OBJECTIVE:To estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women. METHODS:Saline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding. RESULTS:The mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%, P ؍ .04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted. CONCLUSION:Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic. (Obstet Gynecol 2002;100:3-7. Benign uterine lesions, such as endometrial polyps and leiomyomata, are common in women, especially those over age 35 years. 1-4 Submucosal leiomyomata or polyps are found in approximately 50% of premenopausal women referred for ultrasound evaluation of abnormal uterine bleeding. 1,5-7 However, the prevalence of both lesions is lower in nonselected populations of perimenopausal women being evaluated for their initial complaint of abnormal bleeding. 8 These lesions are also found in asymptomatic women. 1 Endometrial polyps and leiomyomata are frequently removed surgically because of their association with abnormal uterine bleeding. 1,9 Despite the high prevalence of these conditions and the morbidity attributed to them, little is known about their natural history.In 1999, using saline infusion sonography, we compared the prevalence of benign uterine lesions in 80 women with abnormal uterine bleeding to a cohort of 100 asymptomatic premenopausal women over age 30 years. 1 We detected polyps in 10% and leiomyomata in 13% of the asymptomatic controls. In our current study, we add to the understanding of the natural history of uterine polyps and leiomyomata. By reevaluating this group of initially asymptomatic women, we aimed to estimate the incidence rate and regression rate of uterine leiomyomata and polyps, as determined by saline infusion sonography. MATERIALS AND METHODSThis study was approved by the Universit...
Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic.
The development of multitargeted tyrosine kinase inhibitors has provided significant advances in the treatment of renal cell carcinoma. This case describes initial therapy for managing renal cell cancer with the administration of sorafenib, a multitargeted tyrosine kinase inhibitor. We report the development of localized palmar-plantar epidermal hyperplasia, a rare but significant cutaneous adverse event from sorafenib therapy.Mild-to-moderate dermatologic toxicity from sorafenib has been well described in the literature. We also review the current knowledge and the proposed hypothesis for the development of cutaneous events related to tyrosine kinase inhibitors. This particular case represents a unique form of dermatologic toxicity to sorafenib that has not previously been described in the literature. The Oncologist
BACKGROUND: In the present milieu of rapid innovation in undergraduate medical education at US medical schools, the current structure and composition of clinical education in Internal Medicine (IM) is not clear. OBJECTIVE: To describe the current composition of undergraduate clinical education structure in IM. DESIGN: National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. PARTICIPANTS: One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. MAIN MEASURES: IM core clerkship and post-core clerkship structure descriptions, including duration, educational models, inpatient experiences, ambulatory experiences, and requirements. KEY RESULTS: The survey response rate was 83% (107/ 129). The majority of schools utilized one core IM clerkship model (67%) and continued to use a traditional block model for a majority of their students (84%). Overall 26% employed a Longitudinal Integrated Clerkship model and 14% employed a shared block model for some students. The mean inpatient duration was 7.0 ± 1.7 weeks (range 3-11 weeks) and 94% of clerkships stipulated that students spend some inpatient time on general medicine. IMspecific ambulatory experiences were not required for students in 65% of IM core clerkship models. Overall 75% of schools did not require an advanced IM clinical experience after the core clerkship; however, 66% of schools reported a high percentage of students (> 40%) electing to take an IM sub-internship. About half of schools (48%) did not require overnight call or night float during the clinical IM sub-internship. CONCLUSIONS: Although there are diverse core IM clerkship models, the majority of IM core clerkships are still traditional block models. The mean inpatient duration is 7 weeks and 65% of IM core clerkship models did not require IM-specific ambulatory education.
Purpose To evaluate the fourth-year medical student's assessment and management of an unstable patient. Method The authors compared the performance of fourth-year medical students in a Clinical Performance Examination (CPX) across a spectrum of simulated stable conditions as compared to a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an 8-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are as mean (standard deviation [SD]) and P<.05 was considered significant. Results A total of 143 fourth-year medical students participated in the study. Correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P<.001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared to history, differential diagnosis, labs/tests, and diagnosis. Conclusion Fourth-year medical students were less prepared to manage a simulated STEMI case compared to a range of non-acute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.
BackgroundThere is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.MethodsThis case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys.ResultsTo meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career.ConclusionA health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system’s value (better care and health for lower cost).
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