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A small proportion of miscarriage specimens obtained by uterine evacuation exhibit increased perivillous fibrin/oid deposition (PVFD). To understand the significance of this finding, the authors reviewed cases from 5/20/02 to 11/10/04 in which surgical pathologists recognized this finding and documented it in their reports. Of 55 cases initially collected, 29 contained at least 30 villi on the slide with at least 50% of villi showing adherent fibrin/oid, and showed no molar change or extensive coagulative necrosis. Review of these 29 cases identified 2 patterns of fibrin/oid deposition: nodular (8 cases) and diffuse (21 cases). A maternal and gestational age-matched control group was collected (21 cases). The diffuse pattern of PVFD encased villi and had tinctorial characteristics of fibrin. Its pattern is similar to that seen in maternal floor infarction and massive perivillous fibrin deposition. The nodular pattern is an exaggerated form of the nodular deposition of matrix-type fibrinoid seen in normal placentas. Comparison of the 3 groups identified a longer duration of vaginal bleeding before uterine evacuation in the diffuse pattern (P=0.001). One patient had a history of 8 miscarriages, 2 of which were represented in this study. All other obstetrical factors studied showed no significant difference between the 3 groups. Thus, diffuse PVFD in miscarriage specimens is associated with prolonged vaginal bleeding and not with maternal thrombophilia or autoimmune disease. Rarely, a patient showing this pattern may have a history of repeated miscarriages.

Background: Chronic postoperative complaints (CPC), including pain and dysfunction, lasting months to years after common operations, have reached epidemic proportions. There is a paucity of reports on acupuncture acupuncture treatments for CPC. Objective: The aim of this study was to perform nonblinded observation of acupuncture treatment for chronic postoperative complaints. Design: This study was comprised of a nonblinded, nonrandomized, prospective, observational case series. The records presented in this article are a subset of research clinic records. Setting: The study was conducted at a free acupuncture research clinic, at Fletcher Allen Health Care. The clinic was managed by the Department of Anesthesia of the University of Vermont's College of Medicine. Patients: The patients in this study were 17 nonblinded volunteers. Interventions: The interventions included Kiiko Matsumoto-style pressure-release acupuncture, and supplementary electroacupuncture, auriculotherapy, and additional points when indicated. Main Outcome Measures: The study measured the patients' reported symptoms, which were assessed in each case by the treating physician as being minimum, moderate, or full improvement/recovery. Results: Eleven of 17 patients were benefited by acupuncture. Among 9 patients who received 5 or more treatments, 100% of these patients reported improvement. Eight of the 9 patients achieved moderate-to-full improvement, and 1 patient had minimal improvement. For 8 patients, who only received 1-4 treatments, 2 of these patients reported benefit, 1 moderate and 1 full. The Spearman nonparametric rank correlation coefficient = 0.6296; p-value = 0.0094. This showed improvement was highly correlated to the number of treatments received. Conclusions: Improvement in patients with CPP treated with acupuncture correlates to the number of treatments. Nonbinding pain contracts to motivate patients with CPP to stay under acupuncture treatment are advisable.

Neoadjuvant systemic therapy (NST) for operable breast cancer can increase the options for conservative surgery in patients with breast cancer. We performed an analysis of a breast cancer outcomes database as a quality assessment of neoadjuvant therapy use in relation to breast conservative rate (BCR). Data were reviewed from a breast cancer database established to monitor outcomes of breast cancer surgery at a tertiary care breast cancer clinic. The frequency of NST-use was correlated to tumor size and BCR. Cause-specific factors for omitting NST in patients undergoing mastectomy for tumors 3 cm or greater were determined. NST was employed in 29 of 241 (12%) cases of invasive breast carcinoma treated surgically from 2003 to 2005. Although a significant decrease in BCR occurred in tumors >3 cm, NST was not frequently employed until tumors reached >5 cm. Defined contraindications to breast conservation (65%) and patient choice for mastectomy (30%) were the two most common reasons for omitting NST in tumors > or = 3 cm. Despite the initial appearance of NST under-utilization in tumors measuring between 3-5 cm, appropriate exclusion of patients not suitable for breast conservation and patient choice for mastectomy both emerged as leading factors for the omission of NST in this group. Use of NST is an important quality metric in optimizing breast conservation. Patient education and greater understanding of patient-related barriers to NST may help improve BCR.

Background: Pharmacoinvasive Therapy (PIT) is a potential treatment for STEMI patients who are not able to achieve primary PCI within guideline recommended time limits. The risk of bleeding complications with PIT has not been studied in the setting of routine use of bleeding avoidance strategies (BAS). Methods: We analyzed a contemporary multicenter registry (2009-2013) of consecutive patients undergoing PCI as part of a 10 hospital regional algorithm involving 1 PCI center and 9 transfer centers: PIT for hospitals > 60 minutes (N=140) and Primary PCI if < 60 minutes travel time to PCI center (N=346). We compared the risk of HORIZONS Major Bleeding for patients undergoing PIT vs Primary PCI in the setting of routine use of BAS and determined the independent predictors of major bleeding in the entire cohort. Results: The PIT patients had a median travel time of 103±49 minutes and were more frequently female, had a higher incidence of renal failure and less cardiogenic shock than the primary PCI group. BAS was routine and similar in both groups (Table). Rates of death, stroke, ischemic and major bleeding outcomes were similar among the two groups, and length of stay was shorter in the PIT group. Multivariate logistic models indicated that two independent predictors of major bleeding were cardiac arrest (OR=3.89, 95% CI: 1.2-12.1, p=0.02) and bailout GPI utilization (OR=3.23, 95% CI 1.2-9.9, p =0.03). The PIT strategy in conjunction with BAS did not predict major bleeding (OR=2.1, 95% CI: 0.85-5.44, p=0.11). Conclusions: We report the largest study of BAS in conjunction with a regional STEMI strategy of PIT: PIT is associated with low rates of bleeding and thrombotic complications. Bleeding and ischemic rates were similar to the primary PCI strategy. PIT in conjunction with BAS is not an independent predictor of bleeding risk in a regional STEMI population.