摘要:

ObjectiveTo examine whether an increase in sympathetic nervous tone contributes to the augmented response to cardiovascular reflex testing in preeclamptic women.MethodsMaternal electrocardiograms were recorded from 11 nonpregnant women and 25 normotensive and 15 preeclamptic nulliparous women at term, during periods of quiet respiration in the left-lateral position and after shifting to the supine position. Power spectral analysis was applied to epochs of 512 consecutive beat-to-beat intervals to determine the contribution of sympathetic tone, parasympathetic tone, and respiratory sinus arrhythmia to heart rate variability.ResultsBoth normotensive and preeclamptic pregnant women showed a significant decrease in respiratory sinus arrhythmia and an increase in sympathetic tone compared with nonpregnant women. In nonpregnant and in normotensive pregnant women, shifting from the left-lateral to the supine position did not cause any change in autonomic characteristics. In contrast, preeclamptic women demonstrated a marked increase in power within the very lowfrequency range representing sympathetic tone, from 288 ± 214 to 556 ± 322 second2/Hz, in response to the same challenge (P< .05).ConclusionThird-trimester pregnancy is characterized by sympathetic overactivity. When complicated by preeclampsia, sympathetic overreactivity to cardiovascular reflex testing is observed. Our data support the notion that the pathophysiologic phenomena that characterize preeclampsia are mediated not only by circulating or locally acting vasoactive substances, but also, at least in part, by an increase in sympathetic nervous tone.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether maternal midtrimester serum N-terminal peptide of proatrial natriuretic peptide, free beta subunit of human chorionic gonadotropin (hCGβ), or alpha-fetoprotein (AFP) levels can predict preeclampsia.MethodsA population-based cohort included 1037 nulliparous women, of whom 637 (61%) participated in a maternal serum Down syndrome screening program. Measurements of hCGβ, AFP, and N-terminal peptide of proatrial natriuretic peptide were made from maternal serum collected at 15-19 weeks' gestation. Sensitivity, specificity, and predictive values were calculated for elevated AFP (at least 2.0 multiples of the median [MoM]) and hCGβ (at least 2.0 MoM) values.ResultsNo difference was found in the concentrations of the N-terminal peptide of proatrial natriuretic peptide among the 30 women in whom preeclampsia developed later (median 270 [range 142-604] pmol/L) compared with 536 women who remained normotensive (274 [51-2626] pmol/L). The sensitivity and specificity of elevated AFP in predicting preeclampsia were 3% and 98% and those of elevated hCGβ were 20% and 84%, respectively. When a stepwise multiple logistic regression model was used, only mean arterial pressure was an independent risk factor in predicting preeclampsia.ConclusionDeterminations of the proposed new marker N-terminal peptide of proatrial natriuretic peptide, as well as serum hCGβ or AFP, are not helpful in predicting preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo assess the roles of interleukin-1β, interleukin-8, and fibroblasts in the lower uterine segment during parturition.MethodsLower uterine segment biopsy specimens were obtained from 36 women undergoing cesarean delivery at various stages of cervical dilation (less than 2 cm,n= 8; 2 to less than 4 cm,n= 9; 4-6 cm,n= 10; more than 6 cm,n= 9). The concentrations of interleukin-1β and interleukin-8 in protein extracts prepared from the tissue samples were measured by enzyme immunoassays. The effect of incubation with interleukin-1β (30 U/mL) on interleukin-8 secretion by lower uterine segment fibroblasts in vitro also was determined.ResultsThe median interleukin-1β concentration in the specimens increased from 1.3 pg/mg of total protein at less than 2 cm of dilation to 22.2 pg/mg of total protein at 4-6 cm of dilation (P< .05). No further increase was detectable after 6 cm of dilation. The interleukin-8 concentration increased from 17.2 pg/mg of total protein at less than 2 cm of dilation to 2080.7 pg/mg of total protein at 4-6 cm of dilation (P< .05), thus paralleling the increase in interleukin-1β concentration. Interleukin-1β induced a significant increase in interleukin-8 secretion by fibroblasts in vitro, from 0.8 ng/106cells to 35.6 ng/106cells.ConclusionThe increase in interleukin-8 concentration in the lower uterine segment during parturition may be induced by interleukin-1β and fibroblasts may be one of the sources of this interleukin-8.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the occurrence of the most common mutations and deletions in mitochondrial DNA and deficiencies in the enzyme complexes of the mitochondrial respiratory chain in placentas from preeclamptic women.MethodsMitochondria were isolated from the placentas of 17 preeclamptic or 25 control women, and the activities of mitochondrial respiratory chain complexes were measured. Deletions and three common point mutations of mitochondrial DNA were searched for by the Southern blot and polymerase chain reaction (PCR) methods from the same placentas.ResultsMean (± standard deviation) mitochondrial respiratory chain enzyme complex activities in placentas on protein basis (nmol/min/mg of protein) were similar in preeclamptics and controls (nicotinamide adenine dinucleotide, reduced form-ubiquinone oxidoreductase 25.84 ± 9.29 versus 31.02 ± 7.52; nicotinamide adenine dinucleotide, reduced form-cytochrome-coxidoreductase 77.88 ± 42.24 versus 104.06 ± 56.73; succinate-cytochrome-coxidoreductase 57.90 ± 13.83 versus 64.44 ± 20.16; cytochrome-coxidase 106.43 ± 35.46 versus 128.37 ± 48.64, respectively) and they were similar also when referenced to the mitochondrial marker enzyme citrate synthase. The sample sizes in both patient and control groups were found to be large enough by post hoc test. Large-scale deletions or the common 5-kb and 7.4-kb deletions were not detected, even at the sensitivity level of PCR. The three most common point mutations were not found in either control or preeclamptic placental samples.ConclusionCommon mitochondrial DNA mutations seem to play no major role in the universal etiology of preeclampsia, as assessed by analysis of the mitochondrial genome and respiratory chain enzyme activities in vitro. This does not exclude possible alterations in the energy state of the preeclamptic placenta.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine if intrauterine intravascular fetal transfusion affects fetal umbilical venous endothelin levels.MethodsEndothelin concentrations were measured by radioimmunoassay in fetal umbilical venous blood obtained immediately before and after 36 fetal transfusions performed for Rh alloimmune hemolytic anemia. Umbilical venous pressures also were recorded before and after transfusion.ResultsThe mean (± standard deviation [SD]) gestational age at transfusion was 27.0 ± 4.6 weeks, whereas the initial and post-transfusion hematocrits were 23.3 ± 8.5% and 41.8 ± 6.3%, respectively. Post-transfusion endothelin levels correlated significantly with the volume of transfused blood (r= .41;P= .03) and with post-transfusion increases in umbilical vein pressure (r= .86;P< .001). Among fetuses undergoing initial transfusion, there were significant differences between mean (± SD) pre- and post-transfusion endothelin levels [3.6 (± 2.2) pg/mL versus 6.3 (± 4.0) pg/mL, respectively;P= .02]. In contrast, among fetuses undergoing a repeat fetal transfusion, no differences in mean (± SD) pre-versus post-transfusion endothelin levels were observed [3.8 (± 1.8) pg/mL versus 2.2 (± 1.77) pg/mL, respectively;P= .3)]. Step-wise multiple regression analysis identified order of transfusion as a significant predictor of change in endothelin levels from pre- to post-transfusion measurements (adjustedr2= .26;P= .003).ConclusionRapid expansion of fetal intravascular volume by intravenous transfusion of packed red blood cells with a high hematocrit enhances fetal endothelin levels in those fetuses undergoing initial but not subsequent transfusions.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine if there is a significant difference in the degree of pelvic organ prolapse assigned during examination in the standing position compared with the dorsal lithotomy position with the patient performing maximal Valsalva maneuver.MethodsFifty-one women with symptoms of pelvic organ prolapse were examined in both the dorsal lithotomy position, while performing maximal Valsalva, and in the standing position at the same visit by one of two examiners. Nine site-specific measures and summary stages were recorded, as outlined by the International Continence Society's classification system for pelvic organ prolapse. The data were analyzed by Wilcoxon signed-rank test and correlation coefficients.ResultsThe mean age was 52 ± 15 years. Excellent correlation was noted between all six points representing the vaginal prolapse. TheRvalues for point Aa were 0.97, Ba 0.96, C 0.98, Ap 0.97, Bp 0.96, and D 0.97. The total vaginal length, perineal body, and genital hiatus measurements were performed in the dorsal lithotomy position with the patient at rest and were not repeated. The stages were identical in 48 of 51 patients. The average stage in the dorsal lithotomy position was 2.3 and in the standing position, 2.3. There was no statistically significant difference between the stage or any of the measured points in the dorsal lithotomy and standing examinations.ConclusionThe degree of pelvic organ prolapse can be assessed adequately in the dorsal lithotomy position with the patient performing maximal Valsalva. It is not necessary to routinely repeat the examination in the standing position.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine if the clinical diagnosis of stress urinary incontinence made on the basis of simple criteria correlates with the diagnosis of genuine stress incontinence as determined by provocative multichannel urodynamic testing.MethodsThe charts of 652 women who presented for clinical evaluation of a variety of lower urinary tract complaints were reviewed if they met all of the following criteria: 1) a predominant complaint of stress incontinence, 2) positive cough stress-test results, 3) postvoid residual urine volume no more than 50 mL, 4) a functional bladder capacity of at least 400 mL as determined by a completed 24-hour frequency-volume chart, and 5) a full multichannel urodynamic evaluation. Seventy-four patients met all these criteria. The clinical diagnosis of stress incontinence was based on the presence of factors 1-4; this diagnosis then was compared with the results of provocative multichannel urodynamic testing.ResultsGenuine stress incontinence was confirmed in 72 (97%) of 74 patients meeting the aforementioned clinical criteria. In one patient, detrusor instability alone was demonstrated during urodynamic testing. In 11 patients with genuine stress incontinence (15%), an element of detrusor instability was also present at the time of urodynamic testing. One patient had normal urodynamic study findings, with no incontinence demonstrated.ConclusionRigorously defined clinical criteria are highly reliable in predicting the presence of genuine stress incontinence at the time of urodynamic testing. Because of the potential implications of this finding for clinical practice, further investigation is warranted.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo characterize time trends in incidence of intraepithelial and invasive vulvar neoplasia, transition of intraepithelial vulvar neoplasia to invasive cancer, and survival rate based on a total population.MethodsThe Cancer Registry of Norway was used to identify all Norwegian inhabitants diagnosed during 1956-1990 with squamous cell carcinoma of the vulva, and all those with intraepithelial vulvar neoplasia diagnosed during 1973-92.ResultsThe incidence rate of intraepithelial neoplasia increased three-fold from 1973-77 to 1988-92, and 3.4% changed into invasive disease. Multivariate analyses identified age as a significant variable. The age-adjusted incidence rate for squamous cell carcinoma was constant for the whole period. The ratio between recurrence and the total number of invasive cancer varied from 21% to 31%. The 5-year survival rates have not changed significantly over the period. Age was revealed as a strong prognostic factor, showing an excess death rate by increasing age.ConclusionThe incidence of vulvar intraepithelial neoplasia has increased substantially over the last 40 years, but that of invasive vulvar cancer has not changed appreciably.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo characterize the relative contributions of the different abnormal Papanicolaou smear cytologic diagnoses in the Bethesda System to the subsequent histologic diagnosis of high-grade cervical neoplasia.MethodsA total of 46,009 nonpregnant female members of the Kaiser Permanente Health Plan, Northern California Region, were studied prospectively. The main outcome measures included routine Papanicolaou smear diagnoses and subsequent histologic diagnosis of colposcopically directed cervical tissue specimens.ResultsAtypical squamous cells of undetermined significance (ASCUS) was the most common abnormal Papanicolaou diagnosis, representing 3.6% of the total number of smears. Of the total number of cases of histologically confirmed high-grade cervical neoplasia present in the population, the largest proportion (38.8%) was in women with smears showing ASCUS. Minimal abnormalities combined (ASCUS, atypical glandular cells of undetermined significance, and low-grade squamous intraepithelial lesion) were coincident with 68.6% of the cases of histologic high-grade cervical neoplasia diagnosed in this routine screening population.ConclusionRecognition of the importance of equivocal and mild Papanicolaou test abnormalities in the subsequent diagnosis of high-grade cervical neoplasia emphasizes the need for accurate and cost-effective triage of the large population of women with minimally abnormal Papanicolaou diagnoses.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo compare the efficacy of adjuvant chemotherapy after radical hysterectomy with that of adjuvant radiotherapy.MethodssOne hundred one women with invasive cervical carcinoma (stage IB through early stage IIB) underwent radical hysterectomy at Saga Medical School Hospital. Of these patients, 53 with squamous or adenosquamous carcinoma were classified as high risk, based on the presence of one or more of the following high-risk factors for recurrence: 1) lymph node metastasis, 2) deep cervical stromal invasion (greater than 3/4 thickness), and 3) parametrial invasion. Adjuvant chemotherapy with a combination ofcis- diamminedichloroplatinum (CDDP), vincristine, mitomycin C, and peplomycin (POMP), was prescribed. The outcome was compared with that for 127 patients who were classified as high risk under the same criteria and who received adjuvant radiotherapy at Kyushu University Hospital.ResultsThe 5-year survival rates were much the same: 83.0% for adjuvant chemotherapy and 81.7% for adjuvant radiotherapy. In the chemotherapy group, intra- and extrapelvic recurrences accounted for 85 and 23% of all recurrences, respectively, whereas recurrences were noted for 38 and 71% in the radiotherapy group, respectively (P< .01).ConclusionThe use of adjuvant chemotherapy reduces extrapelvic recurrences. The combination of both adjuvant therapies may improve the prognosis for high-risk patients.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID