摘要:

ObjectiveTo determine the effect of prophylactic antibiotics on endometrial and endocervical microflora upon diagnosis of postcesarean endometritis.MethodsThe medical records of patients enrolled in open-label comparative trials of therapeutic antibiotics for postpartum endometritis between 1989 and 1994 were reviewed (n= 682). Endometritis was diagnosed by a standard definition that included fever and localizing signs. Endometrial cultures were obtained by a sheathed injection/aspiration technique. Aerobes and anaerobes were isolated by standard microbiologic techniques. The primary outcome, endometrial and endocervical microflora, was compared in women who received intravenous ampicillin (2 g every 6 hours for 1-3 doses), cephalosporin (2 g every 6 hours for 1-3 doses), or no prophylaxis. Secondary outcomes included the cure of endometritis and the prevalence of wound infection in the three groups.ResultsFour hundred sixty-five of 682 patients (67%) had a cesarean delivery. One hundred fifty-one patients received ampicillin prophylaxis, 100 patients received cefazolin prophylaxis, 18 patients received extended-spectrum antibiotics, and 196 patients received no prophylaxis. Patients who received cefazolin prophylaxis had a significant increase in enterococcus (P< .05) and a significant decrease inProteusspecies (P< .05) from endometrial samples. Patients who received ampicillin prophylaxis had a significant increase ofMycoplasmaspecies (P< .05),Klebsiella pneumoniae(P< .0001),Escherichia coli(P= .04), and any aerobic gramnegative rod (P= .003) from endometrial samples. Ampicillin prophylaxis was associated with a decrease inPrevotella bivia(P< .05) and any anaerobe (P< .01). Endometritis cure rates were similar between prophylaxis groups and between prophylaxis and treatment groups. However, the cefazolin prophylaxis followed by cephalosporin treatment was associated with more wound infections (19%) than other prophylaxis and treatment groups, (6%,P< .01).ConclusionAmpicillin and cefazolin prophylaxis alters endometrial and endocervical microflora of women who develop endometritis. Whereas these changes had no effect on endometritis cure rate (power > 80%), the association between cefazolin prophylaxis followed by an extendedspectrum cephalosporin and wound infection may warrant caution against the use of the combination.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo estimate the subsequent incidence of cancers of endometrium, ovary, vulva, and vagina among women with positive cytology at screening for cervical cancer followed by negative histology.MethodsThis was a longitudinal cohort study involving women attending the organized mass screening in Finland from 1971-1990 with class II, III, IV, or V cytology followed by negative histologic confirmation, and a sample of 42,844 women attending the organized mass screening in Finland in 1971-1976 with cytologic class I smears without any gynecologic symptoms or infections. Follow-up on the women to the end of 1994 for subsequent cancers was maintained by linkage to the national cancer registry. Standardized incidence ratios with 95% confidence intervals (CI), with rates for all of Finland as reference, were estimated.ResultsThe standardized incidence ratios after negative class I smears of all the cancers studied were between 0.9 and 1.0. Ovarian cancer was not associated with positive cervical cytology. After positive class III-V cytology, the standardized incidence ratio of endometrial carcinoma was 1.6 (CI 1.0, 2.2) and that of vulvar carcinoma was 5.8 (CI 2.3, 12). The standardized incidence ratios of vaginal cancer after class II and III-V cytological smear were 2.7 (CI 1.7, 4.1) and 16.4 (CI 7.1, 32), respectively. The relative risks of all the cancers studied were greatest during the first year of follow-up and persisted for more than 5 years for vulvar and vaginal cancers.ConclusionAlthough the Papanicolaou smear is poor in detecting cancers other than cervical, in clinical practice, the possibility of other gynecologic cancer has to be considered in surveillance after positive cervical cytology is followed by negative histology.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo assess whether hypertension is a risk factor for hysterectomy performed for benign diseases.MethodsSelf-report questionnaires were collected from 77% of 2301 Danish women aged 30, 40, 50, or 60 years selected at random in 1982 for a prevalence study. Information about cardiovascular diseases, hypertension, use of medicine, weight and dieting history, life-styles, psychologic factors, gynecologic history (including history of hysterectomy), and social background were recorded. Weight, height, and blood pressure were measured. In an incidence study, the cohort was followed during 1982-1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regressions were used to analyze data.ResultsIn the prevalence study, history of hypertension partly explained the relation between hysterectomy and cardiovascular diseases. In the incidence study, history of hypertension and use of diuretics were significant risk factors for hysterectomy. After confounder control, use of diuretics was explained by weight-related variables, and hypertension was a risk factor for hysterectomy in educated women (adjusted relative risk [RR] 2.88, 95% confidence interval [CI] 1.07, 7.76) and in women with weight fluctuations (adjusted RR 3.31, 95% CI 1.35, 8.14). Weight cycling and lack of education remained significant risk factors for hysterectomy in women with and without hypertension, respectively.ConclusionHistory of hypertension, weight cycling, and lack of education are closely related risk factors for premenopausal hysterectomy. These three risk factors contribute to women undergoing hysterectomy having an increased risk for cardiovascular diseases. We proposed that hypertension might be a plausible biological cause of menorrhagia and an indication for hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine the results of primary repair of posthysterectomy vaginal vault prolapse in a current, large series of patients with long-term follow-up.MethodsFrom January 1976 to December 1987, 693 patients underwent primary repair of vault prolapse at the Mayo Clinic. The Mayo culdoplasty technique was used in 95% of these patients. Patients were followed up by reference to their Mayo Clinic medical records, a specifically designed questionnaire, and pelvic examination in a subgroup of patients.ResultsThe median age at operation was 66 years. Abdominal hysterectomy had been performed on 49.5% of patients and vaginal hysterectomy on 43.4% (hysterectomy type was not documented on 7.1%). The median number of years to vault prolapse repair after hysterectomy was 15.8 (range 0.4-48.4). Information about prolapse after primary repair was available for 504 patients (72.7%) and 80 had evidence or complaint (bulge, protrusion) of recurrent prolapse. Thirty-six of 693 patients (5.2%) had subsequent prolapse repair. Eighty-two percent of patients indicated satisfaction with the result. Complications of operation included entry into the bladder or rectum (2.3% of patients), vault hematoma (1.3%), cuff infection (0.6%), and ureteral complications (0.6%). The number of patients presenting for vault prolapse repair increased during the study interval.ConclusionThe Mayo culdoplasty can be performed with minimal morbidity. It achieved an anatomic restoration of upper vaginal support in a high percentage of patients with long-term follow-up.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveDetermine the efficacy of a new external antiincontinence urethral device.MethodsA before-after 1 month trial, open longitudinal study of 155 women complaining of urinary incontinence recruited from a referral urogynecology practice and local media advertising was performed. Primary outcomes included assessing the efficacy of the device using visual analogue scales, quality-of-life questionnaires, 1and 48hour standardized pad tests, and voiding diary. Secondary outcomes consisted of the evaluation of the adverse effects and the clinical profile of patients willing to use the device after study completion.ResultsNinety-six (62%) of 155 women enrolled completed the study. Scores on the visual analogue scales improved for the symptoms of stress incontinence, urgency, and urge incontinence (P< .001). The score for irritation/discomfort increased (P< .001). Data from diaries showed that 38 (44%,n= 86) patients were dry. Of 454 recorded patient-days, 325 (72%) were dry days. On pad testing, incontinence was cured in 49% (1-hour pad test,n= 59,P< .001) and 44% (48-hour pad test,n= 32,P< .001) of patients. Quality-of-life scores were significantly improved in 48% (n= 96, Incontinence Impact Questionnaire,P< .001) and 32% (n= 96, Urogenital Distress Inventory,P< .001) of patients. There was no increase in bacteriuria. After study completion, 61 (39%) women chose to continue using the device, but this was not predictable from baseline data.ConclusionUse of this device resulted in a significant reduction in incontinence and improvement in quality-oflife issues with minimal adverse events in the majority of women. This new anti-incontinence device could become a useful addition to the armamentarium of nonsurgical options.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo perform a cost-benefit analysis of aChlamydia trachomatisscreening program based on first-void urine testing of asymptomatic women using a polymerase chain reaction (PCR) test.MethodsA decision tree was developed. Selected variables based on assumptions were subjected to sensitivity analyses to make the model accurate and defensible.ResultsScreening for chlamydial infections using the PCR test was shown to be cost-effective even in lowprevalence populations. Compared with a symptom-driven no-screening situation, a universalC trachomatisscreening program using the PCR test would save money, in terms of direct cost, when the baseline prevalence ofC trachomatisinfection exceeds 3.9%.ConclusionCost analyses are still rare among trials that compare pharmacologic or procedural health care interventions. Socioeconomic studies linking secondary prevention ofC trachomatisinfection and infertility and adverse pregnancy outcome are needed to convince public health authorities of the need for and the benefit of such programs.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundSpectral Doppler ultrasound, an important diagnostic tool for the functional assessment of various organs, as yet has no major use in prenatal diagnosis due to the conventional technique's limitation of analyzing only one site at a time. Our aim was to develop a new modality that shows simultaneous studies of multiple sites in a vascular area, which should provide improved assessment of hemodynamic status of vascular systems.TechniqueThe new Doppler modality features automatic acquisition and analysis of blood flow in multiple sites over a large area. The quantitative Doppler data are presented as color-coded maps of the spectral Doppler indices overlaid on the gray-scale sonographic images and as histograms of indices distribution.ExperienceSerial sequences of Doppler measurements in the umbilical artery were taken in 14 women. The reproducibility of the new modality was confirmed.ConclusionOur new Doppler modality provides reproducible and reliable data. This method is a viable alternative to the traditional Doppler ultrasound and might offer better assessment of feto-placental circulation.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundAmniocentesis is an important procedure for antenatal diagnosis but requires stereotactic skill acquisition that may be facilitated by the use of a model.TechniqueA model using a gelatin mold with “targets” within is created. The model is used to facilitate development of stereotactic skills and to demonstrate technique principles for ultrasound-guided amniocentesis.ExperienceThe model has been incorporated into an educational program for antenatal diagnosis within a residency and provides a reasonable simulation of clinical features important in learning genetic amniocentesis.ConclusionThe use of this model augments the learning of important skills needed for ultrasound-guided amniocentesis.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We present a theorized mechanism for the development of preeclampsia, suggesting that one important underlying pathophysiologic mechanism is intolerance to volume expansion. The stage is set for this intolerance by chronic volume constriction, which leads to a requirement for increased basal peripheral vasoconstrictor tone to maintain blood pressure and allow for continued perfusion of the upright hominid head. In pregnancy, volume expansion signaled by the placenta cannot be accommodated by the constricted vascular system. The inability of the normally adaptive endothelial vasodilatory mechanisms to overcome the chronic vasoconstrictor tone leads to endothelial damage, exacerbation of vasoconstriction, and clinical hypertension. Disease resolution, characterized by diuresis, occurs with the elimination of the placenta-derived drive to retain volume. The reason preeclampsia does not recur uniformly with subsequent pregnancy is permanent restructuring of the maternal cardiovascular system with pregnancy that allows for greater plasma volume expansion in future gestations.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The Magnesium and Neurologic Endpoints Trial was a randomized controlled trial (RCT) done to learn whether or not receiving magnesium sulfate during preterm labor could prevent cerebral palsy. Unexpectedly, in the tocolytic arms of the trial, seven (including one set of twins) of 46 cases assigned to receive magnesium ended in total pediatric mortality (fetal + neonatal + postneonatal), compared to none of 47 cases assigned to other tocolytics ending in death. The difference between the two treatment arms is highly statistically significant (risk difference 15.2%; 95% confidence interval 4.8, 25.6;P= .006). If this relationship is confirmed by experimentation with animals or through the conduct of a large RCT at other institutions, it is possible that tocolytic magnesium will be found to be associated with the deaths of several thousand newborns in the United States annually. If the true excess total pediatric mortality is 10%, and if magnesium accounts for 40% of all tocolytics used, then tocolytic magnesium increases the absolute number of infant deaths by about 4800 every year.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID