Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

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The U.S. domestic airline industry was deregulated in 1978 as part of a regulatory reform movement that has transformed the banking, telecommunications, energy, and transportation industries. A geography of deregulation has emerged conforming to a core-periphery structure in which industries are increasingly controlled by fewer firms through their major headquarters and operations centers. As a consequence of industry consolidation and the shift to "hub-and-spoke" network service structures, strong domestic "hubs" (e.g., Dallas, Chicago, Atlanta) and international gateway cities (e.g., Los Angeles, New York, San Francisco) have emerged as the core control centers of the air-transport system, while "spoke" cities have become peripheralized in the process. The group of core centers has benefited more than the periphery from increased air transportation employment, frequency of service, passenger flow, and lower fares, except in cases where hubs were dominated by one or two airlines, where fares rose. The latter is manifested in a pattern of higher fares in the more concentrated hubs of the southeastern U.S. and their peripheral hinterlands.

Objectives To assess the long term outcome of laparoscopic supracervical hysterectomy. Design Retrospective study. Setting Minimal Access Surgical Unit, Department of Gynaecology, Royal Surrey County Hospital, Surrey. Methods Analysis of patient case records. Population Seventy consecutive women who had a laparoscopic supracervical hysterectomy. Outcome measures Symptoms related to the cervical stump and the need for further surgery. Results The mean time of patient follow up was 66 months (range 52–84). The mean time from initial procedure to second treatment was 14 months (range 3–53). Seventeen women (24.3%) reported symptoms related to the cervical stump, and all required further surgery. The cervical stump was removed in 16 (22.8%). One patient had laparoscopic adhesiolysis only and two had a laparotomy and trachelectomy because the bowel was adherent to the cervical stump. Nine had a laparoscopically assisted cervical trachelectomy as the sole procedure. Five had laser treatment to endometriotic deposits, and laparoscopically assisted cervical trachelectomy. Histological analysis showed normal cervical tissue in six (35.3%). Endometriosis was detected in four cervical stumps (23.5 %), residual endometrium in another four (23.5 %) cases, and chronic cervicitis, mild CIN and a mucocoele in a further three patients. Of the 17 women who reported cervical stump symptoms, 14 (82.3%) had been treated for endometriosis in the past, compared with 17/53 (32%) who did not have symptoms (P<0.0002, χ2 test). Conclusions Symptoms related to the cervical stump requiring further surgery frequently occur following a laparoscopic supracervical hysterectomy.

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