摘要:

Estrogen treatment of postmenopausal women has been suggested to improve mood and psychological function. However, this remains controversial because previous studies involved heterogeneous groups, were not double blind, and included women who were also experiencing somatic symptoms that were relieved by estrogen. A randomized double-blind study was carried out comparing the effects of placebo and conjugated equine estrogens (0.625 and 1.25 mg) on psychological function over 3 months in 36 asymptomatic women, aged 45-60. The tests included the Minnesota Multiphasic Personality Inventory-168, the Profile of Adaptation to Life, and the Beck Depression Inventory. Memory was assessed directly by the Wechsler Adult Intelligence Scales, measuring both digit span and digit symbol. All women were well-adjusted psychologically. The income management scale of the Profile of Adaptation to Life improved (P<.05) with estrogen, as did the Beck Depression Inventory (P<.05), but these results were not dose-related. Memory assessed prospectively by the Wechsler Adult Intelligence Scales was not affected significantly. These results suggest that estrogen use may improve the overall quality of life in postmenopausal women.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hypothalamic amenorrhea, a common disorder associated with abnormalities in gonadotropin pulsatility and subsequent estrogen deficiency, is usually transient, and treatment indications are unclear unless fertility is desired. To determine whether this disorder is associated with progressive bone loss, we studied 24 women with primary or secondary amenorrhea related to stress or simple weight loss, compared with 31 normal women of the same age. Amenorrheic women had significantly lower (P=.01) body fat (26.4 ± 7.3 versus 30.6 ± 4.7%) and higher (P=.0001) urine free cortisol levels (250 ± 100 versus 140 ± 50 nmol/day) than normals. Trabecular bone density in women with hypothalamic amenorrhea as assessed by spinal computed tomography was significantly (P=.001) lower than in normals (140.2 ± 27.3 versus 175.1 ± 24.6 mg K2HPO4/mL, respectively). Twenty of the 24 amenorrheic women had initial spinal bone density below the mean in normals, and in eight it was 2 standard deviations or more below the normal mean. Initial bone density correlated negatively with duration of amenorrhea (r=-0.489,P=.02) and positively with serum free testosterone levels (r=0.517,P=.02). Prospective evaluation showed a decline in spinal bone density in those who were amenorrheic for fewer than 5 years. The slope of change in bone density correlated with initial weight, percent ideal body weight, and percent body fat (R2=0.597,P=.0003; R2=0.549,P=.0007; and R2=0.618,P=.0002, respectively). We conclude that in women with hypothalamic amenorrhea: 1) Trabecular osteopenia is common; 2) the greatest risk of progressive bone loss occurs early after the onset of amenorrhea; 3) low levels of androgens may play a role in the development of osteopenia; 4) low indices of body mass predict higher risk for declining bone density; and 5) prolonged amenorrhea can occur. These findings may have implications about the benefit and timing of gonadal steroid replacement in hypothalamic amenorrhea.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The effect of hormone implants on the bone density of postmenopausal women was studied in 110 patients (mean age 54.7 years; mean menopausal age 8.6 years, range 2-30) who had received hormone replacement in the form of estradiol (50-75 mg) and testosterone (100 mg) pellets at 6-month intervals for 2-24 years (mean 5.2). They were compared with 254 untreated women (mean age 55.0 years; mean menopausal age 6.8 years, range 1-37). The bone density at the spine, measured by quantitative digital radiography, was 1.123 grams hydroxyapatite (gHa)/cm2in the treated group and 0.951 gHa/cm2in the controls (P<.0001). The total bone density at the proximal femur was 1.002 gHa/cm2in the treated group, compared with 0.914 gHa/cm2in the controls (P<.0001). There were significant differences in the density of the trochanteric, intertrochanteric, and neck areas of the proximal femur as well as the Ward triangle (allP<.0001). These differences became significant from the age of 55 at the neck of the femur, Ward triangle, and lumbar spine, and from age 60 for all other values. Subcutaneous estradiol and testosterone prevent postmenopausal osteoporosis and maintain normal bone density for as long as treatment is continued.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Continuous combined estrogen and progestogen preparations enable the postmenopausal woman to enjoy the benefits of estrogen replacement without the inconvenience of regular progestogen-induced withdrawal bleeding. The endometrium appears to be adequately protected in the short term, but no published data are available on the bleeding patterns or endometrial response after more than 18 months of therapy. Therefore, we reviewed 41 patients who continued on such preparations for up to 10 years (mean duration of use 8.0 years). Six women had experienced episodes of breakthrough bleeding after achieving amenorrhea, two of whom had benign endometrial polyps and two with adenocarcinoma of the endometrium. The remaining 35 women each had prolonged amenorrhea and were found to have an atrophic inactive endometrium. It is too early to comment on the long-term endometrial effects of these preparations because the numbers are too small; however, any breakthrough bleeding occurring after a period of prolonged amenorrhea must be investigated by means of endometrial biopsy.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A 25-year experience with 519 anterior colporrhaphies was reviewed to assess the results in treating genuine and mixed stress urinary incontinence, the incidence of new urinary incontinence following prolapse surgery, the incidence of new detrusor instability after incontinence and prolapse surgery, and the morbidity associated with anterior colporrhaphy. The cure rate in treating genuine stress incontinence in 194 patients was increased from 75 to 94% when a Kelly-Kennedy-type technique was modified to include a vaginal retropubic urethropexy. The surgical cure in treating mixed incontinence was unsatisfactory (64%) in unselected cases but good (84%) in selected cases. Previous incontinence surgery, especially more than one procedure, significantly reduced the cure rate for genuine stress incontinence. The incidence of new incontinence after prolapse surgery in one subgroup of patients was 11%, indicating the need for measures to minimize this possibility at prolapse surgery. The incidence of new detrusor instability after surgery was 6% (higher after incontinence surgery than after prolapse surgery). The incidence of significant morbidity, excluding incontinence, was minimal (1%) among the 519 anterior colporrhaphies.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective:The purposes of this prospective investigation were to determine the frequency of glove perforation during obstetric and gynecologic procedures and to assess the value of double gloving in preventing damage to the inner glove.Methods:During a 2-month period, surgeons in the Department of Obstetrics and Gynecology were asked to double glove during all operative procedures. At the conclusion of surgery, the gloves were collected and the surgeons noted the type of procedure and their role as primary surgeon or first assistant. They also indicated whether a perforation was recognized intraoperatively. The gloves were tested for damage by first filling them with air and immersing them in water and then by directly filling them with water.Results:Four hundred forty-one sets of double gloves were evaluated. Of these, 61 sets (14%, 95% confidence interval 10.8-17.2%) had holes in at least one of the four gloves and six sets had more than one perforation, for a total of 67 holes. Fifty-two holes (78%) penetrated only the outer glove and nine (13%) were only in the inner glove. Penetration of both gloves at identical sites occurred in only six of the total glove sets (1.4%, 95% confidence interval 0.3-2.5%). The two most common sites of perforation were the thumb and index finger of the nondominant hand. Glove perforation occurred in 15% of cesarean deliveries and 11% of vaginal deliveries, a nonsignificant difference. In contrast, penetration occurred in 28% of major gynecologic procedures (P<.05 compared with cesarean or vaginal delivery). Chief and third-year residents were significantly more likely to sustain perforation than were attending physicians or junior residents (P<.01). Perforation to the gloves of chief residents typically occurred while they were serving as assistants for first- and second-year residents. Third-year residents usually sustained perforations while functioning as primary surgeons.Conclusions:Glove perforations occur with relatively high frequency during pelvic surgery, particularly abdominal procedures. Double gloving offers a measure of protection against damage to the inner glove and may prevent subsequent exposure of the surgeon to blood and other body fluids.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report four sisters whose maternal pedigree suggested a site-specific ovarian cancer syndrome, whereas their paternal pedigree closely fit the Cancer Family Syndrome (Lynch II). Eliciting a complete family history, both maternal and paternal, is important for defining the correct ovarian cancer syndrome. Once the definition is made, the patient and other family members at risk must be counseled and encouraged to begin the appropriate schedule of screening and intervention. These recommendations may be summarized as follows: 1) site-specific ovarian carcinoma: screening with physical examination, CA 125, and ultrasound, and bilateral oophorectomy after childbearing has been completed; 2) breast/ovary syndrome: screening for ovarian cancer as above, mammography and bilateral oophorectomy as above, and possible prophylactic mastectomy; and 3) Lynch Cancer Family Syndrome: screening for ovarian cancer as above, colonoscopy and endometrial biopsy, and prophylactic hysterectomy and bilateral oophorectomy once childbearing is complete.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The records of 31 women with ovarian tumors of low malignant potential were retrospectively reviewed to identify factors that determine the prognosis. Median follow-up was 51 months. Eighteen women had stage I disease. Twenty- three women (74%) had serous tumors, of which 46% were bilateral. Nine patients (29%) had concomitant endometriosis or endosalpingiosis. Two patients died of disease; both had mucinous tumors with extraovarian metastases at initial operation and inadequate pathologic sampling of their tumors. These results were combined with those of 970 women identified in previous reports to show that the rate of recurrence or persistence of ovarian tumors rises from 2% for women with stage I disease to 14% for those with stage III or IV disease, while mortality rises from 2 to 5%. Careful staging and pathologic sampling are important for establishing the prognosis. Testing of adjuvant therapy should be limited to patients with extraovarian disease.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We conducted a retrospective review of 44 patients with metastatic or recurrent endometrial carcinoma treated with cisplatin, doxorubicin, cyclophosphamide, and medroxyprogesterone acetate. Thirty-six women had metastatic disease; eight had recurrent disease. In the metastatic group, 12 women had positive peritoneal cytology as the only criterion for metastatic disease. Grade 1 tumors represented 25%, grade 2, 47.7%, and grade 3, 27.3%. The series was divided into four groups based on disease volume before chemotherapy: positive peritoneal cytology only (N=12), microscopic (N=11), macroscopic less than 2 cm (N=6), and macroscopic greater than 2 cm (N=15). Fifteen patients had measurable disease and eight (53%) had an objective response. The median survival was 31 months for the whole group. Median survivals were not reached for the positive peritoneal cytology only and the microscopic groups. Median survival for the macroscopic less than 2 cm and greater than 2 cm groups were 15 and 10 months, respectively (P<.0001). The volume of disease was the most important factor in determining survival as well as the time to progression (P<.0001). The distribution of grade was similar in all groups (P=.88), and grade did not predict survival (P=.80) or recurrence (P=.87). The significant number of low-grade lesions in our series as well as the importance of positive cytology as a predictor of survival underscore the need for surgical pathologic staging in an effort to identify those patients in need of adjuvant therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Risk factors for complete and partial hydatidiform mole were analyzed in a case-control study conducted in the greater Milan area on 139 complete moles, 49 partial moles, and 410 obstetric control subjects. Patients tended to be more frequently nulliparous than controls, and the risk of complete mole and partial mole decreased with number of births, although the trend in risk was significant only for partial mole (X21trend,P=.05). The risk for both histopathologic subgroups was greater in women reporting spontaneous miscarriages. Compared with women with no previous miscarriage, the estimated odds ratios (as estimators of relative risks) were 3.1 and 1.9, respectively, for complete mole and partial mole for two or more miscarriages. Infertility problems or difficulty in conception were associated with an odds ratio of 2.4 (95% confidence interval 1.3-4.3) and 3.2 (95% confidence interval 1.4-7.0), respectively, for complete mole and partial mole. No association emerged between mole and induced abortions and age at first pregnancy. A personal history of gestational trophoblastic disease increased the risk of both complete mole and partial mole: The odds ratios were 12.0 (95% confidence interval 3.0-38.9) and 18.1 (95% confidence interval 5.0-64.7), respectively. Similarly, a family history of gestational trophoblastic disease was more frequently reported in complete mole cases (five of 128) than in controls (one of 395) (odds ratio 16.0, 95% confidence interval 3.2-80.3). When the mating frequencies by patient/husband blood groups were considered, a nonsignificant increased risk was evident for women with group A married to men of group O in both histopathologic subgroups (odds ratio 1.5 compared with all other combinations). Estimated odds ratios were also elevated in smokers, and a higher educational level was associated with an increased risk of partial mole.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID