摘要:

OBJECTIVETo assess, from the patient's perspective, the prevalence and impact of postoperative fatigue after hysterectomy and to increase understanding of physician–patient communications before and after surgery regarding recovery and diminished postoperative energy level.METHODSWe completed a telephone survey of 300 women aged 25–50 who had undergone a hysterectomy or myomectomy within the past 2 years. The patients were recruited randomly from two national, random samples of households: 1) women aged 25–50, and 2) women taking hormone replacement therapy in the target age range. Patients were asked a series of questions about their postoperative fatigue after surgery.RESULTSOverall, 74% of patients experienced moderate-to-severe fatigue within the first few weeks after surgery. Fatigue occurred more frequently and persisted twice as long as pain, the next most frequent symptom, which was experienced by 63% of patients overall. Fatigue was the symptom that most interfered with daily activities (37%) and also contributed to feelings of frustration (52%), to depression (37%), and to difficulty in concentrating (42%). Patients employed at the time of surgery missed an average of 5.8 weeks of work; 69% of those surveyed required 2 or more weeks of caregiver assistance. Postoperative fatigue was discussed by 68% of patients' physicians before surgery, and 57% of patients discussed postoperative fatigue with their physicians after surgery. Oral iron therapy and dietary supplements were the most frequently recommended treatments; 52% of patients were not offered any treatments or recommendations to alleviate their fatigue.CONCLUSIONSFatigue is a highly prevalent posthysterectomy and myomectomy symptom and has substantial negative physical, psychosocial, and economic effects on patients during recovery.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the efficacy and safety of dexamethasone administered intravenously at three different doses (4 mg, 8 mg, 16 mg) for the prevention of nausea and vomiting after dilatation and curettage.METHODSIn a prospective, randomized, double-masked, placebo-controlled trial, 120 women received placebo or dexamethasone intravenously at doses of 4 mg, 8 mg, or 16 mg immediately before induction of anesthesia (n= 30 in each group). Propofol-based general anesthetic was used. Emetic episodes and safety assessments were performed. To estimate a sufficient sample size, it was calculated that 30 patients per group would be required with &agr; = .05 and β = .2.RESULTSThe rate of patients who were emesis-free (no nausea, retching, or vomiting) 0–24 hours after anesthesia was 57% with dexamethasone 4 mg (P= .796), 87% with dexamethasone 8 mg (P= .005), and 87% with dexamethasone 16 mg (P= .005), compared with placebo (50%). Patients who had received dexamethasone 8 mg or 16 mg were more satisfied than those who had received placebo (P< .05). No clinically important adverse events were observed in any of the groups.CONCLUSIONDexamethasone 8 mg is an effective antiemetic for preventing postoperative nausea and vomiting 0–24 hours after anesthesia in women undergoing propofol-based general anesthesia for termination of pregnancy. Increasing the dose to 16 mg provided no additional benefit.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine whether sonographic urethral sphincter morphology is different in patients with detrusor instability than in those with normal urodynamic testing.METHODSPatients from a population of women presenting for evaluation of urinary incontinence or pelvic organ prolapse underwent intraurethral ultrasonography before multichannel urodynamic testing. Maximal rhabdosphincter thickness, total urethral diameter, total urethral circumference, and longitudinal smooth muscle thickness, diameter, and circumference were measured. For patients with detrusor instability, the strength of the involuntary detrusor contraction and the bladder volume at its onset were recorded. These data were compared with information from history questionnaires and urodynamic evaluations.RESULTSThe 17 patients with detrusor instability and 16 patients with normal urodynamic testing did not differ with respect to age, vaginal parity, race, weight, body mass index, prior continence surgery, or maximal total urethral closure pressure. Patients with detrusor instability, had decreased urethral longitudinal smooth muscle thickness (3.0 ± 0.9 mm vs 4.1 ± 0.7 mm,P= .001), total urethral diameter (18.0 ± 1.6 mm vs 19.4 ± 1.4 mm,P= .01), and total urethral circumference (5.65 ± 0.5 cm vs 6.1 ± 0.4 cm,P= .012) compared with those with normal urodynamic tests. A linear relationship between rhabdosphincter thickness and strength of involuntary detrusor contraction was observed (r= .686,P= .002).CONCLUSIONUrethral sphincter morphology is different in patients with detrusor instability compared with those who have normal urodynamic tests. These findings provide an anatomic basis for the physiologic findings in patients with “urethrogenic” detrusor instability.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare computer-assisted virtual urethral pressure profile changes between women with and without genuine stress incontinence.METHODSA full urogynecologic assessment including conventional urodynamic measurements and a clinical stress test were carried out. Computer-assisted virtual urethral pressure profile uses conventional urethral pressure profile measurements during stress, with the only change being that withdrawal of the catheter is stopped at distinct points along the whole urethra while the patient coughs. Cough-related changes of maximal urethral closure pressure, functional urethral length, and area under the urethral closure pressure curve were determined.RESULTSSixty-one women were enrolled in our study: 30 symptom-free women (group A) were continent, and genuine stress incontinence was present in 31 patients (group B) complaining of urinary loss. Significant differences between group A and group B women were found for all parameters of computer-assisted virtual urethral pressure profile including maximal urethral closure pressure (91.59 ± 39.00 versus 20.70 ± 22.61 cm H2O;P< .001), functional urethral length (31.81 ± 9.02 versus 10.83 ± 10.76 mm;P< .001), and the area under the urethral closure pressure curve (2036 ± 1025.29 versus 253 ± 206.69 cm H2O × mm;P< .001).CONCLUSIONComputer-assisted virtual urethral pressure profile is a new application of urethral pressure profile measurements during stress. Our data show significant differences between continent women and patients with genuine stress incontinence. Further studies are needed to assess the potential of computer-assisted virtual urethral pressure profile for diagnosing genuine stress incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the efficacy and safety of propofol at subhypnotic doses for reducing emetic symptoms in parturients undergoing cesarean delivery under spinal anesthesia.METHODSIn a randomized, double-masked trial, 80 patients received lidocaine intravenously 0.1 mg/kg (for injection pain relief) followed by either placebo or propofol at three different doses (0.5 mg/kg per hour, 1.0 mg/kg per hour, 2.0 mg/kg per hour) (n= 20 in each group) immediately after clamping of the umbilical cord. Emetic episodes and safety assessments were performed during spinal anesthesia for cesarean delivery. To estimate a sufficient sample size, it was calculated that 20 patients per group would be required with &agr; = .05 and β = .2.RESULTSThe rate of patients experiencing no emetic symptoms in an intraoperative, postdelivery period was 45% with propofol 0.5 mg/kg per hour (P= .5), 80% with propofol 1.0 mg/kg per hour (P= .011), and 80% with propofol 2.0 mg/kg per hour (P= .011), compared with placebo (40%). No clinically serious adverse events caused by the study drugs were observed.CONCLUSIONPropofol 1.0 mg/kg per hour is the minimum effective subhypnotic dose for reducing emetic symptoms during cesarean delivery. Increasing the dose to 2.0 mg/kg per hour provides no further benefit.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess the potential role of amniotic fluid (AF) matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.METHODSEighty-four women with singleton gestations with preterm contraction, preterm labor, preterm premature rupture of membranes, or clinical suspicion of intra-amniotic infection were studied. Amniotic fluid was obtained by transabdominal amniocentesis before starting any treatment. Intra-amniotic infection was defined as the presence of a positive AF culture. Amniotic fluid glucose concentration, leukocytes, matrix metalloproteinase-9, and interleukin-6 were determined.RESULTSAmniotic fluid matrix metalloproteinase-9 and interleukin-6 levels were significantly higher in women with intra-amniotic infection than in those without. With intra-amniotic infection, levels of matrix metalloproteinase-9 significantly correlated with interleukin-6 (r= 0.813,P< .001). Each of matrix metalloproteinase-9 and interleukin-6 significantly correlated with AF leukocytes and inversely correlated with AF glucose. Using AF cutoff levels of 13.6 ng/mL for matrix metalloproteinase-9 and 11.4 ng/mL for interleukin-6, the sensitivity, specificity, and positive and negative predictive values for diagnosing intra-amniotic infection were 77% versus 73%, 100% versus 79%, 100% versus 61%, and 90% versus 86%, respectively. Combining AF matrix metalloproteinase-9 with interleukin-6 slightly improved the sensitivity and the negative predictive values in diagnosing intra-amniotic infection.CONCLUSIONSAmniotic fluid matrix metalloproteinase-9 and interleukin-6 are significantly elevated in women with intra-amniotic infection. Amniotic fluid matrix metallo-proteinase-9 is an accurate biochemical marker in predicting intra-amniotic infection with better sensitivity, specificity, and positive and negative predictive values than interleukin-6.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine whether preeclampsia influences insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-1 (IGFBP-1), and insulin-like growth factor binding protein-3 (IGFBP-3), independent of its effect on birth weight.METHODSCord blood was collected in 12,804 consecutive deliveries. We identified 258 preeclamptic pregnancies that were subclassified as mild or severe and early or late. For comparison, 609 control pregnancies were selected. Fetal growth was expressed as the ratio between observed and expected birth weight, with adjustment for gestational age at birth. IGF-I, IGFBP-1, and IGFBP-3 were measured in umbilical plasma. The contribution of preeclampsia and birth weight to each measured factor was assessed by multiple linear regression analyses.RESULTSBetween mild preeclampsia and controls, there were no differences in IGF-I, IGFBP-1, and IGFBP-3. In severe and early onset preeclampsia, umbilical cord plasma IGF-I was approximately 50% lower, and IGFBP-1 was more than twice as high as in controls (bothP< .01). At each birth weight level, IGF-I was lower and IGFBP-1 was higher in severe or early preeclampsia than among controls of similar weight. Birth weight and preeclampsia were, independent of each other, associated with IGF-I, whereas birth weight, but not preeclampsia, was associated with IGFBP-1, after adjustment for gestational age.CONCLUSIONFetal growth restriction caused by severe or early preeclampsia is associated with lower umbilical levels of IGF-I than low birth weight caused by other conditions. Preeclampsia may contribute to the observed IGF-I reduction, either as part of the underlying causes of preeclampsia, or as a consequence of the disease.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the rate of gestational diabetes in triplet pregnancies and to assess the impact of fetal reduction on the incidence of this complication.METHODSOne hundred eighty-eight consecutive triplet pregnancies referred to the Sheba Medical Center between 1994 and 1998 were included. One hundred three of these pregnancies continued as triplets, whereas 85 women elected to undergo fetal reduction to twins. The incidence of gestational diabetes (based on the criteria of Carpenter and Coustan) and other outcome variables were compared between the two groups. Studentt-tests and χ2analysis were used as appropriate.RESULTSMean (±SD) maternal age was 29.2 ± 4.8 in the triplet group and 29.3 ± 4.1 in the reduction group. The groups had similar median parity (1.6 ± 1.1 in the triplet group and 1.5 ± 0.7 in the reduction group). The rate of gestational diabetes was significantly higher in the triplet group than in the reduction group (22.3% vs 5.8%). A lower birth weight (1764 ± 448 g vs 2208 ± 526 g) and an earlier gestational age at delivery (33.4 ± 2.8 weeks vs 36.0 ± 2.8 weeks) were observed in the triplet group compared with the reduction group.CONCLUSIONThe number of fetuses in multifetal pregnancies influences the incidence of gestational diabetes. These findings support the hypothesis that an increase in placental mass and, thus, an increase in diabetogenic hormones play a role in the etiology of gestational diabetes.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the effect of a resident-created study guide on Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training and American Board of Obstetrics and Gynecology (ABOG) written examination scores.METHODSIn 1995, a group of residents at the University of Texas Southwestern Medical Center began creating an annual study guide based on the CREOG Test Item Summary Booklet. Individual, program, and national scores for 3 years before the intervention were compared with scores for 3 years after the intervention. A four-way analysis of variance was used to evaluate the effect of the intervention accounting for sex, Alpha Omega Alpha Medical Honor Society (AOA) status, and calendar year. A random effects model was also used to adjust for confounders. Categoric variables were compared using Mantel-Haenszel χ2. Program failure rates for the ABOG written examination before and after the intervention were compared with relative risks.RESULTSAfter introduction of the study guide, the annual difference between our program and the national percent correct increased significantly (2.1% versus 4.8%,P< .001), after adjustment for AOA status and calendar year. The improvement was distributed among resident levels 2–4 (allP< .02) and for non-AOA residents (P≤ .001). The relative risk of failure of the written ABOG examination before the study guide was 3.5 (95% confidence interval 0.77, 15.9).CONCLUSIONThese findings demonstrate an important cooperative use of the Test Item Summary Booklet as an educational resource.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine whether antenatal corticosteroid use is associated with weight and head circumference at birth.METHODSWe conducted a retrospective analysis of non-anomalous newborns admitted to 100 neonatal intensive care units from 23 to 34 6/7 weeks of gestation using multivariable analysis of variance that controlled for several potentially confounding variables.RESULTSThere were 14,338 cases of birth weight and 13,670 for head circumference available for analysis. Independent variables included maternal age, race, nulliparity, poor prenatal care, multiple gestation, obstetric complications, alcohol, smoking, illicit drugs, presentation, gestational age at birth, and method of delivery. The mean (±SD) birth weight was 1671 ± 574 g and head circumference was 289 ± 33 mm. The multivariable effect of antenatal corticosteroid on birth weight (mean ± SE) was −63 ± 5.7 g and on head circumference was −3.1 ± 0.4 mm. Even after controlling for birth weight, a significant reduction in head circumference (−1.2 ±0.3 mm; 95% CI = −1.8, −0.6) was associated with antenatal corticosteroid use. This suggested that antenatal corticosteroids were associated with a greater reduction in brain growth than somatic growth.CONCLUSIONAntenatal corticosteroid may be associated with a reduction in birth weight and head circumference, independent of other major predictive factors. The reduction in head circumference persists even after controlling for the reduction in birth weight. The clinical significance of these findings is unknown.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID