摘要:

Objective:To describe patient characteristics and diagnoses associated with hysterectomy in the United States from 1988‐1990 using data from the National Hospital Discharge Survey.Methods:We analyzed data from the National Hospital Discharge Survey, an annual probability sample of discharges from nonfederal, short‐stay hospitals in the United States. A population‐based sample of all women aged 15 years or older in the United States civilian population who had a hysterectomy during 1988‐1990 was examined to characterize factors associated with hysterectomy: patients' age and race, diagnoses, surgical approach, and oophorectomy.Results:Approximately 1.7 million women had a hysterectomy during 1988‐1990. The highest rates—100.5 hysterectomies per 10,000 women—were for women aged 30‐54 years. Total rates of hysterectomy for black women were similar to those for white women (61.7 and 56.5 per 10,000 women, respectively); uterine leiomyoma (“fibroid tumor”) was reported as the primary diagnosis for 61% of black women and 29% of white women. Abdominal surgery was used for 75% of all hysterectomies. Concomitant bilateral oophorectomy was done for 37% of the women under 45 years old and 68% of the women 45 years or older.Conclusions:Two‐thirds of all hysterectomies for noncancerous conditions were performed for uterine leiomyoma or endometriosis—conditions that are most common before the age of menopause. Future assessments of the appropriateness of hysterectomy will require better understanding of these disorders. Continued monitoring of hysterectomy rates is critical to understanding the appropriate use of hysterectomy, alternative therapies for uterine disorders, and future trends in women's health care.(Obstet Gynecol 1994;83:549‐55)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the effect of hysterectomy for nonmalignant conditions on symptoms and quality of life and to identify adverse effects 1 year after surgery.Methods:The Maine Women's Health Study was a prospective cohort study of 418 women ages 25‐50 years under‐going hysterectomy for any nonmalignant condition. Patients recruited from the practices of 63 physicians performing hysterectomy throughout Maine were interviewed at the time of surgery and 3, 6, and 12 months later. Clinical and hospitalization data were obtained from physician reports and from a statewide hospital discharge data base. The primary outcomes of interest were symptom relief, changes in quality of life, and the development of new symptoms or problems during the year following surgery.Results:The most frequent indications for hysterectomy were leiomyomas (35%), abnormal bleeding (22%), and chronic pelvic pain (18%). For these indications, hysterectomy resulted in marked improvements in a range of symptoms, including pelvic pain, urinary symptoms, fatigue, psychological symptoms, and sexual dysfunction. Significant improvements in scores for indices of mental health, general health, and activity were evident at 6 months and sustained at 1 year. New problems after hysterectomy (measured in those free of the symptom preoperatively) included hot flashes (13%), weight gain (12%), depression (8%), and lack of interest in sex (7%).Conclusions:Hysterectomy is highly effective for relief of symptoms associated with common nonmalignant gynecologic conditions. Symptom relief following hysterectomy is associated with a marked improvement in quality of life. New problems are reported after hysterectomy by a limited number of women.(Obstet Gynecol 1994;83:556‐65)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the effect of nonsurgical management of leiomyomas, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life.Methods:We performed a prospective cohort study of women receiving nonsurgical management (n= 380) or hysterectomy (n= 311) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Maine were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of physical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity.Results:Medical therapy for abnormal bleeding and chronic pelvic pain produced significant improvements in symptoms and quality of life. However, almost one‐quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgical therapy, 25% with abnormal bleeding and 50% with chronic pelvic pain reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treated nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regression analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlated with a positive outcome at 1 year for all three conditions.Conclusions:Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.(Obstet Gynecol 1994;83:566‐72)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the effectiveness and perioperative morbidity of the modified Pereyra procedure in the treatment of recurrent stress urinary incontinence.Methods:Data of 54 patients who underwent a modified Pereyra procedure for the treatment of recurrent stress urinary incontinence between January 1, 1978, and August 1, 1992, were analyzed retrospectively regarding presenting symptoms, preoperative evaluation, surgical procedure, complications, and cure and failure rates. The patients were divided into two groups depending on the preoperative absence (group I) or presence (group II) of risk factors for repeated failure (detrusor instability, low‐pressure urethra, fibrotic urethra, negative Q‐tip test, and neurogenic incontinence).Results:After a mean follow‐up of 36.3 months, the cure rate of 81.6% in group I (N= 38) was significantly (P= .005) higher than that in group II (N= 16; 43.8% cured). The mean time of occurrence of failure was 11.9 months for group I and 6.8 months for group II. The incidence of intraoperative complications (Pereyra suture in bladder, hemorrhage) for both groups was 7.4%. Immediate postoperative complications were found in 25.9% of all patients; these were mainly infectious processes. Late postoperative complications occurred in 33.3%, with the most prevalent being new‐onset urge incontinence and de novo detrusor instability (11.1%) and obstructive voiding dysfunction (9.3%). The rates of perioperative morbidity were not significantly different between the groups.Conclusion:The modified Pereyra procedure is well suited for the treatment of uncomplicated recurrent stress urinary incontinence, with a long‐term cure rate of over 80%. However, success rates are significantly lower for recurrent stress incontinence in association with persistent risk factors for failure. In either instance, the procedure is associated with appreciable perioperative morbidity.(Obstet Gynecol 1994;83:573‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To investigate the relation between handedness and age at menarche or age at menopause, as both handedness and reproductive variables have been suggested to be influenced by the intrauterine endocrine environment.Methods:Self‐reported information on handedness, age at menarche, age at menopause, and other demographic and reproductive variables was recorded for 10,328 women still menstruating or in natural menopause. These women had been selected as controls in a multicenter case‐control study of breast cancer conducted in the 1960s. Left‐handedness (including ambidexterity) was modeled as the outcome variable through multiple logistic regression.Results:After adjusting for center, age, menopausal status, age at menopause, years of schooling, and parity, there was no significant relation of handedness to age at menarche (odds ratio for each year delayed 1.01, 95% confidence interval [CI] 0.97‐1.06) or age at menopause (odds ratio 1.00, 95% CI 0.98‐1.02).Conclusion:These findings lend no support to the hypothesis that intrauterine endocrine variables associated with handedness also are related to reproductive variables.(Obstet Gynecol 1994;83:579‐82)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether women with abnormal Papanicolaou smears who received educational brochures at the initial booking for colposcopy were more likely to complete recommended treatment and follow‐up after 18‐24 months than were those who did not receive the brochures.Methods:One hundred eight women participated in an earlier randomized study of the effect of educational brochures on emotional distress and knowledge about abnormal Papanicolaou smears. Their medical records were reviewed 18‐24 months later for completed treatment and follow‐up compliance.Results:Women who received the brochure had more completed treatment and follow‐up compliance (75.4%) than did those who did not receive the brochure (45.8%). The difference in compliance was 30% (99% confidence interval [CI] 6‐54%,P= .002). There were no significant differences in age, education, marital status, or levels of emotional distress between subjects with complete and incomplete follow‐up. Knowledge of the recommended number of follow‐up visits was greater in women who completed follow‐up (difference in frequency 30.4%; 99% CI 7‐54%,P= .002). All women with completed treatment and follow‐up who had received the brochure found it helpful.Conclusions:Given the high patient acceptability and demonstrated effectiveness in improving completed treatment and follow‐up compliance, educational brochures should routinely accompany, or immediately follow, notification about abnormal Papanicolaou smears.(Obstet Gynecol 1994;83:583‐5)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether lymphocytic infiltration of the endometrium accompanies human immunodeficiency virus (HIV) infection.Methods:Endometrial samples from 12 HIV‐infected women and from rigorously matched controls were examined. The following markers were used: common leukocyte antigen (CD45), T lymphocytes (CD3), monocytes‐macrophages (CD68), and CD4 and CD8 lymphocytes. Cell counts were performed without knowledge of HIV status. Factors considered in relation to these markers were menstrual symptoms, pelvic pain, peripheral blood CD4+ count, and time since seroconversion.Results:Histology showed conventional features of chronic endometritis in only one case. In the remainder, the endometrium of HIV‐infected women, compared with controls, showed an increase in CD45 cells (P< .02) and an increase in CD3 staining cells (P< .05). This appeared to be restricted to those with menstrual symptoms, and this group also had lower peripheral blood CD4 counts. There was no difference in cells of the monocyte‐macrophage series (CD68). In contrast to control samples, CD4 lymphocytes were infrequent or absent in the endometrium of HIV‐infected women, regardless of peripheral blood CD4 count or presence of menstrual symptoms; however, this was not universal, as one sample showed an area of dense CD4 cell infiltration. The ratio of CD4 to CD8 was reduced in HIV‐seropositive samples compared with controls (P< .02).Conclusion:We hypothesize that chronic endometritis of a nonclassical form may be common in advancing HIV disease, possibly directed against HIV‐infected cells or self‐determined antigens. This could be associated with morbidity and may represent a reservoir of infection. Endometrial depletion of CD4 cells is a common, but not universal, feature and may be independent of immune compromise.(Obstet Gynecol 1994;83:586‐93)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To evaluate laparoscopic treatment of postmenopausal women with an adnexal cystic mass predicted to be benign.Methods:Selection criteria were transvaginal sonographic appearance other than a complex cyst and a normal serum CA 125 level. During the period May 1988 to June 1993, 55 women fulfilled the criteria and underwent operative laparoscopy. During the same period, 75 postmenopausal women underwent exploratory laparotomy for an adnexal cystic mass that was complex in appearance or associated with elevated serum CA 125.Results:Laparoscopic bilateral oophorectomy was performed in all 55 women. All had benign masses (positive predictive value 100%). Malignant tumors were found in 23 of the 75 women undergoing laparotomy (negative predictive value 30.7%). There was no significant difference in size of the tumors between women undergoing laparoscopy or laparotomy.Conclusion:Because of its safety and efficacy, laparoscopic management is the preferred procedure in postmenopausal women with a non‐complex adnexal mass and a normal CA 125 level.(Obstet Gynecol 1994;83:594‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the feasibility of laparoscopic staging in patients with presumed early stage but incompletely surgically staged adenocarcinoma of the endometrium.Methods:Thirteen patients with incompletely staged adenocarcinoma of the endometrium underwent laparoscopic staging. The women ranged in age from 36‐74 years (mean age 64) and weighed 132‐201 1b (mean 147.5). The interval between hysterectomy and laparoscopic staging ranged from 14‐63 days, for an average of 47. All patients underwent inspection of the entire intraperitoneal cavity, procurement of pelvic washings, and/or pelvic or para‐aortic lymphadenectomy, and two patients had remaining ovaries removed.Results:Extrauterine disease was found in three patients: One had intraperitoneal washings positive for adenocarcinoma, and two had pelvic lymph nodes positive for microscopic carcinoma. The average number of lymph nodes removed was 17.5. There were no intraoperative complications. Estimated blood loss averaged less than 50 mL, and the mean hospital stay was 1.5 days.Conclusion:Our initial experience indicates that this is a safe, effective procedure that offers a short hospital stay. We consider laparoscopic staging an attractive option for some patients with incompletely staged early adenocarcinoma of the endometrium.(Obstet Gynecol 1994;83:597‐600)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the severity of emesis caused by ultra‐high‐dose cisplatin‐carboplatin chemotherapy and to compare the antiemetic efficacy of an ondansetron regimen and a metoclopramide regimen.Methods:Forty consecutive patients with stage III or IV epithelial ovarian cancer or advanced or recurrent endometrial cancer were treated with ultra‐high‐dose cisplatincarboplatin chemotherapy. No patient had received prior chemotherapy. Chemotherapy consisted of intravenous (IV) cisplatin 70 mg/m2and IV carboplatin 100 mg/m2administered on days 1 and 8 every 28 days for five cycles, representing a total monthly organoplatin dose of 207 mg/m2. Patients were randomized to receive metoclopramide, diphenhydramine, prochlorperazine, and lorazepam; or ondansetron, dexamethasone, prochlorperazine, and lorazepam. Patients were blinded and there was no crossover. The metoclopramide dose was 2 mg/kg IV every 2 hours × 3, and the ondansetron dose was 0.15 mg/kg IV every 4 hours × 3.Results:All 40 patients developed vomiting; 21 (52%) developed severe vomiting and seven (17%) required home IV therapy (grade 4). Eight patients (40%) receiving the metoclopramide regimen developed severe vomiting, compared to 13 (65%) in the ondansetron group (P= .50). Two patients (10%) in the metoclopramide group developed grade 4 vomiting, compared to five (25%) in the ondansetron group (P= .45). Except for sedation and amnesia, there were no significant side effects associated with either regimen.Conclusion:Neither regimen was effective in preventing high‐dose cisplatin‐carboplatin‐induced emesis, and the ondansetron regimen did not appear to be superior.(Obstet Gynecol 1994;83:601‐4)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID