摘要:

ObjectiveTo investigate whether the thickness of the layers of the carotid artery (externa, media, and intima) are affected by menopause and its treatment with hormone replacement therapy (HRT).MethodsOne hundred twenty-nine postmenopausal women were recruited sequentially and classified into three groups. Forty-six were taking oral HRT, 32 had estradiol implants, and 51 had never taken HRT. The three layers of the externa wall of the carotid artery were identified and measured by high-resolution ultrasound.ResultsWomen with implants had thicker carotid artery wall measurements (0.84 ± 0.26 mm) than the other groups. The media (0.32 ± 0.11 mm) was significantly thicker in the implant group. This layer has a high connective tissue component, including collagen type I, collagen type III, and elastin fibers. The intima layer was thinner (0.25 ± 0.09 mm) in the oral HRT group compared with controls (0.29 ± 0.1 mm). A statistically significant higher intima-media ratio (1.17 ± 0.05) was calculated for the control group, compared with both the oral HRT (0.92 ± 0.04) and implant groups (0.94 ± 0.03).ConclusionOur findings suggest that HRT given to postmenopausal women influences differentially the layers of the carotid artery. Hormones seem to encourage thickening of the layers with the highest connective tissue component (externa and media) and to delay thickening of the atheromatous intima layer. These effects on the vascular system may be partly responsible for the cardioprotection attributed to HRT.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo quantify the numbers of leukocytes in the normal cervix and relate these numbers to the diagnosis of cervicitis.MethodsIsolated cell suspensions were prepared from cervical tissue recovered at hysterectomy from 37 women who had no obvious cervical disease. The percentages of CD45+ cells (leukocytes) in these preparations were determined using immunofluorescence-based flow cytometric analysis. These percentages were compared with the pathologist's assessment of cervicitis.ResultsLeukocytes were present in all cervical samples tested. For endocervical samples tested. For endocervical samples, the mean (± standard error of the mean [SEM]) percentage of CD45+cells was 12.4 ± 1.9% of cells in patients with a diagnosis of cervicitis (n= 16) and 9.1 ± 1.1% in patients without cervicitis (n= 17). For ectocervical samples, the mean (± SEM) percentage was 14.8 ± 3.0% in those with cervicitis (n= 16) and 9.5 ± 1.6% in those without cervicitis (n= 19). The differences between samples from patients with cervicitis and those without cervicitis were not statistically significant at the .05 level. Intra- and interassay variabilities were 5.7 ± 1.2% and 7.3 ± 1.6%, respectively.ConclusionOur study demonstrates there is a resident population of leukocytes in the cervix. Leukocyte number did not relate clearly and consistently to the diagnosis of cervicitis made by the pathologist. We suggest that the resident population of leukocytes, in the absence of other indicators of infection, may confuse determinations of cervicitis.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the association between vaginal douching and cervicalChlamydia trachomatisinfection.MethodsWe analyzed cross-sectional data from a study conducted at Group Health Cooperative of Puget Sound, a nonprofit health maintenance organization in western Washington state. Participants were nonpregnant women Group Health enrollees between the ages of 18 and 34 years who were attending two primary care clinics either for nonurgent visits, primarily routine preventive health visits, or in response to an invitation from the study. Before the clinical examination, all completed a self-administered survey assessing demographic and behavioral characteristics, including the timing, frequency, products used, and reasons for douching. Chlamydial infection was ascertained via cell culture isolation ofC trachomatisfrom endocervical specimens obtained at the same visit.Results Chlamydia trachomatiswas isolated from cervical cultures in 58 (3.4%) of 1692 study participants. Women who reported douching in the 12 months before their clinic visit had an increased likelihood of chlamydial infection compared with women who did not douche (prevalence odds ratio [OR] 2.29, 95% confidence interval [CI] 1.22, 4.30, after adjusting for confounding factors). The likelihood was higher for women who reported douching more often: OR 2.60 (95% CI 1.29, 5.24) for women who douched one to three times per month, and OR 3.84 (95% CI 1.26, 11.70) for those douching four times or more per month. These associations were slightly stronger when women who reported douching because of an infection were excluded from the analysis.Conclusion:These results support the hypothesis that vaginal douching predisposes to acquisition of cervical chlamydial infection and are compatible with previous studies that report associations between douching and sequelae of chlamydial infection, including pelvic inflammatory disease, ectopic pregnancy, and infertility.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo review experience with 20 women treated for sciatic hernia between 1993 and 1997.MethodsPatients with chronic pelvic pain and sciatic hernias, identified retrospectively from chart review, were seen during a 46-month period that covered the surgical experience at our institution and included approximately 1100 cases. The median length of follow-up was 13 months (range 3-36).ResultsSciatic hernia was diagnosed in 20 white women with chronic pelvic pain and was treated using laparoscopy. In 14 cases the hernias were right sided, in five they were left sided, and in one they were bilateral. All sciatic hernias contained the ipsilateral ovary alone or with its fallopian tube. All 20 patients reported symptomatic relief at followup.ConclusionSciatic hernia is a cause of chronic pelvic pain and should be considered in the differential diagnosis.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine the prevalence of self-reported abuse in a population of women aged 18 years or older seeking elective pregnancy termination, and to compare abused and nonabused women with respect to the primary reasons for pregnancy termination.MethodsA self-administered questionnaire was returned by 486 women seeking outpatient abortion. The survey included demographic information, abuse screening, and items regarding partner involvement/awareness of the pregnancy, and abuse as a determinant of the abortion decision. One open-ended item asking the primary reason for pregnancy termination was included.ResultsThe prevalence of self-reported abuse in this population was 39.5%. White women were significantly more likely to report any history of abuse than nonwhite women. Relationship issues were the only reason for pregnancy termination given more often by women with an abuse history than by nonabused women. Women with abuse histories were significantly less likely than nonabused women to inform the partner of the pregnancy or to have partner support for or involvement in the abortion decision.ConclusionThe prevalence of abuse reported by women in this population suggests that many women seeking abortion services may have abuse histories. Abused women may have different reasons for pregnancy termination than nonabused women and may be more likely to make the abortion decision without partner involvement. When routine screening for abuse is included in abortion counseling, health providers have the opportunity for developing a safety plan and initiating appropriate referral.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo assess rates of visits to emergency departments for gynecologic disorders among women of reproductive age in the United States.MethodsData from the National Hospital Ambulatory Medical Care Survey for 1992-1994 were analyzed to determine rates of visits to emergency departments among women, ages 15-44 years. Average annual rates per 1000 women were calculated using age, race, and region-specific population estimates. Rate ratios were used to compare rates among subgroups.ResultsApproximately 1.4 million gynecologic visits were made to emergency departments annually, for an average annual rate of 24.3 visits per 1000 women, ages 15–44 years (95% confidence interval [CI] 22.0, 26.6). The most frequent diagnoses were pelvic inflammatory disease (average annual rate 5.8, 95% CI 5.0, 6.6), lower genital tract infections including sexually transmitted diseases (average annual rate 5.7, 95% CI 4.8, 6.6), and menstrual disorders (average annual rate 2.9, 95% CI 2.3, 3.5). Nearly half of all gynecologic visits resulted in diagnoses of genital tract infections. Younger women (ages 15–24 years) were 2.3 (95% CI 2.0, 2.6) times as likely as older women (ages 25–44 years), and black women were 3.6 (95% CI 2.9, 4.3) times as likely as white women, to visit emergency departments for gynecologic disorders. Rate ratios for genital tract infections were 10–20 times higher for younger black women than for older, white women.ConclusionAlmost half of gynecologic visits to emergency departments were related to genital tract infections, which largely are preventable.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveDuring 1994, our department adopted several strategies in an attempt to decrease our cesarean delivery rates. This study evaluates the effect of these changes on our cesarean delivery rates.MethodsWe studied data of women who delivered at our community hospital obstetric unit over a period of 6 years, from January 1, 1991, to December 31, 1996. During 1994, our department adopted labor management and cesarean delivery guidelines, with review of every cesarean delivery that did not meet guidelines and confidential individual feedback; established 24-hour in-house coverage; and attempted to achieve the goal of an annual cesarean delivery rate of less than 15%. These data were evaluated byX2analysis. Women who delivered in the first 3 years (group A) were compared with those who delivered in the second 3 years (group B) (ie, when the changes occurred).P< .05 was considered significant.ResultsGroups A and B shared similar demographic characteristics. The total cesarean delivery rate decreased from 22.5% (group A) to 18.6% (group B) (P= .001), whereas the primary cesarean delivery rate decreased from 13.5% to 10.6% (P= .001) and the repeat cesarean delivery rate decreased from 9.0% to 7.9% (P= .03). The proportion of women who received oxytocin and regional anesthesia and underwent vacuum-assisted deliveries increased (P< .001), whereas perinatal mortality and morbidity did not change.ConclusionThe cesarean delivery rate safely decreased. These data suggest the importance of the commitment of attending physicians to a lower cesarean delivery rate, of service improvements, and of detailed feedback.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundCertain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition.TechniqueWith the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first.ExperienceWe have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief.ConclusionIn women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine the correlation among the National Board of Medical Examiners subject examination, the US Medical Licensure Examination step 1 scores, and grade point average and to determine if poor performance could be predicted by the US Medical Licensure Examination step 1 score and grade point average.MethodsThe subject examination scores of 148 third-year medical students were compared with their US Medical Licensure Examination step 1 scores and grade point averages. Scores below the 20th percentile were defined as poor performance.ResultsThere was a significant correlation between the US Medical Licensure Examination score and the subject examination score (r= .6,P< .001). The correlation with grade point average was also significant (r= .57,P< .001).Conclusion:The US Medical Licensure Examination step 1 performance, grade point average, and performance on the subject examination are all correlated. However, use of the US Medical Licensure Examination step 1 scores and grade point averages to identify all students at risk was associated with a high false-positive rate at our institution.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine fellowship satisfaction through a survey of maternal-fetal medicine fellows.MethodsWe constructed a survey using multiple choice, Likert scale, ordinal, and categorical scale questions. The questions focused on faculty involvement, mentorship, research time and productivity, education, fellowship selection, ultimate goals of fellows, and satisfaction. We sent the survey in two mailings to all maternal-fetal medicine fellows during April and May 1996.ResultsOne hundred thirty-eight surveys were mailed, and 136 were returned (98.5% return rate). Twenty-seven percent of fellows did not believe they would complete their thesis by the end of their fellowship. No statistically significant relationship was noted between the fellows' predicted thesis completion and the availability of funding, support for statistical analysis, the presence of animal research facilities, age, number of dependents, or year of fellowship. The presence of a mentor on the maternal-fetal medicine faculty increased the likelihood of thesis completion from 52.3% to 83.5% (P< .001). Similarly, the presence of a faculty advisor increased the likelihood of thesis completion from 58.9% to 83.5% (P= .001). Thirty-two percent of the respondents did not have a mentor on the faculty, and 41% did not have a faculty advisor. Forty percent indicated that they were too involved in clinical pursuits to perform research. This group was significantly more likely to believe that their theses would not be completed (63% versus 80%,P= .029). Overall, 22% of the fellows would not recommend their fellowships. Fellows with a mentor (88.2% versus 55.8%;P< .001) or faculty advisor (87.3% versus 64.9%;P= .002) were more likely than those without to recommend their fellowship.ConclusionA mentor or faculty advisor plays a significant role in the training of maternal-fetal medicine fellows and is associated with a higher incidence of satisfaction with the fellowship program, thesis completion, and entrance into academic practice.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID