摘要:

AbstractTamoxifen has been used as an adjuvant therapy for breast cancer for nearly two decades. The benefits of adjuvant tamoxifen therapy in prolonging disease‐free and overall survival have been shown in randomized clinical trials. Despite this, some developing evidence suggests that tamoxifen causes a 2‐ to 3‐fold increase in endometrial cancer. This paper reviews the reports of endometrial carcinoma in tamoxifen‐treated patients. Two hundred fifty cases of endometrial carcinoma are reported, but only one case is identified in a premenopausal woman. When documented, 77% (n= 127) of the cases are good‐grade (grade 1 or 2) and 80% (n= 125) are stage‐I disease. Since the distribution of good grade (79%) and stage I (74%) from the Surveillance, Epidemiology and End Results (SEER) data are comparable, concerns about more aggressive or late‐stage disease appear to be unwarranted. The modest increase in the incidence of early‐stage, good‐grade endometrial carcinoma described during tamoxifen therapy suggests that it would be unreasonable to institute an aggressive detection strategy of endometrial biopsies. This approach would only lead to further detection bias and would not be cost‐effective. Physicians should ensure that patients do not have pre‐existing endometrial cancer prior to adjuvant tamoxifen therapy for breast cancer and, furthermore, they should educate patients about signs and symptoms of early endometrial carcinoma and when reported these should be followed up with a gynecologic examination.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02387-R

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: The study was carried out to assess the clinical value of serum CA 125 in association with serum β‐human chorionic gonadotropin (hCG) for predicting pregnancy outcome. Methods: One hundred spontaneous pregnancies, 52 non‐threatened pregnancies and 48 with threatened abortions, observed in the Department of Obstetrics and Gynecology at the University ‘La Sapienza’, Rome, Italy, were evaluated during the first trimester using ultrasound examination, CA 125 and β‐hCG titrations. Results: Threatened pregnancies had statistically significantly higher CA 125 serum values than non‐threatened pregnancies, especially those with a negative outcome (P<0.01). The CA 125 levels in the threatened pregnancies were positively correlated with the tropho‐decidual hematoma volume (r = 0.839, P<0.0001). The CA 125‐β‐hCG association showed a higher prognostic value (sensitivity 78.9%, specificity 96.5%) in assessing pregnancy outcome than CA 125 or β‐hCG alone (sensitivity 78.9% and 57.9%, respectively; specificity 75.8% and 86.2%, respectively). Conclusions: Our findings are in accordance with the hypothesis of a tropho‐decidual origin of this marker, suggesting its possible usefulness in the prognostic evaluation of first trimester threatened abortion.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02371-I

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: The purpose of this study was to compare the efficacy of nifedipine (Cordipin) and hydralazine in lowering blood pressure in severe preeclampsia. Method: A randomized, prospective study of 104 patients with severe preeclampsia in the Department of Obstetrics and Gynecology, Korle‐Bu Teaching Hospital, Accra, Ghana, was conducted between January 1992 and June 1994. Results: Of the 104 patients recruited into the study, six did not deliver at our hospital and were thus excluded from the study. Nifedipine and hydralazine as first‐line drugs controlled the blood pressure in 44 and 35 patients, respectively, but failed in 5 and 14, respectively. This was statistically significant (P<0.05). The mean birth weight was higher in the nifedipine group (2500 ± 800 g vs. 2400 ± 800 g). There were 11 admissions to the neonatal intensive care unit in the nifedipine group and 13 in the hydralazine group but the difference was not statistically significant. Conclusion: Nifedipine and hydralazine could both be used effectively to control blood pressure in severe preeclampsia in our subregion. While hydralazine is administered intravenously and needs strict monitoring, nifedipine is more effective, is easy to administer orally, less demanding on hospital staff, convenient and more predictable.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02372-J

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjective: The purpose of this study was to determine whether the incidence of urinary tract infections and postpartum endometritis were increased in preeclamptic pregnancies. Method: We conducted a retrospective study of 13 852 pregnant women, using a perinatal database at The Johns Hopkins Hospital, over the past 5 years. The incidence of urinary tract infections and postpartum endometritis was analyzed using the chi‐squared test and logistic regression analysis. Statistical significance was set at P<0.05. Results: There were 345 (2.5%) mild preeclamptics and 440 (3.2%) severe preeclamptics. The incidence of urinary tract infections and postpartum endometritis in preeclamptic patients was significantly higher than that in non‐hypertensive pregnant patients. After controlling for confounding variables, severe preeclampsia was still found to be an independent significant risk factor for both urinary tract infections and postpartum endometritis. Conclusion: Our data show a significant increase in urogenital infection in preeclamptic pregnancy. This may reflect higher rates of underlying renal disease and placental bed abnormalities occurring in preeclampsia.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02373-K

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjectives: To investigate the activity of the smooth muscles in the cervix at the onset of induced labor and to further elucidate this activity in relation to uterine contractions and to the duration of the latent phase of labor, taking cervical ripeness into account. Methods: Cervical electromyographic (EMG) activity was studied at the onset of labor induced with amniotomy and oxytocin. Bipolar measurement of cervical electrical activity was performed. The root mean square of the cervical EMG activity and the intensity of intrauterine pressure in two groups of parturients with different cervical ripeness were compared. Results: The EMG activity was higher in the group with lower Bishop scores. We found a significant positive correlation between EMG activity and duration of the latent phase of labor. Conclusion: Smooth muscles in the human cervix are active during labor and act to some extent independently of the uterine corpus.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02374-L

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To investigate free α‐human chorionic gonadotropin (hCG) as a marker of preeclampsia. Methods: Four groups of patients were studied: normal pregnancies, preeclampsia, eclampsia and normal pregnant women<20 weeks' gestation. Patients were further divided according to parity and gestational age (≤20, 21–30, 31–40 weeks). An immunoradiometric assay employing monoclonal antibodies specific for free α‐hCG was used. Results: A total of 313 patients were analyzed. Thirty‐four patients ≤20 weeks' gestation were followed until delivery: five (14.7%) developed preeclampsia; none had abnormal α‐hCG levels before onset of preeclampsia. Patients with preeclampsia (21–30 weeks' gestation) demonstrated a mean α‐hCG level greater than that of normotensive controls but this was not statistically significant. Between 31 and 40 weeks' gestation, mean α‐hCG levels in the hypertensive and control groups were 210.8 ng/ml and 115.8 ng/ml, respectively (P<0.001). A stronger association was observed between α‐hCG and preeclampsia with increasing gestational age (relative risk [RR]2.07, 21–30 weeks; RR 3.02, 31–40 weeks) and severity (RR 4.51, mild; RR 12.15, severe; RR 16.88, eclampsia). Conclusion: There is a strong association between α‐hCG and preeclampsia, nevertheless this test is unsuitable for predicting preeclampsia.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02375-M

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To examine the efficacy of magnesium sulfate (MgSO4) as an anticonvulsant in eclampsia and imminent eclampsia. Methods: Case records of 562 consecutive patients with eclampsia and 174 with imminent eclampsia treated at the Institute of Obstetrics and Gynaecology, Hyderabad, India, during the 3‐year period from January 1987 to December 1989, were reviewed. Management consisted of: (1) MgSO4to control convulsions; (2) sublingual nifedipine to control hypertension; and (3) delivery of the fetus. Results: Convulsions were controlled in 95% of cases with the initial dose of magnesium and within half an hour in a further 2%. Cesarean section was performed mainly for obstetric indications. Depression of knee jerks was found to be the first sign of impending magnesium toxicity and with the precautions observed, magnesium toxicity was negligible. Maternal mortality was 2.4% (18 maternal deaths) and perinatal mortality 36% (247 perinatal deaths). Sixteen women with eclampsia (2.8%) and two with imminent eclampsia (1.1%) died. Of the 247 perinatal deaths, 61 were in the category of imminent eclampsia. There were 10 sets of twins. Cerebrovascular accident was the leading cause of maternal death. Fetal deaths and prematurity were important causes of perinatal loss. Conclusions: The control of convulsions is the most important aspect in the management of eclampsia, and MgSO4is a very effective anticonvulsant.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02388-S

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To determine the effects of regular exercise on women receiving danazol for the treatment of endometriosis. Methods: Thirty‐nine patients were randomized to a danazol‐only or a danazol/exercise regimen in a prospective clinical trial carried out at tertiary care institutions. Patients in the danazol/exercise group were instructed to exercise four times per week, for 40 min per session, at an intensity of 20 metabolic units. Side effect profiles, pelvic symptoms, aerobic fitness, strength and hormone levels were compared for all subjects. The number of side effects of danazol was analyzed by the method of generalized estimating equations. Results: The number of side effects reported during a 4‐week period was 1.09–2.17 times greater for the danazol‐only than for the danazol/exercise group. All patients had improvement of symptoms during treatment. The danazol/exercise group had significantly lower testosterone levels during treatment. The time to recurrence of endometriosis was not different between groups. Conclusions: Exercise during danazol therapy reduces the number of androgenic side effects. Relief of pain and time to recurrence are unaffected.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02359-K

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To examine the expression of interleukin‐1 (IL‐1) and IL‐1 receptor antagonist (IL‐1ra) in the human endometrium in the follicular and luteal phases. Methods: The concentrations of IL‐1α and IL‐1β in the culture supernatants of endometrial cells were determined by enzyme‐linked immunosorbent assay. Transcription of the IL‐1ra gene in the endometrium was investigated by reverse polymerase chain reaction (PCR). Human endometrium was immunohistochemically stained using a monoclonal antibody specific to IL‐1ra. Results: The concentrations of IL‐1α and IL‐1β in the culture supernatants were 11 and 55 pg/ml, respectively, in the follicular phase, and 10 and 40 pg/ml, respectively, in the luteal phase. The concentration of IL‐1ra was 465 pg/ml in the follicular phase and 1710 pg/ml in the luteal phase. Densitometric analysis of the reverse PCR products showed that the expression of IL‐1ra mRNA was increased in endometrial cells in the luteal phase. Immunohistochemical staining revealed that epithelial cells were the main source of IL‐1ra in human endometrium. Conclusions: Human endometrial cells produce IL‐1 (mainly IL‐1β) and IL‐1ra. The level of IL‐1ra production in human endometrial epithelial cells was greater in the luteal phase than in the follicular phase due to the increased transcription of the IL‐1ra gene.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02366-K

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjectives: To assess the efficacy and risks of laparoscopic para‐aortic lymph node sampling compared with standard laparotomy in staging cervical carcinoma. Methods: From August 1993 through July 1994, 38 patients with biopsyproven invasive cervical carcinoma (24 early and 14 advanced invasive cancers) were entered into the study. This was a prospective study of laparoscopic para‐aortic lymphadenectomy in invasive cervical carcinoma, with patients serving as their own controls. Video laparoscopic lymph node sampling was performed. In patients with early invasive cancer, the nodes were sent for frozen section and, if negative, laparotomy was performed to look for any residual nodes. Radical hysterectomy was performed immediately if residual nodes were negative. Patients with either nodal metastasis on frozen section or with advanced cancer underwent para‐aortic lymphadenectomy only. The operative technique was also evaluated. Results: Laparoscopy required an average of 77 min (S.D. 40), with an average blood loss of 116 ml (S.D. 321). The average number of nodes was 15 (S.D. 7). At subsequent laparotomy the average number of residual nodes found was 0.4 (S.D. 0.9) and none showed metastasis. One vena cava laceration and one ureteral injury required immediate repair, and two patients were too obese to undergo laparoscopy. Conclusions: Laparoscopic para‐aortic lymph node sampling is a less invasive, reliable method for staging invasive cervical carcinoma and can substitute for traditional open procedures. The incidence of risks with this method appears to be low.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02367-L

出版商:Wiley    

年代:2000

数据来源: WILEY