ISSN:0001-6349    

DOI:10.3109/00016349309013360

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-6349    

DOI:10.3109/00016349309013361

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0001-6349    

DOI:10.3109/00016349309013362

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Loss of bone mass with age, is a universal phenomenon and is more pronounced in women than in men. The condition where the bone loss has proceeded to the extent that fractures occur is termed osteoporosis. As the number of elderly persons in the population increases, its magnitude is likely to increase, both in the developing and the developed countries.Bone mass increases rapidly in childhood and the adolescent years, reaching a peak in the third decade of life, and begins to decline soon thereafter. Several factors are thought to influence bone loss: these include race, diet, smoking, and physical exercise. Although the rate of bone loss accelerates in the immediate postmenopausal period, the process actually begins in the premenopausal years. By the time osteoporosis is clinically apparent and manifested by fracture, it probably cannot be reversed. The peak adult bone mass achieved, and the subsequent rate of bone loss are the major factors that determine a woman's susceptibility to postmenopausal osteoporosis. A primary cause of bone loss after menopause is the associated decline in ovarian function.Scanty information is available on the factors that affect bone mineral density or initiate bone loss before menopause, although both estrogens and progestins have been shown to prevent bone loss in postmenopausal women.Available data on the relationship between steroid hormone contraceptive use and bone massldensity is limited to combined oral contraceptives and one report related to the use of depot medroxy progesterone acetate. While there are several studies which show that oral contraceptive preparations have a beneficial effect on bone mass, there are many other studies which fail to demonstrate such an effect. The divergent findings from the research to date reflect the dificulties in controlling not only for the many variables in studies based on small numbers, but also drawing inferences from studies which were undertaken during periods when changes in pill dosages/ formulations occurred and diagnostic techniques improved, plus the complex nature of the disease itself. It is not yet clearly understood if the possible protection conferred by steroidal contraception persists throughout the postmenopausal years — a period when there is acceleration of bone loss and whether or not this beneficial effect is specific to the trabecular bone which is more sensitive to metabolic influences.The effect of lactation on bone mass is not well understood. (Cross‐sectional and longitudinal studies report conflicting effects, both beneficial and adverse.) The association may be mediated not only through intake of calcium during lactation, the duration of lactation, and age at lactation, but the anatomic site and the technique employed to measure bone mass are important considerations. No single study has addressed all these factors together. Most of them have dealt with small numbers of subjects with low statistical power to detect small or even medium changes in bone maddens

ISSN:0001-6349    

DOI:10.3109/00016349309013363

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This study was performed to elucidate whether endometriotic lesions can affect peripheral blood lymphocyte‐subsets. Changes of lymphocyte‐subsets of normal healthy women and patients with uterine myoma or endometriosis before and after operation were also examined by using two‐color assay methods. The percentage and absolute number of CD57+CD16+cells [moderately differentiated natural killer (NK) cells] of NK cell subsets in peripheral blood from patients with endometriosis were signficantly lower than values from normal healthy women and patients with uterine myoma, while there was no difference in CD4+and CD8+lymphocyte‐subsets between normal healthy women and patients with uterine myoma or endometriosis. In patients with endometriosis the percentage and absolute number of CD8+CD11+cells (suppressor T‐cells) was significantly increased after operation, while those in patients with uterine myoma did not change. On the other hand, resection of endometriotic lesions resulted in a significant decrease of the percentage of CD57+CD16+cells (immature NK cells) and a significant increase of not only the percentage but also the absolute number of CD57+CD16+cells (moderately differentiated NK cells), suggesting that existence of endometriotic lesions disturbs differentiation of the NK cells. Furthermore, suppressor inducer T‐cells as shown by measuring CD4+2H4+and CD4+4B4−cells were significantly increased after operation of endometriosis. These results suggest that endometriotic lesions can affect differentiation of NK cells and such functional changes of the NK cells may be involved with progression or development of

ISSN:0001-6349    

DOI:10.3109/00016349309013364

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We performed Doppler studies of the uterine artery in 85 women with postmenopausal and perimenopausal bleeding. Sixty‐six women had non‐malignant changes and 19 women had malignant changes on histologic examination of the endometrium. Uterine fibroids were detected in 30 women. When malignant changes were detected in the endometrium, uterine artery resistance index was always below 0.83. The mean uterine artery resistance index was significantly lower in the group of women with pathologic changes of the endometrium (RI = 0.77±0.03) compared to the group with non pathologic changes (RI=0.85±0.08p<0.01), excluding the women with uterine fibroids. The lowest mean resistance index in the uterine artery was observed in the group of women with uterine fibroids (RI = 0.60 ± 0.09p<0.001). In five of six patients with endometrial carcinoma blood vessels were detected around the myometrium by using color flow imaging. Their RI was always less than 0.5. In five patients, blood vessels were detected in uterine fibroids but their RI was always more than 0.5. All six women with endometrial carcinoma but only seven of 13 women with endometrial hyperplasia, had endometrial thickness greater than 5 mm. Doppler velocimetry of the uterine artery carries a high sensitivity (100%) in detecting pathological changes of the endometrium in patients presenting with postmenopausal or perimenopausal bleeding. The presence of high resistance in this vessel, may allow a more conservative approach in this group of pa

ISSN:0001-6349    

DOI:10.3109/00016349309013365

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Uteroplacental insufficiency is a major cause of perinatal mortality and postnatal morbidity. Doppler velocimetry has been used to assess well‐being of the fetus for several years. In the present study we evaluated the perinatal outcome of growth retarded fetuses with presence or absence of diastolic flow in umbilical artery at Doppler analysis. Forty‐six pregnant women with intra‐uterine‐growth‐retardation were studied. Ultrasound assessment of amniotic fluid was performed on alternate days until parturition. A weekly ultrasound measurement of fetal abdominal circumference was done. Doppler analysis of fetal/maternal circulation was performed upon arrival of the patient in hospital and thereafter on alternate days until delivery. Fetal blood was sampled by cordocentesis for immediate blood‐gas analysis. In the group (/i = 26) with absent or reversed diastolic flow in the umbilical artery, we observed a correspondingly worse blood‐gas analysis; a reduced time interposed between the diagnosis and the delivery; a reduced birth weight associated with an increased fetal risk and with a perinatal mortality approaching 60%. Our data suggest that absent or reversed diastolic flow in umbilical artery of growth‐retarded fetuses, associated with alterations in other vessels, are ominous signs of serious f

ISSN:0001-6349    

DOI:10.3109/00016349309013366

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study objective.To analyse the information on maternal smoking routinely recorded during antenatal care by general practitioners, with emphasis on the impact of smoking on birth weight and risk for small‐for‐gestational age (SGA) births.Design.Geographically based cohort study.Setting.Evaluation of information recorded by general practitioners in antenatal records, in routine clinical practice without intervention.Material.Women residing in one Norwegian county delivering during a 12 month period 1988/1989.Main results.1908 women gave birth. 30 % were recorded as smokers at first antenatal visit, 4% lacked information on smoking. The recording of smoking habits in week 36 was deficient as data were missing in 75% of the women who smoked at first antenatal visit. Smokers experienced a mean birthweight impairment of 182 grams (adjusted for parity and age). A dose‐response effect on birth weight of the number of cigarettes smoked per day at first visit was found. Also, a synergistic effect of increasing maternal age and smoking with regard to risk for SGA was demonstrated. The relative risk for SGA for smokers below 25 years was not significant, whereas women of 35 years and more had a relative risk of 3.8 for SGA. 18% of the SGA‐cases among the study subjects were attributable to smoking.Conclusions.Using the routinely collected information on smoking at first antenatal visit, the well known effects of smoking on birthweight are reproduced. The routine recording of smoking habits in week 36 is insufficient. Information on smoking registered in the antenatal records should be recorded in the Medical Birth Registry. Smoking in pregnancy appears not to be equally harmful for all women. The highest risk for SGA is found in the age group where smoking is most infrequent. The question of a more differentiated approach to the problem of smoking cessation in pregnancy, is

ISSN:0001-6349    

DOI:10.3109/00016349309013367

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study objective: To analyze risk factors for multiple births.Design: A case‐control study. Cases were 103 women (median age 31 years, range 20‐44) who delivered multiple births not related with treatment for infertility at the ‘Clinica Luigi Mangiagalli’ of Milan. A total of 27 women delivered monozygotic twins and 76 dizygotic ones. Controls were 308 women (median age 30, range 17‐45) admitted for normal delivery on selected days to the same clinic where cases had been identified.Results: Cases tended to be less educated than controls and the relative risk of multiple pregnancy, compared with women reporting seven years of schooling or less, was 0.4 in those reporting 7‐11 and 12 or more years of education. When the analysis was done separately for dizygotic and monozygotic multiple pregnancies, this relationship was restricted to dizygotic multiple pregnancies (χ21trend for dizygotic pregnancies=3.82,p= 0.05). A family history of multiple pregnancies was reported in 36 women (48%) with dizygotic multiple pregnancy and 13 (52%) monozygotic ones and 88 (30%) controls. The corresponding relative risks (RR) were 2.2 and 2.5 respectively for dizygotic and monozygotic pregnancies. Compared with nulliparae, the estimated RR of dizygotic multiple pregnancies was 0.5 in women reporting two or more births, but the trend in risk with number of births was not statistically significant. No relationship emerged with spontaneous or induced abortions, body mass index, oral contraceptive or IUD use, age at menarche and risk of multiple pregnancies.Conclusions: This study confirms the role of familiarity in the risk of multiple pregnancies and suggests some different epidemiological characteristics in dizygotic and monozygotic multiple

ISSN:0001-6349    

DOI:10.3109/00016349309013368

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The purpose of this study was to describe the characteristics of women choosing alternative maternity care compared with women who preferred conventional care. The former group of women had their antenatal, intrapartum and postpartum care at a birth center in Stockholm, Sweden. Characteristics of the birth center care were continuity of care, restriction of medical technology, parental responsibility and self care. Altogether 1086 women enrolled for birth center care were included in the Alternative Group (AG). A sample of 630 was selected from among pregnant women who preferred conventional care (CG). Both groups filled in a structured questionnaire, and the response rate was 100% (1086) in the AG and 70% (441) in the CG. Besides having a more critical attitude to conventional procedures of maternity care, women in the AG were older, better educated and had other professions than CG women. They were in better physical health, and tended to be less anxious when thinking of the approaching birth and motherhood. They had more positive expectations of the coming birth, and a greater interest in not being separated from the newborn and the rest of the family immediately after the birth. They were also more interested in being actively involved in their own care. Generally speaking, AG women were more concerned about the psychological aspects of childbirth. No differences were found between the groups regarding civil status, proportion of native Swedes, or parity. Women whose characteristics coincide with those of the AG may be a growing proportion of the female population, due to better education and a growing concern about the disease orientation of maternity care. Interest in alternatives, particularly so‐called natural childbirth, may therefore be expected to increase. Such developments ought to be considered in the planning of maternity car

ISSN:0001-6349    

DOI:10.3109/00016349309013369

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY