ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We evaluated 148 women who had had simple hysterectomy in the presence of invasive cervical cancer between the years 1973-1987. Two had microinvasive squamous carcinoma for which hysterectomy was not a planned procedure. The remaining 146 women all had either adenocarcinoma or squamous carcinoma exhibiting greater than 3 mm of stromal invasion or lymph-vascular space involvement. Medical records were reviewed retrospectively to determine the reasons for hysterectomy. Causes of inappropriate hysterectomy were as follows: inadequate evaluation of an abnormal Papanicolaou smear or cervical biopsy (21%), failure to perform an indicated conization (12%), deliberate hysterectomy for grossly invasive cancer of the cervix (11%), lack of preoperative Papanicolaou smear (7%), conization margins positive or not evaluated (7%), misreading of pathology results (5%), emergent operation because of bleeding (3%), failure to check cytology preoperatively (1.5%), and failure to biopsy a gross cervical lesion (1.5%). The remaining 31% of cases had normal or inflammatory Papanicolaou smears and negative cervical examinations. Although 93% of this latter group complained of abnormal bleeding, 78% did not have endocervical or endometrial sampling preoperatively. Despite the increasing emphasis on cervical cancer screening, the number of referrals following hysterectomy performed in the presence of cervical carcinoma is not decreasing. Most cases could be avoided by careful adherence to well-established guidelines for cervical cancer detection.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Although cure rates are high, the morbidity of radical operation for carcinoma of the vulva is substantial. Between 1983-1989, member institutions of the Gynecologic Oncology Group entered 155 patients in a prospective evaluation of modified radical hemivulvectomy and ipsilateral inguinal lymphadenectomy for clinical stage I vulvar cancer. Only patients with neoplastic thickness of 5 mm or less, without vascular space invasion, and negative inguinal lymph nodes were eligible for this study. There have been 19 recurrences and seven deaths from disease among the 121 eligible and evaluable patients. Patients whose disease recurred on the vulva were frequently (eight of ten patients) salvaged by further operation. Five of the seven deaths due to cancer occurred among patients whose first recurrence was in the groin. Acute and long-term morbidity as well as hospital stay were each less than in the Group's previous experience in a comparable patient population treated with radical vulvectomy and bilateral inguinal-femoral lymphadenectomy. There was a significantly increased risk of recurrence but not death when compared with these same historic controls. Modified radical hemivulvectomy and ipsilateral inguinal lymphadenectomy is an alternative to traditional radical operation for these selected patients with stage I carcinoma of the vulva. The number of patients who experienced recurrence in the operated groin is of concern and may be attributable to the decision to leave the femoral nodes intact.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Between January 1986 and June 1990, systematic para-aortic and pelvic lymphadenectomy was performed in 208 women with untreated ovarian, endometrial, and cervical cancers. This study aimed to evaluate the median number of nodes collected from each pelvic and para-aortic group and to verify a new detailed nomenclature for the various lymph node groups. The para-aortic nodes were distinguished as paracaval, precaval, and retrocaval, depending on their relationship with the vena cava. Para-aortic, pre-aortic, and retro-aortic nodes were located close to the aorta. The nodes situated between the vena cava and aorta were designated intercavo-aortic. A median of 26 (range 15–48) para-aortic nodes were collected during ovarian or endometrial cancer operations. The lymphatic system of the pelvis was divided into six groups, depending on the relationship with the pelvic blood vessels. The pelvic nodes were distinguished as common, internal and external iliac, presacral, obturator, and parametrial. In cases of cervical cancer, the median number of pelvic nodes collected was 38 (range 20–88). Such anatomical study of the lymphatic system shows that a higher number of nodes than expected can be found in the retroperitoneum.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cases of AIDS among women of reproductive age have increased dramatically since 1981; nearly a third of all cases among females were reported in 1990 alone. Surveillance of human immunodeficiency virus (HIV) infection among women is essential for monitoring the spread of HIV over time and identifying specific populations and geographic areas in need of HIV counseling, testing, and prevention services. Blinded (unlinked) serologic surveys were conducted in the United States and Puerto Rico in sentinel clinics providing reproductive health services to women, including family planning, prenatal care, and abortion services. Seventy-eight of 94 clinics (83%) in 30 cities conducting surveys during 1988 and 1989 detected at least one HIV-positive woman. Clinic-specific prevalence ranged from 0-2.28% (median 0.22%), with rates over 1% occurring in clinics predominantly on the East Coast and in Puerto Rico. Seroprevalence varied by primary type of service, raceethnicity, and age group. Median rates were higher in clinics offering prenatal services and lower in abortion and family planning clinics in the same cities. In general, women 25-29 years of age showed the highest median rate of infection (0.32%), and rates were higher among black women (median 0.34%) than among Hispanic (median 0.11%) and white women (median 0%). Our data indicate the need to educate women about recognizing and reducing their risk of HIV infection. Reproductive health clinics with high seroprevalence should implement voluntary HIV counseling and testing with appropriate follow-up clinical evaluation and referral for infected women. Clinics with low prevalence should seize the opportunity to enhance HIV education and prevention efforts.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Serum CA 125 levels were studied in 2544 healthy women. Menopausal status and a history of hysterectomy were both highly significant influences on the CA 125 level (P <.0001 for both factors). A history of hormone replacement therapy was also highly significant in reducing CA 125 levels (P =.002) in postmenopausal women. Other factors such as parity, history of unilateral oophorectomy or oral contraceptive usage, or family history of ovarian cancer were not significant influences when analysis of covariance was performed. When premenopausal women were assessed separately, age was significant (P =.04). The number of years since menopause did not influence CA 125 levels. Both hysterectomy and menopausal status have a clear effect on serum CA 125 levels and must be considered if serum CA 125 is to be used as a screening test.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We reviewed the case records of all women (N=748) who underwent Iaparoscopy for infertility in our department from 1985-1990. The patients were divided into two groups, cases and controls, according to the presence of nonobstructive mullerian anomalies (N=198) or absence of such anomalies (N=545); women with obstructive mullerian anomalies (N=5) were excluded. The patients were analyzed for the presence of endometriosis, malformation class, and reproductive history. The frequency of endometriosis was 30.8% in the women with nonobstructive mullerian anomalies, versus 38.5% in the controls (P=.209). Among the subjects with unicornuate uterus, the prevalence of endometriosis (55%) was significantly greater compared with the patients with other nonobstructive mullerian anomalies (28%) (P<.05), but not compared with the controls (38.5%). Overall, no differences were observed in the frequency of endometriosis between infertile women with and without nonobstructive mullerian anomalies. Our results seem to exclude a common pathogenetic factor underlying endometriosis and nonobstructive mullerian anomalies.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Interceed(TC7) is a fabric composed of oxidized, regenerated cellulose that was designed to reduce the formation of postsurgical adhesions. We evaluated Interceed(TC7) in a randomized, multicenter clinical study. Sixty-three infertility patients had bilateral pelvic sidewall adhesions removed at laparotomy. One pelvic sidewall was covered by Interceed( TC7) and the other was left uncovered. The deperitonealized areas (N=205) of all sidewalls were divided into three groups: less than 100 mm2, N=72; 100-1000 mm2, N=95; and more than 1000 mm2, N=38. The effectiveness of Interceed(TC7) was evaluated at laparoscopy 10-98 days after laparotomy. Significantly more adhesions were observed at laparoscopy on the control pelvic sidewalls (48 of 63,76%) than on the treated sides (26 of 63,41%) (P<.0001). The Interceed(TC7)-treated sidewalls also had significantly less area involved with adhesions at laparoscopy (P<.05, P<.001, and P<.001 in the three groups, respectively). Twenty-eight women with severe endometriosis also had significantly more adhesions on the control side (23 of 28, 82%) than on the treated side (14 of 28, 50%) (P<.05). We conclude that Interceed(TC7) effectively reduced the incidence and extent of postoperative adhesions, even in patients with severe endometriosis.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Healthy postmenopausal women were randomly assigned to groups receiving 28-day treatment cycles of estradiol (E2) valerate (2 mg, days 1-21) combined with medroxyprogesterone acetate (10 mg, days 12-21) (N=18), 17 β-estradiol (1.5 mg, days 1-24) combined with desogestrel (150 µg, days 13-24) (N=20), or placebo (N=18). The progestational effects on the endometrium were assessed by histology, uterine bleeding pattern, and biochemical markers of secretion measured in endometrial tissue (E2 and isocitrate dehydrogenase) and serum (placental protein 14). After 2 years of therapy, 24 women in the hormone groups had secretory endometrium and 13 had atrophic endometrium; in the placebo group, the results were one and 15, respectively. Withdrawal bleeding generally started between days 9-12 after the addition of progestogen in the E2-medroxyprogesterone acetate group, and between days 14-17 in the E2- desogestrel group. All three biochemical markers of secretion were increased in each of the hormone-treated groups compared with the placebo group (P<.01-.001). Serum placental protein 14 was twice as high in the secretory as in the atrophic phase (P<.01). Isocitrate dehydrogenase, but not E2 dehydrogenase, was also higher in the secretory phase (P<.05). Only serum placental protein 14 was significantly related to the uterine bleeding pattern (P<.01). We conclude that serum placental protein 14 reflects both endometrial histology and bleeding pattern and may be a useful marker of progestational effects on the endometrium. The markers of secretion measured in endometrial tissue are not as reliable for endometrial histology or bleeding pattern.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This population-based case-control study assessed the effect of current use of monophasic or triphasic oral contraceptives (OCs) on the risk of functional ovarian cyst development. The cases were all 15-39-year-old enrollees in the Group Health Cooperative of Puget Sound who had either an inpatient primary diagnosis of functional ovarian cyst in 1988 or 1989 (N=67) or an outpatient primary diagnosis of functional ovarian cyst from March 1988 through August 1989 at one of five Group Health Cooperative primary care clinics (N=39). Controls were randomly selected enrollees matched to the cases for age, primary care clinic, and enrollment date (N=255). Subjects with previous hysterectomy or oophorectomy were excluded from this analysis. Pharmacy and medical record review showed that 16% of cases and 19% of controls were currently using monophasic OCs, whereas 11% of cases and 9% of controls were using triphasic OCs. Compared with women not using hormonal contraception, the relative risks of a diagnosed functional ovarian cyst among women currently using OCs were 0.8 (95% confidence interval [CI] 0.4-1.8) for users of monophasic OCs and 1.3 (95% CI 0.5-3.3) for users of triphasic OCs. In contrast to previous studies of monophasic OCs containing higher steroid dosages, the results of this study suggest that current use of low-dose monophasic OCs does not substantially decrease a woman's risk of functional ovarian cyst formation. In addition, our results do not support recent speculation that current use of triphasic OCs appreciably increases the risk of functional ovarian cysts.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID