摘要:

ObjectiveTo assess the nitric oxide synthase activity in placentas from women with either normal or abnormal Doppler ultrasound umbilical artery flow velocity waveforms who delivered by elective cesarean.MethodsThis prospective observational study involved 16 women admitted either for elective cesarean for standard obstetric indications (with normal umbilical artery Doppler waveform studies,n= 8) or with evidence of fetal or maternal complications of pregnancy (with abnormal umbilical artery Doppler studies,n= 8). Placental tissue was collected and frozen in liquid nitrogen immediately upon delivery. Following storage at −80C, nitric oxide synthase activity was analyzed by measuring the conversion of [3H]L-arginine to [3H]L-citrulline.ResultsPlacentas from women with abnormal umbilical artery flow velocity waveforms showed significantly lower mean nitric oxide synthase activity than did placentas from women with normal umbilical artery flow velocity waveforms (Vmax= 11.3 pmol/minute/mg protein versus 22.6 pmol/minute/mg protein).ConclusionThere is a statistically significant reduction in nitric oxide synthase activity in placentas from pregnancies with abnormal umbilical artery flow velocity waveforms.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the effect of nitric oxide synthase activity inhibition on the fetal lamb umbilical artery flow velocity waveform.MethodsFive pregnant Corriedale cross ewes were operated on at 125–130 days' gestation. Fetal and maternal vascular catheters were inserted along with a Doppler flow meter cuff on the fetal common umbilical artery. Each fetus received a 40-minute intravenous (IV) infusion of Nω-nitro-L-arginine as a control, and then after a recovery period of 1 hour, a 40-minute IV infusion of Nω-nitro-L-arginine, an inhibitor of nitric oxide synthase activity. Maternal and fetal heart rate, blood pressure, blood gases, and fetal umbilical artery flow velocity waveforms were recorded at basal time and after the 40-minute IV infusions.ResultsThere were no differences in fetal or maternal heart rate, blood pressure, or blood gases with the infusion of the nitric oxide synthase inhibitor Nω-nitro-L-arginine. However, Nω-nitro-L-arginine caused a significant increase (41%) in the fetal umbilical artery flow velocity waveform systolic to diastolic ratio (S/D) above the baseline levels.ConclusionsInhibition of nitric oxide synthase activity in the lamb fetoplacental circulation with Nω-nitro-L-arginine is associated with an increase in the umbilical artery S/D.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the change in fetal serum bilirubin levels in response to intrauterine transfusion for red cell alloimmunization.MethodsThe records of 37 patients who underwent more than one intrauterine transfusion were reviewed. The following indices were extracted: pre- and post-transfusion fetal hematocrit, total and direct serum bilirubin, reticulocyte count, Kleihauer-Betke test results, volumes of intravascular and intraperitoneal transfusions, and the source used for transfusion. The data were compared for interval 1 (transfusion 1 to 2) and interval 2 (transfusion 2 to 3). The rates of change in bilirubin, reticulocyte count, and percent fetal cells on the Kleihauer-Betke test were defined as the differences between the initial values of one transfusion and the initial values of the next transfusion divided by the number of days between transfusions. Analysis of variance, sign-rank test, and linear regression analysis were used when appropriate.P< .05 was significant.ResultsThe median number of intrauterine transfusions for each patient was 3 (range 2–8). Gestational ages ranged from 22 to 37 weeks. Total bilirubin remained above the 97.5 percentile for gestational age in all but five patients. There was a significant decrease in reticulocyte count and fetal cells on the Kleihauer-Betke test, and an increase in hematocrit with serial intrauterine transfusions. Bilirubin increased significantly after the first intrauterine transfusion (3.9 versus 5.0 mg/dL) and remained elevated thereafter.ConclusionFetal total serum bilirubin remains elevated with repeated intrauterine transfusions in fetal alloimmunization. Total bilirubin should not be used to evaluate fetal hematologic responses to the transfusions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo survey the current knowledge, attitudes, and practices of obstetric providers regarding the education of pregnant women about infant hepatitis B vaccination.MethodsA questionnaire was mailed to 264 physicians providing obstetric services in San Francisco. Of these, 113 were confirmed to be providing prenatal care.ResultsSeventy-six obstetric providers returned completed questionnaires. Among eligible respondents, 79% believed that hepatitis B vaccine should be administered to all infants at birth, and 92% believed that it is feasible to educate all expectant mothers about infant hepatitis B vaccination. However, only 53% of respondents provided such education to all their pregnant patients. Only 23% provided education about other routine childhood immunizations.ConclusionsObstetric providers in San Francisco are willing to educate pregnant patients about hepatitis B vaccination but are not always doing so. Providing education in a consistent manner may improve infant hepatitis B vaccination rates and may increase coverage with other childhood vaccines.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify the effect of human immunodeficiency virus (HIV) infection on the clinical course of pelvic inflammatory disease (PID).MethodsWomen hospitalized with PID at an urban hospital serving a population at high risk for HIV were studied cross-sectionally. Data abstracted from medical records of 349 women, admitted between July 1992 and April 1994 were linked anonymously to HIV serology. Main outcome measures were length of hospital stay, prolonged fever, tubo-ovarian abscess, surgery, and change in antibiotics.ResultsAmong the 349 women with PID, 27 were HIV-positive. These HIV-positive women had lower mean white blood cell counts at admission (7411 versus 11,266,P< .01), lower mean lymphocyte counts (1411 versus 1928,P< .01), greater febrile morbidity (54 versus 28.3%,P< .01), and longer hospital stays (10.5 versus 6.4 days,P< .01) than HIV-negative women. Women who were HIV-positive required more time for defervescence and needed to change their antibiotic regimen more frequently (41 versus 12.7%,P< .01); differences in tubo-ovarian abscesses (19 versus 14%,P= .52) or surgery (15 versus 6.2%,P= .10) were not significant. The differences in hospital course between HIV-positive and HIV-negative women were modest, and they were resolved largely by the fourth or fifth hospital day. All HIV-positive women were treated successfully with first- or second-line antibiotic regimens.ConclusionDespite more severe initial presentation and a prolonged hospital course, HIV-positive women with PID, but without other acute illnesses, were treated successfully with standard therapeutic regimens. These observations support current recommendations for hospitalization of HIV-positive women with PID and treatment according to current standards.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the incidence of genital tract infections and cervical abnormalities in 185 human immunodeficiency virus (HIV)-positive outpatients with a view toward establishing an effective policy for gynecology screening.MethodsGynecology results were reviewed for 185 HIV-positive women seen as outpatients at the Royal Free Hospital in London. All subjects underwent screening for cervical abnormalities (smear and colposcopy) and sexually transmitted disease (STD) at 6-month intervals for 6 years. The STD prevalence was calculated, and the relationship between the occurrence of STDs and the demography and sexual lifestyle of the women was examined to determine whether these factors were predictive for women at risk for STDs. The incidence of cervical intraepithelial neoplasia (CIN) was determined. We reviewed the use of colposcopy in addition to cytology as a primary screening test to see whether it improved the detection rate of CIN.ResultsSixty-five (35.1%) women had a history of previous STDs, and new STDs were detected in 18 women at their first visits. None were detected at subsequent visits. Sexual lifestyle details did not predict women at risk for STDs. Ninety-eight (53%) cervical smears were reported as normal at the first visit, but there was a 3.1% (95% confidence interval 0, 6.6) false-negative rate when compared with colposcopy and directed biopsy. Five of fifty women (10%) with CIN 1 had progressed to higher-grade lesions by 6-month follow-up.ConclusionsGiven the low prevalence of STDs detected, except for initial screening at presentation, regular, repeat STD screening of HIV-positive women appears to be unnecessary. Because of the high incidence of cervical abnormalities, screening for cervical disease is important, and colposcopy with directed biopsy improved the detection rate of cervical abnormalities.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the importance of cervical cancer in the spectrum of human immunodeficiency virus (HIV)-related diseases at a single high-risk institution and to compare disease characteristics in HIV-infected women with cervical cancer and those with other AIDS-related malignancies.MethodsWe retrospectively reviewed data on cervical cancer and AIDS in women registered through the New York City Department of Health and institutional tumor registries from 1987 through 1995.ResultsDuring the study period, cervical cancer was diagnosed in 28 HIV-positive women. In 26, cervical cancer was the initial AIDS-defining illness, representing 4% (26 of 725) of the subjects, and it was the sixth most common initial AIDS-defining illness in women. Cervical cancer was the most common AIDS-related malignancy among women, representing 55% of the cases, followed by lymphoma (29%) and Kaposi sarcoma (16%). In 71% of the women with cervical cancer, HIV infection was diagnosed at the time of cancer presentation by routine testing, whereas in women with other malignancies, HIV diagnosis preceded cancer diagnosis (70%) by a mean of 2.7 years. Patients with other malignancies had greater immunosuppression (mean CD4 count 153/μL) than those with cervical cancer (mean CD4 count 312/μL). The recurrence rate for women with cervical cancer was 88%. Although the interval from cancer diagnosis to death was similar in all three groups (9.1–12.4 months), cancer was the cause of death in 95% of HIV-infected women with cervical cancer, compared with 60% of those with other AIDS-related malignancies.ConclusionIn urban populations at increased risk for both diseases, cervical cancer is an important AIDS-defining illness and may be the most common AIDS-related malignancy in women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the prevalence of human papillomavirus (HPV) DNA in squamous cell carcinoma of the vulva by polymerase chain reaction (PCR).MethodsArchival diagnostic phase biopsies from 74 patients with squamous cell carcinoma of the vulva were investigated for HPV DNA by PCR. We used both consensus primers located in the open reading frame L1 and type-specific primers for HPV 6 (open reading frame E5), HPV 11 (open reading frame L1), HPV 16, HPV 18, and HPV 33 (open reading frame E6).ResultsHPV DNA was detected in 27 (36%) of the 74 patients, of whom 19 had HPV 16, nine had HPV 18, one had HPV 33, and one had unclassified HPV DNA. No case of HPV type 6 or 11 was detected. Two squamous cell carcinomas were positive for both HPV 16 and 18, and one was positive for both HPV types 16 and 33. Three squamous cell carcinomas positive for E6 gene using type-specific primers were negative using L1 consensus primers.ConclusionOur PCR methods using both consensus open reading frame L1-derived primers and type-specific open reading frame E6-derived primers of HPV types 16, 18, and 33 seemed to be an appropriate combination for the detection of HPV DNA in archival tissues of vulvar carcinoma. Both HPV types 16 and 18 were associated with squamous cell carcinoma of the vulva, although the prevalence of HPV 16 was considerably lower than in cervical carcinoma. It appears that vulvar and cervical carcinomas are not identical etiologically and that factors other than HPV are important in vulvar carcinogenesis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify the nature of adnexal and uterine disease in women with a history of colorectal adenocarcinoma who develop new pelvic masses or uterine cancers during follow-up.MethodsWe conducted a retrospective chart review of the Memorial Hospital Gynecology Service database and identified 50 women, each with a history of colorectal carcinoma who underwent a hysterectomy or adnexectomy between January 1, 1977, and February 29, 1996. Subject characteristics, indications for re-operation, and findings at surgery were recorded.ResultsThe mean age at re-operation was 66 years (range, 37–76), with a median interval from initial diagnosis to re-operation of 25 months (range, 3–444). Indications for re-operation were: 1) new pelvic mass in 35 women, and 2) cancer on endometrial or cervical biopsy in 15. Twenty-six of the 35 (74%) women who presented with a pelvic mass had a malignancy in the ovary, with metastatic colon cancer noted in 20 of 26 (77%) women, and epithelial ovarian cancer in six of 26 (23%). The mean ovarian tumor size for metastatic colorectal carcinoma, ovarian cancer, and benign tumors was 15, 8, and 6 cm, respectively. Fifteen women underwent hysterectomy for a newly diagnosed cancer in the uterus, with the majority, 11 (73%), having endometrial adenocarcinoma, followed by metastatic colon cancer to the endometrium or cervix in three (20%) women, and primary cervical carcinoma in one.ConclusionWomen with a history of colorectal cancer who underwent adnexectomy for a new pelvic mass had metastatic colon cancer to the ovary in 57%, benign ovarian neoplasm in 26%, and primary ovarian cancer in 17% of cases. Women who underwent hysterectomy for a newly diagnosed carcinoma in the uterus had primary endometrial adenocarcinoma in 73% and metastatic colon cancer in 20% of cases.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo prove that microinvasive adenocarcinoma of the cervix exists and, like its squamous counterpart, carries an excellent prognosis.MethodsSeventy-seven women with microinvasive adenocarcinoma of the cervix were seen from 1971 to 1995. Microinvasion was defined as depth of invasion or tumor thickness of at most 5 mm. Microscopic assessment was made on punch biopsies, serially sectioned conization specimens, and extensively sampled hysterectomy specimens.ResultsMost of the women had abnormal Papanicolaou smears. We made definitive diagnoses on conization specimens in 49 women, hysterectomy specimens in 22, and colposcopically directed punch biopsies in six (there being no residual disease in the subsequent conizationhysterectomy specimens). The length of microinvasive adenocarcinomas ranged from 0.8 to 21 mm, and the volume was between 3 and 1000 mm.3The tumors were multicentric in 21 cases, but no true “skip” lesions were found. Overall, 58 cold-knife conizations were performed: the margins were free in 39 cases, involved in 18, and inconclusive in one. The one loop conization had involved margins. Definitive therapy included cold-knife conization in 16 women, combined with pelvic-node dissection in four. In the remainder of the women, we performed some type of hysterectomy. None of the 26 women who had radical hysterectomy had parametrial spread, and none of the 48 who had pelvic-node dissection or the 23 in whom one or both adnexa were removed had metastases. There have been two “recurrences” to date; one was an adenocarcinoma and the other a squamous cell carcinoma, both at the vault.ConclusionMicroinvasive adenocarcinoma of the cervix is a clinicopathologic entity that appears to have the same prognosis, and should be treated in the same way, as its squamous counterpart.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID