摘要:

AbstractGerm cell tumors (GCT) compose most of the preadolescent malignant ovarian tumors; dysgerminoma being the most common (48%), followed by endodermal sinus tumor, immature teratoma, mixed GCT and embryonal carcinoma. The percentage of malignant epithelial ovarian tumors rises with increasing age, while that of the GCT tumors declines. Of all tumor markers discussed, only AFP ang hCG are being routinely monitored. Their most effective use is in monitoring response to therapy and detecting recurrences early. The current therapeutic regimens are presented, among them bleomycin, etoposide and platinol (BEP) and other new regimens; their influence on the patients' fertility is discussed. Further improvement in the prognosis of these young patients will hopefully follow development of new surgical and chemotherapeutic approaches.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02719-1

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: The aims of this work were to establish automated blood pressure monitoring (ABPM) standards during the three trimesters of pregnancy and to analyze the chronobiological trend of blood pressure during gestation. Methods: A longitudinal study using 24‐h ABPM was performed on 192 healthy pregnant women, (aged 20–42 years, mean ± S.D. 28 ± 5) both nulliparas (n = 85) and multiparas (n = 107), and also on 26 pregnant women with chronic hypertension and 132 preeclamptic patients. The arterial pressure (AP) of the healthy women, at the start of the pregnancy, was<140/90 mmHg, as measured by the standard mercury sphygmomanometer, and it remained so at subsequent check‐ups throughout the pregnancy and puerperium. AP was monitored using the Spacelabs 90207 (Nippon Collin, Takeda UA 751), beginning at 08:00 h. Results: The normal pregnancies demonstrated an AP circadian rhythm with daytime systolic (SAP) and diastolic (DAP) values about 8–9 mmHg (P<0.01) higher than at night. In the normal pregnancies, the mean 24‐h AP values, like mean daytime and night‐time, SAP and DAP values, remained the same in the first two trimesters, while a slight but significant increase occurred in the third (P<0.05). Conclusions: This study enabled a range of normal pressure values to be deduced for each hour of the day throughout the three trimesters of pregnancy. This may facilitate a more accurate evaluation of individual pressure readings in pregnant women so as to ensure a more reliable and timely diagnosis of hypertension.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02742-7

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: Our purpose was to examine the change in peripartum vaginal group B streptococcal concentration. Methods: From 1989 to 1993, 251 pregnant women who delivered over 48 h after admission were included in this study. Group B streptococcal quantitative culture of vaginal specimens was performed within 24 h before delivery and on the previous day, and the GBS concentrations compared. Results: A statistical difference between positive rates for group B Streptococcus on the delivery day and that on the previous day was found (14 vs. 22%). In 20/58 (34%) of the cases between the two time points the vaginal group B streptococcal colonization increased. Conclusions: This study suggests the existence of major variation in peripartum vaginal group B streptococcal concentrations. We conclude that the rate and the concentration of perinatal vaginal group B streptococcal colonization even one day before delivery cannot be used to predict that at delivery.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02729-4

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To assess the role of bacterial vaginosis (BV) on pregnancy complications in a developing community where mixed cervico‐vaginal infections are common. Setting: The antenatal clinic at King Edward VIII Hospital (KEH), Durban, South Africa, which is a large urban tertiary hospital serving mainly a Black underprivileged population of KwaZulu/Natal. Methods: Asymptomatic pregnant women ≤30 weeks gestation were recruited at their first antenatal visit. Clinical data including the sexual history were recorded. Swab specimens were collected from the vagina and endocervix for diagnosing BV, trichomoniasis, candidiasis, gonorrhea and chlamydial infection. Venous blood specimens were tested for antibody to syphilis and human immunodeficiency virus (HIV). All women continued standard antenatal care and hospital records were reviewed following delivery to evaluate pregnancy outcome. Results: BV was found in 52% of the women studied and was the commonest infection diagnosed. Mixed vaginal infections of BV and trichomoniasis were diagnosed in 14%. Only 29% of asymptomatic women did not have any microbiological evidence of a lower genital tract infection. A total of 46% of women studied had poor pregnancy outcome as measured by obstetrical complications, pregnancy loss and/or neonatal morbidity. There was a significant difference in outcome in women with BV (55 of 88) compared to those having infections other than BV (13 of 31), or no infection (5 of 9) —P = 0.005. This difference was for obstetrical complications of preterm delivery, premature rupture of membranes and intrauterine infection, but not for pregnancy losses and neonatal morbidity. Conclusions: The high prevalence of BV and concomitant lower genital tract infections among asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with BV, confirms reports from developed countries of the need for screening for BV at the initial antenatal clinic visit. Whether pregnancy outcome was worse in the presence of BV and other infections than BV alone could not be determined. Future studies with appropriate interventions are needed to evaluate the unique problems of developing countries.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02744-0

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the effect of antenatal detection of the idiopathic term small for gestational age (SGA) fetus upon perinatal outcome. Methods: A 3‐year retrospective review of all term pregnancies with no associated maternal disease, with birth weights at least 2 S.D.s below the mean for gestational age. Perinatal outcome measures were compared between pregnancies that were diagnosed as SGA antenatally, and those that were detected only after delivery. Results: Of 158 term SGA pregnancies, 47 were diagnosed antenatally, and 111 were recognized as such only after delivery. The antenatally diagnosed group had a higher incidence of adverse neonatal outcome (P<0.01), as well as higher incidences of inductions of labor and emergency Cesarean sections (68% vs. 12%, P<0.001, and 23% vs. 10%, p<0.03, respectively). Logistic regression analysis with adverse neonatal outcome as the dependent variable has shown it to be dependent only on gestational age at delivery (P<0.004), and birth weight (P<0.001), and not on antenatal diagnosis. Conclusions: Antenatal detection of SGA may be associated with an increased incidence of obstetric interventions, with no demonstrable positive effect upon the short‐term neonatal outcome.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02730-0

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the hormonal and hematologic parameters of 24 patients with hyperemesis gravidarum without evidence of thyroid disease compared with matched controls. Methods: Twenty‐four pregnant women with hyperemesis and 20 control subjects were included in this study. A prospective comparison of hormonal milieu of hCG and thyroid function was performed. Results: Mean serum hCG, fT3, and fT4 levels of patients were significantly higher than those of controls (P<0.007), while there was no statistically significant difference in terms of TSH. Serum hCG correlated negatively with TSH and positively with fT3 and fT4 in the patient group (r = 0.66, r = 0.70, r = 0.85; P<0.05, respectively), while there was no relationship between hCG and thyroid functions in controls (r<0.25). The lymphocyte count of patients was significantly higher than that of controls (P0.007). The lymphocyte count correlated positively with serum hCG, fT4 and fT3, and negatively with TSH in the patient group (r = 0.73, r = 0.72, r = 0.64 and r = −0.63; P<0.05, respectively), while there was no relationship between lymphocyte count and serum hCG, fT4, fT3 and TSH in controls (r<0.25). Conclusions: Maternal immune recognition of the conceptus and immune response, hypothetically, may be related to the high level of hCG and/or fT4. Patients who have hyperthyroidism in early pregnancy should be assessed for transient hyperthyroidism as it relates to hyperemesis gravidarum.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02737-3

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: To determine the importance of endometrial biopsy and transvaginal ultrasound in patients with postmenopausal bleeding. Methods: Eighty patients with postmenopausal bleeding were submitted to transvaginal ultrasound followed by endometrial biopsy. Hysteroscopy and dilatation and curettage were carried out to confirm normality of the uterine cavity. Results: The endometrial echo could be visualized in all patients with postmenopausal bleeding. The biopsy failed to detect one case (1.38%) of adenocarcinoma and 14 cases (17.5%) of endometrial polyps. The sensitivity in detecting endometrial malignancy was 94.44% for endometrial biopsy and 100% for transvaginal ultrasound, when the endometrial thickness was more than 8 mm. Conclusions: When the thickness of the endometrial echo is less than 3 mm there is no need for anatomopathologic investigation. When this limit was adopted, all cases were associated with endometrial atrophy, and when the limit was 4 mm or more, active endometria were detected, requiring further histopathologic investigation by hysteroscopy and directed biopsies. Above 8 mm, malignancy may be found.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02720-8

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the impact of abdominal metroplasty for symmetric uterine anomalies on reproductive performance. Method: A retrospective analysis of 24 patients who conceived following metroplasty for symmetric congenital anomalies during a 5‐year period. Results: In patients with poor obstetric histories before surgery, the overall fetal survival rate increased from 2.5%. before treatment to 73.3% after treatment and 90.5% of women gave birth to a surviving infant. The remaining three patients suffering from infertility delivered a full‐term infant after metroplasty. Antenatal complications occurred in 56.7% of the pregnancies. Conclusion: Abdominal metroplasty clearly improves fetal survival particularly in women suffering from a history of poor obstetric outcome associated with symmetric malformations.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02695-1

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: To determine the hormone profile during the menstrual cycle in women at sea level and at high altitude, and whether the time between the gonadotropin peak and ovulation is different at high altitude from that at sea level. Methods: The study was carried out in Lima (150 m) and Cerro de Pasco (4340 m), Peru. The hormone profile of 10 adult regularly menstruating women at sea level and 10 women at high altitude was assessed. Ovulation was identified by vaginal ultrasonography. Results: The pre‐ovulatory follicle diameter was lower (P<0.001) at high altitude than at sea level. Ovulation after LH peak occurred earlier at high altitude than at sea level. Serum FSH levels were higher at late luteal phase and early follicular phase at high altitude than at sea level (P<0.05). The serum LH and FSH peaks were similar in women at sea level and at high altitude. During the early follicular phase serum estradiol levels were significantly higher at high altitude than at sea level (P<0.05). During the late follicular phase the production of estradiol was higher at sea level than at high altitude (P<0.05). The peak of serum estradiol was at day −1 in Lima and in day 0 at high altitude. At ovulation, the serum estradiol levels in women at sea level were 55.1% of the peak, but remained at high levels (80% of the peak) in women at high altitude (P<0.05). The second increase of serum estradiol occurred earlier at sea level than at high altitude. From days +12 to +15, there was a significant decline in serum estradiol levels in women at sea level (P0.05). Serum progesterone levels at days +5, and +8 to +12 were significantly higher at sea level than at high altitude. Conclusion: Our data suggest that hormone profile during menstrual cycle is different at high altitude than at sea level, probably as an effect of low barometric pressure.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02697-5

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: The clinical characteristics of ovarian tumors associated with pregnancy were investigated. Method: A series of 106 cases of ovarian tumor surgically resected during pregnancy was investigated with respect to incidence, clinicopathologic features and outcome. Results: Among 106 cases undergoing ovarian surgery, 31 (29.2%), 70 (66%) and five (4.7%) were diagnosed as physiologic, benign and malignant, respectively. The incidence of benign neoplastic tumor was 1:112 deliveries and that of malignant neoplastic tumor was 1:1684 deliveries. Dermoid cyst was the most common lesion found. Of the 70 benign tumors, 51 (72.9%) were greater than 8 cm in diameter and 55 (78.6%) were preoperatively diagnosed before the 10th gestational week; 44 (62.9%) were operated before the 15th gestational week. The spontaneous abortion rate in 80 cases followed up after surgery was only 10%, 61 patients (76.3%) progressing to full‐term delivery. Five malignant tumors included three epithelial carcinomas, one embryonal carcinoma and one dysgerminoma. Conclusion: Ovarian surgery in the first trimester for persistent or enlarging masses is important to obtain a final histologic diagnosis and rule out malignancy.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02718-X

出版商:Wiley    

年代:1999

数据来源: WILEY