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Supplemental Digital Content is Available in the Text. Introduction.: A greater sense of belonging has been found to correspond with better academic performance/motivation, retention, and general mental well-being among college students. As a result, it is important to be able to meaningfully assess student physical therapists' sense of belonging. Review of Literature.: While there are questionnaires available to assess sense of belonging at the university level, it is also important to be able to assess students' sense of belonging in a narrower context, such as within their program of study. The purpose of this study was to develop and evaluate a program-specific tool, referred to as the Program Sense of Belonging (ProSB) questionnaire, that could be used to assess sense of belonging among student physical therapists. As part of this study, we examined the internal structure of the ProSB questionnaire items and assessed internal consistency. Subjects.: One hundred twenty-four student physical therapists from 2 different physical therapist education programs completed the ProSB questionnaire. Methods.: We conducted an exploratory factor analysis to examine the internal structure of the ProSB questionnaire and examined Cronbach's alpha to assess the internal consistency of the items associated with each retained factor. Results.: For the final 10-item version of the ProSB questionnaire, 2 factors were retained, which explained 57.5% of the variance (factor 1 = 30.9%, factor 2 = 26.6%). The 5 items that loaded on factor 1 were related to "social acceptance," while the 5 items that loaded on factor 2 were related to "valued competence." Both subscales exhibited acceptable levels of internal consistency (Cronbach's alpha ≥0.84). Discussion.: The ProSB questionnaire appears to capture different dimensions of student physical therapists' sense of belonging (social acceptance, valued competence) at the program level. Conclusion: Based on our preliminary findings, the ProSB questionnaire appears to be a valid tool for assessing program-level sense of belonging among student physical therapists. [ABSTRACT FROM AUTHOR]

Purpose: To explore how perinatal nurses perceive the effects of visitor restrictions on patient care within a hospital setting. Study Design and Methods: We distributed a cross-sectional survey online to perinatal nurses in May of 2022. Characteristics of respondents were analyzed using descriptive statistics. Responses to an open-ended question were analyzed via conventional content analysis. Results: Among our sample of 101 nurses, we identified seven codes representing positive effects and seven codes representing negative effects. The most frequently reported positive effects were ability to provide person-centered care (n = 36,35.6%) and less patient stress and more rest (n = 29, 28.7%). The most frequently reported negative effects were limited patient support (n = 22, 21.8%) and emotional distress to the patient (n - 15,14.9%). Fourteen percent (n = 14) of respondents cited both positive and negative effects. Clinical Implications: Nurses perceived that visitor restrictions resulted in both positive and negative patient experiences. Balancing clinical needs and safety considerations with emotional needs of the childbearing individual requires careful consideration by maternity care clinicians and health care systems. Subsequent research is needed to determine optimal visitation policies during intrapartum and postpartum with consideration to hospital context and patient preferences for optimal care. [ABSTRACT FROM AUTHOR]

Purpose: To describe the expectations of early labor by nulliparous pregnant women in their third trimester and first-time mothers' experiences of early labor after they had given birth. Study Design and Methods: A descriptive qualitative approach involving semi-structured, video-call interviews conducted between September 2020 and April 2021. Data were analyzed using content analysis. Results: Twenty-two women took part in this study. Only 3 of the 10 nulliparous pregnant participants reported pain as an expected symptom of early labor. There were two themes identified from interviews with pregnant participants: Desire to stay at home in early labor and Lack of knowledge and two themes from interviews from postpartum participants: Expectations didn't match experiences and Feelings of anxiety and uncertainty during early labor. Clinical Implications: Nulliparous women lack knowledge of and skills to effectively cope with pain during early labor while at home. There is a need for an innovative labor support program for childbearing women to remain safely at home in early labor. Women who are giving birth for the first time need information about what to expect in early labor, how to manage pain, discomfort, fear, rupture of membranes, and when to come to the hospital. In this study, women at term shared their knowledge of early labor and women during postpartum described the experience of early labor compared to what they had expected. More research is needed on how to improve knowledge and support of women in early labor to promote safely staying at home until admission to the hospital is clinically appropriate. [ABSTRACT FROM AUTHOR]

Introduction: White matter hyperintensities (WMHs) are magnetic resonance imaging markers of small vessel cerebrovascular disease that are associated with cognitive decline and clinical Alzheimer disease. Previous studies have often focused on global or total WMH; less is known about associations of regional WMHs and cognitive abilities among older adults without dementia. Methods: A total of 610 older adults with normal cognition (n=302) or mild cognitive impairment (n=308) from the Alzheimer's Disease Neuroimaging Initiative underwent neuropsychological testing and magnetic resonance imaging. Linear regression models examined associations between regional WMH volumes and cognition, adjusting for age, sex, education, apolipoprotein E ε4 allele frequency, and pulse pressure. Results: Among all participants, greater regional WMH volume in all lobes was associated with poorer performance on memory and speed/executive functioning. Among participants with normal cognition, greater temporal and occipital WMH volumes were associated with poorer memory, whereas no regional WMH volumes were associated with speed/executive function. Discussion: Results show that greater regional WMH volume relates to poorer cognitive functioning—even among those with normal cognition. Together with results from previous studies, our findings raise the possibility that WMH may be a useful therapeutic target and/or important effect modifier in treatment or prevention dementia trials. [ABSTRACT FROM AUTHOR]

Purpose: To explore the perceived challenges, job satisfiers, and self-care of perinatal nurses in the United States during the COVID-19 pandemic. Study Design and Methods: In May of 2021, a cross-sectional survey was distributed online to members of the Association of Women's Health, Obstetric, and Neonatal Nurses and the National Association of Neonatal Nurses. We calculated descriptive statistics on respondent characteristics and applied conventional content analysis to free-text comments. Results: Perinatal nurses (N = 297) responded to three open-ended questions on their perceived challenges, job satisfiers, and self-care. Frequently reported challenges included changing guidelines and policies (n = 101, 34%), personal protective equipment as a barrier (n = 73, 24.6%), and visitor restrictions (n = 64, 21.5%). Frequently reported job satisfiers were provision of high-quality care (n = 137, 46.1%) and visitor restrictions (n = 77, 25.9%). Respondents reported using mental (n = 152, 51.2%) and physical (n = 145, 48.8%) self-care strategies and 12.8% (n = 38) reported using no self-care strategies. Clinical Implications: The ability to provide high-quality care was reported as a leading job satisfier. Poor communication of consistent, evidence-based guidelines, lack of personal protective equipment, and inadequate unit staffing were leading challenges. Visitor restrictions were a challenge and a job satisfier, suggesting opportunities to better include visitors as support people. Most respondents reported engaging in one or more types of self-care outside of the hospital setting. Future research is needed to examine strategies for self-care among perinatal nurses when at work in the hospital setting. Perinatal nurses, like other nurses in the United States and around the world, have faced many challenges in providing high quality nursing care during the COVID-19 pandemic. In this study, members of the Association of Women's Health, Obstetric, and Neonatal Nurses and the National Association of Neonatal Nurses participated in an online survey about their experiences during the pandemic. Ability to provide high-quality care was reported as a leading job satisfier, while poor communication of consistent, evidence-based guidelines, lack of personal protective equipment, and inadequate unit staffing were leading challenges. Visitor restrictions were a challenge and a job satisfier, suggesting opportunities to better include visitors as support people. This study adds important information about maternity nursing practice in the United States during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS: Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21–0.46]; P <0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60–1.67]; P =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (P <0.001) but not the remainder of the year (P =0.56). CONCLUSIONS: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery. [ABSTRACT FROM AUTHOR]

Background: The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes. Purpose: Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers. Methods: We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated. Results: Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions. Conclusions: Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance. [ABSTRACT FROM AUTHOR]

Background: Prior studies suggest neighborhood poverty and deprivation are associated with adverse health outcomes including death, but evidence is limited among persons with HIV, particularly women. We estimated changes in mortality risk from improvement in three measures of area-level socioeconomic context among participants of the Women's Interagency HIV Study.Methods: Starting in October 2013, we linked geocoded residential census block groups to the 2015 Area Deprivation Index (ADI) and two 2012-2016 American Community Survey poverty variables, categorized into national tertiles. We used parametric g-computation to estimate, through March 2018, impacts on mortality of improving each income or poverty measure by one and two tertiles maximum versus no improvement.Results: Of 1596 women with HIV (median age 49), 91 (5.7%) were lost to follow-up and 83 (5.2%) died. Most women (62%) lived in a block group in the tertile with the highest proportions of individuals with income:poverty <1; 13% lived in areas in the tertile with the lowest proportions. Mortality risk differences comparing a one-tertile improvement (for those in the two highest poverty tertiles) in income:poverty <1 versus no improvement increased over time; the risk difference was -2.2% (95% confidence interval [CI] = -3.7, -0.64) at 4 years. Estimates from family income below poverty level (-1.0%; 95% CI = -2.7, 0.62) and ADI (-1.5%; 95% CI = -2.8, -0.21) exposures were similar.Conclusions: Consistent results from three distinct measures of area-level socioeconomic environment support the hypothesis that interventions to ameliorate neighborhood poverty or deprivation reduce mortality risk for US women with HIV. See video abstract at, http://links.lww.com/EDE/B863. [ABSTRACT FROM AUTHOR]

Background: In some time-to-event analyses, it is unclear whether loss to follow up should be treated as a censoring event or competing event. Such ambiguity is particularly common in HIV research that uses routinely collected clinical data to report the timing of key milestones along the HIV care continuum. In this setting, loss to follow up may be viewed as a censoring event, under the assumption that patients who are "lost" from a study clinic immediately enroll in care elsewhere, or a competing event, under the assumption that people "lost" are out of care all together.Methods: We illustrate an approach to address this ambiguity when estimating the 2-year risk of antiretroviral treatment initiation among 19,506 people living with HIV who enrolled in the IeDEA Central Africa cohort between 2006 and 2017, along with published estimates from tracing studies in Africa. We also assessed the finite sample properties of the proposed approach using simulation experiments.Results: The estimated 2-year risk of treatment initiation was 69% if patients were censored at loss to follow up or 59% if losses to follow up were treated as competing events. Using the proposed approach, we estimated that the 2-year risk of antiretroviral therapy initiation was 62% (95% confidence interval: 61, 62). The proposed approach had little bias and appropriate confidence interval coverage under scenarios examined in the simulation experiments.Conclusions: The proposed approach relaxes the assumptions inherent in treating loss to follow up as a censoring or competing event in clinical HIV cohort studies. [ABSTRACT FROM AUTHOR]

During periviable deliveries, parents are confronted with overwhelming and challenging decisions. This study aimed to qualitatively explore the language that pregnant women and important others utilize when discussing palliation, or "comfort care," as a treatment option in the context of periviability. We prospectively recruited women admitted for a threatened periviable delivery (22-25 weeks) at 2 hospitals between September 2016 and January 2018. Using a semistructured interview guide, we investigated participants' perceptions of neonatal treatment options, asking items such as "How was the choice of resuscitation presented to you?" and "What were the options presented?" Conventional content analysis was used and matrices were created to facilitate using a within- and across-case approach to identify and describe patterns. Thirty women and 16 important others were recruited in total. Participants' descriptions of treatment options included resuscitating at birth or not resuscitating. Participants further described the option to not resuscitate as "comfort care," "implicit" comfort care, "doing nothing," and "withdrawal of care." This study revealed that many parents facing periviable delivery may lack an understanding of comfort care as a neonatal treatment option, highlighting the need to improve counseling efforts in order to maximize parents' informed decision-making. [ABSTRACT FROM AUTHOR]

Objective: The current study examined the interactive effect of type 2 diabetes and Alzheimer disease (AD) risk factors on the rate of functional decline in cognitively normal participants from the Alzheimer's Disease Neuroimaging Initiative.Methods: Participants underwent annual assessments that included the Functional Activities Questionnaire, an informant-rated measure of everyday functioning. Multilevel modeling, controlling for demographic variables and ischemic risk, examined the interactive effects of diabetes status (diabetes, n=69; no diabetes, n=744) and AD risk factors in the prediction of 5-year longitudinal change in everyday functioning. One model was run for each AD risk factor, including: objectively-defined subtle cognitive decline (Obj-SCD), and genetic susceptibility [apolipoprotein E ε4 (APOE ε4) as well as cerebrospinal fluid β-amyloid (Aβ), total tau (tau), and hyperphosphorylated tau (p-tau).Results: The 3-way diabetes×AD risk factor×time interaction predicted increased rates of functional decline in models that examined Obj-SCD, APOE ε4, tau, and p-tau positivity, but not Aβ positivity.Conclusions: Participants with both diabetes and at least 1 AD risk factor (ie, Obj-SCD, APOE ε4, tau, and p-tau positivity) demonstrated faster functional decline compared with those without both risk factors (diabetes or AD). These findings have implications for early identification of, and perhaps earlier intervention for, diabetic individuals at risk for future functional difficulty. [ABSTRACT FROM AUTHOR]

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines. [ABSTRACT FROM AUTHOR]

Multiple and complex health, social, and environmental factors threaten the school success of children living with HIV. Little is known about interventions to overcome these threats to school success. We aimed to identify the number and types of recommendations from hospital-generated neurodevelopmental exams and school-generated evaluations, Individual Education Plans (IEP), and 504 Plans for adaptations in the classroom for students with HIV infection. We also compared recommendations suggested by both neurodevelopmental exams and IEPs or 504 Plans. Data were derived from the clinic records of 31 school-age children. Content analysis yielded 358 recommendations in 11 categories. Findings highlighted a lack of communication between the clinic and schools. [ABSTRACT FROM AUTHOR]

The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying the development and validation of preventive therapies for Alzheimer disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high-risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry's actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet the criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for the clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches. [ABSTRACT FROM AUTHOR]

For more than 3 decades, the recruitment and retention of African Americans for research in Alzheimer disease have been regarded as difficult undertakings with poor results. The typical explanation for failure to respond to research participation options is a widespread mistrust of research and the biomedical community. Mistrust is a reasonable response; given the historic reality of malfeasance, victimization, and mistreatment over the course of the research participation history of African Americans. The challenges are real but there are opportunities for successful recruitment and retention of African Americans for research including research on Alzheimer disease. Participation, however, comes with specific terms and considerations. Two of the most prominent criteria for research recruitment and retention are the transparency and accountability of the investigator, which may determine how he or she proceeds from the Start of the process throughout the steps of recruitment, retention, and subsequent follow-up with the community. [ABSTRACT FROM AUTHOR]

Many hospitals are working to improve the work environment for their staff. Research has indicated a linkage between work environment characteristics and patient outcomes and this research along with the nursing shortage has been the impetus for focusing on improving the work environment. The authors described the experience of an academic medical center hospital in achieving Magnet hospital status. The process and the required resources and support are discussed. Outcome data from staff nurses regarding their perception of the work environment in a Magnet hospital are presented. [ABSTRACT FROM AUTHOR]

Birth defects are the leading cause of death for infants in their first year of life and contribute substantially to childhood morbidity and long-term disability among survivors. Both the Centers for Disease Control and Prevention and the March of Dimes Birth Defects Foundation actively support birth defects monitoring programs across the United States. Currently, 33 states have some type of birth defects monitoring program and 16 more have programs in the planning stages. In general, these surveillance programs track birth defects to describe incidence and identify subpopulations for possible preventive interventions. The importance of early intervention in reducing or preventing secondary disabilities associated with a primary condition has been well documented. A birth defects registry, because of its ability to capture this information earlier than other data collection methods, is a potentially valuable source of information to use in referring families for services. In this paper, we describe the results of a survey to identify programs that are using, or are planning to use, their birth defects surveillance systems as a means of identifying and referring children and families for services. We report the level of interest and experience in developing such referral systems in state birth defect surveillance programs, provide 4 brief case examples, and recommend steps early intervention professionals can take to further discussion about using registries for making referrals. [ABSTRACT FROM AUTHOR]

Provides information on a study that examined an approach to identifying and referring infants with birth defects and their families for early intervention services. Methodology of the study; Results and discussion on the study.

Objective: To determine the prognostic value of the diagnostic category CIN 1,2.Materials and Methods: Computerized pathology records of patients with CIN 1,2 at colposcopically directed biopsy followed by treatment with excision were examined, and we compared the diagnostic biopsy with the final tissue diagnosis. Two pathologists who were blinded to the final diagnosis reviewed the original biopsies independently. The ability of the referee pathologist to predict CIN 2 or 3 lesions and interobserver consistency are described.Results: Sixty-nine cases of biopsies with CIN 1,2 were reviewed. Nineteen of these patients were lost to follow-up. Of the 46 cases with either an excisional biopsy or hysterectomy, 12 cases (26.1%) demonstrated CIN 2 or greater. Pathologist A and B correctly predicted the high-grade lesions in 66.7% and 58.3% of cases reviewed. Pathologist A and B agreed with each other in 33 of the 46 cases (71.1%).Conclusions: 1) CIN 1,2 on a colposcopic biopsy is associated with a high-grade lesion in 26.1% of the cases. 2) Experienced gynecologic pathologists can identify these high-grade lesions on review in only two thirds of the cases. 3) CIN 1,2 is a useful diagnostic category to prevent undertreatment. [ABSTRACT FROM AUTHOR]

Atypical polypoid adenomyoma (APA) of the uterus is a rare, benign lesion. Histologically, it is composed of a glandular and squamous cell proliferation with architectural complexity and cytologic atypia of glands, and a hypercellular smooth muscle stroma. APA is difficult to distinguish from well-differentiated adenocarcinoma of the uterus. In the case presented, the diagnosis of APA was confused pathologically, radiographically, and clinically with a cervical adenocarcinoma. A review of the English literature is presented. [ABSTRACT FROM AUTHOR]

Case: An 8-year 8-month-old biological female who self-identifies as a boy, Ricardo is brought by his mother for a well-child check to his new pediatrician. Ricardo and his mother report that he is doing well, but have concerns about the upcoming changes associated with puberty. Ricardo states that he is particularly afraid of developing breasts. His mother asks about obtaining a referral to a specialist who can provide "hormone therapy" to delay puberty.Ricardo was adopted from Costa Rica at the age of 2 as a healthy girl named "Angela." From the age of 3, he displayed clear preference for male gender-associated clothes, toys, and games. At age 5, his mother sought care for hyperactivity and sleep problems. He was diagnosed with attention-deficit hyperactivity disorder and sleep onset disorder at age 6, and his symptoms have been well controlled with Adderall and melatonin.Ricardo lives with his parents who are accepting and supportive of his gender preference. He sees a therapist who has experience with gender dysphoria. For the past years, he has attended school as male, with the confidential support of administrators at his elementary school.

Our purpose is to correlate thin section CT of peripheral bronchogenic carcinomas with histologically detected lymphatic or vascular invasion. Retrospective 3-year database search revealed 186 surgical resections for primary bronchogenic carcinoma, of which 58 had available preoperative imaging performed at our institution. Cases with prior surgery, nonconfirmatory pathology, remote imaging, or central location were excluded, resulting in a study population of 42 patients, 25 men, 17 women, with a mean age of 69 years. Imaging with 1-3 mm collimation was performed within a mean of 32 days prior to surgery. Histologic diagnoses included adenocarcinoma (n = 24, 57%), squamous cell carcinoma (n = 13, 31%), large cell carcinoma (n = 4, 10%), and small cell carcinoma (n = 1, 2%), with a mean tumor size of 27 mm. Three radiologists blindly and independently recorded bronchovascular thickening, septal and nonseptal opacities, and the extent of each beyond tumor margins: 1) <5 mm, 2) 5-10 mm, and 3) >10 mm. Lymphangio-invasion was correlated with imaging findings, tumor size, and histology. Adjacent parenchymal abnormalities were recorded in 40 (95%) of 42 masses, with isolated nonseptal opacities representing the most frequent abnormality in 21 (50%), followed by bronchovascular thickening in 16 (38%), and septal opacities in 12 (29%). Lymphangio-invasion was present in 16 (38%) of cases. The frequency of lymphangio-invasion was highest (53%) in cases with 2 or more positive findings, and extension beyond 10mm from the tumor margin. This trend did not achieve statistical significance by ROC analysis. Lymphangio-invasion was positively correlated with tumor size, P =.03, but not histology.In conclusion, parenchymal abnormalities beyond tumor margins shown by CT may be due to lymphangio-invasion but imaging findings did not reliably distinguish cases with and without lymphangio-invasion.

Intravascular bronchioloalveolar tumor of the lung is an unusual neoplasm that usually presents as multiple pulmonary nodules in asymptomatic young women. The course of the disease is often indolent with some patients eventually dying of respiratory failure secondary to progressive tumor infiltration of the pulmonary interstitium. The cell of origin appears to be an endothelial cell, and epithelioid hemangioendothelioma of liver or other soft tissues is a pathologically identical neoplasm. Open lung biopsy is necessary for diagnosis. The radiologist should be aware of this tumor and suggest the diagnosis in the appropriate clinical setting.

Primary appendiceal carcinomas are a rare source of metastases to the ovaries. Three cases are reported here, and 25 others are reviewed from the English literature. The recognition of this entity is important, since the metastases may mimic an ovarian primary tumor clinically, and because of the propensity for a recognized appendiceal carcinoma to relapse in the ovaries. Therapeutic implications dictate that the appendix should always be carefully examined during exploration for ovarian masses, and prophylactic appendectomy should be considered, as part of the treatment of ovarian carcinomas.