Laparoscopic excision of ovarian neoplasms subsequently found to be malignant

Article Abstract:

Ovarian cysts are abnormal growths commonly found in the ovaries of women. Most are benign, but some are found to be malignant (cancerous). In recent years, many physicians have used laparoscopic excision to remove the cysts. This procedure involves insertion of an optical instrument known as a laparoscope into the abdominal area to visualize the location of the cysts and to remove them. It is a much less invasive procedure than is surgery (laparotomy). There are concerns that this procedure might be overused and not carefully performed, allowing malignant cases to not be treated as early or as safely as possible. In addition, laparoscopic excision may disrupt the malignant tumor, allowing cancerous cells to escape, and the method often cannot remove the cancerous tissue completely. This study examined the use of laparoscopic excision to treat ovarian cysts. Questionnaires were sent to physicians specializing in this area. A total of 152 questionnaires were returned, for a response rate of 42 percent. Ovarian cysts that were being treated with laparoscopic means turned out to be malignant in 42 cases. When malignancy was discovered, attempts to excise the cysts were stopped in 16 cases. In the other cases, the cysts were partially excised in 14 cases and completely removed in 12 cases. Of four tissue characteristics considered to be indicative of a benign (noncancerous) state, more than half of the malignant cysts had three or all four of them. Laparotomy, surgical exploration and removal of the malignant cysts, was performed immediately in seven cases (17 percent) and within an average of 4.8 weeks in 30 cases (71 percent). In five cases (12 percent), no surgical exploration was performed and laparoscopy was the only treatment. These results indicate that laparoscopic excision of ovarian cysts is improperly used on some patients. Stricter guidelines on the selection of patients for this procedure are required, and when any suspicion that a cyst is malignant is found, the cyst should not be excised laparoscopically, but should be left intact for surgical examination and removal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Surgery, Cancer, Cancer treatment, Ovaries, Ovarian cysts, Cysts, Abdomen, Laparotomy, Laparoscopy

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Breast-feeding and the potential for human immunodeficiency virus transmission

Article Abstract:

The risk of conferring HIV infection upon nursing infants by mothers infected with HIV (the agent associated with AIDS) must be taken into account when clinicians advise a woman to breast-feed. Women who may transmit the disease unwittingly are those who are asymptomatic but infected, or those who receive transfusions of infected blood following childbirth. Between 30 and 50 percent of the infants born to infected mothers are already infected with HIV, but whether disease-free babies can acquire the virus via breast milk is unknown. Some research results indicate that this risk may be low; for instance, the same proportion of breast-fed as bottle-fed infants of HIV-positive women become infected within seven months. However, other studies have shown a higher rate of HIV transmission in breast milk, and a higher rate for women transfused with infected blood after delivery. Clinicians should advise patients regarding breast-feeding after considering their risk category. Risk varies by region: in New York City, 2.7 percent of all samples of umbilical cord blood taken during a two-month period were HIV-positive. Risk category assessment, however, is incomplete, and many asymptomatic mothers are, in fact, infected. In addition, at-risk pregnant women often refuse screening tests. Five recommendations are made: (1) all women of reproductive age in regions where AIDS is endemic should be tested for HIV infection; (2) in areas where AIDS is not common, women at risk for the disease should be screened; (3) HIV-positive women need appropriate counseling to reduce the possibility of transmitting the disease; (4) in underdeveloped countries, breast feeding, even by infected women, may be preferable to the consequences of not breast feeding; and (5) women who are high-risk or who live in an area where AIDS is common, and who refuse screening, should be told that HIV may be transmissible through breast milk. Moreover, they should be advised not to breast-feed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, HIV infection, HIV infections, HIV infection in children, Pediatric HIV infections, Disease transmission, Breast feeding, Contamination, Breast milk

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The equity of diagnostic related group "all payor" hospital payment and gynecology diagnostic related groups

Article Abstract:

The Diagnostic Related Group payment system (often referred to as DRGs) for Medicare patients, which reimburses hospitals for the care they provide, may inadequately compensate hospitals for certain kinds of gynecological care. Although some gynecologic Diagnostic Related Groups allow more reimbursement for hospital patients who develop complications (after admission) or who have comorbidities (other illnesses when admitted), most (15 of 21) do not. To evaluate whether the payments for some patients really are too low, a study was carried out of 2,920 gynecology patients admitted to one urban teaching hospital during a three-year period. Of particular interest were patients in any of the 15 Diagnostic Related Groups that are not stratified to allow for complications or comorbidity; hospitals were reimbursed by Medicare, Medicaid, Blue Cross, or private insurers. A comparison was made between patients' resource consumption and hospital reimbursement by the different payors. Results showed that gynecology patients in each Diagnostic Related Group with complications or comorbidities consumed more resources than patients in the same group without these additional problems; however, the Diagnostic Related Group weight index did not rise sufficiently to allow appropriate reimbursement. Thus, as the number of complications and comorbidities increased, the hospital lost increasingly more money; this was true for all payors. A strong critique of the Diagnostic Related Group hospital payment system is tendered. Several proposals are underway to address the inequities of the current approach; equity of care, however, must not be compromised. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Economic aspects, Prices and rates, Hospitals, Medicare, Prospective payment systems (Medical care), Hospital rates, Diagnosis related groups

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