ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate prospectively the Centers for Disease Control and Prevention (CDC) recommended regimens for the treatment of antepartum syphilis and prevention of congenital syphilis.MethodsThis was a prospective evaluation of recommended syphilis treatment regimens from September 1, 1987, to August 31, 1989, at Parkland Memorial Hospital, Dallas, Texas. Women with syphilis were staged and treated according to CDC recommendations. Treatment included 2.4 million units of intramuscular (IM) benzathine penicillin G for primary, secondary, or early latent (less than 1 year) syphilis. Women with late latent (uncertain or longer than 1 year) syphilis were treated with 7.2 million units of benzathine penicillin G IM over 3 weeks.ResultsDuring the study period, 448 of 28,552 women (1.6%) delivered were diagnosed with syphilis. One hundred eight were diagnosed at delivery and treated postpartum. The remaining 340 (75.9%) gravidas with untreated syphilis attending prenatal clinic comprised the study group. The success of therapy in preventing congenital syphilis was as follows: primary syphilis, 27 of 27; secondary syphilis, 71 of 75; early latent syphilis, 100 of 102; and late latent syphilis, 136 of 136. The success rate for all stages of syphilis was 334 of 340 (98.2%). The success rate of therapy in secondary syphilis was significantly different from that of the other groups (P= .03). Two of the six fetal treatment failures produced preterm stillborns. Only one maternal treatment failure occurred, in a human immunodeficiency virus-infected woman.ConclusionThe CDC-recommended regimens for the prevention of congenital syphilis and treatment of maternal infection are effective, but the highest risk of fetal treatment failure exists with maternal secondary syphilis.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo examine pregnancy outcomes in women age 40 or older.MethodsWe used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data.ResultsApproximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate for multiparous patients in this group was 29.6%. The cesarean delivery rate was 22.5% for nulliparous and 17.8% for multiparous women in the control group. In the older group, the operative vaginal delivery rate (forceps and vacuum) was 14.2% for nulliparous women and 6.3% for multiparous women. Rates of birth asphyxia, fetal growth restriction, malpresentation, and gestational diabetes were significantly higher among older nulliparas (6, 2.5, 11, and 7%, respectively) compared with rates among control nulliparas (4, 1.4, 6, and 1.7%, respectively), and there were similar significant increases among older multiparas (3.4, 1.4, 6.9, and 7.8%, respectively), compared with younger multiparous controls (2.4, 1, 3.7, and 1.6%, respectively). Mean (± standard error) birth weight of infants delivered by older nulliparous women was 3201 ± 10 g, significantly lower than that among nulliparous controls (3317 ± 1 g), whereas mean birth weight in the group of older multiparas (3381 ± 5 g) was no different than that among younger multiparous controls (3387 ± 1 g). Gestational age at delivery was significantly lower among older nulliparas (273.4 ± 0.4 days), compared with nulliparous controls (278.5 ± 0.05 days), and similarly lower among older multiparous women (274.0 ± 0.2 days), compared with multiparous controls (278.3 ± 0.05 days). More white women age 40 or over than younger white women were having a first child (64 and 39%, respectively).ConclusionNulliparous women age 40 or over have a higher risk of operative delivery (cesarean, forceps, and vacuum deliveries: 61%) than do younger nulliparous women (35%). This increase occurs in spite of lower birth weight and gestational age and may be explained largely by the increase in other complications of pregnancy. The increased frequency at which white women are having their first child at age 40 or over may reflect career choices that involve delaying childbirth until the fifth decade of life. These data will allow us better to counsel patients about their pregnancy expectations and possible outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess etiologic significance of maternal autoimmune thyroid disease on incidence of transient congenital hypothyroidism in newborns.MethodsThyroid function was assessed in 259 mothers of hypothyroid newborns from the Quebec newborn screening program between 1984 and 1996. Maternal blood samples were taken routinely at the time of follow-up serum sampling of the infants, for measurements of free thyroxine, TSH, and antimicrosomal autoantibodies. Thyroid scans were conducted to characterize the type of thyroid dysfunction in affected infants. Results were compared with similar data from a control population of 1773 pregnant women recruited from Quebec City between 1991 and 1992. These samples were collected at routine second-trimester prenatal screenings.ResultsThe mothers of congenitally hypothyroid infants had higher prevalence of suppressed serum TSH concentrations compared with the control population (6.1% versus 2.9%,P= .01), higher prevalence of increased serum TSH levels (7.0% versus 0.9%,P< .001), and similar prevalence of positive antimicrosomal antibodies (11.6% versus 12.1%,P= .90). The prevalence of transient congenital hypothyroidism in the study population of hypothyroid infants was 27%, which is significantly greater than the 15% observed in our overall population of 523 congenitally hypothyroid infants studied between 1974 and 1996 (P= .04). Antimicrosomal antibodies were demonstrable in ten (77%) of 13 mothers of infants with transient congenital hypothyroidism, and antimicrosomal antibodies or abnormal serum TSH levels in 13 of 13 (100%).ConclusionThese results indicate that most, if not all, cases of transient congenital hypothyroidism were attributable to maternal autoimmune thyroid disease, and presumably to maternal TSH receptor-blocking antibody. They suggest that maternal autoimmune thyroid disease is associated with much higher prevalence of transient congenital hypothyroidism than suspected. Because of the 20% prevalence of autoimmune thyroid disease and thyroid dysfunction in the mothers of congenitally hypothyroid infants, we recommend thyroid assessment of such women, if this information is not available.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine long-term survival and predictors of recurrence in patients with platinum-treated ovarian cancer who were followed for 10 years after second-look laparotomy with negative findings.MethodsRecords were reviewed of 91 consecutive patients with negative findings on second-look laparotomy after platinum-based chemotherapy between January 1978 and January 1987. Statistical analysis used Kaplan-Meier survival curves, Cox proportional hazards, and multiple logistic regression.ResultsMean age of patients was 57 (range 30–79) years. Distribution by stage and grade was as follows: stage I, ten; II, 18; III, 57; IV, six; grade 1, 18; 2, 28; 3, 45. Forty-seven of 91 women had optimal initial cytoreduction. Recurrence-free survival rates for all subjects were 75% at 2 years, 55% at 5 years, and 52% at 10 years. For women with stage I disease, the recurrence-free survival rate was 90% at 2, 5, and 10 years. For women with stage II disease, recurrence-free survival rates were 78, 72, and 66% at 2, 5, and 10 years, respectively. Patients with stage III or IV disease had recurrence-free survival rates of 72, 44, and 40% at 2, 5, and 10 years, respectively. Risk of recurrent disease was related to tumor stage (relative risk [RR] 2.02; 95% confidence interval [CI] 1.2, 3.3;P= .005), grade (RR 2.00; 95% CI 1.3, 3.2;P= .004), and presence of a residual tumor of more than 2 cm at the end of initial surgery (RR 3.19; 95% CI 1.2, 8.5;P= .02).ConclusionOvarian cancer patients face an appreciable risk of recurrence in the first 5 years after second-look laparotomy with negative findings after platinum-based chemotherapy, but those who remain disease free at 5 years have excellent long-term survival rates. Tumor stage, grade, and presence of a residual tumor of more than 2 cm after initial surgery are significant predictors of recurrence.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate the distribution of cotinine in fetal fluids and serum during the first half of pregnancy, and compare the fetal and maternal cotinine levels in passive and active smokers.MethodsMaternal smoking status was determined by questionnaire in 85 pregnant women requesting abortion for psychosocial reasons between 7 and 17 weeks' gestation. Coelomic and amniotic fluid samples were collected between 7 and 11 weeks and fetal blood and amniotic fluid between 11 and 17 weeks. Cotinine levels were measured by radioimmunoassay.ResultsWomen classified themselves as nonsmokers in 40 cases, passive smokers in 19 cases, and voluntary smokers in 26 cases. Five nonsmokers, 16 passive smokers, and all smokers had cotinine levels above the detection limit of the assay. Cotinine was invariably found in coelomic, amniotic, and fetal serum when maternal serum and urine cotinine levels exceeded 25 and 250 ng/mL, respectively. Higher cotinine levels were found in fetal fluids and serum than in maternal serum. Positive linear correlations were found between maternal urine and amniotic fluid cotinine concentrations (r= .75), between maternal urine cotinine concentration and number of cigarettes smoked per day (r= .66), and between maternal and fetal serum cotinine concentrations (r= .97).ConclusionCotinine accumulates in the fetal compartments as early as 7 weeks' gestation in both active and passive smokers. Women should be advised to give up smoking from conception and avoid environmental tobacco smoke exposure.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo describe the epidemiology of ovarian cancer mortality in the United States from 1979 to 1995.MethodsThe mortality data of the Centers for Disease Control and Prevention were accessed using the Wide-ranging ONline Data for Epidemiologic Research (WONDER). We selected all deaths among women with International Classification of Diseases, Ninth Revision (ICD-9) code 183.0 (ovarian malignant neoplasm). Mortality data for the years 1979–1995 were age-adjusted to the United States 1990 female population, and mortality rates for each year were calculated for females of all ages by age category, by race, and by geographic location. Trends were obtained for the periods 1979–1983 to 1991–1995, and the impact on the number of ovarian cancer deaths was calculated.ResultsAge-adjusted ovarian cancer mortality rates have changed little in the United States from 1979 to 1995, but rates are increasing in older women (65 years and older) and decreasing in younger women. Age-adjusted mortality rates are higher among whites than in blacks. Ovarian cancer mortality rates are higher in northern compared with southern states.ConclusionThe trends in ovarian cancer mortality among younger and older women parallel published changes in incidence and may be due to changes in risk factors, such as the use of oral contraceptives. The reasons for the higher ovarian cancer death rates in northern states are unknown. Better understanding of how modifiable risk factors and treatment methods affect ovarian cancer mortality trends is needed.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the frequency ofBRCA1mutations 185delAG and 5382insC andBRCA2mutation 6174delT in Jewish women with ovarian cancer and in matched controls in a population-based study.MethodsForty-eight Jewish women with epithelial ovarian cancer (32 invasive and 16 borderline) and 33 Jewish control subjects were obtained from a population-based, case-control study of ovarian cancer in eastern Massachusetts and New Hampshire. Mutational analysis on exons 2 and 20 ofBRCA1and exon 11 ofBRCA2was conducted on blood samples from patients and controls.ResultsFourteen (44%) of 32 Jewish patients with invasive epithelial ovarian cancer carried either a 185delAG mutation ofBRCA1(n= 8) or a 6174delT mutation onBRCA2(n= 6). Neither of these mutations was identified in 16 women with borderline ovarian tumors or in 33 controls. No 5382insC mutation ofBRCA1was identified in any of the patients or control subjects in the series. Family history did not predict mutation status.ConclusionBRCA1185delAG andBRCA26174delT mutations are frequent in Jewish women with invasive epithelial ovarian cancer, irrespective of family history. Genetic counseling might be warranted in women with invasive epithelial ovarian cancer based on Jewish ethnicity alone.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveWhen cancer strikes a patient, it has a major impact on the family. Whereas many health care providers deal with the family while the patient is living, few have any long-term interactions after she has died. The purpose of this study is to interface with family members and reflect upon the impact ovarian cancer had on them.MethodsA retrospective chart review was conducted of 222 patients who had been diagnosed and treated for ovarian carcinoma between the years 1990 and 1994 at Maine Medical Center, a tertiary care medical center. Of these, 34 patients who had been deceased for longer than 1 year were selected on the basis of specific criteria. The families of these individuals were each mailed a questionnaire comprising seven questions tailored to evaluate one family member's impressions and experiences of coping with a loved one who had died from ovarian cancer. Candid responses of any length were invited.ResultsWritten responses were received from 32 of the 34 families that were mailed questionnaires. Of those responding, 65% were spouses, 22% were children, and 13% were siblings of the deceased. Each questionnaire was answered by only one relative, and the majority of questions posed received multiple detailed answers. According to the vast majority of respondents, the worst part of treatment was continuing chemotherapy. The most common emotion expressed by family members at the time of diagnosis was one of something having gone wrong. Both travel and living longer appeared to be the most treasured aspects of the patient's life once the diagnosis had been made. Watching their loved one suffer and the overwhelming sense of helplessness were the worst aspects of the disease process. The loved one was most often thought of on her birthday, and 90.6% of the respondents thought another female in their family was likely to get ovarian cancer.ConclusionThis study attempted to define those concerns and thoughts that remain important to family members whose loved ones had died from ovarian cancer. Common emotions expressed by family members years after the death of their loved one include their sense of surprise at the diagnosis, their sense of helplessness during the progression of the disease, and their pain in watching their loved one suffer. For them, the worst part of their loved one's treatment was continued chemotherapy, and a common unfounded fear was that another female family member would likely die from ovarian cancer. The responses encourage us as health care providers to remain in touch with these families even after the death of their loved one and to address the misconceptions, fears, and anxieties that our patients and their families may have.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate the feasibility, safety, and tolerance of early feeding in patients undergoing surgery for gynecologic malignancies.MethodsPatients were stratified according to operative time and type of tumor and were randomized into two arms: A) early oral feeding and B) nasogastric decompression followed by feeding at the first passage of flatus. Variables assessed included nausea, vomiting, time to first passage of flatus and stool, time elapsed before adequate tolerance of a regular diet, postoperative stay, and complications.ResultsSixty-one patients were randomized into each arm. The types of tumor, the surgical procedures performed, and the operative times were similar in both groups. Early oral feeding in patients in arm A was associated with a significantly faster resolution of postoperative ileus (P< .01), with a more rapid return to a regular diet (P< .01), with an earlier first passage of stool (P< .01), and with a shorter postoperative stay (P< .05) than patients in arm B. Rates of nausea and vomiting were similar in both arms. Hindered deglutition and nasal soreness caused by the nasogastric tube were observed in 88% of patients in arm B. Insertion of a nasogastric tube was necessary in six patients in arm A (10%), and three of these had postoperative complications. Thus, early feeding was feasible in 95% of patients and did not seem to be related to preoperative chemotherapy, tumor type, or lymphadenectomy.ConclusionEarly feeding is feasible and well tolerated and is associated with reduced postoperative discomfort and a more rapid recovery in patients undergoing major surgery for gynecologic malignancies.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID