摘要:

AbstractObjective: To determine whether there is a relationship between plasma glucose level in a glucose screening test and the occurrence of pre‐eclampsia in non‐diabetic pregnant women. Methods: All pregnant non‐diabetic women attending the antenatal clinic at the Aga Khan University Medical Center were screened with a 75 g — 2 h glucose challenge test (GCT). From 1988–1990, a data base of 1316 cases was compiled for use in this study. Of these, 67 had to be excluded because of one or more abnormal levels in the 75 g — 3 h oral glucose tolerance test (GTT) that required treatment to maintain euglycemia. Among the remaining patients (n = 1249) who had no evidence of glucose intolerance and were included in the analysis, there were 42 cases of pre‐eclampsia. The association between pre‐eclampsia and plasma glucose level in the GCT was evaluated using logistic regression analysis that adjusted for effects of age and gravidity. Results: The odds of having pre‐eclampsia were increased by 20% (95% confidence interval 0%–44%) per mmol/1 rise in plasma glucose level in the GCT. The same statistic for age was 9% (95% confidence interval 2%–17%), and for primigravidity it was 210% (95% confidence interval 55%–517%). There was no significant interaction between these variables. Conclusions: Minor degrees of glucose intolerance, age and primigravidity are associated with a higher occurrence of pre‐eclampsia in non‐diabetic pregnant women.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02634-7

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: To describe the experience of management of gestational diabetes ‘GDM’ among a high‐risk population and to determine the relative contribution of maternal risk factors and some indices of glucose intolerance on pregnancy outcome. Methods: A total of 173 antenatal patients with GDM, matched to 337 non‐diabetic controls were evaluated. Incidences of fetal macrosomia, large birth weight (>4000 g), and operative delivery were noted. Patients with GDM were subgrouped into group I and II, according to the fasting blood glucose (FBG) level on the glucose tolerance test ‘GTT’, whether ≥ or4 kg, and operative delivery. Conclusion: Among patients with gestational diabetes, a GTT with a FBG level ≥ 5.8 mmol/l is a strong predictor for perinatal outcome. Maternal weight is an independent risk factor that increases the risk of both macrosomia and operative delivery.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02635-5

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To study the relationship between epidural analgesia and instrumental and non‐elective cesarean delivery in the 1990s in Finland. Methods: The data was extracted from a nationwide birth register in 1991–1993. To adjust for other factors, hospital‐based analyses were made separately for different types of hospitals and in individual‐based analyses logistic regression was used. Results: In the hospital‐based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual‐based analyses are partly due to selection bias, and partly to different hospital policies. Conclusions: The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02641-X

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjectives: A retrospective study to confirm the clinical impression of an increasing prevalence of granuloma inguinale (GI) in women, and to evaluate its association with pregnancy and HIV infection. Methods: Clinical records of all patients with a definitive diagnosis of GI attending the gynecology and antenatal clinics at King Edward VIII Hospital, Durban, South Africa, over a period of 36 months (January 1991–December 1993). Results: A total of 123 women were diagnosed with GI. The diagnosis was made by tissue smear alone in 21% (n = 26), histology 43% (n = 53) and by a combination of smear and histology in the rest. Forty‐two percent (n = 52) were pregnant. The only difference between pregnant and non‐pregnant women were the presence of rectal and pelvic lesions in the latter. Sixty‐nine percent (n = 36) delivered vaginally while the remaining (n = 16) were delivered by cesarean section. The indications for cesarean section were obstetric except for a patient in labor with extensive untreated vulval granuloma. In the majority (85%) GI had no influence on pregnancy outcome. There was no evidence of congenital GI in the neonates. Twenty‐seven percent (30/113) had positive syphilis serology and 16% (18/110) had antibody to HIV. There were no differences in the clinical features and outcome of HIV positive and negative women. Conclusion: This study shows that GI is increasing in pregnancy in Durban, South Africa. Despite the concern that pregnancy promotes dissemination of GI, such an effect could not be established as the clinical response to treatment and outcome were similar in both pregnant and non‐pregnant women. Infection with HIV also did not alter the clinical presentation and outcome of the disease in the patients studied.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02648-7

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To examine the long‐term survival of patients with borderline ovarian carcinomas. Method: A population‐based retrospective analysis of patients registered with West Midlands Regional Cancer Registry. The files of all patients registered with ovarian carcinoma during the triennium 1985–1987 were examined and those with borderline ovarian carcinomas identified. Results: During the period, 1654 patients were registered, of whom 1344 had histologically confirmed ovarian carcinoma. From these 54 (4%) patients had borderline tumors — all Stage I or II. Follow‐up ranged from 5 to 10 years, with only 2 patients identified where death was due to recurrent ovarian malignancy. Conclusions: Epidemiological studies avoid the bias associated with hospital‐based series, and enable a crude evaluation of practice standards. From this series certain areas were identified where management could be improved. Thus the information gleaned can be utilized to address such issues, and comparative studies performed in the future to assess the impact of any changes made. The series confirms the excellent prognosis associated with early stage borderline ovarian carcinomas.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02642-8

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjective: To evaluate adhesion formation after classic abdominal myomectomy and the role of early, second‐look laparoscopic adhesiolysis in the management of post‐myomectomic pelvic adhesions in a prospective study. Method: Forty‐eight patients with infertility, recurrent abortion or symptomatic myoma underwent second‐look laparoscopy (SLL) 8 days after abdominal myomectomy. The degree of adnexal adhesions were scored according to the American Fertility Society Classification and were lyzed laparoscopically. The success of the SLL was evaluated in 18 patients who underwent a third‐look procedure (cesarean section or laparoscopy) Results: Myomectomy incisions on the posterior uterine wall were associated with more adhesions than that on the fundus or anterior wall (P<0.01). Myomectomies performed on uteri larger than 13 weeks gestation resulted in significantly higher adhesion scores than smaller ones (P<0.001) and mainly intra‐mural myomas than only sub‐serous ones (P<0.01). More than one uterine incision was found to result in more adhesions (P0.05). In the patients who underwent a third‐look procedure, adhesion scores were found to be significantly lower than the SLL (6.2 ± 6.4 vs. 3.1 ± 3.4) (P<0.01). Conclusion: Myomectomy operations frequently result in pelvic adhesions, which may impair fertility. Early laparoscopy and adhesiolysis after myomectomy is useful for assessing the degree of adhesions, technical ease in performing adhesiolysis and resulting in lower adhesion scores as shown by third‐look procedures.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02644-4

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: Fifty patients with malignant ovarian germ cell tumors, which accounts for 10.8% of all ovarian malignancies, were treated from 1977 through 1994. Their cases are reviewed. Methods: The histology includes endodermal sinus tumor (EST) in 15 patients, immature teratoma in 14, dysgerminoma in 13, and mixed germ cell tumor in eight. The mean age at presentation was 21.5 years and mean primary tumor diameter was 16 cm. All patients underwent surgery as the initial treatment, and 10 received more than one operation. Postoperative adjuvant chemotherapy was not given to cases with stage Ia immature teratoma and dysgerminoma. VAC (vincristine, actinomycin D, cyclophosphamide) and BVP (bleomycin, vinblastine, cisplatin) regimens were utilized in early 1980s for EST and advanced‐stage tumors of immature teratoma and dysgerminoma. BEP (bleomycin, etoposide, cisplatin) and EP (etoposide, cisplatin) regimens were applied in advanced‐stage disease and some stage I disease since 1990. VIP (VP‐16, ifosfamide, cisplatin) regimen was employed as salvage regimen in cases where other combinations failed. Results: α‐Fetoprotein (AFP) was elevated in every tumor containing endodermal sinus element, and AFP served as a good indicator for prediction of tumor recurrence. The follow‐up time ranged from 5 to 144 months with the mean of 54.5 months. Conclusions: The survival rate for EST was 54%, that for immature teratoma and dysgerminoma was 85% and 90%, respectively.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02657-4

出版商:Wiley    

年代:1999

数据来源: WILEY

摘要:

AbstractObjectives: The average age of menopause among women in Mexico City was calculated, considering their reproductive and socio‐demographic characteristics. The information was obtained from a population‐based control group from a case‐controlled study of gynecologic cancer. Methods: Interviews were carried out with 1005 women resident in Mexico City chosen at random from a sample using the housing sample framework of the Mexico General Directorate of Epidemiology, 472 of whom had undergone a natural menopause. Results: The most important results include an average age for menopause in this population of 46.5 ± 5 years (95% C.I. 46–48) with a median of 47. Groups of women with an average early menopause were those with no formal education (1.6 years), low socio‐economic level (1.3 years, P<0.05), nulliparas (2.6 years, P<0.05), those who had never breastfed (2.2 years, P<0.05) and those who had not used contraceptive hormones (1.7 years, P<0.05). Conclusion: This phenomenon must be documented in Mexico because of its strong links with the morbidity and mortality of the growing number of women who are reaching advanced ages and whose survival is calculated at 30 years after menopause.

ISSN:0020-6695    

DOI:10.1016/0020-7292(96)02655-0

出版商:Wiley    

年代:1999

数据来源: WILEY

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02645-2

出版商:Wiley    

年代:1999

数据来源: WILEY

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02646-0

出版商:Wiley    

年代:1999

数据来源: WILEY