摘要:

OBJECTIVETo compare a traditional 28-day cycle to an extended 49-day cycle of the 30 μg ethinyl estradiol (E2)/300 μg norgestrel monophasic birth control pill regimen.METHODSNinety subjects randomized to either 28-day cycles with 21 active pills or 49-day cycles with 42 active pills for a prospective open label trial over four 84-day reference periods or trimesters. Bleeding, pill taking, and symptom diaries were completed. The sample size with 80% power to detect a 40% reduction in bleeding days required 24 subjects in each arm.RESULTSOf the 90 women, 24 subjects (54.5%) on the 28-day cycle and 29 (63%) on the 49-day cycle completed the entire study (P= .41). There were no statistically significant differences between the two groups in demographics or continuation rates. There was a significant reduction in bleeding days in the experimental arm beginning in the first trimester (28-day = 10.9, 49-day = 6.4 mean days of bleeding,P< .001) and continuing to the fourth trimester (28-day = 11.3, 49-day = 5.8 mean days,P= .005). The number of spotting days was similar between both schedules in the first trimester (28-day = 4.8, 49-day = 3.7 mean days,P= .24) and continued into the fourth trimester (28-day = 3.4, 49-day = 2.9 mean days,P= .30). Annual expenditure for hygiene products was significantly less for extended use subjects (28-day = $41.45, 49-day = $17.54 spent,P< .001).CONCLUSIONExtension of the 28-day oral contraceptive (OC) cycle to a 49-day cycle resulted in fewer bleeding days and no increase in mean spotting days or bleeding episodes.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma.METHODSFifty-four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph-vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearsonrand point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression.RESULTSThe depth of residual invasion correlated significantly with the depth of invasion (r= .374) and presence of lymph-vascular invasion (rpb= .372) in the conization specimen, post-cone ECC status (rpb= .669), and age at diagnosis (r= .347). The same factors were jointly assessed using multiple regression (R2= .636,P< .001). Depth of invasion on conization, lymph-vascular invasion, and ECC status were identified as independent predictors of the depth of residual invasion. Patients with deep (5 mm or greater) stromal invasion and lymph-vascular invasion on conization had significantly higher rates of positive parametrial margins (22% compared with zero,P= .001) and adjuvant radiation (66.7% compared with 20%,P= .004) compared with all other patients.CONCLUSIONDepth of invasion, presence of lymph-vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo compare the effectiveness of two transperitoneal laparoscopic Burch procedures.METHODSThe sample size required was 30 subjects per group to detect a statistically significant estimated difference of 15% between two surgical procedures with an &agr; = 0.05 and a power of 0.7. Sixty women affected by genuine stress incontinence (GSI) were enrolled and randomly assigned to two groups of 30 women each. All women were treated with the transperitoneal laparoscopic Burch procedure using nonabsorbable sutures (group A) or Prolene mesh (Ethicon, Somerville, NJ) fixed with tacks or staples (group B). The failure rate was defined subjectively and objectively. The subjective evaluation was performed by asking the women to rate their urine loss on a visual analog scale. The objective evaluation was a clinical evaluation using multichannel urodynamic studies.RESULTSThe subjective failure rate was not significantly different between the two groups at 3 months (0% for both groups), 6 months (3.7% versus 3.8% for groups A and B, respectively), and 12 months (7.4% versus 15.4% for groups A and B, respectively) after surgery. At 3 months (3.7% versus 3.8% for groups A and B, respectively) and 6 months (7.4% versus 15.4% for groups A and B, respectively) follow-up, the objective failure rate was not significantly different between the two groups. However, at 12 months after the surgical procedure, the objective failure rate was significantly lower in group A than in group B (11.1% versus 26.9%, respectively;P< .05).CONCLUSIONTransperitoneal laparoscopic Burch colposuspension performed using sutures was more effective than the mesh technique.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo discuss the differential diagnosis and the management of venous malformations of the vulva.METHODSFive symptomatic patients were treated. The degree of pain and discomfort was self-assessed by using a horizontal visual analog scale before and after treatment. Preoperative evaluation included Doppler ultrasound scanning in all patients and magnetic resonance imaging (MRI) in one. All patients had direct-injection venography and sclerotherapy during the same session. Ethanol was used in two cases and polidocanol in three. Patients were followed-up by means of Doppler ultrasound scanning and office visits.RESULTSAll patients experienced marked swelling after the injection, and one developed cutaneous necrosis that healed within 2 weeks. Transient hemoglobinuria was observed in two cases. No early or late major complications occurred. At a mean follow-up of 23 months (range 5–43), all patients experienced complete relief from symptoms and currently have normal vulvar sensation. Four patients had complete ablation of the treated lesion. In one patient the procedure resulted in a significant, albeit incomplete, occlusion of the lesion, and no further treatment was deemed necessary. From a cosmetic standpoint, both patients and physicians considered the results successful.CONCLUSIONVulvar venous malformations should be distinguished from vulvar varicosities, hematomas, soft-tissue neoplasms, and other vascular anomalies. Doppler ultrasound, MRI, and direct-injection venography are the most accurate diagnostic modalities. Sclerotherapy can successfully treat this condition. The procedure should be monitored with an imaging modality, preferably direct-injection venography with digital subtraction serial imaging.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo perform a histologic examination of tissue identified as fascia and used during colporrhaphy.METHODSIn patients undergoing primary anterior and posterior colporrhaphy, biopsies were taken from three surgically distinct vaginal tissues types: the wall, the “fascia,” and areolar tissue. The biopsies were placed in formalin, identified numerically, and sent to pathology for staining with hematoxylin-eosin, Masson trichrome for collagen, Movat for elastin, and immunoperoxidase stain for actin in smooth muscle. Simultaneous photographs were taken of the biopsy sites. The histologic diagnosis was compared with the surgical diagnosis.RESULTSA total of 60 samples were taken from five women. The specimens from two of these patients were disqualified. The pathologist made the following histologic diagnosis for each type of surgical specimen: vaginal wall, mucosa and underlying connective tissue; fascia, moderately dense connective tissue with smooth muscle; areolar tissue, loose connective tissue. The histologic appearance of the “fascia” was indistinguishable from the deeper aspects of the vaginal wall. It was composed of the same proportions of smooth muscle, elastin, and collagen. Using the histologic appearance as the “gold standard,” the accuracy of the surgical diagnosis was: “vaginal wall,” 12 of 12 (100%); “fascia,” seven of 12 (58%); and “areolar tissue,” eight of 12 (67%).CONCLUSIONSThe surgical “fascia” used during colporrhaphy consists of moderately dense connective tissue with smooth muscle similar to the deep aspects of the vaginal wall, is the same in both the anterior and posterior compartments, and is an artifact of the surgical dissection used to separate the vaginal wall from the underlying organs.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVESTo evaluate the efficacy, cycle control, compliance, and safety of a transdermal contraceptive system that delivers norelgestromin 150 μg and ethinyl estradiol 20 μg daily.METHODSIn this open-label, 73-center study, 1672 healthy, ovulatory, sexually active women received ORTHO EVRA/EVRA for six (n= 1171) or 13 cycles (n= 501). The treatment regimen for each cycle was three consecutive 7-day patches (21 days) followed by 1 patch-free week.RESULTSThe overall and method-failure probabilities of pregnancy through 13 cycles were 0.7% and 0.4%, respectively. The incidence of breakthrough bleeding was low throughout the study. Perfect compliance (21 consecutive days of dosing, followed by a 7-day drug-free interval; no patch could be worn for more than 7 days) was achieved in 90% of subject cycles; only 1.9% of patches detached completely. Adverse events were typical of hormonal contraception, and most were mild-to-moderate in severity and not treatment limiting. The most common adverse events resulting in discontinuation were application site reactions (1.9%), nausea (1.8%), emotional lability (1.5%), headache (1.1%), and breast discomfort (1.0%).CONCLUSIONSThe transdermal contraceptive patch provides effective contraception and cycle control, and is well tolerated. The weekly change schedule for the contraceptive patch is associated with excellent compliance and wearability characteristics.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo examine the relationship between total fluid volume at menstruation and the volume of blood loss, and to assess the feasibility of using total fluid volume to estimate menstrual blood loss.METHODSFifty-three women were studied over two menstrual periods each. Hemoglobin in menstrual pads and tampons was measured using the alkaline hematin technique; total menstrual fluid volume was simultaneously measured using a weighing technique and meticulous care to avoid evaporation.RESULTSDespite period-to-period change in measured total menstrual fluid and menstrual blood loss volumes, there was a significant correlation between total fluid volume and blood loss (r= .93,P< .001). Blood comprised 48% of total menstrual flow for women with moderately heavy blood loss (>60 mL) and 50% for women with excessive blood loss (>100 mL). Regression estimation of blood loss from total fluid volume was reasonably accurate. For clinical purposes, estimated blood volumes correctly classified 98% of periods in terms of actual blood loss as normal (<60 mL blood), moderately heavy (60–100 mL), or excessive (>100 mL).CONCLUSIONIf total fluid volume is measured carefully, the estimate of actual blood loss is sufficiently accurate for clinical purposes. This simple technique has considerable clinical potential, and inexpensive commercial packs for this purpose could easily be developed.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo clarify histologic localization of estrone sulfatase in normal uterine endometrium and adenomyotic tissue and to confirm that estrone sulfatase is one of the enzymes that supplies estrogen to adenomyotic tissue.METHODSSpecimens from 21 patients who had undergone hysterectomy were obtained from uteri with histopathologically proven adenomyosis. Specimens from 28 patients who had undergone hysterectomy for a disease of the uterine cervix were used as control specimens of normal uterine endometrium. Cases of hormone-dependent disease, such as leiomyoma, adenomyosis, and endometrial neoplasm, were excluded from cases of normal endometrium. The myometrium in patients with adenomyosis was examined. These tissues were examined by immunohistochemistry using anti-estrone sulfatase monoclonal antibodies. Power analysis was performed. With α = 0.05, 1 − β = 0.8, P1= 25%, and P2 = 75%, 14 specimens from each group were sufficient to detect significant differences among them. The Fisher exact test, sign test, and McNemar test were used for statistical analysis.RESULTSIn normal endometrial tissue, immunostaining for estrone sulfatase was observed only on the glandular epithelial cells of the basilar layer of the endometrium. However, all functional layers of the endometria were negative for staining for estrone sulfatase. In adenomyotic tissue, glandular epithelial cells showed immunostaining for estrone sulfatase. Rates of immunostaining in adenomyotic tissue were higher than those in the basilar layer of normal uterine endometrium (76% and 43%, respectively,P= .02). The myometrium was not stained.CONCLUSIONEstrone sulfatase may be one of the enzymes supplying estrogen for growth of adenomyosis.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo compare intensive and conventional therapy for severe fear of childbirth.METHODSIn Finland, 176 women who had fear of childbirth were randomly assigned at the 26th gestational week to have either intensive therapy (mean 3.8 ± 1.0 sessions with obstetrician and one with midwife) or conventional therapy (mean 2.0 ± 0.6 sessions), with follow-up 3 months postpartum. Pregnancy-related anxiety and concerns, satisfaction with childbirth, and puerperal depression were assessed with specific questionnaires. Power analysis, based on previous studies, showed that 74 women per group were necessary to show a 50% reduction in cesarean rates.RESULTSBirth-related concerns decreased in the intensive therapy group but increased in the conventional therapy group (linear interaction between the group and birth-concernsP= .022). Labor was shorter in the intensive therapy group (mean ± standard deviation 6.8 ± 3.8 hours) compared with the conventional group (8.5 ± 4.8 hours,P= .039). After intervention, 62% of those originally requesting a cesarean (n= 117) chose to deliver vaginally, equally in both groups. Cesarean was more frequent for those who refused to fill in the questionnaires than for those who completed them (57% compared with 27%,P= .001). In the log-linear model, parous women who had conventional therapy and refused to fill in the questionnaires chose a cesarean more often than expected (standardized residual 2.54,P= .011). There were no differences between groups in satisfaction with childbirth or in puerperal depression.CONCLUSIONBoth kinds of therapy reduced unnecessary cesareans, more so in nulliparous and well-motivated women. With intensive therapy, pregnancy- and birth-related anxiety and concerns were reduced, and labors were shorter.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo compare cerebrovascular reactivity in normotensive and preeclamptic pregnant women.METHODSTranscranial Doppler ultrasound was used to measure peak, end-diastolic, and mean velocities in the middle cerebral arteries of 45 normotensive and 36 pre-eclamptic women in the third trimester. All measurements were done in the left lateral position at baseline, during 5% carbon dioxide (CO2) inhalation, and during an isometric hand-grip test. Blood pressure (BP), heart rate, oxygen (O2) saturation, and end-tidal partial pressure of carbon dioxide (pCO2) were recorded with each Doppler measurement. The mean pulsatility index (PI), resistance index (RI), and cerebral perfusion pressure at each time was compared using two-way repeated measures analysis of variance. Cerebrovascular reactivity, calculated as the percentage change in response to each maneuver, was also compared using analysis of covariance. A post hoc power analysis was performed to evaluate the primary measures of the study (middle cerebral artery PI and RI). Using alpha error of 5%, the statistical power to identify a difference in PI and RI in women with preeclampsia compared with normotensive women was 90% and 67%, respectively. The statistical power to identify a difference in PI and RI in response to the two maneuvers was 69% and 53%, respectively. Statistical significance was set atP< .05.RESULTSPreeclamptic women had higher baseline cerebral perfusion pressure (90.4 compared with 61.9 mmHg,P< .05) and lower PI (0.64 compared with 0.76,P< .05) and RI (0.46 compared with 0.51,P< .05) than normotensive pregnant women. In normotensive patients, both 5% CO2inhalation and isometric hand-grip test caused a significant decrease in PI (−9.5% and −6.1%, respectively) and RI (−6.5% and −4.2%, respectively). In contrast, in preeclamptic patients there was no change in any of the middle cerebral artery parameters in response to either maneuver.CONCLUSIONNormotensive pregnant women had normal middle cerebral artery responses to both 5% CO2inhalation and isometric hand-grip test. Preeclamptic patients had elevated baseline cerebral perfusion pressure and reduced vasodilatory responses to both tests. These findings are consistent with a state of vasoconstriction in preeclamptic women that is unresponsive to stimuli that under normal circumstances result in vasodilation.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID