摘要:

ObjectiveTo analyze the placental histology in cases of preterm premature rupture of membranes (PROM), classify the cases according to the results of the histologic examination, and determine if these histologic groups have different clinical characteristics and outcomes.MethodsDuring a 3-year period, a cohort of 235 women with preterm PROM was studied prospectively. The women were classified according to placental histologic findings, and their prenatal and intrapartum courses and perinatal mortality and morbidity were analyzed and compared.ResultsOne hundred two placentas (43.4%) exhibitied acute inflammatory lesions, 48(20.4%) had vascularlesions, 48(20.4%) had both inflammatory and vascular lesions, (13.2%) had no abnormal findings, four (1.7%) had villous edema, and two (0.8%) had chronic villitis. The four largest histologic groups had distinctive characteristics with respect to gestational age at the time of PROM and at delivary, duration of the latency period, and perinatal mortality and morbidity.ConclusionCases of preterm PROM may be classified according to placental histologic findings, and these groups have different clinical manigestations, prognoses, and outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the current frequency of red blood cell antigen alloimmunizations that are capable of causing hymolytic disease and would be suitable for prenatal DNA studies.MethodsWe reviewed blood-bank records at a single large tertiary center to identify patients with a positive antibody screen between January 1993 and June 1995. Data were analyzed based on age, gender, and specific blood-group alloimmunizations. The incidence of antibodies as published in the literature was reviewed and compared with our data.ResultsWe identified 452 women who had a positive antibody screen. The frequencies of specific alloimmunization relevant to the development of fetal hemolytic disease were: anti-D, 18.4%, anti-E, 14%; anti-c, 5.8%, anti-C, 4.7%; Kell group, 22%; anti-MNS, 4.7%; anti-Fya(Duffy), 5.4%; and anti-Jka, 1.5%. Compared with other populations, in our group the frequency of antibodies to RhD decreased and Kell alloimmunization increased between 1967 and 1996.ConclusionsDespite the use of rhesus immune globulin, anti-D is still a common antibody identified in women presenting to a tertiary care center. The frequency of Kell-group alloimmunization is higher among the central New York female populatin that in other populations. Rhesus and Kell antigen status can be determined by DNA studies. Research in prenatal determination of fetal antigen status should continue, as alloimmunization to these antigen is common.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the bioavilability of oral and intramuscular (IM) dexamthasonei in third-trimester pregnant women.MethodsOral and IM dexamethasone levels were compared in a randomized, parallel, crossover bioavailability study involving 11 gravid women in the third trimester of pregnancy. Subjects were randomized to receive either 6 mg of IM or 8 mg of oral dexamethasone. The following week, the alternative regimen was administered. Serial blood samples were obtained after drug administration. Dexamethasone concentrations were measured by radioimmunoassay. Total area under the curve was compared for the oral and IM groups using a pairedttest.ResultsEight of the 11 women completed the study through 12 hours; all 11 women completed the study through 6 hours. Among the 11 women, peak levels of dexamethasone occurred 30 minutes after IM injection (mean ± standardf deviation, 101.7 ± 19.2 ng/mL) and 120 minutes after oral administration (65.9 ± 20.5 ng/mL). Area under the curve did not differ significantly between those receiving IM dexamethasone (258.3 ± 50.0 ng/minu/mL) when measured 6 hours after administration of the drug. Terminal half-lives were similar in the IM and oral groups. Similar findings were noted among the eight women who were studied through 12 hours. This study had a power of 87% to detect a 20% difference in area under the curve between the two groups.ConclusionThe bioavailability of 8 mg of oral dexamethasone is similar to that of a 6-mg IM dose, as determined by the area under the curve.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify variables that increase the chance of neonatal scalp injury during vacuum extraction.MethodsWe conducted a prospective observational study of 134 vaccum extraction-assisted deliveries at Olive View-UCLA Medical Center in 1995. Data collected included parity, gestational age, duration of first and second stages of labor, indication for operative delivery, station and position of fetal head, duration of vaccum application, number of “pop-offs”, neonatal weight, and descriptions of scalp marks or injury. Cranial imaging studies were obtained if clinically indicated.ResultsThere were 28 infants with scalp trauma, including 17 superficial lacerations, six large caputs, and 12 cephalohematomata; one infant had subgaleal, subdural, and subarachniod hemorrhages. Logisitc regression analysis showed duration of vacuum application to be the best predictor of scalp injury, followed by duration of second stage of labor and paramedian cup placement. Duration of vaccum application ranged from 0.5 to 26 minutes, with a median length of 3 minutes. The proportion of injuries was greater for applications exceeding 10 minutes (6 of 9) than for those 10 minutes or shorter (22 0f 121,P< .01). We did not encounter any cases of clinically important scalp injury.ConclusionsCosmetic scalp trauma occurred in 21% of our newborns delivered by vaccum extraction and was more common after longer vaccum applications, longer second stages, and paramedian cup placement.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare three platinum compounds for their antitumor effects on cervical cancer after systemic and intraarterial infusion.MethodsAdult female rabbits with squamous cell carcinoma of the uterine cervix received infusion of 1.7 mg/kg cisplatin, 10 mg/kg carboplatin, or 6 mg/kg cis-diammine (glycolato) platinum (254-S) via the internal iliac artery or ear vein. Platinum concentrations in the tumor and tumor size were measured after internal iliac arterial or intravenous (IV) infusion with these platinum compounds.ResultsThe platinum concentration in the tumor after intra-arterial infusion was significantly higher than that after IV infusion for cisplatin. However, the tumor concentrations of platinum for carboplatin and 254-S did not differ between the infusion methods. The platinum concentration 20 minutes after IV infusion was significantly higher for 254-S than for cisplatin or carboplatin. The platinum concentration 7 days after intra-arterial infusion was significanlty higher with cisplatin than with carboplatin or 254-S. Tumor size 7 days after intra-arterial infusion was significantly smaller than that after IV infusion for cisplatin (1.85 ± 0.54 versus 5.60 ± 2.60 cm2;P< .05). Tumor size was significantly smaller with 254-S than with cisplatin or carboplatin using the IV infusion method (2.40 ± 0.21 cm2for 254-S, 5.60 ± 2.60 cm2for cisplatin, and 5.13 ± 1.59 cm2for carboplatin,P< .05).ConclusionsIntra-arterial infusion seems to be a suitable route of administration for cisplatin, whereas IV infusion appears to have an advantage for 254-S in the treatment of cervical cancer.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare levels of two inflammatory cytokines, interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), in selected regions of the vulva, vestibule, and vagina in women with vulvar vestibulitis and in asymptomatic controls.MethodsSelective samplings of surgical specimens from 12 women undergoing perineoplasty for vulvar vestibulitis and ten pain-free subjects undergoing posterior vaginal repair were prepared into tissue homogenates and analyzed for concentrations of IL-1β and TNF-α. Interleukin-1β and TNF-α concentrations were measured by sandwich enzymelinked immunosorbent assay. The results were reported after adjustment for total tissue protein concentration.ResultsMedian tissue levels of IL-1β and TNF-α were elevated 2.3-fold and 1.8-fold, respectively, in women with vulvar vestibulitis relative to pain-free women. Median IL-1β tissue levels were increased significantly from 1.3 pg/mg to 3.0 pg/mg total protein in women with vulvar vestibulitis compared to pain-free women. Median TNF-α tissue levels were increased from 83 pg/mg to 148 pg/mg total protein in women with vulvar vestibulitis compared to pain-free women. Analysis by selected anatomic site of women with vulvar vestibulitis revealed a significant 2.2-fold higher median level of TNFα at the vulvar site compared to the vestibule.ConclusionConcentrations of IL-1β and TNF-α were elevated in women with vulvar vestibulitis relative to those in asymptomatic controls. This elevation in inflammatory cytokines with vulvar vestibulitis varied according to anatomic site and was, paradoxically, lowest in the area of highest hyperalgesia, the vulvar vestibule. Inflammatory cytokine elevation may contribute to the pathophysiology of mucocutaneous hyperalgesia.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the systemic and therapeutic effect of topical testosterone treatment in vulvar lichen sclerosus.MethodsThis prospective clinical, single-arm study in cluded ten postmenopausal women with vulvar lichen sclerosus. Testosterone propionate (0.04 g daily) was administered topically for 4 weeks. Serum androgens (testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate) were determined before and after 4 weeksof treatment, and vulvodynia was evaluated by a horizontal visual analogue scale.ResultsSerum levels of total testosterone increased in all patients (P< .01) and exceeded normal range in eight of ten women. Vulvodynia improved in nine of ten patients (pairedttest:P< .01). Four of ten patients showed clinical signs of hyperandrogenism (enlargement of the clitoris, alterations of the voice, increase in libido) after 4 weeks of treatment. The only patient without subjective improvement had elevated basal serum androgen levels and showed clinical signs of hyperandrogenism before therapy.ConclusionTopical testosterone is effective in normoandrogenic women with lichen sclerosus. Androgen status should be evaluated before treatment, and dosage should be individualized to avoid virilization and metabolic side effects. Because there is a marked systemic effect, clinical controls and a follow-up with evaluation of serum testosterone levels are recommended. Other steroids should be included in therapeutic decisions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Human placental cord blood contains a large number of hemotopoietic progenitor cells, which could be used as a source of stem cells for the treatment of hematologic disorders and malignancies. Advantages of cord blood use include noninvasive collection, low risk for viral infection, and immunologic naiveté. Cord blood may be used as stem-cell resuce in all applications of bone marrow transplantation, including gene therapy. Given this potential utility, questions are raised regarding the regulation of cord-blood collection, storage, and use. Should the prospective parent(s) donate the infant's cord blood for treatment of unrelated recipients, or should they invest in cord-blood storage as biologic “life insurance” for the chiild's later use? This issue presents many conflicts for families and their health care providers.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo complete a systematic review of the published literature comparing complications, postoperative recovery time, and costs following laparoscopy-assisted vaginal hysterectomy, total abdominal hysterectomy(TAH), and vaginal hysterectomy.Data SourcesWe searched MEDLINE and several bibiliographies, identifying all reports using the term “laparoscopy-assisted hysterectomy” published from 1989 to september 1995.Methods of study selectionWe excluded case reports, letters, and reports of laparoscopy-assisted vaginal hysterectomy procedures used for radical cancer surgery, sex-change operations, total laparoscopic hysterectomy, or supracervical hysterectomy.Tabulation, Integration, and ResultsCases identified included 3112 laparoscopy-assisted vaginal hysterectomies, 1618 TAHs, and 690 vaginal hysterectomies. Laparoscopy-assisted vaginal hysterectomy cases compared with TAH cases demonstrated significantly greater incidence of blader injury (1.8% for laporoscopy-assisted vaginal hysterectomy versus 0.4% for TAH;P= .01), significantly longer operating room time (115 minutes, standard deviation [SD] 37 minutes, for laparoscopy-assisted vaginal hysterectomy versus 87 minutes, SD 18 minutes, for TAH;P< .001), and significantly shorter hospitalization (49 hours, SD 16 hours, for laparoscopy-assisted vaginal hysterectomy versus 79 hours, SD 20 hours, for TAH;P< .001). Use of analysis was consistenly less for laparoscopy-assisted vaginal hysterectomy and return to full activity was always sooner when compared to TAH. Cost for the new procedure was higher in seven out of 11 studies, but when disposable instruments and hospital length of stay are considered, the remaining vaginal hysterectomy.ConclusionAlthough laparoscopy-assisted vaginal hysterectomy involves a shorter hospital stay, speedier postoperative recovery, and less analgesia use, there is also a higher rate of bladder injury and lenghier surgery. These outcomes must be weighed when choosing an intervention.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo summarize the literature on anterior vaginal prolapse, focusing on vaginal anatomy, etiologic theories, and comparison of anterior colporrhaphy and paravaginal repair.Data SourcesWe identified articles related to anterior vaginal prolapse through a MEDLINE search of English language literature published from January 1966 through December 1995 and in bibliographies in gynecologic text-books.Methods of Study SelectionWe reviewed 80 articles published in peer-reviewed journals or textbooks and related to anterior vaginal proplapse. In addition, ten articles on operative procedures for uninary incontinence were studied.Tabulation, Intergration, and ResultsWe abstracted and synthesized information from 31 papers that contained descriptions of and opinions on vaginal anatomy and etiology of vaginal prolapse. The vagina has three layers—mucosa, muscutaris, and adventitia; there is no vaginal “fascia.” Vaginal support is provided by the underlying levator ani muscles and by lateral connective-tissue attachments at the arcus tendineus fasciae pelvis or “white line.” Anterior vaginal prolapse results from direct or indirect damage to the pelvic muscles or connective tissue or both. Forty-nine articles described surgical techniques for the correction of anterior vaginal prolapse, and 24 of them reported postoperative outcomes. Reported failure rates ranged from 0–20% for anterior colporrhaphy and 3–14% for paravaginal repair. No controlled studies compared different procedures performed primarily for correction of anterior vaginal prolapse.ConclusionsDissection during anterior colporrhaphy splits vaginal muscularis, and repair involves plication of the muscularis and adventitia (not vaginal “fascia”) in the midline, which may pull the lateral attachments further from the pelvic sidewall. Paravaginal repair restores the lateral attachments to the pelvic sidewall at the white line. Controlled studies that compare directly these two procedures for anterior vaginal prolapse repair are necessary to determine their relative effectiveness.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID