摘要:

AbstractsOver the past three decades, medical management of endometriosis has included high-dose synthetic estrogen, diethylstilbestrol, androgens, progestins (with or without estrogen), danazol, a synthetic derivative of 17-ethinyl testosterone, and expectant management. With the exception of the last named, each of these therapies has been associated with untoward side effects, vagaries of optimal dosage, and questionable effectiveness with regard to restoration of fertility. In the present article, the authors report their experience with three modes of therapy for mild endometriosis associated with infertility and draw tentative conclusions about the management of these conditions.One hundred and forty-four patients who were investigated for infertility and found to have laparoscopically confirmed mild to moderate endometriosis (stage I or II) were included in the study. They were divided into three treatment groups: 1) no treatment (controls) (N = 56); 2) medroxyprogesterone acetate (MPA), 10 mg three times a day orally for 90 days (N = 36); and 3) danazol for 6 months (N = 52). Danazol was given in a dose of 600 mg a day orally and increased to 800 mg if breakthrough bleeding occurred or pelvic pain persisted. After therapy, patients were followed for a minimum of 30 months. During this period, other infertility factors were treated if present. There were no significant differences in mean age or duration of infertility among the three groups. The maximum cumulative pregnancy rate was reached at 30 months and was higher for the medroxyprogesterone acetate group than for the danazol or control group, but the differences were not significant.Because infertility is multifactorial, the frequency of other problems that were present and corrected, such as male factors and cervical and ovulatory disorders, were compared also. The presence of other infertility factors was not significantly different among the three treatment groups. The presence of corrected confounding factors and ovulatory disorders did not appear to influence the rate of pregnancy.Figure 1 illustrates the life-table analysis of all three treatment regimens. The cumulative pregnancy rate reached a plateau at 30 months. At that time, it was 71 per cent for the medroxyprogesterone acetate group, 46 per cent for the danazol group, and 55 per cent for the controls. The mean conception rate per month of exposure to pregnancy was 3.6 per cent for the medroxyprogesterone acetate group, 3.4 per cent for the danazol group, and 3.1 per cent for the control group. Patients with stage I disease did not differ from those with stage II disease.The rate of spontaneous abortion among the patients who became pregnant was examined also, according to treatment modality. Although the danazol and medroxyprogesterone acetate groups had lower abortion rates than controls, the difference was not significant.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

AbstractsA prospective randomized study in selected patients with stage IB and IIA carcinoma of the uterine cervix was carried out at Washington University between January 1966 and December 1979. Patients were randomized to be treated with 1) irradiation alone consisting of 1000 cGy to the parametria with a stepwedge midline block, and two intracavitary insertions for 7500 mgh; or 2) irradiation and surgery, consisting of 2000 cGy whole pelvis irradiation, one intracavitary insertion for 5000 to 6000 mgh followed 2 to 6 weeks later by a radical hysterectomy with pelvic lymphadenectomy. A total of 40 patients with stage IB and 16 with stage IIA were randomized to be treated with irradiation alone. A similar group of 48 patients with stage IB and 14 with IIA were randomized to the preoperative radiation and surgery group.The 5-year, tumor-free actuarial survival for stage IB patients was 89 per cent with irradiation alone and 80 per cent in the preoperative radiation and surgery groups. In stage IIA, the 5-year survival was 56 per cent for the irradiation and hysterectomy alone group and 79 per cent for the preoperative irradiation and hysterectomy patients. The difference in these results is not statistically significant.In the stage IB group only one parametrial failure was noted in the 40 patients treated with irradiation alone. Four patients developed distant metastases, one combined with periaortic lymph node involvement. In the preoperative radiation group, there were six parametrial failures, all combined with distant metastases. Two of these patients developed concomitant suburethral recurrences.In stage IIA, of the 16 patients treated with radiation alone, one patient developed a central recurrence and three a parametrial failure (three of them combined with distant metastases). In the preoperative group, there were two pelvic failures combined with distant dissemination.An analysis of the chronological distribution of recurrences showed that 85 per cent of the failures occurred with 3 years from therapy, at about the same rate in the radiation alone or irradiation and surgery groups.The pathological status of the hysterectomy specimens were reviewed in all patients. In 48 patients with stage IB nine showed residual microscopic tumor in the cervix and three (7.3 per cent) in the pelvic lymph nodes. Of these patients, three developed pelvic recurrences. In contrast, of 33 patients with no residual tumor in the cervix or pelvic lymph nodes, only one (3.3 per cent) showed evidence of pelvic recurrence.No residual carcinoma was observed in the cervix or the lymph nodes in the 14 patients with stage IIA disease. Only two of these patients developed a pelvic recurrence.In the irradiation alone groups, one patient suffered a rectosigmoid fistula; another patient developed a pelvic inflammation and an abscess with subsequent formation of a rectovaginal and vesicovaginal fistula 3 months after the completion of radiotherapy. One patient had severe proctitis, and one a sigmoid stricture. An additional patient had a vesicovaginal fistula, and another patient was found to have an ureteral stricture. The total incidence of complications was 8.9 per cent (5/56). One patient developed thrombophlebitis and nonfatal pulmonary embolus. Two patients in the preoperative group developed rectal fibrosis and stricture, one a small bowel stricture, and three ureteral fibrosis in the pelvis. The overall incidence of major complications was 9.7 per cent (6/62).Minor complications consisted mainly of vaginal fibrosis, which was more common in the patients treated with irradiation alone; eight patients developed this complication. In the patients treated with combined therapy, there were two instances of pelvic thrombophlebitis, one pelvic cellulitis, one wound infection, and one vaginal vault necrosis. Only one patient developed a lymphocyst.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID