摘要:

ObjectiveTo determine the effect of bone density information on a woman's decision about hormone replacement therapy (HRT).MethodsOne hundred forty women were assigned randomly to receive either educational information about osteoporosis and a voucher for a bone mineral density test 12 months later or the same educational information plus an immediate dual-energy x-ray absorptiometry test for bone mineral density. Women in both groups were offered prescriptions for HRT.ResultsOf the 93 women who received a bone mineral density test, 63.4% elected HRT and filled their prescription, compared with only 20.0% of the 43 women who did not have a bone mineral density test (P<. 01). Women who were classified as osteopenic (between −1 and −2.5 standard deviations [SDs] of the young normal bone mineral density) or osteoporotic (more than 2.5 SDs below young normals) were more likely to choose HRT (69.4%) than were women whose bone mineral density was in the normal range (51.6%) (above −1 SD of the young normal bone mineral density value).ConclusionsA bone mineral density test, regardless of the result, had a significant effect on women's decisions to accept HRT. Within the group having the test, women with lower bone mineral density were more likely to choose HRT.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the relationship of estrogen-induced changes in lipids and lipoproteins with alterations in the coagulation system.MethodsCoagulation and lipid indices were measured in 31 postmenopausal women, ages 40–60 years, after a 3-month course of 0.625-mg conjugated equine estrogen. We analyzed changes in variables from baseline to 3 months usingttests for paired samples or the Wilcoxon matched-pairs signed-rank test.ResultsUnopposed estrogen replacement therapy produced statistically significant decreases in antithrombin-III antigen (P= .006) and activity (P= .001) and total protein S (P= .003) and a significant increase in protein C antigen (P= .017). C4b-binding protein also decreased significantly from baseline to 3 months (P< .001). Mean fibrinogen level decreased by 18.2 mg/dL, not a statistically significant change (P= .213). Estrogen produced the expected statistically significant changes in lipids and lipoproteins. Several correlations between changes in lipids and lipoproteins and coagulation indices were statistically significant. Protein C antigen and activity changes correlated directly with high-density lipoprotein cholesterol changes (r= .52,P≤ .005;r= .38,P≤ .05; respectively), and protein C antigen also correlated directly with increases in apoprotein A-I (r= .54,P≤ .005). Triglyceride changes correlated directly with changes in protein C antigen (r= .36,P≤ .05) and activity (r= .49,P≤ .005) and inversely with C4b-binding protein (r= − .58,P≤ .01). Apoprotein B was correlated with free protein S (r= .48,P≤ .01).ConclusionsAlthough several estrogen-induced changes may decrease atherosclerotic potential and hypercoagulability, others may promote coagulability. These divergent effects may be manipulated pharmacologically by other estrogen compounds or by the addition of various progestins.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the effect of estradiol (E2) replacement therapy on cardiac structure and function in healthy post-menopausal women.MethodsWe conducted a randomized, double-blind, placebo-controlled, crossover study of 31 healthy postmenopausal female volunteer study subjects (55–65 years) using 12 weeks of micronized E2 replacement therapy (2 mg/day). Echocardiography and Doppler techniques were used to assess the cardiac effects of E2 at rest and during graded bicycle ergometry.ResultsCrossover analysis demonstrated no carryover effects of estrogen treatment (which increased serum E2 15-fold to 37.6 pmol/L) on the cardiac characteristics measured. Estradiol treatment did not affect measurements of systolic function, diastolic function, left ventricular mass, or pulmonary artery pressure at rest or during bicycle ergometry. Left ventricular end-diastolic volume at rest was slightly higher with E2 treatment (P= .03). However, this change was not reflected by changes in stroke volume, ejection fraction, or cardiac output.ConclusionsEstrogen replacement therapy, which results in physiologic serum concentrations, does not affect cardiac structure or function in normal postmenopausal women after 12 weeks of treatment.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the pharmacokinetic profiles of different doses of micronized 17β-estradiol administered by oral or sublingual routes.MethodsSingle doses of micronized 17β-estradiol were administered orally (1 mg, 0.5 mg) or sublingually (1 mg, 0.5 mg, 0.25 mg) to six postmenopausal women in a randomized clinical trial. We calculated pharmacokinetic parameters for estradiol (E2) and estrone (E1) of maximum serum concentration, time to maximum serum concentration, terminal half-life, area under the concentration curve, and oral clearance. Serum levels of El sulfate also were compared at 4, 12, and 24 hours after dosing.ResultsSublingual administration resulted in rapid absorption with significantly higher E2 levels than did comparable oral dosing. Estrone levels did not vary with route of administration but correlated with the dosage administered. Estrone sulfate levels correlated with the dosage administered and also tended to be higher with sublingual administration. Sublingual administration resulted in a significantly lower E1 to E2 ratio during the 24 hours than did oral administration.ConclusionSublingual administration of micronized 17β-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the relation between cigarette smoking and the incidence of genital warts in a cohort of human immunodeficiency virus (HIV)-infected women (without AIDS-defining conditions) (n= 148) and in HIV-negative women (n= 428).MethodsWomen were recruited between March 1990 and December 1993 from an urban, inner-city medical center and nearby community health centers. Woman initially free of genital warts (n= 576) were followed prospectively for up to 37 months, with an average of 14 months.ResultsThe observed incidence of genital warts per 100 person-years was almost three times higher in smokers than in non-smokers, both in HIV-positive (13.3 versus 5.0, respectively) and HIV-negative women (1.5 versus 0.5, respectively). In a Foisson regression model adjusting for variables significantly related to genital warts, including sexual activity, current smokers were 5.2 times (95% confidence interval 1.02, 26.0) more likely to develop genital warts. The prevalence of human papillomavirus (HPV) by polymerase chain reaction at baseline examination and the incidence of other sexually transmitted diseases were similar in smokers and non-smokers.ConclusionsOur findings are compatible with the hypothesis that the rate of progression of symptomatic exophytic HPV disease is increased in smokers.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the treatment of continuous data in a sample of obstetric and gynecologic literature.MethodsWe reviewed articles in Obstetrics and Gynecology published in the first 4 months of 1985 and 1995. Data were tabulated on a data form created specifically for this purpose and reviewed for accuracy.ResultsThe sample set included 170 variables in 102 original articles fromObstetrics and Gynecologypublished from January to April 1995, inclusive (group A, contemporary articles), and 117 variables in 89 articles published between January and April 1985, inclusive (group B, historic articles). Fifty-three variables (31% of total variables) in group A and 27 variables (23% of total variables) in group B (X2,P= .05) were continuous predictor variables. The historic-period articles (63%) were significantly more likely to represent continuous data only as categoric variables than were articles in the contemporary period (38%) (Fisher exact test,P= .037). Correlation coefficients,rvalues, were provided where possible in ten articles in the contemporary period (83%) and four articles in the historic period (31%) (Fisher exact test,P= .008). In articles in which continuous predictors were treated only as categoric variables, an emphasis was placed on the findings based only on categories in four of 12 (33%) of these articles in 1995 and nine of 13 (69%) in 1985 (Fisher exact test,P= .05).ConclusionsThe treatment of continuous data has improved over the time period reviewed. However, clinicians should be aware that continuous data may be mischaracterized as categoric variables in some journal articles. We hope that in the future, editors will consider requestingrvalues for all continuous data relations. The quality-of-care implications of using discrete cutoffs of continuous data for patient care should be investigated.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify any race-ethnicity-specific differences in serum alpha-fetoprotein (AFP), hCG, and unconjugated estriol (E3) levels in women between 14 and 21 weeks' gestation.MethodsData from the 3-year period 1992–1994 were analyzed from 208,257 women who had AFP screening, of whom 155,142 also had hCG and 62,121 also had E3 screened, between 14 and 21 weeks' gestation. Subjects were categorized into four groups: white, black, Asian, and Hispanic.ResultsThere was a consistent pattern of analyte differences across gestational ages. Levels for AFP were generally higher in Asian and black women than in Hispanic and white women (median AFP at 16 weeks—31.2,30.9, 27.4,27.3, respectively), and levels of hCG and E3 were highest in Asians (hCG at 16 weeks—34.7, 30.3, 28.2, 26.8, respectively). Weight correction for AFP, hCG, and E3 levels did not compensate for the ethnic differences.ConclusionsBecause hCG and E3 demonstrate the same general pattern of differences as AFP among ethnic groups, averaging values for all ethnic groups tends inappropriately to lower calculated Down syndrome risks for black and Asian women. Additionally, the slopes of the curves are not parallel, such that separate data bases are preferable to multiplicative correction factors. Separate data bases should be used in laboratories with volume sufficient to permit the establishment of race-ethnicity–specific regressions. Use of separate data bases should result in more accurate screening.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the ability of second-trimester maternal serum CA-125 levels to detect fetal Down syndrome.MethodsFrom stored, second-trimester maternal serum analyzed previously with the multiple-marker screening test for fetal Down syndrome, we selected 306 samples from euploid pregnancies and 22 samples from Down syndrome pregnancies at 14–20 weeks' gestation. CA-125 levels were measured by enzyme-linked immunosorbent assay and converted to gestational week-specific multiples of the median (MoM).ResultsThe mean maternal age (± standard deviation) of the study population was 35.5 ± 5.3 years. The Down syndrome group CA-125 mean MoM was significantly higher than the euploid group mean MoM (1.47 ± 0.51 MoM versus 1.05 ± 0.44 MoM;P< .001). CA-125 at or above 1.5 MoM identified 10 of 22 (45%) Down syndrome cases. Substituting CA-125 for estriol (E3) in the multiple-marker screening test resulted in a lower screen-positive rate (67 of 328, 20% [95% confidence interval (CD 16, 25) versus 91 of 328, 28% [95% CI 23, 33]) with a similar Down syndrome detection rate (18 of 22, 82%). Alternatively, when the screen-positive rate was held constant, the Down syndrome detection rate improved (20 of 22, 91% [95% CI 71, 99] versus 18 of 22, 82% [95% CI 60, 95]).ConclusionsDown syndrome pregnancies have higher second-trimester maternal serum CA-125 levels than euploid pregnancies. CA-125 may be superior to E3 in the multiple-marker screening test for fetal Down syndrome.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the clinical significance of placenta previa at 12–16 weeks' gestation found by transvaginal sonographic screening.MethodsAn unselected population of 6428 pregnant women was scanned by transvaginal sonography during 1993–1994 to assess the gestational age and to diagnose major fetal anomalies. The location of the placenta was also recorded systematically. If the edge of the placenta extended over the internal cervical os, this distance was measured with electronic calipers.ResultsIn 156 of 6428 patients (2.4%), the placental edge extended 15 mm or more over the internal cervical os at 12–16 weeks' gestation. Eight of these patients had placenta previa at delivery. Using this criterion at screening, two cases of placenta previa at delivery were missed. The frequency of placenta previa at delivery in this nonselected population was ten of 6428 (0.16%).ConclusionsThe likelihood of placenta previa at delivery is 5.1% (95% confidence interval 2.2, 9.9) if the placenta extends at least 15 mm over the internal cervical os at 12–16 weeks' gestation.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether twin pregnancies conceived by assisted reproductive techniques are at increased risk for obstetric complications or perinatal morbidity.MethodsA computerized perinatal data base was reviewed for all twin pregnancies managed by private obstetricians and delivered between 1990 and 1995. The obstetric and neonatal outcomes of those conceived following in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) were compared to the outcomes of those conceived spontaneously.ResultsThere were 105 twin deliveries following IVF or GIFT and 279 following natural fertilization. Discordant birth weight and low birth weight occurred more frequently in pregnancies conceived by IVF or GIFT (adjusted odds ratio [OR] 2.11, 95% confidence interval [CI] 1.14, 3.91; OR 1.65, 95% CI 0.98, 2.79, respectively). Elective cesarean delivery was more frequent in twin pregnancies conceived after IVF GIFT (relative risk [RR] 4.02, 95% CI 1.28, 12.6). There were no statistically significant differences in the frequency of antepartum or intrapartum complications, preterm delivery, or mean gestational age at delivery. There was no statistically significant increase in the frequency of neonatal complications among infants born after IVF GIFT.ConclusionAlthough twin pregnancies following IVF or GIFT are more likely to result in discordant birth weight infants, the perinatal outcome is comparable to that of spontaneously conceived twin pregnancies.

ISSN:0029-7828    

出版商:OVID    

年代:1997

数据来源: OVID