摘要:

ObjectiveTo analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results.MethodsTwo-hundred eighty-five women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Long-term follow-up was obtained. Recurrence was defined as the need for further surgery. The relation of several variables with the outcome was analyzed using Cox proportional hazard regression analysis.ResultsSeventeen cases (6%) were lost to follow-up. The median follow-up was 46 months (range 1–104 months); for cases without recurrence median follow-up was 42 months (range 16–104 months). Forty-one (14.5%) patients had repeat surgery. An independent prognostic value of uterine size (P< .001) and number of submucous myomas (P< .001) for recurrence was noted. Twenty of 41 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 94.3% (standard error ± 1.8%) at 2 years and 90.3% (± 3.0%) at 5 years.ConclusionTranscervical resection of submucous myomas is a safe and effective treatment for patients with a normal sized uterus and not more than two myomas. It is an acceptable alternative for selected other patients. The need for a combined endometrial ablation is questionable. Transcervical resection of submucous myomas will give patients a high chance of averting further surgery and should modify the way patients are counseled.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the efficacy of prophylactic nitrofurantoin in preventing bacteriuria after urodynamics and cystourethroscopy.MethodsWe assumed that nitrofurantoin prophylaxis would decrease the rate of infection after urodynamics and cystourethroscopy from 19% to 5%. All women presenting for urodynamics and cystourethroscopy during a 27-month period were offered enrollment, and 142 were randomly assigned to receive two doses of long-acting nitrofurantoin 100 mg (n= 74), or two doses of placebo (n= 68). Nitrofurantoin and placebo capsules were identical, and subjects and physicians were masked to group assignment. Differences were assessed using Studentttest for continuous data and χ2analysis for dichotomous data.ResultsThere were no statistical differences in demographic characteristics or final diagnoses between groups. Seven women (5%) who had bacteriuria on initial urine culture were not included in the final analysis. The frequency of bacteriuria in the postinstrumentation urine cultures was 6% overall, 7% in the treatment group, and 5% in the controls, a nonsignificant difference ([relative risk] 1.49, [confidence interval] 0.37, 5.95). The power of the study was 33% to detect a significant difference.ConclusionBacteriuria after combined urodynamics and cystourethroscopy was not improved by a 1-day course of nitrofurantoin.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo analyze the influence of body mass on the outcome of surgery for urinary incontinence.MethodsAmong 291 women operated on for stress incontinence, 187 (64%) were available for follow-up at 5 years. Eighty women had anterior colporrhaphy, 49 anterior colporrhaphy with needle suspension of the bladder neck, and 58 Burch colposuspension. Body mass index was calculated preoperatively and at follow-up. Women were classified as being of normal weight (body mass index [BMI] 20–25), overweight (BMI 26–30), or obese (BMI greater than 30). Reported continence rates were analyzed according to BMI for each operation and the BMIs of continent patients were compared with those of incontinent patients.ResultsThe continence rates at 5-year follow-up for anterior colporrhaphy, anterior colporrhaphy with needle suspension of bladder neck, and Burch colposuspension were 58, 51, and 86%, respectively (P< .001). The continence rates did not differ significantly among the three BMI groups for each procedure. A statistical power of 26% was found for the hypothesis that the outcome of the procedures does not depend on BMI. The preoperative and postoperative BMIs of continent and incontinent women for each procedure did not differ significantly.ConclusionWe did not find preoperative obesity to be a risk factor for failure of incontinence surgery, but the power of our study was limited.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo define factors that identify patients at highest risk for osteoporosis who should be screened.MethodsWe gave a questionnaire we developed for osteoporosis risk factors to 1346 menopausal women who were being screened by bone densitometry at the spine, hip, and femoral neck. Chi-square analysis using the one-tailed test was done on all categoric variables to determine differences or patterns in bone mineral density at specific sites. Multivariate logistic regression analysis was done on each of the three sites scanned to determine which combination of independent variables was a significant predictor of the presence or absence of osteoporosis.ResultsFactors identified that were significant for the presence of osteoporosis were age 61 years or older, weight 165 pounds or less, or lack of any use of estrogen, either oral contraceptives or estrogen replacement therapy.ConclusionWe devised a simple system to identify which patients should be screened for osteoporosis.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo quantitate vascular endothelial growth factor of cervical carcinoma and elucidate its clinical correlation.MethodsIntratumoral protein levels of vascular endothelial growth factor were measured in 104 cervical cancer patients and in 30 cervical tissue specimens of benign gynecologic diseases as controls. The concentrations were correlated with clinical and pathologic characteristics.ResultsThe median concentrations of vascular endothelial growth factor in cervical cancer tissues were higher than those in benign cervical tissues (180.0 versus 0.0 pg/mg of protein,P< .001). Tumors larger than 4 cm (1030.0 versus 118.0 pg/mg of protein,P< .001) and with deep stromal invasion (364.0 versus 111.0 pg/mg of protein,P= .016) had higher levels than those smaller than 4 cm or with superficial stromal invasion. Higher levels were also found in tumors with lymphovascular emboli (568.0 versus 118.0 pg/mg of protein,P= .006), parametrial invasion (582.0 versus 117.0 pg/mg of protein,P=.04), and pelvic lymph node metastasis (759.5 versus 121.0 pg/mg of protein,P= .002) than in those without. The protein levels of vascular endothelial growth factor correlated positively with tumor sizes (r= 0.340,P< .001). Tumors with overexpressed VEGF were larger (3.35 ± 1.17 versus 2.13 ± 1.28 cm,P< .001) and had higher incidence of deep stromal invasion (20 of 57 versus 6 of 47,P= .009), lymphovascular emboli (15 of 33 versus 11 of 71,P= .011), parametrial invasion (15 of 32 versus 11 of 72,P= .002), and lymph node metastasis (10 of 20 versus 16 of 84,P= .004).ConclusionIntratumoral protein level of vascular endothelial growth factor in cervical cancer tissue correlates well with local tumor progression and tumor metastasis. Vascular endothelial growth factor might be a marker for evaluating disease severity.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the efficacy and acceptability of oral misoprostol, vaginal misoprostol, and laminaria tents for cervical dilation before surgical abortion.MethodsWe conducted a randomized, double-blind, placebo-controlled trial comparing oral misoprostol 400 μg, vaginal misoprostol 400 μg, and one medium laminaria for dilating the cervix over 4 hours before surgical abortion. The study sample consisted of 106 women at 7–14 weeks' gestation who presented to San Francisco General Hospital requesting abortion. The primary outcome was the amount of cervical dilation measured by Pratt dilators. Secondary outcomes were the proportion of subjects needing further manual dilation, difficulty of dilation, duration of the procedure, blood loss, and side effects.ResultsThe vaginal-misoprostol group had a significantly greater mean dilation (28.0 mm) than the oral misoprostol group (24.2 mm;P< .05) and a greater mean dilation than the laminaria group (25.9 mm), although this difference did not reach significance. Women who received laminaria reported significantly more pain at the time of placement (85.7% reported at least “a little” pain) compared with women who received misoprostol by either route (28.9% of oral-misoprostol and 34.0% of vaginal-misoprostol subjects reported “a little” pain;P< .01). The proportion of subjects who required further manual dilation, ease of dilation, duration of the procedure, and blood loss were not significantly different among the groups. There was no difference in side effects during the 4-hour waiting period among the three groups, and gastrointestinal side effects were rare in all groups.ConclusionVaginal misoprostol is superior to oral misoprostol and is an acceptable alternative to laminaria tents for cervical dilation before surgical abortion in pregnancies of 7–14 weeks' gestation. It is inexpensive and easy to administer, and achieves equal or greater dilation with less pain on insertion and no increase in side effects compared with laminaria.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate whether ACOG's patient education pamphlets comply with the recommended readability level for health education materials intended for the general public.MethodsAll 100 English-language pamphlets available during 1997 (created or revised between 1988 and 1997) were evaluated using four standard readability formulas.ResultsMean readability levels of ACOG's pamphlets were between grade 7.0 to grade 9.3, depending on the formula used. Analysis of readability over the 10 years showed a trend toward lower readability levels. Analysis by category of pamphlet found that the lowest readability levels were in “Especially for teens” pamphlets.ConclusionOur data suggested that most of ACOG's patient education pamphlets currently available are written at a higher readability level than recommended for the general public. The readability of those pamphlets improved in the 10 years since the organization published its first pamphlet, but the goal of sixth-grade readability level has not been reached.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate epicutaneous application of 5% lidocaine-prilocaine and 30% lidocaine cream anesthetics for neonatal circumcision.MethodsThe efficacy of 5% lidocaine-prilocaine and 30% lidocaine creams was compared in a randomized, double-blind, placebo-controlled trial. Sixty-one neonates were randomly assigned to one of three groups: 5% prilocaine-lidocaine (n= 20), 30% lidocaine (n= 20), and a control group that received an acid-mantle cream (n= 21). Heart rate, oxygen saturation, and crying time were monitored before, during, and after circumcision. Blood pressure was measured before and after circumcision.ResultsMean peak heart rates for the 5% lidocaine-prilocaine, 30% lidocaine, and control groups (± standard deviation) were 146 ± 16, 157 ± 10, and 164 ± 16 beats per minute, respectively. During four of six active phases of circumcision, the 5% lidocaine-prilocaine group suppressed significant increases in heart rate better than 30% lidocaine, which was more effective than control (dorsal clamp,P< .001; bell clamp on,P= .001; tightening,P= .001; bell clamp off,P< .001). During tightening of the bell clamp, significantly less crying was seen in the 5% lidocaine-prilocaine group (13 ± 12 seconds) compared with 30% lidocaine (24 ± 14 seconds) and controls (38 ± 27 seconds) (P< .001). The group that received 5% lidocaine-prilocaine also had no significant increase in systolic (t= 1.6,P= .12) or diastolic (t= 1.9,P= .067, respectively) blood pressure, unlike the group receiving 30% lidocaine (t= 4.8,P= .001 andt= 2.9,P= .009, respectively) and the placebo group (t= 2.5,P= .023 andt= 2.3,P= .032). There were no significant differences in oxygen saturation (&agr; = .05, power 0.79).ConclusionEpicutaneous 5% lidocaine-prilocaine was more effective than 30% lidocaine for neonatal circumcision, better reducing neonatal stress indicators. Lidocaine-prilocaine significantly shortened crying time during one of the most painful phases of circumcision. Both topical anesthetics were more effective than placebo in attenuating the behavioral and physiologic indicators of neonatal pain.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate urea nitrogen and creatinine levels in peritoneal fluid.MethodsWe prospectively evaluated 20 consecutive women having radical hysterectomy with lymphadenectomy. On postoperative days 2 and 3, serum, urine, and peritoneal fluid samples were tested for urea nitrogen and creatinine. Using power analysis we calculated an adequate sample size to be 16 patients.ResultsThe mean urea nitrogen was 11 mg/dL in serum, 11 mg/dL in peritoneal fluid, and 469 mg/dL in urine. The mean creatinine was .9 mg/dL in serum, 1.0 mg/dL in peritoneal fluid, and 141 mg/dL in urine. Urea nitrogen and creatinine values in peritoneal fluid and serum were essentially identical. Urine urea nitrogen and creatinine values were significantly greater than serum and peritoneal values (47 to 157 times greater) (P< .011). On postoperative days 2 and 3, serial levels of serum, peritoneal fluid, and urine urea nitrogen and creatinine in the same subject showed no significant variation (Pranging from .19 to .31).ConclusionNormal reference values of urea nitrogen and creatinine in peritoneal fluid are equivalent to serum values and significantly less than urine levels.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundHundreds of residents are trained to perform neonatal circumcision every year. This article describes the construction and use of a model designed to introduce trainees to neonatal circumcision using the Gomco technique.TechniqueA circumcision model was constructed using a clipboard, a pacifier, examination gloves, a rubber band, a syringe, tape, surgical towels, and a circumcision kit containing a 1.3 Gomco clamp, hemostats, surgical scissors, and a scalpel blade.DiscussionWith each trainee using a separate model, one instructor was able to guide four interns through three simulations each during a 1-hour orientation session.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID