摘要:

OBJECTIVETo assess incidence during a 10-year study period and to identify and discuss clinical relevance for prognostic factors of survival within a cohort of Norwegian ovarian cancer patients.METHODSIncidence and prognostic factors of survival within a population-based cohort of ovarian cancer patients from one health region in Norway were examined over the 10-year period 1987 through 1996. A total of 571 histologically verified cases of primary ovarian cancer originally registered either in the Cancer Registry of Norway or in the hospital's discharge registers were included in the study. Pearson χ2test was used in univariate analyses of cofactors by 5-year survival, and Kaplan-Meier survival curves were computed and tested statistically by the log rank test. A multivariable proportional hazard model (Cox) was applied to assess the prognostic significance of the different covariates.RESULTSThe incidence and crude 5-year survival remained stable over the 10-year study period. The standardized incidence rate for the time periods 1987–1991 and 1992–1996 was 11.9/100,000 and 12.5/100,000, respectively. The crude 5-year survival rate for the cohort was 39%, whereas median survival was 32 months. Cox multivariable regression analysis showed that the only independent significant prognostic factors were International Federation of Gynecology and Obstetrics stage (P< .001), size of residual tumor at the end of primary surgery (P< .001), and age at diagnosis (P< .01). Variables such as time period, histologic type and grade, treating hospital, comorbidity, or CA 125 were insignificant in predicting 5-year survival.CONCLUSIONThe results underline the importance of improved surgical management of ovarian cancer, as residual tumor is the only prognostic factor achievable.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo assess obstetrician–gynecologists' attitudes and practices related to depression screening.METHODSA total of 282 obstetrician–gynecologists completed a 36-question mail survey that assessed attitudes regarding depression screening, training to treat depression, psychosocial concern, professional influence, and ease of screening.RESULTSDepression screening (employed regardless of signs or symptoms) was reported by 44% of physicians. Positive attitudes toward depression screening, high psychosocial concern, high ease of screening, and adequate training to treat depression were significant independent predictors of depression screening practices.CONCLUSIONThe majority of obstetrician–gynecologists are concerned about depression, believe depression screening is effective, and perform some degree of depression screening with their patients. However, they perceive depression screening as difficult to carry out in everyday practice, and some question whether screening improves outcomes

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo test the hypothesis that increased first trimester nuchal translucency is associated with isolated cardiac foci in the second trimester.METHODSWe identified all pregnancies delivered between January 1997 and June 2000. We included 7686 normal singleton fetuses who had a nuchal translucency scan and either a subsequent normal anomaly scan at 18–23 weeks' gestation (n= 7447) or isolated cardiac foci (n= 239). Fetuses were divided into two groups: normal (95th percentile or less) and increased (greater than 95th percentile) nuchal translucency.RESULTSThe prevalence of cardiac echogenic foci in fetuses with normal nuchal translucency was 218 of 7427 (2.9%; 95% confidence interval [CI] 2.6, 3.3%), whereas 21 of 259 fetuses (8.1%; 95% CI 5.1, 12.1%) with increased nuchal translucency were subsequently found to have cardiac foci. The adjusted odds ratio for cardiac echogenic foci in cases of increased nuchal translucency was 2.92 (95% CI 1.83, 4.66).CONCLUSIONAn association exists between first trimester nuchal translucency and second trimester cardiac echogenic foci. Risk calculation algorithms for trisomy 21 based on nuchal translucency thickness should not use cardiac foci as an independent marker.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate the usefulness of absent nasal bone by ultrasound in the prenatal detection of second-trimester fetuses with trisomy 21.METHODSThis was a matched case–control study of sonograms from January 1, 1997 to April 30, 2002. Genetic sonograms and facial profile pictures of all fetuses that were subsequently proven to have trisomy 21 were reviewed (study group). A control group was identified during the same study period by using a 4-to-1 ratio matching for gestational age at the time of the ultrasound examination. The sensitivity and specificity of absent fetal nasal bone for trisomy 21 were determined, and overlap with other ultrasound aneuploidy markers was assessed.RESULTSForty fetuses were identified with trisomy 21; in 29 (72.5%) a facial profile had been obtained. Of the 160 controls, 102 (64%) had facial profiles documented. Of the 29 fetuses with trisomy 21 with facial profile available, 12 had absent nasal bone (sensitivity 41%). None of the 102 control fetuses with facial profiles available had absent nasal bone (specificity 100%). The sensitivity of genetic ultrasound was increased from 83% (24 of 29) to 90% (26 of 29) by adding absent nasal bone to the other ultrasound aneuploidy markers.CONCLUSIONIn the second trimester of pregnancy, absent nasal bone has a sensitivity of 41% and a specificity of 100% in detecting fetal trisomy 21. Absent fetal nasal bone may be added to the list of ultrasound aneuploidy markers evaluated during a genetic sonogram.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo examine the association between intratriplet birth weight discordance, fetal and neonatal mortality, and smallness for gestational age.METHODSThe 1995–1997 Centers for Disease Control and Prevention's Matched Multiple Birth file was used for this analysis. Birth weight discordance was calculated as the difference in birth weight between the largest and the smallest triplet's weight and expressed as percentage of the largest triplet's weight. For the middle-weight triplet, we also used the largest triplet's weight as a reference in calculating percentage birth weight discordance, which was then grouped into quintiles.RESULTSAmong 15,511 triplet live births and fetal deaths (at least 20 weeks' gestation), 35% had less than 10% birth weight discordance, 19.3% had 10–15%, 16.4% had 15–21%, 15.2% had 21–29%, and 14.1% had 29% or more. After controlling for confounders, the risk of fetal death associated with quintile V was significantly higher than that associated with quintile I for smallest (odds ratio [OR] 10.88; 95% confidence interval [CI] 4.87, 26.56), middle (OR 22.6; 95% CI 11.05, 46.3), and largest (OR 2.41; 95% CI 1.01, 5.89) triplets. Smallest and middle triplets in quintile V were more likely than quintile I triplets to be born small for gestational age (OR 26.0; 95% CI 17.1, 39.9 for smallest, and OR 13.4; 95% CI 8.01, 22.3 for middle). Birth weight discordance quintile was not associated with smallness for geatational age among largest triplets nor consistently with neonatal mortality among smallest, middle, or largest triplets.CONCLUSIONIncreasing birth weight discordance was associated with increased risk of fetal death and smallness for gestational age. A birth weight discordance threshold of at least 29% should alert obstetricians for appropriate decision making.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo evaluate the obstetric outcomes associated with persistent occiput posterior position of the fetal head in term laboring patients.METHODSWe performed a cohort study of 6434 consecutive, term, vertex, laboring nulliparous and multiparous patients, comparing those who delivered infants in the occiput posterior position with those who delivered in the occiput anterior position. We examined maternal demographics, labor and delivery characteristics, and maternal and neonatal outcomes.RESULTSThe prevalence of persistent occiput posterior position at delivery was 5.5% overall, 7.2% in nulliparas, and 4.0% in multiparas (P< .001). Persistent occiput posterior position was associated with shorter maternal stature and prior cesarean delivery. During labor and delivery, the occiput posterior position was associated with prolonged first and second stages of labor, oxytocin augmentation, use of epidural analgesia, chorioamnionitis, assisted vaginal delivery, third and fourth degree perineal lacerations, cesarean delivery, excessive blood loss, and postpartum infection. Newborns had lower 1-minute Apgar scores, but showed no differences in 5-minute Apgar scores, gestational age, or birth weight.CONCLUSIONPersistent occiput posterior position is associated with a higher rate of complications during labor and delivery. In our population, the chances that a laboring woman with persistent occiput posterior position will have a spontaneous vaginal delivery are only 26% for nulliparas and 57% for multiparas.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo compare oral misoprostol with conventional oxytocics in the management of the third stage of labor.METHODSIn a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 μg, followed by two doses of oral misoprostol 100 μg 4 hours apart; group 2 received oral misoprostol 400 μg, followed by two doses of oral misoprostol 100 μg 4 hours apart; group 3 received intravenous infusion of oxytocin 10 IU; and group 4 received intravenous infusion of oxytocin 10 IU plus intramuscular administration of methylergonovine maleate (Methergine) 0.2 mg. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures.RESULTSThe primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2, compared with 3.2% in group 1 and 3.5% in group 4 (P< .01, andP= .01, respectively). There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 (5.9% versus 2.2%;P= .01). The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 (P< .01 andP= .01, respectively).CONCLUSIONOral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo report our experience with our first 350 cases of tension-free vaginal tape (TVT), specifically assessing intraoperative complications, postoperative morbidity, and untoward effects of the procedure.METHODSAlthough increased numbers of reports have documented the efficacy of the TVT procedure, there are minimal data about the incidence of complications and how they are managed. We performed a retrospective review of all patients undergoing the TVT procedure over a 4-year period to report intraoperative complications (bladder perforation and excessive bleeding), postoperative complications (de novo urge incontinence, voiding dysfunction, erosion, nerve injury, urinary retention, hematoma formation), and incidence of reoperation either for voiding dysfunction or for recurrent incontinence.RESULTSA total of 350 patients were included in the study. Fifty-five percent (194) of women underwent the TVT procedure in conjunction with other vaginal surgery, and 45% (156) underwent the TVT alone. Seventy women (20%) had previous antiincontinence surgery. Intraoperative complications included 19 bladder perforations in 17 patients (4.9%) and three cases of significant bleeding (0.9%). Postoperatively, 17 women (4.9%) had voiding dysfunction and 42 (12%) required anticholinergic therapy beyond 6 weeks. Recurrent urinary tract infections developed in 38 (10.9%), erosion or poor healing in three (0.9%), hematoma in six (1.7%), and nerve injury in three (0.9%). Twenty-eight (8%) underwent urethral dilation in the postoperative period for varied amounts of voiding dysfunction. Of these, 82% were either improved or were cured. Six women (1.7%) underwent a takedown of the TVT procedure for continued voiding dysfunction, and two of these (33%) developed recurrent stress incontinence. To date, two patients (0.5%) have undergone another procedure for recurrent or persistent stress incontinence.CONCLUSIONThe TVT procedure is efficacious for the correction of stress incontinence. Our data show that it is a safe procedure with an acceptable complication rate when performed by surgeons who have experience with retropubic and transvaginal antiincontinence procedures.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo describe the proximity of the major vessels in the retropubic space and anterior abdominal wall to the tension-free vaginal tape needle.METHODSTension-free vaginal tape needles were inserted bilaterally in ten cadavers. Dissection of the superficial epigastric, inferior epigastric, external iliac, and obturator vessels was performed. Measurements from the lateral aspect of the needle to the medial edge of the vessels were recorded. In an additional cadaver, three planes were created by placing a string from the midlabia to the shoulder, mid–biceps brachii muscle, and 6 cm lateral to the mid–biceps brachii muscle of the cadaver's extended, ipsilateral arm. An operator, blinded to the retropubic space anatomy, passed the needle in these planes bilaterally. The distances from the needle to the external iliac and obturator vessels were measured.RESULTSAll vessels measured were lateral to the tension-free vaginal tape needle. The mean distance from the tension-free vaginal tape needle to the obturator vessels was the closest: 3.2 cm (range 1.6–4.3 cm). The mean distance from the tension-free vaginal tape needle to the superficial epigastric vessels was 3.9 cm (range 0.9–6.7); to the inferior epigastric vessels, 3.9 cm (range 1.9–6.6 cm); and to the external iliac vessels, 4.9 cm (range 2.9–6.2 cm). When the needle was directed 6 cm lateral to the mid–biceps brachii muscle, the external iliac vein was punctured.CONCLUSIONThe major vessels in the retropubic space and anterior abdominal wall lie 0.9–6.7 cm lateral to the tension-free vaginal tape needles. If the tension-free vaginal tape needle is laterally aimed or rotated, major vascular injury can occur.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUNDTension-free vaginal tape (TVT) is thought to be a most effective therapy against stress urinary incontinence. It is rare to find a bladder tumor by the TVT procedure.CASEA 76-year-old woman with stress urinary incontinence underwent a TVT procedure. Cystoscopy performed in conjunction with the TVT procedure detected a papillary tumor. Transurethral resection of the bladder tumor was performed after the TVT procedure.CONCLUSIONTaking the possible presence of bladder tumors into consideration, TVT-related cystoscopy procedures should be performed carefully. Moreover, the case reported here suggests, at least in the short term, not only that the TVT device does not adversely affect the operability of transurethral resection of the bladder tumor, but also that the transurethral resection of the bladder tumor procedure does not lead to increased levels of urinary incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID