摘要:

OBJECTIVEIn some women, hot flashes and other symptoms attributed to menopause persist for many years after the cessation of menses. The frequency and severity of such symptoms and response to hormone therapy in older women have not been well documented.METHODSWe used data from the Heart and Estrogen/Progestin Replacement Study, a blinded, clinical trial among 2763 women with documented coronary disease and a uterus who were randomized to receive either conjugated estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one tablet or placebo. Participants were queried at baseline and annually regarding menopausal symptoms. Breast symptoms were self-reported, and uterine bleeding was recorded on a daily diary.RESULTSSymptoms associated with menopause were relatively common among Heart and Estrogen/Progestin Replacement Study participants, whose average age was 67 years and who averaged 18 years since menopause. At baseline, 16% of women reported frequent hot flashes, 26% vaginal dryness, 10% genital irritation, 55% trouble sleeping, and 53% early awakening. Women assigned to hormone therapy reported less frequent hot flashes, vaginal dryness, and trouble sleeping compared with women assigned to placebo, but more frequent vaginal discharge, genital irritation, uterine bleeding, and breast symptoms. The reporting of breast symptoms among women in the hormone group decreased from 40% at 1 year to 13% by the 4th year. Uterine bleeding was reported by 31% and spotting by an additional 33% of women in the hormone group during the 1st year of treatment; by the 4th year, these proportions had fallen to 11% and 20%, respectively.CONCLUSIONSymptoms typically attributed to menopause are common in elderly women. Postmenopausal hormone therapy reduces hot flashes, trouble sleeping, and vaginal dryness, but at standard doses in elderly women is associated with vaginal discharge, genital irritation, uterine bleeding, and breast symptoms.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEPremenstrual dysphoric disorder is a menstrually related disorder that intermittently causes disabling emotional, behavioral, and physical symptoms. The goal of the current study was to evaluate the efficacy and tolerability of sertraline for premenstrual dysphoric disorder when treatment was limited to the luteal phase.METHODSTwo hundred eighty-one women who metDiagnostic and Statistical Manual of Mental Disorders(4th edition) criteria for premenstrual dysphoric disorder and who completed two prospective screening cycles and one single-blind placebo cycle were randomized to three cycles of double-blind, luteal phase treatment with either a placebo or sertraline in a flexible daily dose of 50–100 mg. Outcome measures included the Daily Record of Severity of Problems and the Clinical Global Impression Severity and Improvement scales.RESULTSLuteal phase treatment with sertraline was significantly superior to the placebo, as demonstrated by endpoint analysis of Clinical Global Impression Improvement scale scores (sertraline, 2.3 ± 1.1, versus placebo, 2.7 ± 1.1;P< .001), and cycle 3 Daily Record of Severity of Problems change scores (sertraline, 27.6 ± 26.8, versus placebo, 17.6 ± 23.3;P< .002). A significant difference was also noted in responder rates in favor of sertraline (50%) versus placebo (26%,P< .001) by cycle 1 (with responder defined as a Clinical Global Impression Improvement scale score of 1 or 2). Quality of life and functioning outcomes were also significantly improved. Intermittent luteal administration of sertraline was well tolerated, with only approximately 8% of patients on sertraline and less than 1% on placebo discontinuing because of adverse events.CONCLUSIONSertraline was significantly more effective than a placebo and was well tolerated as a treatment for premenstrual dysphoric disorder when administered intermittently during the luteal phase of the menstrual cycle.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo document prevalence of mild, moderate, and severe urinary incontinence among ethnically diverse perimenopausal women, identify risk factors, and assess the effect of severity on women's daily lives using treatment seeking, bother, and nighttime voiding as indicators.METHODSBaseline data from the longitudinal cohort of the Study of Women's Health Across the Nation, a prospective, multiethnic, multisite study of the natural history of menopausal transition was used (n= 3302). Interview and self-completed questionnaires assessed most variables of interest. Body mass index and diabetes mellitus were measured clinically. Incontinence severity was derived by multiplying frequency by volume leaked. Risk factors and effect on treatment seeking, bother, and nighttime voiding were assessed by the construction of multiple logistic regression models for each ethnic group and the total population.RESULTSMean age was 46.4 years. Incontinence prevalence was 57%, with nearly 15% categorized as moderate and 10% as severe. Biologic factors constituted the most important risk for severity, specifically perimenopausal compared with premenepausal status (odds ratio [OR] 1.35), body mass index (OR 1.04), diabetes mellitus (OR 1.55), and current smoking (OR 1.38). Nonwhite groups had lower risk, but the relationship of ethnicity is complex. Severity was associated with likelihood of discussing with a health care provider, with bothersomeness, and with likelihood of nighttime voiding.CONCLUSIONLarge numbers of perimenopausal women experience urinary incontinence with 25% wearing protection or changing undergarments on several days per week. Mutable factors predicting severity included body mass index and current smoking.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the efficacy of lidocaine ointment in relieving pain after a vaginal delivery with an episiotomy or perineal laceration.METHODSIn a randomized, double-blind, placebo-controlled trial, 200 women received lidocaine ointment (n= 108) or a placebo (n= 92). Pain relief was assessed by the amount of ointment used (weight of jar before use (weight of jar after use), total number of pain pills used, and a pain questionnaire. The sample size was calculated using a β of .2 and an β of .05 with an expected reduction of other pain medications from an average use of six pills to four pills for the population.RESULTSThere was no significant difference in the amount of lidocaine versus placebo used for postpartum day 1 (5.1 g versus 4.0 g, respectively [P=.13]) or day 2 (3.7 g versus 2.6 g, respectively [P= 18]). Patients receiving lidocaine instead of the placebo showed no significant difference in the total amount of postpartum pain medications (6.3 versus 6.8 tablets, respectively [P= .53]), subjective pain parameters (P= .36), or satisfaction from ointment (P= .99). Patients with an episiotomy used more pain medications than those with a laceration (7.9 versus 5.6 tablets, respectively [P= .003]). Those with minor versus major lacerations required fewer pain pills (6.1 versus 10.8 tablets, respectively [P< .001]) and used less ointment (4.3 g versus 7.9 g, respectively [P= .02]) on the first postpartum day.CONCLUSIONTopical application of 5% lidocaine ointment was not effective in relieving episiotomy or perineal laceration pain.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine whether maternal methadone dosage affects duration and degree of neonatal narcotic withdrawal.METHODSThis was a retrospective cohort study of pregnant women with opioid addiction who delivered live-born singletons between April 1990 and April 2001. Inpatient detoxification or outpatient methadone maintenance therapy was offered. Women who had a positive drug screen or whose neonate tested positive for opioids were considered to besupplementing. We evaluated indices of neonatal withdrawal according to the maximum daily methadone dosage in the last week of pregnancy.RESULTSSeventy women with opioid addiction were followed. Median methadone dosage was 20 mg (range 0–150 mg), and 32 infants (46%) were treated for narcotic withdrawal. Among women who received less than 20 mg per day, 20–39 mg per day, and at least 40 mg per day of methadone, treatment for withdrawal occurred in 12%, 44%, and 90% of infants, respectively (P< 0.02). Methadone dosage was also correlated with both duration of neonatal hospitalization and neonatal abstinence score (rs= .70 and .73 respectively, bothP< .001). Neonates were more likely to experience withdrawal if their mothers were supplementing with heroin, 68% versus 35% (P= .01). Regardless of supplementation, there was a significant relationship between methadone dosage and neonatal withdrawal (P< .05).CONCLUSIONMaternal methadone dosage was associated with duration of neonatal hospitalization, neonatal abstinence score, and treatment for withdrawal. Heroin supplementation did not alter this dose–response relationship. In selected pregnancies, lowering the maternal methadone dosage was associated with both decreased incidence and severity of neonatal withdrawal.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate if there were dietary or socioeconomic factors associated with preterm premature rupture of membranes (PROM).METHODSIn this case-control study, women with preterm PROM (n= 46) were compared with healthy pregnant women matched for gestational age and vitamin supplementation. Measurements included fasting homocysteine, red blood cell folate, albumin, creatinine, and complete blood count. Dietary intake was determined by a food frequency questionnaire. Socioeconomic and demographic factors were recorded.RESULTSThere were no differences between fasting homocysteine, red blood cell folate, and vitamin B12 levels anddietary intake between patients and controls. There was lower hemoglobin in women with preterm PROM compared with the controls (P< .001). There was a three-fold increased odds of having a total family income of less than $25,000 (Canadian) (odds ratio 3.1, 95% confidence interval 1.6, 6) in women with preterm PROM.CONCLUSIONPreterm PROM is associated with low maternal hemoglobin and low socioeconomic status. There was no association with nutritional intake. The lower hemoglobin level may be a marker for subclinical infection.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo validate an established staging system for twin-twin transfusion syndrome.METHODSProspective observational study in a tertiary referral fetal medicine center of 52 consecutive cases of twin-twin transfusion syndrome. Each pregnancy was assessed longitudinally for a variety of prognostic factors including fetal biometry, amniotic fluid volume, arterial and venous Doppler sonogram abnormalities, and the presence of hydrops. Data were used to determine stage at diagnosis and first treatment, and worst stage throughout pregnancy. Perinatal outcome was assessed by stage. Management comprised serial amnioreduction, septostomy, selective reduction, or delivery, alone or in combination.RESULTSMedian gestation at presentation and first treatment were both 21 weeks (range 14–34 and 15–34), and at delivery it was 29 weeks (range 16–40). Sixty-three percent of pregnancies (33 of 52) were at least stage III at presentation. Forty-five percent of pregnancies (22 of 49) progressed to a more advanced stage. Overall survival was 47% (47 of 100), with no difference between donor and recipient fetuses (40% [20 of 50] versus 54% [27 of 50] [χ2P< .5]). Survival rates were 58% (15 of 26), 60% (six of ten), 42% (20 of 48), 43% (six of 14), and 0% (none of two) for stages I–V, respectively, with no significant influence of stage at presentation on survival. Survival was poorer where stage increased, versus decreased (27% [12 of 44] versus 94% [17 of 18] χ2P< .001). Kaplan-Meier survival curves indicated that staging at presentation identified pregnancies at greater risk of earlier rather than later gestational perinatal loss.CONCLUSIONThe Quintero staging system did not distinguish good from bad outcome at presentation, and thus should be used with caution in guiding initial management of twin-twin transfusion syndrome. However, prognosis was influenced by a change in stage, and pregnancies progressing to higher stage disease were at increased risk of earlier perinatal loss. Staging may thus be more useful in monitoring disease progression.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the relationship between changes in plasma adenosine and the severity of preeclampsia, and norepinephrine and tumor necrosis factor–α concentrations.METHODSPlasma concentrations of adenosine, norepinephrine, and tumor necrosis factor–α relating to the pathogenesis of preeclampsia were measured in women with mild (n= 21) and severe (n= 21) preeclampsia and normal pregnancies (n= 21), matched for age, gestational age, and parity, in the third trimester of pregnancy. We then evaluated the relationships among plasma adenosine, norepinephrine, tumor necrosis factor–α concentrations, and the severity of preeclampsia.RESULTSMean plasma adenosine, norepinephrine, and tumor necrosis factor–α concentrations were significantly higher in women with mild and severe preeclampsia than in normal control subjects (P< .05). In women with preeclampsia, plasma adenosine concentrations increased according to the severity of preeclampsia (0.60 ± 0.03 μmol/L and 0.72 ± 0.03 μmol/L, respectively, versus 0.41 ± 0.03 μmol/L for normal subjects), which correlated with increases of norepinephrine and tumor necrosis factor–α concentrations (r= .58,P< .05;r= .49,P< .05, respectively). In preeclampsia, norepinephrine concentration also correlated with maternal blood pressure (r= .50,P< .05).CONCLUSIONAdenosine is an established suppressor of the effects of norepinephrine and tumor necrosis factor–α The increased plasma concentrations of adenosine in preeclampsia might serve to counteract further progression of the complication.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine if the complication rate of abdominal hysterectomy is increased in women with greatly enlarged myomatous uteri.METHODSThree groups of women undergoing abdominal hysterectomy were analyzed according to uterine size: group 1, 208 women with uteri less than 500 g; group 2, 63 women with uterine weights of 500–999 g; and group 3, 47 women with leiomyomata whose uteri weighed at least 1000 g. Logistic regression was used to compare the groups on the risks of having at least one major complication. Adjusted comparisons on other surgical outcomes were performed using a logistic model (for qualitative variables) or a general linear model (for quantitative variables).RESULTSThe risk of experiencing at least one perioperative complication, including blood loss over 500 mL, perioperative blood transfusion, major organ injury, therapeutic antibiotic use, and hospital readmission, increased significantly with uterine weight (P= .006). Group 3 women were at greater risk of having at least one of these complications than either group 1 or group 2 women, with adjusted odds ratios of 3.42 (95% confidence interval [CI] 1.62, 7.25) and 2.64 (95% CI 1.14, 6.13), respectively. Estimated blood loss with surgery also increased with increasing uterine weight (P< .001). Mean estimated blood losses for the study groups were 555.8 ± 386.5 mL (group 3), 464.33 ± 285.2 mL (group 2), and 387.6 ± 281.4 mL (group 1) (P= .032).CONCLUSIONThe complication rate from hysterectomy increases with increasing uterine weight, due mainly to an increased blood loss associated with surgery for larger uteri.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare a new spiral-shaped tissue-sampling brush with a standard cervical punch biopsy.METHODSBefore large loop excision of the transformation zone, women with cervical intraepithelial neoplasia underwent a transepithelial brush biopsy of a portion of a colposcopically identified lesion, followed by a punch biopsy of the remaining portion. Brush biopsy samples were processed using liquid-based cytology and cell block techniques. Diagnoses were made using a consensus of three pathologists. Brush biopsy samples without basal cells were considered inadequate. The histological diagnosis was compared with the brush biopsy and punch biopsy samples. Patient-reported pain and physician-reported bleeding for punch and brush biopsies were compared.RESULTSFifty-two women were enrolled in the study; 47 successfully completed the study protocol. Eight brush biopsy specimens were inadequate. Thirty-nine women showed abnormal pathology (human papillomavirus/cervical intraepithelial neoplasia I or worse) on large loop excision of the transformation zone, and 32 women had high-grade (or worse) lesions. The punch biopsy correlated with high-grade disease in 53.1% of these women. The brush biopsy result correlated with high-grade disease in 79.3% of these women using a cell block technique and 76.7% using liquid cytology. There was significantly less pain (P< .001) and significantly less bleeding (P< .001) with the brush biopsy.CONCLUSIONWhen an adequate sample is collected, spiral brush biopsy is as good as a standard punch biopsy for detecting cervical pathology, with substantially less pain and bleeding. User training and guidelines for sampling are needed to assure that an adequate sample is collected.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID