Incomplete Workup Research Articles

Fetal pyelectasis: Is it always “physiologic”?

OBJECTIVE: Our purpose was to determine the degree of fetal pyelectasis predictive of neonatal renal pathologic processes. STUDY DESIGN: Eighty-four cases of pyelectasis were identified during the study period (1989 through 1993). Fetuses with an anteroposterior diameter of the renal pelvis ≥4 mm before 33 weeks or ≥7 mm after 33 weeks without caliectasis were included. Fetuses with an anteroposterior diameter of >10 mm were excluded. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies. RESULTS: Sixteen cases were excluded because of incomplete postnatal workup. Renal pathologic processes were found in 30 of 68 (44%) at birth: the most common were ureteropelvic junction obstruction (37%) and vesicoureteral reflux (33%). Only four cases required surgical intervention (13%), and the remaining 87% were managed conservatively. A normal urinary tract was found in 25% of the infants and the remaining 21 of 68 (31%) had regression of pyelectasis before birth. Fetuses with a dilated anteroposterior diameter ≥8 mm after 28 weeks' gestation were found to have renal pathologic features in two of three of the cases, with sensitivity, specificity, and positive and negative predictive values of 87%, 41%, 66.7% and 70%, respectively. CONCLUSION: Fetuses with an anteroposterior diameter of the renal pelvis ≥8 mm after 28 weeks' gestation require appropriate urologic evaluation after birth.

Burning mouth syndrome: Critical review and proposed clinical management

Burning mouth syndrome is characterized by a burning sensation in one or several oral structures. Multiple causal factors have been proposed, and reports on their relative importance are conflicting. Lack of diagnostic criteria, differences in sampling procedures, incomplete workups, and lack of controlled studies make the reliable interpretation of the importance of proposed causal factors and the efficacy of specific treatment modalities difficult. This article summarizes the available data, critically analyzes their scientific merit, and proposes a protocol for clinical management.

Late Survival of Non-small Cell Lung Cancer Patients with Brain Metastases: Influence of Treatment

The presence of brain metastasis in lung cancer patients is a highly unfavorable event that usually allows only palliative treatment. A retrospective study was conducted to evaluate the prognostic factors in patients with non-small cell lung cancer (NSCLC) associated with brain metastases. From July 1984 through June 1990, a total of 50 patients with NSCLC associated with symptomatic brain metastasis seen at National Taiwan University Hospital were included. Patients who had incomplete cancer staging workup or loss of follow-up were excluded. Several possible prognostic variables were analyzed initially with univariate analysis and subsequently with multivariate analysis with maximal partial likelihood ratio test in the Cox model. In the univariate analysis, several factors, including number of brain metastases, treatment for brain metastasis with brain tumor resection (BTR) or whole brain radiation therapy (WBRT), and chemotherapy (C/T) after brain metastasis were found to have significant influence on the survival. However, in the multivariate analysis, patients receiving BTR, WBRT, and/or C/T lived significantly longer. The median survival of patients treated with BTR was nine months, eight months in patients with C/T, and seven months in patients with WBRT. Taken together, these patients had a median survival of seven months, which was significantly longer than patients treated with supportive care only (with a median survival of two months). Treatment of brain metastases with WBRT, BTR, C/T, or in combinations also improved the quality of life. We conclude that NSCLC patients with brain metastases should be more aggressively treated with WBRT, BTR, C/T, or in combinations than supportive care only.

Continued Clinical Experience with an Increasing Dosage Regimen of Clomiphene Citrate Administrations

Between August 1, 1975, and July 31, 1977, 60 patients with infertility and ovulatory dysfunction were evaluated at the Naval Regional Medical Center, Oakland. Of these, 15 had incomplete work-ups or were lost to follow-up. Of the remaining 45 patients, 2 (4.5%) failed to ovulate at a maximal dose of 250 mg of clomiphene for 5 days with 10,000 units of human chorionic gonadotropin. Of the 43 (95.5%) who did ovulate, 33 conceived. Of these 33 patients, 9 (27%) required greater than 100 mg of clomiphene and/or longer than three ovulatory cycles to conceive. Of the 10 patients who did not become pregnant, additional infertility factors were present in 5. When these 5 were eliminated, the corrected pregnancy rate was 87% (33 of 38). The spontaneous abortion rate was 12.2% and there were no multiple gestations. These results would further emphasize that clomiphene can be used safely and effectively at doses greater than 100 mg or for longer than three ovulatory cycles.

Letter To The Editor

Needling hurts less when it is amusing. Drs. Murphy and Chapman comment on Dr. Fink's letter as follows: Is the true measure of success the realization that someone really reads what you write? If so, we must have made it, judging by the thoroughness of Dr. Fink's critique. Not to find sex in an article one reads so carefully is certainly disappointing. There were 6 girls and 21 boys in the enuretic group. Among the girls, two had urethral strictures, grade 1 and 2 respectively, one a meatal stricture, grade 1, one had chronic urinary tract infections, one had a horse shoe kidney, and one had an incomplete work-up.