摘要:

ObjectiveTo assess the changes in the subpopulations of lymphocytes and in lymphocyte mitogenic activity in women with endometriosis receiving GnRH-agonist treatment.MethodsTwenty-six women with advanced endometriosis from the National Cheng Kung University Medical College were studied. Each received a total of six doses of GnRH agonist at 4-week intervals. Immunologic responses at various times after receiving GnRH-agonist treatment, including numbers of peripheral blood lymphocytes subsets and the lymphocyte proliferative activity, were analyzed using a repeated measures analysis of variance. Twenty-six healthy women who visited our gynecologic clinics for routine Papanicolaou smear examination at the time of the recruitment were enrolled as controls. The responses for each patient receiving GnRH agonist were normalized with respect to those of her matched control at each of the time points. The differences between post-and pretreatment data were estimated using generalized estimating equations.ResultsThere was no significant difference in the sizes of lymphocyte subsets between patients and controls before treatment. After GnRH-agonist treatment, there was a trend in the rise of natural killer cell numbers early in the treatment period, withPvalues of .05 and .07 at 1-2 weeks and 2-3 weeks, respectively. This rise in natural killer cell numbers was not significant until 3-4 weeks and the second month after the treatment. There were no significant changes in the CD4+and CD8+T-cell subsets and B cells, although a slight increase in totla T cells (ie, CE3+T) was observed 1-2 weeks after receiving GnRH agonist. The T-cell mitogenic activities at the end of 2 and 4 months after GnRH-agonist treatment were 1.5 and 1.8 times, respectively, of those before treatment.ConclusionThe increase in natural killer cell numbers and the upregulation of T-lymphocyte mitogenic activity, which might be caused by a direct effect of GnRH agonist or a consequence resulting from the depression of estradiol by GnRH agonist, may have implications in the clinical treatment of endometriosis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess patterns and predictors of reliable and unreliable contraceptive use among adolescent mothers in the first 6 monts following delivery.MethodsWe surveyed 462 women, 18 years of age oryounger, at delivery and again at 6 months postpartum. Contraceptive behaviors were evaluated among the 359 adolescents who stated they were sexually ective and not trying to conceive.ResultsMethod discontinuation and sitching were common during the 6-month interval. Only 100 of 189 adolescents (53%) initially prescribed oral contraceptives were still using this method 6 months after delivery; ten of these 100 stated that they had missed at least three pills in the last cycle. Twelve (10%) of the 115 adolescents who initiated depot-medroxyprogesterone acetate failed to obtain a second injection within 4 months of the initial injection or use an alternative method. In contrast, nine of the ten women who received levonorgestrel implants were still using this method 6 months after delivery. Overall, 76% of the sample reported using reliable contraception at last intercourse. Multivariate analyses identified seven factors as predictive of reliable contraceptive use: school enrollment, not having failed a grade in school, adequate support, belief that pregnancy is likely without birth control, attendance at postpartum visit, prior abortion, and the adolescent's desire to wait at least 2 years before having another child.ConclusionInterventions designed to reduce rapid repeat pregnancy during the adolescent years should address emotional, financial, and educational, as well as contraceptive, needs.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess American's knowledge and attitudes about emergency contraceptive pills and the knowledge, attitudes, and practices of obstetrician-gynecologists with respect to emergency contraceptive pills.MethodsA random sample of a national cross-section of 2002 Americans, age 18 and older, including 1000 women and 102 men, was surveyed by telephone between October 12 and November 13, 1994. A nationally representative sample of 307 pnstetrocoam-gunecologists, whose names were drawn from the American Medical Association Physicians' Masterfile, was surveyed by telephone between February 1 and March 21, 1995. Both surveys addressed knowledge and attitudes about unplanned pregnancy and contraception options, including emergency contraception. Despite response rates of 50 and 77%, respectively, both unweighted samples closely mirror the populations from which they were drawn.ResultsAmericans are not well informed about emergency contraceptive pills. Only 36% of respondents indicated that they knew “anything could be done” within a few days after unprotected sex to prevent pregnancy. Fifty-five percent said they had “heard of” emergency contraceptive pills, and only 1% had ever used them. Ninety-nine percent of obstetrician-gynecologists reported being “familiar” with emergency contraceptive pills. Twenty-two percent were “somewhat familiar.” Among those who said they were “very familiar” with the method (77%), the majority considered emergency contraceptive pills to be “very safe” (88%) and “very effective” (85%). Overall, 70% of obstetrician-gynecologists surveyed said they had prescribed emergency contraceptive pills within the last year, but on an infrequent basis; 7% of those who prescribed emergency contraceptive pills did so five or fewer times.ConclusionPublic knowledge about the availability and use of emergency contraceptive pills is limited, as is the prctice of prescribing the pills among obstetrician-hunecologists. Because patients rely on health care providers for information on birth control, health care providers can improve knowledge about and availability of emergency contraceptive pills among their patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evlauate the role of hormone replacement therapy (HRT) as a risk factor for the development of epithelial ovarian cancer.MethodsA case-control study was perfromed that used 491 patients with epithelial ovarian cancer frequency matched for age at diagnosis (±5 years) with a control population of 741 patients with malignancies of nonestrogen-dependent tissues. The odds ratio (OR) for the development of epithelial ovarian cancer was estimated using logistic regression analysis with adjustment ofr age at diagnosis, parity, oral contraceptive use, smoking history, family history of epithelial ovarian cancer, age at menarche, menopausal status, income, and education.ResultsOne hundred of 491 patients (20.4%) in the study population had ever used HRT, and 160 of 741 patients (21.6%) in the control population had ever used HRT (OR 0.85; 95% confidence interval [CI] 0.62, 1.2). A significant association between HRT and specific histologic subtypes of epithelial ovarian cancer was not demonstrable for serous cystadenocarcinoma (OR 1.2, 95% CI 0.4, 3.4), or endometrioid carcinoma (OR 0.4; 95% CI 0.2, 1.2). A significant association between duration of use of HRT and the risk of developing epithelial ovarian cancer was not demonstrable for under 5 years (OR 0.8; 95% CI 0.5, 1.2), 5-9 years (OR 0.6; 95% CI 0.3, 1.1), or 10 or more years (OR 0.6; 95% CI 0.3, 1.4).ConclusionA significant association between the use of HRT and the risk of developing epithelial ovarian cancer, even with prolonged exposure, is not demostrable.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveThere have been few studies concerning the clinical pathology of squamous cell carcinoma arising from ovarian mature cystic teratoma. Thus, the objective of this study is to determine clinicopathologic factors affecting survival in this rare tumor.MethodsFrom September 1979 to June 1996, 37 patients with squamous cell carcinoma arising from ovarian mature cystic teratoma were treated by the Tokai Ovarian Tumor Study Group. A restrospective clinicopathologic and survival analysis of these patients was performed. The mode of infiltration was classified into expansive, moderately diffused, and diffused patterns.ResultsAlthough the 5-year survival rate was 94.7% and 80.0% for stage I and II patients, respectively, 12 and 13 patients with stage III died within 20 months (P= .0001). A significant difference was also observed between the survival of the groups with and without residual tumor at surgery (P= .0001). Pathologic features, grade, mode of infiltration, and vascular involvement were significant factors by univariate analysis. Multivariate analysis showed significant differences in survival related to grade (P= .0154) and mode of infiltration (P= .0053). The preoperative squamous cell carcinoma antigen level was significantly higher in the patients with squamous cell carcinoma arising from mature custic teratoma than in patients with mature cystic teratoma (P< .0001).ConclusionThis study suggests that pathologic factors, grade, and mode of infiltration can provide valuable information for predicting the survival of patients with squamous cell carcinoma arising from mature cystic teratoma. In addition, squamous cell carcinoma antigen may be a useful marker to detect this disease preoperatively.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of incentives for improving compliance with the first prenatal appointment.MethodsOne hundred four low-income women, intending to enroll for prenatal care in a system of Northern California family planning clinics, were recruited for a randomized trial. Study subjects were assigned randomly to one of three groups, receiving a taxicab voucher or a baby-blanket coupon or an appointment slip (Controls). Intention-to-treat analysis was used to compare compliance with the first prenatal appointment between the three groups.ResultsSubjects receiving the taxi voucher had a compliance rate of 82% for the firsgt prenatal appointment, 2% higher than mena appointment compliance in the other groups. The odds ratio for missing the first appointment was 0.32 (95% confidence interval 0.12, 0.88) in the taxi voucher group. This was not affected by controlling for possible confounders. Despite better appointment compliance, only one of 34 taxi vouchers distributed was actually used.ConclusionA taxi voucher incentive was effective in improving compliance with the first prenatal appointment, despite the fact that only one subject actually used the voucher.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recently, observational studies have suggested an increased risk of nonfatal venous thromboembolic complications in women using oral contraceptives (OCs) containing the third-generation progestins, gestodene and desogestrel. Because of the observational, rather than randomized, nature of these trails, the clinical relevance of these findings is difficult to interpret. Each study included one or more potential sources of bias. In particular, cases came almost exclusively from hospitalized patients with nonfatal venous thromboembolism, which represents only a minority of patients diagnosed with this condition according to current clinical practice. In the absence of a sound biologic rationale to expalin the increased risk with third-generation OCs, and considering the potential sources of bias within the current sudies, an alternative view argues against causlity. Oral contraceptives remain safe and effective. Clearly, additional research is needed to determine the relationship between thromboembolic disease and the use of third-generation OCs. In the interim, women should be informed thoroughly with objective data on all risks associated with the use of OCs.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Because the reporting requirements imposed by the Residency Review Committee (RRC) for Obstetrics and Gynecology have become more extensive, we sought to develop a Microsoft Windows 3.1 (Microsoft Corp., Redmond, WA)- based computer program for maintaining an on-line record of resident surgical experience. Data input for our program occurs in two stages. All residents are responsible for maintaining separate obstetrics and gynecology-primary care statistical booklets. Eacht booklet consists of individual perforated data sheet. The front of the obstetrics data sheet is a replica of the bottom portion of RRCS Form Obstetrics. The reverse side is a replica of the top half ofS Form Obstetrics, lisiting all “accountable” obstetric procedures, coded by level of operator responsibility. The front of the gynecology data sheet replicates theS form Primary and Preventive Ambulatory Medicine. The reverse of this sheet is a replica ofS Form Gynecologyand lists all “accountable” gynecologic procedures, again coded by level of operator responsibility. Residents submit data sheets on a daily basis to the residency program coordinator, who then enters each patient encounter into a user-friendly data base program. Data entry screens are essentially identical to the individual encounter forms, and input requires fewer than 30 seconds per form. Once the individual patient's data is entered on the scree, the computer program automatically updates the resident's cumulative surgical experience and stratifies experience by year of training. At any time, program administrators have on-line access to a comprehensive record of an individual resident's or group of residents' clinical experience.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare rates of cearean birth, endometritis, chorioamnionitis, and serious neonatal infections among pregnancies complicated by premature rupture of membranes (PROM) at term and managed by immediate oxytocin induction, by conservative management (or delayed oxytocin induction), or by vaginal (or endocervical) prostaglandin E2gel, suppositories, or tablets.Data SourcesThe English-language literature in MED-LINE and other databases was searched through April 1996 using the terms “fetal membranes,” “premature rupture,” and “term.”Methods of Study SelectionWe included randomized trials comparing two or more management schemes for PROM at term.Tabulation, Integration, and ResultsTwenty-three studies with a total of 7493 subjects met the inclusion criteria and were included for analysis. Data regaridng chorioamnionitis, endometritis, neonatal infections, and cesarean delivery were extracted. Meta-analyses were performed for the three interventions for these outcomes of interest using the Dersimonian and Laird and Mantel-Haenszel techniques to estimate the pooled odds ratios (ORs). No statistically significant differences in cesarean deliveries or neonatal infections were noted among management schemes. Vaginal prostaglandins resulted in more chorioamnionitis than immediate oxytocin (OR 1.55, 95% confidence interval [CI] 1.09, 2.21), but less chorioamnionitis than immediate oxytocin induction resulted in fewer cases of chorioamnionitis (OR 0.67, 95% CI 0.52 0.85) and endometritis (OR 0.71, 95% CI 0.51, 0.99) than conservative management, although these results achieved significance only with the Mantel-Haenszel technique.ConclusionConservative management may result in more maternal infections than immediate induction with oxytocin or prostaglandins.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hpothesis that women receiving intrapartum amnioinfusion have more rapid labors than do ccontrols.Data SourcesProspective clinical trials of amnioinfusion published in major american obstetric and gynecologic journals between 1985 and 1995, identified through aliterature search using MEDLINE and manual index review, were examined.Method of Study SelectionEleven studies that presented data regarding the length of labor were identified. Each study was reviewed for the design, number of subjects enrolled, volume of amnioinfusate, birth weight, maternal parity, interval from amnioinfusate, birth weight, maternal parity, interval from amniorrhexis to delivery, and total length of labor.Tabulation, Integration and ResultsMeta-analysis revealed no differences between amnioinfusion groups and controls with regard to length of labor or the interval between menbrane rupture and delivery.ConclusionAmnioinfusion has no effect on the duration of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID