摘要:

ObjectiveTo determine whether gonadal steroids and insulin-like growth factor I influence the final cervical remodeling during parturition.MethodsCervical biopsies were obtained transvaginally before labor (n= 10) and after spontaneous cervical ripening and vaginal delivery (n= 20). Levels of estrogen and progesterone receptors, their messenger RNAs, insulin-like growth factor I messenger RNA, and serum estradiol and progesterone were measured. Collagen and proteoglycan concentrations and compositions were measured to estimate the degree of cervical ripeness.ResultsThe concentrations of estrogen and progesterone receptors decreased in comparison with the clinically unripe cervix before labor. The median estrogen receptor concentration (range) decreased from 10 (2–18) to 4.5 (2–14) fmol/mg protein (P< .01), and the progesterone receptor concentration from 105.5 (32–153) to 74 (30–115) fmol/mg protein (P< .05), whereas their messenger RNA levels were unchanged. The insulin-like growth factor I messenger RNA concentration declined from 16.1 (8.4–20.4) at term to 8.9 (1.5–18.5) amol/μg DNA after parturition (P< .01). The collagen solubility by pepsin increased, but not significantly, and the collagen concentration was unchanged. The concentration of small proteoglycans, mainly decorin, decreased from 1.59 (1.20–1.97) to 0.84 (0.24–1.41) μg/mg wet weight (P< .001), and the concentration of versican increased, but not significantly (P= .07).ConclusionConcentrations of estrogen and progesterone receptors and insulin-like growth factor I messenger RNA were decreased significantly after spontaneous cervical ripening in comparison to levels before labor. These changes coincided with a tendency toward increased collagen solubility and a decline in concentration of small proteoglycans, which probably alters collagen organization, thus allowing for cervical softening and dilation. These observations suggest that gonadal steroids influence the final cervical remodeling during parturition, an influence perhaps mediated by insulin-like growth factor I.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables.MethodsFor the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions.ResultsPostpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect of “time awake” at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss.ConclusionWomen must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the effects of age, bone mineral density, risk of cardiovascular disease, and of breast cancer on the prevalence of hormone replacement therapy (HRT) prescriptions.MethodsSeventeen charts of postmenopausal women were summarized. For each chart, we constructed 36 different cases by modifying the age (two levels), the bone mineral density (three levels), the cardiovascular risk (three levels), and the breast cancer risk (two levels). Twelve cases of these 612 files were sent to each Belgian gynecologist (n= 1010).ResultsOverall, HRT was prescribed in 67% of the cases. It was prescribed in 54.6% of women who had a normal bone mass, 67.9% of women with a low bone mass, and 79.0% of those with osteoporosis (P< .001). The prescription rate was higher in younger women (mean ± standard deviation 55 ± 4 years) than in their peers who were 10 years older (79.3% versus 55.2%;p< .001). No significant variation was observed in relation to the cardiovascular risk profile or to breast cancer risk.ConclusionOsteoporosis is associated with an increased rate and older age with a decreased rate of HRT prescription, whereas no difference is observed in association with cardiovascular or breast cancer risk.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the effect of insulin-lowering treatment on menstrual cyclicity in polycystic ovary syndrome (PCOS).MethodsForty oligoamenorrheic women with PCOS were recruited in a prospective clinical study to receive metformin for a minimum period of 6 months. Twenty-two women completed the study. Serum LH, FSH, free testosterone, and glucose and insulin response to oral glucose load were measured both before and after 8 weeks of metformin treatment. Menstrual cyclicity and serum progesterone levels at the midluteal phase were assessed at the 30th week of metformin treatment.ResultsTwenty-one of 22 women had restoration of menstrual cyclicity (95.7%). Four of these women (19%) became pregnant within the 6th and 7th months of treatment. All four of the pregnant women delivered, and the infants were healthy. Thirteen of 15 women who had regular menses demonstrated a serum progesterone level within the ovulatory range (3.1–28 ng/mL). Fasting (P< .001) and the integrated insulin response to the glucose load decreased (P< .001) after 8 weeks of metformin treatment. This was accompanied by significant decreases in serum LH (P< .001) and free testosterone (P< .001) levels and LH/FSH ratio (P< .001). There was a small but significant reduction in body mass index after 8 weeks of metformin treatment (P< .001).ConclusionA 6-month course of metformin may improve menstrual cyclicity and fertility in women with the PCOS. Insulin-sensitizing agents provide a rational approach to the treatment of the metabolic and endocrine abnormalities in PCOS women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the endometrial effects of three different doses of progesterone administered vaginallyMethodsForty women 25–41 years old deprived of ovarian function received estradiol (E2) for 28 days. From days 15 to 27, a new mucus-like vaginal gel of progesterone was administered every other day, randomly, dosed at 45 mg (group A,n= 14), 90 mg (group B,n= 13), or 180 mg (group C,n= 13). Plasma gonadotropins, estrone, E2, and progesterone were measured. An endometrial biopsy was performed on day 20 (n= 20) or 24 (n= 20) for endometrial dating and for estrogen and progesterone receptor determinations.ResultsPlasma estrogen levels were in the menstrual cycle range. Mean progesterone levels were lower in group A (2.4 ± 0.2 ng/mL) than in group B (3.6 ± 0.2 ng/mL) or C (3.4 ± 0.4 ng/mL) (P< .005). Plasma FSH and LH decreased significantly during progesterone treatment. In all groups, we observed secretory transformation in the glands (day 20) and stroma (day 24) and the distribution of estrogen and progesterone receptors seen in normal menstrual cycles.ConclusionTransvaginal administration of progesterone induced normal secretory transformation of the endometrium despite low plasma levels, suggesting a direct transit into the uterus or “first uterine pass effect.”

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate steroid hormone receptor status in the uterosacral ligament, a structure that contributes to pelvic support.MethodsA descriptive study was conducted by sampling the uterosacral ligaments from 25 consecutive women undergoing hysterectomy by the primary author for nonmalignant conditions. Using immunohistochemical staining techniques, uterosacral ligaments were assessed for the presence and location of estrogen and progesterone receptors. Positive and negative controls were used. Confirmation of the uterosacral ligament was performed histologically.ResultsUsing commercially available monoclonal antibodies, estrogen and progesterone receptors were detected in the nuclei of smooth muscle cells of the uterosacral ligament in all patients, regardless of variations in age, race, menopausal status, parity, body mass index, and medications affecting serum steroid hormone levels. Hormone receptors were not found in the collagen, vascular, or neuronal components.ConclusionThe presence of estrogen and progesterone receptors in the uterosacral ligaments means that this structure may be a target for estrogen and progesterone. This finding might suggest a possible role for steroid hormones in pelvic support.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the relationships between histories of sexual or physical abuse and current reports of dissociation, somatization, substance abuse, adaptive coping, and maladaptive coping strategies among chronic pelvic pain patients.MethodsUsing a structured interview, we assessed sexual and physical abuse and somatization. The Dissociative Experiences Scale was used to assess dissociation, and an abbreviated version of the COPE scale was employed to assess adaptive and maladaptive coping strategies as well as substance abuse. Participants included 46 women with chronic pelvic pain.ResultsWomen with self-reported sexual or physical abuse histories were found to have significantly higher dissociation, somatization, and substance abuse scores than women without such a history. Significant positive correlations were found between reports of both dissociation and somatization with maladaptive coping strategies and among dissociation, somatization, and substance abuse.ConclusionThese results support the association between a positive abuse history and the high levels of dissociation, somatization, and substance abuse often noted in the chronic pelvic pain population. Findings suggest that such psychological variables are more likely to be associated with abuse than with the general medical condition. These psychological variables are conceptualized as maladaptive coping, which may be addressed as part of a biopsychosocial model of treatment for chronic pelvic pain patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare postoperative course and hospital charges of an open versus laparoscopic approach to Burch colposuspension for the treatment of genuine stress urinary incontinence.MethodsA retrospective chart review was performed to identify all patients undergoing open or laparoscopic Burch colposuspension by the same surgeon over a 2-year period. Patients undergoing additional surgical procedures at the time of colposuspension were excluded from the study. Twenty-one patients underwent open Burch colposuspension and 17 patients underwent laparoscopic colposuspension. Demographic data including age, parity, height, and weight were collected for each group. Both groups also were compared with regard to operative time, operating room charges, estimated blood loss, intraoperative complications, change in postoperative hematocrit, time required to resume normal voiding, length of hospital stay, and total hospital charges.ResultsThe laparoscopic colposuspension group had significantly longer operative times (110 versus 66 minutes,P< .01) and increased operating room charges ($3479 versus $2138,P< .001). There was no statistical difference in estimated blood loss or change in postoperative hematocrit between the two groups. No major intraoperative complications occurred in either group. Mean length of hospital stay was 1.3 days for the laparoscopic group and 2.1 days for the open group (P< .005). However, total hospital charges for the laparoscopic group were significantly higher ($4960 versus $4079,P< .01).ConclusionLaparoscopic colposuspension has been described as a minimally invasive, cost-effective technique for the surgical correction of stress urinary incontinence. Although the laparoscopic approach was found to be associated with a reduction in length of hospital stay, it had significantly higher total hospital charges than the traditional open approach because of expenses associated with increased operative time and use of laparoscopic equipment.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if the theoretic advantages of gasless laparoscopy are realized in direct comparison to laparoscopy with pneumoperitoneum.MethodsFifty-seven patients undergoing laparoscopic surgery chose to participate in this trial and were randomized after the induction of general anesthesia. Twenty-nine of the 57 patients were randomized to the pneumoperitoneum group. Of the 28 patients in the gasless group, six were converted to pneumoperitoneum because of inadequate exposure. The adequacy of exposure and ease of surgery were assessed with a subjective score, and the times to exposure and for incision closure were recorded. Various anesthetic factors were measured. Patients completed an analog pain score in the recovery area and for the first 5 postoperative days. Analgesic and antiemetic use also was recorded, as was the number of days to return to normal activity.ResultsTimes to achieve exposure and close incisions were longer, and exposure and ease of surgery were worse in the gasless group. Patients in the gasless group had lower diastolic blood pressure, minute ventilation, peak inspiratory pressures, and end tidal pCO2. There were no differences in body temperature, systolic blood pressure or heart rate, postoperative pain scores, analgesic or antiemetic use, or times to hospital discharge or return to activity between the groups.ConclusionPerforming laparoscopy using the Laparolift device compromised surgical exposure and thus increased technical difficulty. Patients realized no benefits from its use in terms of postoperative discomfort or return to activity. Eliminating the pneumoperitoneum allowed lower minute ventilation and peak inspiratory pressures, and end tidal pCO2was lower. Although the concept of gasless laparoscopy holds appeal, the current prototype is not well-suited for infertility procedures.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the screening effectiveness of speculoscopy, a magnified chemiluminescent visual examination combined with the Papanicolaou smear as compared with the Papanicolaou smear alone.MethodsThis was a prospective, practice-based study. The study participants were women aged 16–60 years who were regularly scheduled for Papanicolaou smears. All women were subject to a Papanicolaou smear and speculoscopy. Positive speculoscopy findings and/or Papanicolaou smear findings of a squamous intraepithelial lesion (SIL) were investigated further with colposcopy and biopsy.ResultsA total of 5692 women were evaluated, and 799 (14%) were positive by one or both screening tests. Of the 410 biopsy specimens that were obtained, 32 showed highgrade SIL, 191 low-grade SIL, 145 reactive and reparative cells, and 42 were found to be within normal limits. The addition of speculoscopy to the routine Papanicolaou smear resulted in finding 11 of the 32 (34%) women with highgrade SIL and 154 of the 191 (81%) women with low-grade SIL.ConclusionSpeculoscopy, when combined with the Papanicolaou smear as a screening test, yields a higher percentage of women with biopsy-confirmed cervical pathology than the use of the Papanicolaou smear as a sole screening test.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID