摘要:

OBJECTIVETo review our experience with secondary cytoreductive surgery for recurrent epithelial ovarian cancer with regard to its feasibility, morbidity, mortality, patient selection, and survival.METHODSForty-six patients who underwent secondary cytoreductive surgery at the Royal Hospital for Women, Sydney, between July 1988 and October 1996 were retrospectively reviewed. The mean age at surgery was 50.3 years, and the median disease-free interval was 26 months. Eighty-nine percent of patients had a disease-free interval of at least 12 months. Twenty-five patients (54%) had localized disease at the time of surgery. Univariate survival outcomes were analyzed using the log rank test, and survival curves were calculated using the method of Kaplan-Meier.RESULTSTwo patients (4%) were inoperable and 19 patients (41%) were cytoreduced to no macroscopic disease. There was one postoperative death (2%), and four patients (8.7%) had significant postoperative morbidity. With a median follow-up of 88 months, the overall median survival was 22.5 months. Patients with a disease-free interval of less than 12 months after their initial treatment had a median survival of 6 months, compared with 11 months if the disease-free interval was 12–24 months and 39 months for those with a disease-free interval of 24 months or more (P= .001, log rank). Patients who had any residual disease had a median survival of 11 months, whereas those with no residual disease had a median survival of 38 months (P= .002, log rank).CONCLUSIONFor carefully selected patients with recurrent epithelial ovarian cancer: 1) complete surgical resection is feasible more commonly than with primary cytoreduction, 2) serious morbidity and mortality are acceptable, and 3) significant survival benefit accrues when a) all macroscopic disease can be resected, or b) the disease-free interval is 24 months or more.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo describe severity of emotional and physical symptoms in a large diverse sample; to examine demographic, health status, and behavioral correlates of symptom severity; and to describe use of medications and alternative remedies for premenstrual symptoms.METHODSA total of 1194 women, ages 21–45, selected from members of a large northern California health maintenance organization, completed daily ratings of symptom severity for two menstrual cycles. An empirically derived algorithm defined symptom severity groups as minimal (n= 186), moderate (n= 801), severe (n= 151), or premenstrual dysphoric disorder (n= 56). Symptom severity as a continuous variable was defined by the two-cycle mean symptom ratings in the luteal phase. Demographic, health status, and behavioral factors and use of treatments for premenstrual symptoms were assessed by self-report.RESULTSLuteal phase symptom-specific ratings were generally significantly greater in the premenstrual dysphoric disorder group than in the other groups (P< .001). Symptom severity score increased with each comorbidity and decreased with each year of age. Symptom severity was also inversely associated with oral contraceptive use (emotional symptoms) and better perceived health (physical symptoms). Hispanics reported greater severity of symptoms, and Asians less, relative to whites. Use of herbal and nutritional supplements for premenstrual symptoms steadily increased from 10.8% in the minimal group to 30.4% in the premenstrual dysphoric disorder group (P< .01).CONCLUSIONThe degree of premenstrual symptom severity varies in the population, is relatively constant within each woman over two consecutive cycles, particularly for emotional symptoms, and is influenced by age, race/ethnicity, and health status.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo describe an alternative method of vaginal birth to the conventional assisted delivery for extremely preterm breech infants within intact amnions, and to compare the immediate neonatal outcomes with those delivered by cesarean.METHODSRetrospective review of singleton breech deliveries under 26 weeks' gestation after spontaneous labor with intact membranes. Nine “en caul” vaginal births after tocolysis and six cesarean deliveries performed for the sole indication of preterm labor were identified between 1996 and 2001.RESULTSThe vaginal group's mean gestation and cervical dilatation on admission were 23+6weeks and 3.2 cm, respectively, and 24+6weeks and 2.8 cm in the cesarean group. Vaginal delivery occurred an average of 4 days after admission and 1 day for cesarean delivery. Mean time interval between the first corticosteroid injection and delivery was greater in the vaginal group (90 versus 22 hours). Failure to start or complete a steroid course was more likely in the operative group (67% versus 11%). Mean birth weights were comparable. Five-minute Apgar scores and cord pHs were 6 and 7.41, respectively, for vaginal births, and 5.5 and 7.32 after cesarean deliveries. Fifty-five percent of vaginally delivered infants had a 5-minute Apgar score less than 7, with 22% of the whole group dying during the first week of life. This compared with 66% and 50%, respectively, for cesarean infants. Of the survivors, average age at discharge was 121 days for both groups.CONCLUSIONVaginal birth can be effected in extremely preterm breech pregnancies with intact membranes by adopting the “en caul” delivery method.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate gender preferences for obstetricians in a hospital setting and to examine its relationship to patient satisfaction.METHODSUsing methods of qualitative analysis, we interviewed a convenience sample of 67 obstetric patients during their postpartum hospital stay, asking open-ended questions about gender preferences of health care providers and satisfaction with health care.RESULTSOverall, 58% of patients (n= 39) had no preference for physician gender, 34% (n= 23) preferred female physicians, and 7% (n= 5) preferred male physicians. Physicians' interpersonal style, communication style, and technical expertise were considered important characteristics by patients. Although most patients had no preference for physician gender, the majority of patients preferred a female nurse. Patient satisfaction scores were not associated with physician gender.CONCLUSIONOur study found that a majority of women did not prefer a female obstetrician. Our results suggest that physician gender is less important to patients than other physician characteristics.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate whether specimens obtained from the perianal area have a Group B streptococcal culture detection rate similar to anorectal specimens.METHODSThis is a prospective cohort study at a tertiary care university-affiliated teaching hospital. A total of 136 pregnant women between 33 and 40 weeks' gestation were recruited. Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perianal sample, vaginoperianal sample, and an anorectal sample. The women were asked to rank their pain or discomfort with obtaining the anorectal sample. The vaginoperianal specimen is the standard sample obtained from antepartum patients in this clinic, and, therefore, it serves as the control.RESULTSOf the 136 subjects, 26.5% of the control, vagino-perianal samples were positive for Group B streptococcal culture. In comparison, 27.2% of the anorectal specimens and 28.7% of the perianal specimens were positive for Group B streptococcal culture. There was no statistically significant difference in the detection of Group B streptococcal culture among the three sample sites. Evaluation of the pain experienced with an anorectal sampling showed that 68% of subjects ranked their pain between mild to moderate, and 5% noted severe pain.CONCLUSIONThe Group B streptococcal detection rate was not different among the three sampling sites. Therefore, pregnant women do not need to be subjected to the additional pain of anorectal sampling to detect Group B Streptococcus.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate whether the risk of neonatal thyrotoxicosis was related to the value of maternal thyroid-stimulating immunoglobulin in women with Graves disease.METHODSThe records of pregnant women undergoing testing for thyroid-stimulating immunoglobulin over a 10-year period were analyzed. Neonatal thyrotoxicosis was defined as the presence of tachycardia, goiter, hydrops, tremulousness, voracious appetite, irritability, cardiomegaly, or congestive heart failure, with elevated thyroid hormone levels. The relationship between maternal thyroid-stimulating immunoglobulin values and the development of thyrotoxicosis was examined. The sensitivity, specificity, and positive and negative predictive values were calculated using an arbitrarily chosen cutoff for thyroid-stimulating immunoglobulin.RESULTSTwenty-nine women with a history of Graves disease and positive thyroid-stimulating immunoglobulin values were available for analysis. Of the 35 live births, there were six cases of neonatal thyrotoxicosis (17.1%). A maternal thyroid-stimulating immunoglobulin value at least 5 index units predicted neonatal thyrotoxicosis with a sensitivity of 100%, specificity of 76.0%, positive predictive value of 40.0%, and negative predictive value of 100%.CONCLUSIONPregnancies complicated by high values of maternal thyroid-stimulating immunoglobulin appear to be at risk of developing neonatal thyrotoxicosis.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare the safety and effectiveness of vaginal with oral misoprostol for induction of labor.METHODSA total of 107 women with clinical indication for induction were randomly assigned to receive oral or vaginal misoprostol. Doses of 100 μg of oral or 25 μg of vaginal misoprostol were given every 3–4 hours. If cervical ripening or active labor did not occur, repeated doses of oral (100–200 μg) or vaginal (25–50 μg) were given until labor was established.RESULTSFifty-nine women received oral misoprostol, and 48 received vaginal administration. Delivery time was similar for the vaginal and oral arms (1074 ± 488 minutes versus 930 ± 454 minutes,P= .11). Parity was significantly different (P= .04) for the vaginal and oral groups. The cesarean delivery rate was similar for the vaginal and oral arms (17% versus 15%,P= .72). The number of medication administrations was consistent between groups. Birth weight was not different for patients in the control and treatment groups (vaginal 3281 ± 507 g versus oral 3359 ± 541 g,P= .44). Chorioamnionitis and tachysystole were comparable for the oral and vaginal groups. There was no statistical difference in neonatal outcomes. Similar proportions of infants were admitted to the well baby nursery and intermediate care nursery.CONCLUSIONThese findings indicate that, in a closely supervised hospital setting with adequate monitoring, oral misoprostol has the potential to induce labor as safely and effectively as its vaginal analogue.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo measure the rate of hepatitis B (HBV) transmission from chronic HBV carriers to breast-fed infants after immunoprophylaxis.METHODSSince 1992, information on women with HBV during pregnancy has been collected in a prospective longitudinal study. Those HBV carriers and their infants participating in a county HBV immunoprophylaxis program were identified. Infants were followed for up to 15 months and examined for hepatitis B infection by hepatitis B surface antigen (HBsAg).RESULTSA total of 369 infants born to women with chronic HBV met the inclusion criteria and received hepatitis B immune globulin at birth and the full course of the hepatitis B vaccine series. We compared 101 breast-fed infants with 268 formula-fed infants. There was no significant difference between the two groups with respect to the number of women who were positive for hepatitis B e antigen (HBeAg) (22% versus 26%,P= .51). Three women in the breast-feeding group had liver transaminase abnormalities, compared with six women in the formula-feeding group (P= .29). Overall, there were nine cases of HBV infection transmission (2.4%). None of the 101 breast-fed infants and nine formula-fed infants (3%) were positive for HBsAg after the initial vaccination series (P= .063). The mean length of time for breast-feeding was 4.9 months (range 2 weeks to 1 year).CONCLUSIONWith appropriate immunoprophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, breast-feeding of infants of chronic HBV carriers poses no additional risk for the transmission of the hepatitis B virus.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate whether ThinPrep smears without versus those with a transformation zone component were more likely to have falsely negative cytology findings.METHODSWomen aged 18–50 (N= 4389) attended one of three Planned Parenthood clinics between 1997 and 2001 for screening by ThinPrep Papanicolaou and polymerase chain reaction-based human papillomavirus (HPV) DNA testing. Women with 1) any cytologic abnormality, 2) high-risk HPV types, and 3) a random sample with normal Papanicolaou and negative HPV tests were offered repeat cytology, colposcopy, and biopsy. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence (n= 3689) or absence (n= 700) of a transformation zone component at screening.RESULTSAmong women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio 1.3, 95% confidence interval 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio 2.0, confidence interval 1.0, 3.8). Transformation zone-negative smears were more common among older women, current oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types.CONCLUSIONAbsence of a transformation zone component in a screening ThinPrep Papanicolaou test was not associated with missed high-grade lesions. Based upon our data, we do not recommend repeat screening of reproductive-aged women with negative liquid-based tests and no cytologic evidence of a transformation zone component.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo identify predictive factors that will ensure successful menorrhagia treatment using hot fluid balloon endometrial ablation.METHODSThis is a prospective study on patients referred for menorrhagia and treated with hot fluid thermal balloon ablation. Potential prognostic factors for assessing the success of treatment were recorded. Success was defined as patient satisfaction and no subsequent hysterectomy at 2-year follow-up.RESULTSA total of 130 women were included in the final analysis. The cumulative rate of patients undergoing a hysterectomy after 2 years was 12%. After 2 years, 81% of the remaining patients were satisfied with the results of the treatment. Predictive factors for adverse outcome were a retroverted uterus (hazard rate ratio 3.3, 95% confidence interval [CI] 1.2, 8.6), pretreatment endometrial thickness of at least 4 mm (hazard rate ratio 3.6, 95% CI 1.3, 11), and the duration of menstruation (hazard rate ratio 1.2, 95% CI 1.0, 1.3, per day in excess of 9 days). The risk of an adverse outcome declined steadily with increasing age (hazard rate ratio 0.86, 95% CI 0.77, 0.96 per year over 42 years of age). Uterine depth and dysmenorrhea were not predictive factors, which significantly affected outcome.CONCLUSIONYoung age, retroverted uterus, endometrial thickness of at least 4 mm, and prolonged duration of menstruation were associated with an increased risk of treatment failure. Uterine depth and dysmenorrhea had limited impact on the effectiveness of balloon ablation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID