摘要:

ObjectivesTo determine the growth patterns of the fetal heart and the development of cardiac function during gestation in fetuses of diabetic mothers, and to compare these findings with those of normal fetuses.MethodsSerial M-mode and Doppler echocardiographic recordings were made at 4-week intervals in 14 fetuses of well-controlled type I insulin-dependent diabetic mothers and in ten control fetuses at 20–36 weeks' gestation. The following variables were measured: interventricular septal thickness, left ventricular wall thickness, right ventricular wall thickness, ratio between the peak velocities during early passive ventricular filling and active atrial filling at the level of the atrioventricular valves, peak velocities, and time to peak velocity at the level of the ascending aorta and pulmonary artery.ResultsIn both groups of fetuses, all of the indices increased linearly with gestation. However, fetuses of diabetic mothers showed significant differences in the slope and intercept values for the function describing the growth of the interventricular septum (P± .001) and the right and left ventricular wall thicknesses (P± .01), resulting in accelerated cardiac growth. The function describing the development of the ratios between early and active ventricular filling showed differences in slope and intercept values at the level of both the mitral (P± .001) and tricuspid valves (P± .001), resulting in a lower rate of increase during diabetic pregnancy when compared with control fetuses. Significantly higher intercept values were found in the functions describing the increase of peak velocities in the aorta and pulmonary artery in fetuses of diabetic mothers (P± .01), whereas the slopes were similar to those of control fetuses. No differences were found in the time to peak values between the groups of fetuses. No relationships were found between the echocardiographic results and the metabolic control of pregnancy or fetal characteristics.ConclusionsThis study suggests that strict maternal diabetes control does not exclude accelerated fetal cardiac growth and abnormal development of cardiac function.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The aim of this study was to see whether umbilical artery Doppler velocimetry predicts intrapartum fetal distress evidenced by poor perinatal outcome. Umbilical velocimetry was performed on 102 parturients with a presumptive diagnosis of fetal distress based on fetal heart rate (FHR) patterns. A mean systolic-diastolic ratio (S/D) of 3 or more after 30 weeks' gestation was considered abnormal. Poor perinatal outcome was defined by any of the following: small for gestational age, low Apgar score, acidosis, meconium below the vocal cords, prolonged neonatal hospital stay, neonatal intensive care unit admission, and neonatal morbidity. Eighty-two patients had normal S/Ds and 20 had abnormal ratios. Eighteen neonates (90%) in the abnormal-SD group had at least one adverse outcome, compared with only 13 (15.8%) of those with a normal S/D, a statistically significant difference (P< .001). Umbilical artery S/D used as a screening tool to detect poor perinatal outcome had a sensitivity of 65–100%, specificity of 83–92%, positive predictive value of 20–81%, negative predictive value of 91–100%, and a kappa index of 0.24–0.63. These findings suggest that umbilical artery Doppler velocimetry may be useful as an adjunct in the assessment of intrapartum FHR patterns suggesting fetal distress.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo establish nomograms of fetal ear measurements. Newborns with trisomies have smaller ears than the normal population. This observation led us to believe that ear measurements might be useful in the antenatal prediction of fetuses with abnormal karyotypes.MethodsFetal ear length and width were obtained ultrasonographically in 124 normal singleton pregnancies between 18–12 weeks' gestation. Regression analyses were used to create the nomograms.ResultsLinear relationships were found between ear length and width and gestational age (r= 0.956 and 0.898, respectively). In addition, there were significant correlations between ear measurements and biparietal diameter, head circumference, abdominal circumference, and femur length. The ear width-length ratio and the biparietal diameter-ear length ratio were independent of gestational age.ConclusionThese normative data may be helpful in the antenatal prediction of chromosomal abnormalities.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveWe sought to determine the natural history of the cytologic and colposcopic changes in patients with minimal abnormalities on their Papanicolaou smears (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion [SIL]).MethodsBetween November 1988 and November 1990, 632 women with abnormal Papanicolaou smears as listed above were evaluated at Los Angeles County-Olive View Medical Center. Each had review of cytology, repeat Papanicolaou smear, and colposcopy of the lower genital tract. We excluded those who were pregnant or had findings demonstrative of moderate dysplasia or worse, or had a cervical biopsy for any other indication. Women with symptomatic vaginal discharge were treated and remained in the study. Subjects were followed every 3 months with repeat Papanicolaou smear and colposcopy for a minimum of 9 months. If at any time the Papanicolaou smear or colposcopy was consistent with moderate dysplasia or worse, directed biopsies and endocervical curettage were performed, and treatment was given accordingly. Two hundred ninety-four patients fulfilled all inclusion criteria and had adequate follow-up data.ResultsNine months after enrollment, 42 of 91 women (46.2%) with atypical squamous cells had persistent changes, none had progression, and 49 (53.8%) had regression to normal. In those with low-grade SIL, 37 of 203 cases (18.2%) persisted, seven (3.4%) progressed, and 159 (78.3%) regressed by 9 months. Patients in the first group were more likely to have persistence of the cytologic abnormalities than were those in the second (P< .01). Only the latter group progressed to high-grade dysplasia during the 9-month study interval.ConclusionThe majority of women with confirmed minimal cytologic changes on Papanicolaou smear will have complete colposcopic and cytologic regression over a short interval.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine the usefulness of human papillomavirus (HPV) testing as a triage method for predicting which women referred to a colposcopy clinic were most likely to have histologically confirmed cervical intraepithelial neoplasia (CIN).MethodsFapanicolaou tests, ViraPap tests for HPV infection, and colposcopically directed biopsies were performed concurrently on 482 women referred to a student health colposcopy clinic.ResultsThe results demonstrated that HPV positivity was associated with a greatly increased likelihood of histologic confirmation of CIN, especially among women with concurrent cytologic findings that were negative or showed only atypical squamous cells of undetermined significance.ConclusionsTesting for HPV appears to have a role in the triage of students now being referred to our colposcopy clinic. A combination of HPV testing and repeated cytologic screening would provide reasonably sensitive screening for cervical neoplasia while limiting the use of colposcopic services, which are currently overburdened. The eventual usefulness of HPV testing will depend on the cost and availability of colposcopy services, the cost of Papanicolaou tests, the cost and accuracy of HPV tests, and the predictive value of HPV detection in the population being screened.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess different strategies for improving the specificity of screening for ovarian cancer with tumor-associated antigens, including concomitant measurement of multiple tumor markers and serial measurement of CA 125.MethodsA combination of CA 125, CA 15–3, and TAG 72.3 was evaluated in serum samples from 217 of 1010 apparently healthy postmenopausal women who had participated in a study of screening for ovarian cancer and who had a serum CA 125 level of 20 U/mL or greater. In addition, serial serum CA 125 levels were determined in 30 women with an initially elevated CA 125 level (30 U/mL or more) and 30 women with a CA 125 level less than 30 U/mL.ResultsThe specificity of CA 125 at upper limits of 30 and 50 U/mL was increased from 97.0 and 99.5%, respectively, to 98.9 and 99.9% when a positive test was defined as an elevated serum CA 125 level in combination with either a CA 15–3 greater than 30 U/mL or a TAG 72.3 greater than 10 U/mL. Definition of a positive result as a serum CA 125 level greater than 50 U/mL at the initial test and greater than 30 U/mL at 3-month follow-up achieved a specificity of 99.6%.ConclusionLevels of specificity suitable for screening asymptomatic postmenopausal women can be achieved using tumor-associated antigens measured serially or in combination. Further studies are required to determine the sensitivity of these strategies for preclinical ovarian cancer.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The growth of breast cancer may be mediated by endogenous or exogenous sex steroid hormones, particularly estrogen. However, neither contraceptive nor noncontraceptive estrogen use has been associated definitively with an increased risk of developing breast cancer. In this study, we addressed a corollary question: If a postmenopausal woman develops carcinoma of the breast, is her survival affected by previous use of replacement estrogen? Two hundred fifty-six postmenopausal women with breast cancer entered our Tumor Registry between 1972–1981, inclusive. Of these, 174 took no replacement estrogen before the diagnosis (never-users), 21 had used estrogen previously (past users), and 61 were taking estrogen at the time of diagnosis (current users). Survival analysis revealed a median survival of less than 84 months after diagnosis for never-and past users and greater than 143 months for current users, but these differences were not significant when controlled for stage of disease at diagnosis. We conclude that prior postmenopausal estrogen replacement therapy does not compromise survival in women who subsequently develop carcinoma of the breast.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo understand growth regulation of the endometrium by studying the effect of interleukin-1β (IL-1) on human endometrial stromal cell proliferation in vitro.MethodsEndometrial stromal cells from human endometrium were separated and purified and placed in culture. Fresh and first-and sixth-passage cells were incubated with IL-1 (0.025, 0.25, and 2.5 ng/mL) for 24, 48, and 72 hours, respectively. Proliferation as a function of DNA synthesis was assessed by measuring3H-thymidine incorporation. Experiments were then repeated in the presence of indomethacin to determine whether IL-1 effects were dependent upon prostaglandin synthesis. We evaluated overall growth by adding IL-1 to cell cultures of sixth-passage stromal cells every 3 days and by performing cell count studies.ResultsInterleukin-1β significantly inhibited3H-thymidine uptake in freshly explanted endometrial stromal cells at all doses in a dose-dependent manner; a 44% inhibition was seen at 2.5 ng/mL IL-1 after 72 hours of incubation. In first-and sixth-passage cells,3H-thymidine uptake was inhibited only at intermediate and high doses of IL-1. Cell count studies showed that sixth-passage cells were significantly inhibited by IL-1 after 23 days of growth (22%;P< .01). Adding indomethacin did not affect inhibition of growth.ConclusionInterleukin-1β inhibits growth of normal human endometrial stromal cells in vitro and does not appear to be mediated by arachidonic acid metabolites. This inhibition of growth may be important for maintenance of a normal endometrial phenotype.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo examine the cellular localization of each inhibin subunit in human placenta throughout pregnancy.MethodPlacental tissues were collected and fixed in Bouin's solution, and studied with the immunohistochemical technique avidin-biotin-peroxidase complex.ResultsThere was immunohistochemical staining with antisera against each inhibin subunit in the syncytiotrophoblast, but not in the cytotrophoblast. In the first-trimester placenta, positive immunostaining for α-and βA-subunits was clearly observed in the syncytial layer of villi, whereas staining for βB-subunit was faint. In the second-trimester placenta, the relative intensities of staining for α-and βA-subunits were similar to those in the first-trimester placenta, and enhanced positive immunostaining with βB-subunit antiserum was observed. The relative amount of immunostainable α-subunit declined within the syncytiotrophoblast of the third-trimester placenta, whereas levels of immunostainable β-subunits were unchanged.ConclusionsInhibin subunits may be produced in the syncytiotrophoblast throughout pregnancy, and activin as well as inhibin may be synthesized in the syncytiotrophoblast of the term placenta.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We analyzed retrospectively the incidence of subchorionic fluid and embryonic death in 2116 consecutive patients evaluated with abdominal ultrasound and 783 patients evaluated with vaginal ultrasound. These women were examined during the first 12 postmenstrual weeks and had conceived as a result of infertility treatment. In addition, we analyzed the relationship of subchorionic bleeding to subchorionic fluid in 230 patients evaluated with color Doppler ultrasound and the relationship of subchorionic bleeding to clinical bleeding, precipitating factors, pregnancy outcome, and the karyotypes of abortuses. In single gestational sac pregnancies, subchorionic fluid was found equally often in women scanned with vaginal or color Doppler ultrasound, and less often with abdominal ultrasound (P< .0001). Embryonic death was increased only in patients with large amounts of subchorionic fluid observed on abdominal ultrasound. Color Doppler ultrasound revealed subchorionic bleeding in 87 of 235 ultrasound scans (37%) and in 48 of 102 patients (47%) when subchorionic fluid was present. Subchorionic bleeding was associated with moderate or large amounts of subchorionic fluid (P= .041), with precipitating events (P< .0001), and with clinical bleeding (P= .001). It was occult in ten of 48 patients (21%). Embryonic death occurred equally often in women with no fluid and in those with subchorionic fluid, with and without subchorionic bleeding. Abortuses were karyotypically abnormal in an equal proportion of cases with subchorionic bleeding, subchorionic fluid, and no fluid. These findings indicate that subchorionic fluid and subchorionic bleeding are common findings in early pregnancy and are not associated with embryonic death unless they are accompanied by clinical bleeding.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID