摘要:

To examine whether the risk of pelvic inflammatory disease associated with intrauterine device (IUD) use varies with a woman's sexual behavior, we analyzed data from the Women's Health Study, a hospital-based, case-control study carried out in the United States from 1976-1978. The cases were 657 women hospitalized with pelvic inflammatory disease; controls were 2566 women hospitalized with non gynecologic conditions. After controlling for confounding factors, we found no consistent differences in the risk of pelvic inflammatory disease associated with IUD use among women in different categories of gonorrhea history, frequency of intercourse, or number of recent sexual partners. However, among women with only one sexual partner, married and cohabiting women had little appreciable increased pelvic inflammatory disease risk associated with IUD use compared with those using no contraception, whereas previously and never-married women using IUDs had relative risk estimates of 1.8 and 2.6, respectively. These results suggest that women at low risk of acquiring sexually transmitted infections have little increase in the risk of pelvic inflammatory disease from use of an IUD.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Sixty-two women were randomized in a double-blind fashion to receive one of two antibiotic regimens for the treatment of clinically diagnosed pelvic inflammatory disease. Thirty of .31 patients (96.8%) receiving a combination of cefoxitin with doxycycline and 28 of 31 (90.3%) receiving a combination of clindamycin with amikacin responded to therapy (P = not significant).Chlamydia trachomatis, Neisseria gonorrhoea,or both were isolated from 13.3, 7.0, and 4.8% of patients, respectively. Of the four patients not responding to therapy, all had inflammatory complexes. Cefoxitin/doxycycline and clindamycin/amikacin are both effective in the treatment of pelvic inflammatory disease.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fibionectin, a known growth factor for fibroblasts, is produced by alveolar macrophages from patients with interstitial pulmonary fibrosis. Because peritoneal macrophages have been implicated in the disease process of endometriosis, we measured the production of fibronectin by peritoneal macrophages in vitro and the concentration of fibronectin in peritoneal fluid samples. Twenty-nine patients had a normal pelvis, 22 had endometriosis, and 14 had tubal occlusion and/or adhesions. Human peritoneal macrophages demonstrated de novo synthesis of fibronectin. The peritoneal macrophage fibronectin was detected by an enzyme-linked immunosorbent assay for serum fibronectin. Peritoneal macrophages from patients with endometriosis produced approximately three times the amount of fibronectin as normal patients or patients with tubal occlusion and/or adhesions (P≤ .01 and P≤ .02 respectively). The mean peritoneal fluid concentration of fibronectin, however, was about 30% lower in patients with endometriosis than in normal patients (P ≤.02). We suggest that increased peritoneal macrophage fibronectin production in patients with endometriosis may contribute to the adhesion formation and associated reactive fibrosis seen in this disease, and may also influence the implantation of endometrial cells and their subsequent growth in the pelvis.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Seventy-one women underwent follow-up laparoscopy for persistent infertility six to 24 months after conservative treatment of endometriosis. The disease was staged according to the revised American Fertility Society classification of 1985. The serum CA 125 concentration was also measured in each patient to evaluate its efficacy in the diagnosis of endometriosis recurrence. The patients with stages I and II endometriosis had serum CA 125 levels not significantly higher than in the patients with negative findings, whereas those with stages HI and IV endometriosis presented significantly higher levels (P<.005 and P<.001, respectively) than the disease-free women. The sensitivity of serum CA 125 measurements in the diagnosis of endometriosis recurrence was 14.8%, the specificity was 100%, and the predictive values of normal (less than 35 U/mL) and elevated levels were 27 and 100%, respectively. In some cases, serum CA 125 measurements may be used instead of follow-up laparoscopy, or to indicate when laparoscopy should be performed or postponed.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Serum CA 125 levels were assayed from 44 normal healthy women, 153 patients with benign pelvic masses, and 58 patients with malignant pelvic masses. CA 125 levels were less than 35 U/mL in 42 of the 44 normal women and were greater than 35 but less than 65 U/mL in the other two women. Among 153 patients with benign pelvic masses, CA 125 levels greater than 35, 65, or 194 U/mL were detected in 61 (39.9%), 31 (20.3%), and eight (5.2%) patients, respectively. Of 58 patients with malignant pelvic masses, CA 125 results were greater than 35, 65, or 194 U/mL in 48 (82.8%), 45 (77.6%), and 38 (65.5%), respectively. Among the latter group, the positivity rates of 30 patients with epithelial ovarian cancers were 100, 93, and 80%, respectively. This study suggests that defining positive serum CA 125 levels as those greater than 35 U/mL is of limited clinical value because there is a 39.9% false-positive rate in patients with benign disease. However, serum CA 125 values greater than 65 U/mL may be considered positive in clinically normal women. Serum CA 125 greater than 194 U/mL, representing the units at the 95th percentile for 153 patients with benign pelvic masses, is defined as a new positivity criterion, and could be used to differentiate malignant tumors from benign pelvic masses.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The incidence of congenital anomalies of the uterus has generally been obtained from studies of women undergoing evaluation for infertility, and has been reported as 1-10%. However, the true incidence of uterine malformations is not known. This study reviews hysterosalpingograms obtained for evaluation of tubal closure after transcervical sterilization in normal multiparous women using methylcyanoacrylate and the FEMCEPT device. Of the 840 hysterosalpingograms studied, 16 congenital uterine anomalies were identified, for an incidence of 1.9%. The presence of anomalies in this population of women may more closely represent the incidence of congenital uterine anomalies in the general population.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cytogenetic analysis was performed on 1142 couples with recurrent pregnancy loss. The frequency of major chromosomal abnormalities per couple was 4.8%. Among 771 couples who had only abortions, the rate of rearrangement did not correlate with the number of abortions. The highest incidence of cytogenetic abnormalities (6.6%) was found in 256 couples with abortion and a normal child. With regard to pregnancy outcome, no unbalanced fetal karyotype was found in prenatal diagnoses, and 40 normal children were born. The risk of unbalanced fetal karyotype is therefore low, but probably high enough for these couples to be offered the possibility of a prenatal diagnosis.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Early identification of fetal abnormalities is possible as a result of improved ultrasound resolution, chorionic villus sampling, and early genetic amniocentesis. A potential advantage of early genetic amniocentesis over chorionic villus sampling is its ability to detect neural tube defects. We obtained 476 amniotic fluid samples between ten and 15 weeks' gestation and analyzed them for karyotype and alpha-fetoprotein (AFP); 142 were also tested for acetylcholinesterase. Amniotic fluid AFP levels rose to a peak at 12-13 weeks' gestation and then gradually declined, closely approximating the pattern in fetal blood. The rate of inconclusive acetylcholinesterase results (a faint but true band) was four times higher than that later in pregnancy (10.6 versus 2.46%, respectively). However, the rate of associated fetal congenital anomalies was lower than that later in pregnancy. Chromosomal abnormalities were detected in the study group, and the association with low amniotic fluid AFP in early genetic amniocentesis levels was identical to that further along in pregnancy. These data help establish normal values for AFP in early pregnancy. With AFP and cautious interpretation of acetylcholinesterase, early genetic amniocentesis can be used for neural tube defect detection.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The fluorescence polarization of amniotic fluid, a measure of fetal lung maturity, was determined in 518 amniotic fluid samples obtained by amniocentesis. The subjects were divided into seven clinical groups: premature contractions, premature rupture of the membranes, pregnancy-induced hypertension, diabetes, intrauterine growth retardation, vaginal bleeding, and “other” for gestational-age groups of 30 weeks or less, 31-36 weeks, and 37 or more weeks. The proportion of mature values (fluorescence polarization 0.285 or lower) increased progressively from 12.5% at 27-28 weeks to 100% at 39-40 weeks. In the 31-36-week gestation group, the proportion of mature values in subjects with premature rupture of the membranes (84.6%) was significantly higher than in those with premature contractions (60%), severe pregnancy-induced hypertension (50%), mild pregnancyinduced hypertension (55.2%), diabetes class A (50%), insulin- dependent diabetes (60%), and other (63.5%). The mean ± SD fluorescence polarization value was significantly lower in premature rupture of the membranes (0.256 ± 0.030) than in premature contractions (0.274 ± 0.032), mild and severe pregnancy-induced hypertension (0.280 ± 0.027 and 0.280 ± 0.035, respectively), and class A and insulindependent diabetes (0.285 ± 0.018 and 0.277 ± 0.030, respectively). The severity of pregnancy-induced hypertension and diabetes did not appear to influence either the fluorescence polarization value or the proportion of mature results. With the exception of a marked influence of premature rupture of the membranes, abnormal pregnancy conditions did not appear to have a significant effect on fluorescence polarization of amniotic fluid.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Short-chain organic acids are byproducts of bacterial metabolism, and their detection by gas-liquid chromatography (GLC) in amniotic fluid has been proposed as a rapid, sensitive, and specific method for the diagnosis of infection. This study was conducted to determine whether GLC analysis of amniotic fluid would be helpful in a population of women in whom the Gram stain examination was negative. Amniotic fluid was retrieved by transabdominal amniocentesis from three groups of patients. Group 1 (negative control) contained 14 women with term pregnancies without clinical and microbiologic evidence of infection of the amniotic cavity; group 2 (positive control) included 17 women with a positive Gram stain examination and culture of amniotic fluid; group 3 (study group) comprised 25 women at risk for intra-amniotic infection who had a negative Gram stain of amniotic fluid. None of the patients in group 1 and 16 of 17 patients (94.1%) in group 2 had pathologic short-chain organic acids in the amniotic fluid. Seven of the 25 patients in group 3 had a positive amniotic fluid culture and only two had an abnormal GLC pattern. Of the remaining 18 patients with negative amniotic fluid cultures, eight had abnormal GLC results. In group 3, the sensitivity of GLC was 28.5% and the specificity was 55.5%. Gas-liquid chromatographic analysis of amniotic fluid has limited clinical value in the prediction of amniotic fluid culture when the Gram stain examination is negative.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID