OBJECTIVE:To develop a simple estimation procedure that will always converge on a solution for a two-parameter model of cumulative pregnancy curves.DESIGN:Utilize raw data from a previous study in which estimation of the two-parameter model did not converge on a solution, and re-estimate the model with the new estimation method. PATIENTS, SETTING, TREATMENT: Infertile women with endometriosis treated as outpatients with laser laparoscopy.MAIN OUTCOME MEASURES:Pregnancy and ability of the new computer program to converge on a solution.RESULTS:The new estimation procedure converged on a solution. Over all stages of endometriosis, the cure rate from laser laparoscopy was 56%, and the monthly probability of pregnancy among those cured was 9.7%.CONCLUSIONS:The new estimation procedure, written for a personal computer, is easy to use and will virtually always converge on a solution for the two-parameter model of cumulative pregnancy after infertility treatment.

Prospective follow-up information from the throat culturing results of 1,653 Eskimo children in 12 Alaskan villages was used to evaluate the effect of duration and intensity of a streptococcal control program begun in 1971 while controlling for several other risk factors related to streptococcal colonization. Relative risks of colonization for each of the subsequent study years relative to the first year indicate that the risk of colonization decreased over the duration of the study by 42% in Year 2 to 55% in Year 4 (P less than 0.0001). Cost-cutting measures such as lengthening the time interval between routine throat cultures led to a 37% increase in the risk of colonization (P = 0.0002). A comparison of the number of cases of acute rheumatic fever during the 5-year period before the streptococcal control program with the number of cases during the 5-year program period showed that cases in villages with the program decreased from 11 to 0. In a similar group of comparison villages without the program, the number of cases decreased from 7 to 4. A benefit-cost study of the program indicates that benefit exceeds cost. These findings and the changes in the carriage of streptococcal organisms during the control program underscore the importance of such long-term programs with regularly scheduled culturing in high-risk populations of children.

To investigate risk factors in male breast cancer, a case-control study of 52 histologically diagnosed cases and 52 controls--matched for age, race, marital status, and hospital--was conducted in 5 U.S. metropolitan areas. Cases were significantly more likely to be Jewish than were the controls, supporting earlier suggestions of an increased risk in Jewish males. A significant association of male breast cancer with mumps infections at age 20 years or older, along with the possible association with antecedent testicular injury and the excess frequency of mumps orchitis among cases, suggests that testicular factors may be important in the development of breast cancer among males. An increased frequency of breast cancer among persons who have worked in blast furnaces, steel works, and rolling mills is of interest because of the possible testicular effect of high environmental temperatures. The observed association between breast cancer and a prior history of swollen breast is difficult to interpret because of potential recall bias, and a possible relationship with military service needs further confirmation.

Few epidemiologic studies have been undertaken to investigate the etiology of cancer of the vulva. To identify risk factors associated with this cancer, a case-control study was conducted in 149 patients with histologically proven vulvar carcinoma and the same number of control patients matched for age, race, marital status, and hospital from five U.S. metropolitan areas. As previously suspected, we found prior histories of leukoplakia of the vulva, inflammation of the vulva or vagina, and urogenital cancer to be significantly associated with vulvar cancer. In addition, we found moderately high odds ratios associated with occupational histories of private household maids and servants, and work in laundry, cleaning, and other garment services. A slightly increased odds ratio was associated with coffee consumption and a dose-response effect was demonstrated. The findings suggest that environmental exposures may play a role in vulvar carcinogenesis.

A case-control study was undertaken to investigate possible etiologic factors in nasopharyngeal cancer, a rare tumor in the United States. Data from 39 nasopharyngeal cancer cases and the same number of matched controls showed significantly more cases born in Asia than controls, supporting the notion that exposure in early life has a prolonged carcinogenic effect. Cases also smoked significantly more cigarettes than controls, indicating a need for investigating the role of cigarette smoking and other exposures in the etiology of nasopharyngeal cancer in western countries.

When evaluating the results of infertility therapy, it is often of interest to know whether differences exist between a new form of therapy and the established one, between medical and surgical therapy, or between patient groups that differ in severity of disease, age, parity, and so on. In this paper, a likelihood-ratio test is developed to evaluate differences between cumulative pregnancy curves of different patient groups. The test takes into account variation in patient follow-up and can be applied to any type of infertility therapy. It is illustrated by consideration of a group of patients who underwent artificial insemination by donor (AID) and determination of whether pregnancy outcome differed according to parity. It was found that the cure rate for both nulliparous and parous patients was virtually 100% and that the monthly probability of pregnancy was not significantly different between the two groups.

To identify predictive parameters for incidence and severity of acute graft-versus-host disease (GVHD), 136 patients, transplanted with histocompatible marrow as therapy for aplastic anemia and hematologic malignancies, were examined using univariate and multivariate analyses. The risk of GVHD increased in patients with acute lymphocytic leukemia (p less than 0.05), in sex-mismatched donor-recipient pairs (p less than 0.01), and in patients older than 23.7 yr (p less than 0.05). No other commonly observed factors appeared to have any relationship to GVHD except the presence of certain alleles. The presence of a Cw4 allele or of the Bw21 specificities B49 and B50 were associated with significantly increased risks of GVHD (p less than 0.05), whereas the presence of Aw19 (or the related specificities A29, Aw30, Aw31 , Aw32, Aw33 ) was associated with a significantly decreased risk (p less than 0.01). Using these factors, a regression equation can be constructed that estimates the risk of a given patient to develop clinically significant acute GVHD.

Total body irradiation is part of the preparatory regimen for allogeneic bone marrow transplantation because of its cytotoxic and immunosuppressive properties. A major toxicity of bone marrow transplantation has been interstitial pneumonitis, which may be, in part, related to the lung irradiation. One hundred and sixty-one consecutive patients receiving allogeneic bone marrow transplantation for leukemia and aplastic anemia at Johns Hopkins Hospital (1968–1979) were retrospectively studied. The present study demonstrated that lung shielding to 600 rad maximum in single dose total body irradiation, fractionation of total body irradiation in comparison to single dose total body irradiation, and absence of graft versus host disease in the leukemia patients, each reduced the risk of interstitial pneumonitis. Total body irradiation significantly reduced the leukemia recurrence rate and/or the failure of remission induction.

In order to promote uniform reporting of endometriosis. The Americal Fertility Society (AFS) recently proposed a classification in which severity was categorized on the basis of both location and extent of disease. The results of this study indicate that the AFS scale poorly specifies the relation between severity of disease and pregnancy outcome after therapy, because of the arbitrary point scores assigned to each classification category, and the arbitrary cutoff points chosen to divide patients into severity groupings. A nonparametric monotonic estimator, which generates a dose-response relationship between AFS score (dose) and pregnancy following treatment (response) is shown to improve the discriminatory power of the AFS scale; however, in order to obtain the full benefit of the detail provided by the AFS classification, it is recommended that the current arbitrary individual-category weights be replaced by empirically derived weights.

A multimodality treatment program has been applied to ovarian carcinoma at the Johns Hopkins Hospital since August 1975. Forty-nine patients were subdivided into 23 patients with maximally resected Stage III micrometastatic, and 26 patients with significant retained disease, 20 with Stage III macrometastatic and 6 with Stage IV. After initial pilot studies, those patients with minimally retained disease entered a randomized prospective study. Antiovarian antiserum was used in one arm of the study; in both study arms colloidal P-32, delayed split whole abdominal irradiation, and maintenance melphalan were used. For the 23 patients with micrometastatic disease the cumulative survival and survival without evidence of disease at four years is 78 and 34% respectively. Twenty-six patients with macrometastatic disease were treated with or without intraperitoneal antiserum and multiagent chemotherapy; their cumulative one year survival is 50%. The lack of significant toxicity of intraperitoneal antiovarian antiserum and the results of multimodality therapy indicate the feasibility of this therapeutic approach to further improve ovarian cancer therapy.

Split course prostatic irradiation is a treatment technique where 4000–4500 rod whole pelvis irradiation is followed by two weeks of rest and an additional 2000–2500 rod by reduced field technique to a total dose of 6000–6500 rod. Eighty-four patients were studied and the results indicated a local regional control rate of 97.6% with an overall 3 year survival without evidence of disease of 96.6% for Stages A and B and 60% for Stage c. Significant complications occurred in 1.2 % of the patients. None of the patients needed surgical correction of a complication other than a perineal abscess. The risk/benefit ratio for pelvic and prostatic irradiation favors split course prostatic irradiation in that it demonstrates a low complication rate, high local regional control, and comparable disease-free survival to continuous irradiation.

The data-input phase of clinical record systems necessarily involves medical and paramedical personnel who are unenthusiastic about interacting with computers. One strategy for dealing with the troublesome problems of biomedical data-input is to develop unobtrusive systems. The performance of such a system (TICES: Type-In Coding and Editing System) shows that unobtrusive data-input systems, based on natural-language computing principles, are now feasible.