摘要:

ObjectiveTo simulate a uterine contraction using a novel computer model for uterine communication and to validate the assumptions of the computer model by comparing the simulated contraction with a real uterine contraction.MethodsThe computer model assumed two known mechanisms of intercellular communication: action potential propagation and calcium wave propagation. Simulations were performed on a desktop computer using available programming language. Model validity was assessed by fitting the computer-simulated contraction to a real contraction and comparing the fit values with values measured independently.ResultsThe simulated contraction demonstrated five characteristics that are also observed in human labor: 1) gradual onset, 2) a linear rising segment, 3) a plateau region, 4) a symmetrical fall, and 5) gradual offset. The fit values agreed well with values determined experimentally and supported the model.ConclusionsOur results support the model, strongly suggesting that intercellular communication occurs throughout the uterus by action potentials and locally within the tissue by calcium waves.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo estimate the long-term probability of hysterectomy after sterilization according to demographic and clinical characteristics before the procedure.MethodsWe used a prospective, multi-center cohort study of 10,698 women undergoing tubal sterilization to examine the cumulative probability of hysterectomy up to 14 years after sterilization. Independent risk factors for subsequent hysterectomy were examined using the life-table approach and the Cox proportional hazards model.ResultsThe cumulative probability of undergoing hysterectomy 14 years after sterilization was 17%. The highest long-term cumulative probabilities of hysterectomy occurred among women who, at the time of sterilization, reported a history of endometriosis (35%) or were older than 30 years and reported prolonged bleeding during menses (46%). Multivariate modeling demonstrated an independently increased risk of hysterectomy among women who, at the time of tubal sterilization, reported a history of heavy menstrual flow (relative risk [RR] 1.4; 95% confidence interval [CI] 1.1, 1.7), severe menstrual pain (RR 1.3; 95% CI 1.1, 1.6), bleeding of more than 7 days during menstrual cycles (RR 1.8; 95% CI 1.1, 2.8), pelvic inflammatory disease (RR 1.3; 95% CI 1.04, 1.7), ovarian cysts (RR 1.6; 95% CI 1.2, 2.0), endometriosis (RR 2.5; 95% CI 1.7, 3.9), or uterine leiomyomata (RR 2.7; 95% CI 2.0, 3.7).ConclusionsAlthough women with gynecologic disorders before tubal sterilization were at greater risk of hysterectomy during the 14 years after sterilization than were women without these disorders, the majority of sterilized women in both categories did not undergo subsequent hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of a triphasic, combination oral contraceptive (OC), (norgestimate-ethinyl estradiol), in comparison with placebo in the treatment of moderate acne vulgaris.MethodsTwo hundred fifty women were enrolled in a multicenter, randomized, double-blind, placebo-controlled clinical trial to evaluate the effectiveness of norgestimateethinyl estradiol in the treatment of acne vulgaris. Subjects were 15–49 years old and had moderate acne vulgaris. Each month for 6 months, subjects received either 3 consecutive weeks of active OC treatment followed by 1 week of inactive drug, or 4 consecutive weeks of color-matched placebo tablets. Efficacy was assessed by facial acne lesion counts, the investigator's global assessment, and the subject's self-assessment. Hormone levels were also measured.ResultsDespite the large placebo effect inherent in an acne trial (due to, for example, careful skin care, frequent office visits, regression to the mean), of the 164 subjects who completed the study without major protocol deviations, the OC group was significantly better than the placebo group for all primary efficacy measures: inflammatory lesions (mean reduction, 51.4% compared to 34.6%,P= .01), total lesions (mean reduction, 46.4% compared to 33.9%;P= .001); investigator's global assessment (83.3% compared to 62.5%;P= .001). Free testosterone decreased significantly and sex hormone-binding globulin increased significantly in the OC group, but remained unchanged in the placebo group.ConclusionsA triphasic combination of norgestimate and ethinyl estradiol is an effective treatment for moderate acne vulgaris in women with no known contraindication to OC therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A suburethral sling anchored to the posterior-inferior aspect of the pubic bone with bone screws placed transvaginally is described for recurrent urinary incontinence. The technique involves placing a suburethral patch of a synthetic fiber at the junction of the upper one-third and lower two-thirds of the urethra and securing it by titanium bone screws to the posterior-inferior pubis for site-specific urethral support and stabilization of normally positioned continence anatomy. The procedure was performed from August 1990 through December 1991 in 27 patients with recurrent stress urinary incontinence after previous urinary incontinence surgery, of whom 25 patients were followed yearly until August 1994. None of these 25 patients have had a recurrence as of August 1996. The initial success of the pubic bone suburethral stabilization sling merits further study for the cure of urinary incontinence in patients with a hypermobile urethra or low-pressure urethral conditions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo review the technique of meta-analysis and its uses and limitations in obstetrics and gynecology.Data SourcesWe reviewed four major journals in obstetrics and gynecology (American Journal of Obstetrics and Gynecology, Fertility and Sterility, Journal of Reproductive Medicine, andObstetrics & Gynecology).Methods of Study SelectionJournals were reviewed to determine frequency of meta-analysis as a method of systematic review in obstetrics and gynecology. We also summarized objectives and scientific guidelines for performing a meta-analysis.Tabulation, Integration, and ResultsMeta-analysis is used with increased frequency in obstetrics and gynecology as a way of systematically reviewing medical evidence. This technique is an attempt to improve on traditional methods of narrative review by an expert and as a framework for evidence-based medicine and developing practice guidelines. By combining data from replicate studies, a metaanalysis can increase statistical power, more precisely estimate the typical effect size of treatment or risk factor, and attempt to resolve controversies in the medical literature. Meta-analysis is a retrospective look at data already collected and is therefore subject to the biases of all retrospective studies.ConclusionsThe technique of meta-analysis requires all the scientific rigor of a randomized clinical trial with careful attention to study design, including a formal protocol for literature search strategies, quality assessment of candidate studies, specific inclusion and exclusion criteria, issues of sampling and publication bias, statistical tests of homogeneity, and sensitivity analysis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo analyze published randomized trials assessing the safety and efficacy of misoprostol for cervical ripening and labor induction.Data SourcesWe supplemented a search of entries in electronic data bases with references cited in original studies and review articles to identify randomized trials of misoprostol for cervical ripening and labor induction.Methods of Study SelectionTwo blinded investigators performed independent trial quality evaluation and data abstraction of randomized clinical trials assessing the efficacy of misoprostol as a cervical ripening and labor-inducing agent.Tabulation, Integration, and ResultsWe calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using both a random- and fixedeffects model. Continuous outcomes were pooled using a variance-weighted average of the within-study difference in means. Of 16 studies identified, eight met our criteria for meta-analysis. These eight trials included 966 patients (488 received misoprostol and 478 were controls). Women who received misoprostol for cervical ripening and labor induction had a significantly lower overall cesarean rate (OR 0.67, 95% confidence interval [CI] 0.48, 0.93) and a higher incidence of vaginal delivery within 24 hours of misoprostol application (OR 2.64, 95% CI 1.87, 3.71). Use of misoprostol was associated with a higher incidence of tachysystole (OR 2.70, 95% CI 1.80, 4.04) but not hyperstimulation (OR 1.91, 95% CI 0.98, 3.73). The incidences of abnormal 5-minute Apgar scores and admissions to the neonatal intensive care unit were similar in the misoprostol and control groups. The pooled estimate of the mean interval from start of induction to delivery was 4.6 hours fewer (95% CI −3.5, −5.7) in the misoprostol group.ConclusionsPublished data confirm the safety and efficacy of intravaginal misoprostol as an agent for cervical ripening and labor induction.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID