclophosphamide exposure, combined hormonal contraceptive (CHC) use, and tamoxifen use, AFC recovered faster and to a greater degree for those women who underwent GnRHa therapy for ovarian protection during chemotherapy (P = 0.032). CONCLUSIONS: Women with menses after chemotherapy for breast cancer appear to recover their full potential AFC 1 year after their last chemotherapy dose. Treatment with GnRHa during chemotherapy is associated with a higher degree of AFC recovery. The findings of this study can aid in counseling patients prior to chemotherapy about expectations for ovarian recovery and planning post-treatment fertility preservation care to maximize reproductive potential when pre-treatment fertility preservation care is not possible or has limited oocyte yield.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Líquido Folicular/fisiología , Hormona Liberadora de Gonadotropina/administración & dosificación , Folículo Ovárico/crecimiento & desarrollo , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/fisiopatología , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Femenino , Preservación de la Fertilidad/métodos , Líquido Folicular/efectos de los fármacos , Líquido Folicular/metabolismo , Hormona Liberadora de Gonadotropina/metabolismo , Humanos , Oocitos/efectos de los fármacos , Oocitos/crecimiento & desarrollo , Oocitos/metabolismo , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/metabolismo , Folículo Ovárico/fisiopatología , Tamoxifeno/administración & dosificación , Tamoxifeno/efectos adversosRESUMEN
School-based health centers (SBHCs) provide access to health services by bringing providers to children (and sometimes parents) and furnishing low cost services in an atmosphere of trust. While the number of SBHCs has continued to grow and some clinics have continued to expand their services, others have barely survived and some have even closed. This study investigated factors, particularly political forces, that affected the success of SBHCs. Using a national survey of clinic directors, this study assessed clinic success in terms both of longevity and service delivery. Findings indicate the factors most consistently and significantly associated with success include not only measures of "need" (school size and percent African-American enrollment or population) but of "politics" (citizen political ideology and Southern conservatism). Thus, politics matters more than previous studies suggested.
Asunto(s)
Servicios de Salud Escolar , Etnicidad , Educación en Salud , Política , Atención Primaria de Salud , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración , Factores SocioeconómicosRESUMEN
OBJECTIVE: To treat binocular diplopia secondary to macular pathology. METHODS: Seven patients underwent evaluation and treatment. All had constant vertical diplopia caused by various maculopathies, including subretinal neovascularization, epiretinal membrane, and central serous retinopathy. Visual acuity ranged from 20/20 to 20/30 in the affected eye. All except 1 patient had a small-angle, comitant hyperdeviation with no muscle paresis. Sensory evaluation demonstrated peripheral fusion and reduced stereoacuity. Neither prism correction nor manipulation of the refractive errors corrected the diplopia. A partially occlusive foil (Bangerter) of density ranging from 0.4 to 1.0 was placed in front of the affected eye to restore stable, single vision. RESULTS: The Bangerter foil eliminated the diplopia in all patients. Two patients elected not to wear the foil; 1 patient was afraid of becoming dependent, and the other was bothered by the visual blur. Visual acuity in the affected eye was reduced on average by 3 lines. All patients maintained the same level of sensory fusion, with only 2 having reduced stereoacuity. Symptoms returned when the foil was removed or its density was reduced. CONCLUSION: Low-density Bangerter foils provide an effective, inexpensive, and aesthetically acceptable management for refractory binocular diplopia induced by macular pathology, allowing peripheral fusion to be maintained.
Asunto(s)
Diplopía/terapia , Mácula Lútea , Enfermedades de la Retina/complicaciones , Privación Sensorial , Visión Binocular , Adulto , Anciano , Anciano de 80 o más Años , Diplopía/etiología , Anteojos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Agudeza VisualRESUMEN
Cuba's accomplishments in primary care, while controversial, include several developments pertinent to family medicine. These accomplishments involve low-technology and organizational innovations such as neighborhood-based family medicine as the focus of primary care; regionalized systems of hospital services and professional training; innovative public health initiatives and epidemiologic surveillance; universal access to services without substantial barriers related to race, social class, gender, and age; and active programs in treatments such as "green medicine" and "thermalism." High-technology achievements include innovations in pharmacology and biotechnology, surgical procedures, and care of patients infected by the human immunodeficiency virus (HIV). Limited access to Cuban publications, impediments to presentations by Cuban health care professionals at professional meetings, and the prohibition on importing products of Cuban biotechnology to the United States inhibit a detached, scientific appraisal of Cuba's accomplishments. Cuba's isolation from the US clinical and research communities has prevented interchanges that would improve primary care services in both countries.
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Medicina Familiar y Comunitaria , Atención Primaria de Salud , Tecnología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/terapia , Cuba , Medicina Familiar y Comunitaria/organización & administración , Femenino , Administración de los Servicios de Salud , Humanos , Masculino , Medicina Tradicional , Política Pública , Factores Socioeconómicos , Estados UnidosRESUMEN
PURPOSE: To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy. METHODS: A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond pulse photodisruptive laser was used in eight eyes (seven patients) with proliferative diabetic retinopathy as part of a Food and Drug Administration-approved phase 1 protocol. There were three indications for treatment: type I: distortion and shallow elevation of the macular caused by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Traction release was accomplished by laser segmentation of the detached hyaloid interfaces and fibrotic, contracted proliferative tissue. The Nd:YLF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 consecutive seconds) that allows tissue cutting near the retinal surface. RESULTS: Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea with improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic improvement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treatments (two eyes) caused vitreous hemorrhage that resulted in a transient drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage. CONCLUSION: In a small pilot study, the Nd:YLF laser segmented proliferative tissue near the retinal surface and elevated hyaloid interfaces. In selected cases, this may enable flattening of traction retinal detachment or release of retinal distortion.
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Retinopatía Diabética/complicaciones , Terapia por Láser , Desprendimiento de Retina/cirugía , Adulto , Anciano , Retinopatía Diabética/fisiopatología , Femenino , Fibrosis/etiología , Fibrosis/cirugía , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Complicaciones Posoperatorias , Retina/patología , Retina/cirugía , Desprendimiento de Retina/etiología , Desprendimiento de Retina/fisiopatología , Neovascularización Retiniana/etiología , Neovascularización Retiniana/cirugía , Agudeza VisualAsunto(s)
Isquemia/cirugía , Terapia por Láser , Oclusión de la Vena Retiniana/cirugía , Vena Retiniana/cirugía , Segmento Anterior del Ojo/irrigación sanguínea , Glaucoma Neovascular/etiología , Glaucoma Neovascular/prevención & control , Humanos , Isquemia/complicaciones , Neovascularización Patológica/etiología , Neovascularización Patológica/prevención & control , Oclusión de la Vena Retiniana/complicacionesRESUMEN
This study examined both the content of school district programs related to sexual orientation, and the social and political determinants of these school programs. Data were collected from districts within all 126 U.S. communities with legal protection against discrimination on the basis of sexual orientation, and from a random sample of 129 U.S. jurisdictions without such legislation. Results showed that most school districts are not offering recommended program elements related to sexual orientation issues. Districts within localities with gay rights protection are doing more than those without. Although compositional factors account for some of the differences in educational efforts, a politically engaged constituency also made a major difference in school district efforts. To the extent that gays and lesbians served in local public office and mobilized to influence school elections, they were able to affect school programs and policies.
Asunto(s)
Educación en Salud/organización & administración , Homosexualidad , Política , Servicios de Salud Escolar/organización & administración , Derechos Civiles/legislación & jurisprudencia , Curriculum , Femenino , Humanos , Masculino , Prejuicio , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Optic disc swelling is a rare sequela of blunt ocular trauma. METHODS: The authors examined three young patients who had an unusual post-traumatic optic neuropathy in which protracted swelling of the optic nerve head was the salient clinical feature. RESULTS: Associated choroidal ruptures in two patients suggested a contrecoup mechanism of injury to the optic nerve at its junction with the globe. All patients had partial recovery of vision over months, concurrent with resolution of the nerve head swelling and development of optic disc pallor. CONCLUSION: Despite its protracted course, posttraumatic optic disc swelling appears to be associated with a favorable prognosis for visual recovery.
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Lesiones Oculares/complicaciones , Disco Óptico/lesiones , Papiledema/etiología , Heridas no Penetrantes/complicaciones , Adolescente , Adulto , Niño , Coroides/lesiones , Coroides/patología , Lesiones Oculares/diagnóstico , Lesiones Oculares/fisiopatología , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Imagen por Resonancia Magnética , Masculino , Disco Óptico/patología , Disco Óptico/fisiopatología , Nervio Óptico/patología , Nervio Óptico/fisiopatología , Traumatismos del Nervio Óptico , Papiledema/patología , Papiledema/fisiopatología , Rotura , Tomografía Computarizada por Rayos X , Agudeza Visual , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatologíaRESUMEN
The computer-based tutorial, "The Cerebral Ventricles," enables the user to review the anatomy, imaging, and common pathologic conditions of the human cerebral ventricular system. The program runs on a workstation that includes a laser videodisk player and a videodisk with 21,000 still images plus motion sequences. By using a mouse to select specific portions of the anatomic diagram depicting the ventricles, the user can review different planes of normal gross anatomy, corresponding computed tomographic and magnetic resonance images of normal anatomy, images of gross specimens of different pathologic entities, and corresponding radiologic images. The motion sequences portion of the program shows reconstructed three-dimensional images of ventricular anatomy and helps the user gain a greater understanding of the complex anatomy as seen from all angles. Subprograms provide more detailed information about anatomic relationships, disease entities, and bibliographic references. "The Cerebral Ventricles" assists radiologists in gaining a greater understanding of the ventricles so that an appropriate differential diagnosis of an intraventricular lesion can be offered when such masses are encountered in clinical practice.
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Ventrículos Cerebrales , Instrucción por Computador , Radiología/educación , Grabación de Videodisco , Ventrículos Cerebrales/anatomía & histología , Ventrículos Cerebrales/patología , Diagnóstico por Imagen , HumanosRESUMEN
The authors present an overview of Cuba's response to HIV/AIDS including: (a) the development of comprehensive health care in Cuba; (b) the epidemiology of AIDS in Cuba; (c) the sanatoria approach to treatment and recent changes; (d) the idea of comprehensive HIV/AIDS care as a basic human right; (e) the effects of the special period on the HIV/AIDS program and containment of the epidemic; and (f) a critique of Cuba's HIV/AIDS program.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Atención Integral de Salud , Infecciones por VIH/terapia , Instituciones de Salud , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Cuba/epidemiología , Femenino , Infecciones por VIH/transmisión , Educación en Salud/métodos , Humanos , Lactante , Recién Nacido , Masculino , Educación SexualRESUMEN
Systemic hemorheologic abnormalities may play a part in the pathogenesis of central retinal vein occlusions. A statistically significant elevation of plasma viscosity was found in patients with acute central retinal vein occlusion compared with control patients. Local retinal blood flow parameters including arteriovenous passage time and mean arterial dye bolus velocity were significantly altered in the central retinal vein occlusion patients compared with age-matched controls at baseline examination. We performed a randomized, prospective, single-blind clinical investigation to determine the effect of hemorheological manipulation on the clinical course and retinal blood flow of eyes with central vein occlusion. Hemodilution included plasma expansion with hydroxyethyl-starch, withdrawal of whole blood if the hematocrit was above 42%, and rheologic manipulation with parenteral pentoxifylline. We found a statistically significant improvement in visual acuity at 1 year post-treatment for the treated group compared with the control group (increase of visual acuity of 1.5 lines vs decrease of 1.5 lines). The retinal blood flow parameters were markedly improved soon after the institution of therapy, and this may have contributed to the improvement in visual acuity in the treated group. There was no statistically significant difference between the two groups in the progression to ischemic central vein occlusion.
Asunto(s)
Hemodilución , Oclusión de la Vena Retiniana/terapia , Anciano , Femenino , Estudios de Seguimiento , Hemodilución/métodos , Hemodinámica , Humanos , Coagulación con Láser , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Oclusión de la Vena Retiniana/fisiopatología , Vasos Retinianos/fisiología , Reología , Método Simple Ciego , Agudeza VisualAsunto(s)
Coroides/irrigación sanguínea , Angiografía con Fluoresceína , Verde de Indocianina , Neovascularización Patológica/diagnóstico , Disco Óptico , Anciano , Anciano de 80 o más Años , Membrana Celular/patología , Fondo de Ojo , Humanos , Masculino , Neovascularización Patológica/etiología , Grabación en VideoAsunto(s)
Labio Leporino/patología , Displasia Ectodérmica/patología , Deformidades Congénitas del Pie/patología , Desprendimiento de Retina/congénito , Fondo de Ojo , Deformidades Congénitas de la Mano/patología , Humanos , Lactante , Enfermedades Renales/congénito , Desprendimiento de Retina/patología , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica , Síndrome , Agudeza VisualRESUMEN
We report on retinal detachments in six eyes of four patients with incontinentia pigmenti. These nonrhegmatogenous traction retinal detachments are characterized by extensive preretinal and vitreous fibrous organization that pull the retina anteriorly behind the lens. The clinical course and fundus appearance of the retinal detachments, beginning with the avascular peripheral retina and leading to traction retinal detachment, are similar to those of cicatricial retinopathy of prematurity. Vitreous surgery was performed on three eyes (two patients), with partial reattachment of a total retinal detachment in one eye and complete reattachment of a partial retinal detachment in a second eye. These cases represent the first successful surgical interventions reported for retinal detachment in incontinentia pigmenti.
Asunto(s)
Incontinencia Pigmentaria/cirugía , Desprendimiento de Retina/cirugía , Niño , Femenino , Fondo de Ojo , Humanos , Incontinencia Pigmentaria/complicaciones , Lactante , Desprendimiento de Retina/etiología , VitrectomíaRESUMEN
We prospectively evaluated a modified version of a previously reported technique of retrobulbar anesthesia for vitreoretinal surgery involving the use of a blunt 19-gauge cannula to directly infuse anesthetic into the retrobulbar space. Using this method, 60 consecutive patients undergoing scleral buckling surgery had effective anesthesia and akinesia, with no complications.