摘要:

ObjectiveTo determine whether rupture of malignant ovarian epithelial tumors at the time of operation influences the patient's overall prognosis.MethodsBetween 1975 and 1990, 79 patients with stage I invasive epithelial ovarian cancer were treated at Massachusetts General Hospital. Patients were identified from the tumor registry, and charts were reviewed retrospectively. In 71 of the 79 cases, pathologic slides were evaluated. Of the 79 patients, 36 had stage Ia tumors, 20 stage Ic secondary to intraoperative rupture (Ic-rupture), and 17 stage Ic secondary to capsular invasion-serosal disease or positive ascites or washings (stage Ic-other). Survival analysis was performed to compare the three groups of patients.ResultsThere were four recurrences and deaths among the 20 women with stage Ic-rupture tumors (20%), compared to one (3%) among the 36 women with stage Ia. The recurrence-free survival at the median follow-up time for the two groups was 97 ± 3 and 78 ± 10 months, respectively (P= .03); overall survival was 97 ± 3 and 73 ± 12 months (P= .04). There were two recurrences (12%) and one death (6%) among the 17 women with stage Ic-other, giving recurrence-free and overall survivals of 88 ± 8 and 94 ± 6 months, respectively. The survival experience of this last group was not significantly different from that in the Ic-rupture group (P= .2). The hazard ratios for overall survival associated with stage Ic-rupture and each potential confounder, except for bloating, exceeded 6.5, withP≤ .10. All deaths occurred in the 28 patients with grade 2 or 3 tumors. Even in this smaller group, the hazard ratio for stage Ic-rupture was 6.8 (P= .09).ConclusionIntraoperative rupture of malignant epithelial ovarian neoplasms may worsen the prognosis of patients with stage I ovarian cancer.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo assess the impact of surgery and chemotherapy on survival in women with epithelial ovarian cancer.MethodsFive hundred twenty-three women were treated at the same institution in 1977–1990. All pertinent data from patient files were collected by the author. Operations were performed by senior surgeons of the hospital. Cumulative survival and survival analysis with covariates (Cox model) were calculated. Multivariate analysis was used to assess the impact of surgery and chemotherapy on survival in 244 patients who had stage III epithelial ovarian cancer.ResultsThe overall cumulative 5-year survival for patients with epithelial ovarian cancer treated in the period 1977–1980 was significantly (P= .001) lower (33%) than that for patients treated in 1981–1985 (49%) or 1986–1990 (46%). The 5-year survival of women with stage III ovarian cancer improved from 10% in 1977–1980 to 27% in 1986–1990. In these stage III patients, chemotherapy containing cisplatin was associated with better survival than other chemotherapies, both in patients with optimal surgery (1.0− versus 2.9-fold risk of death) and in those with suboptimal surgery (1.4− versus 1.7-fold risk of death).ConclusionsThe results of this study suggest that cisplatin may be more important than surgery in improving survival in stage III epithelial ovarian cancer. Thus, epithelial ovarian cancer, at least in advanced stages, is a disease not curable with aggressive surgical procedures alone.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo evaluate the usefulness of serum assays for CA 125 to detect recurrent endometrial carcinoma.MethodsTwo hundred sixty-six patients were studied with 1101 post-treatment assays. Patients were categorized as low, medium, or high risk based on surgical-pathologic findings. CA 125 values were analyzed with respect to each patient's disease status.ResultsSerial CA 125 levels were elevated (greater than 35 U/mL) in 19 of 33 patients (58%) with recurrent disease. Among 236 surgically treated patients, 97 (41.1%), 42 (17.8%), and 97 (41.1%) were considered low, medium, and high risk, respectively. None of the low-risk and only two (4.7%) of the medium-risk patients developed recurrent disease. One of the latter patients was detected based on an elevated CA 125 level alone. Twenty-seven (27.8%) of the high-risk patients developed recurrent disease, 23 of whom had elevated pre-treatment CA 125. Fifteen of 16 (94%) with recurrent disease had an elevated CA 125 level. Nine of 12 patients with papillary serous carcinoma experienced recurrence; eight of these nine had elevated CA 125 levels at diagnosis and recurrence, in contrast to only one patient with a normal pre-treatment level (P= .018). False elevations were noted in 13 patients, 12 of whom had received radiation therapy.ConclusionsCA 125, if elevated at diagnosis of endometrial carcinoma, is an important marker for recurrent disease. The use of serial CA 125 assays is most beneficial in diagnosing recurrence in a high-risk population, including patients with papillary serous carcinomas. False elevations may occur following radiation therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo review the experience at the Massachusetts General and Brigham and Women's Hospitals with 23 women treated for pseudomyxoma peritonei between 1961 and 1991.MethodsPatients were identified retrospectively from the tumor registry at the Massachusetts General and Brigham and Women's Hospitals, and all charts were reviewed. The median follow-up interval was 2.5 years (range 3 months to 31 years).ResultsThe mean age at diagnosis was 58 years (range 26–76). Pseudomyxoma peritonei was found in association with ten (44%) ovarian tumors of borderline malignancy, nine (39%) ovarian cystadenocarcinomas, and four (17%) appendiceal cystadenocarcinomas. Three patients had synchronous tumors in the ovary and appendix. All patients underwent surgical staging and cytoreduction. Eleven patients received postoperative therapy and, of these, nine developed a recurrence; 12 patients received no further therapy and, of these, three developed a recurrence. However, these groups were not pathologically comparable. With respect to survival, of the ten patients with borderline malignancies, seven had no evidence of disease, one was alive with disease, and two died of disease. For the nine patients with ovarian cystadenocarcinomas, three had no evidence of disease, one was alive with disease, and five died of disease (median time to death 18 months). For the four patients with appendiceal carcinomas, two had no disease, one was alive with disease, and one died with disease. Among all 23 patients, 12 (52%) developed a recurrence, with a range of time to first recurrence of 3 months to 19 years. Eight women required at least one additional laparotomy because of accumulation of gelatinous material.ConclusionsAlthough pseudomyxoma peritonei is associated with borderline and well-differentiated tumors, recurrence is common and the prognosis after recurrence is guarded. Involvement of the appendix is common; therefore, appendectomy is indicated when pseudomyxoma is encountered. To date, surgery has been the only effective therapy for this disease, and adjuvant therapy has not been shown conclusively to be of benefit.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo evaluate the clinical and pathologic presentation of mature cystic teratomas and the trends in management over a 14-year study period.MethodsTumor registry data and medical records between January 1, 1975 and December 31, 1989 were analyzed with respect to patient age, tumor size, bilaterality, malignant transformation, and treatment.ResultsFive hundred seventy-three tumors were removed from 517 patients. The median and mean (± standard deviation) age was found to be 30 and 32 ± 11.3 years, respectively. Three hundred ten (60%) of the patients were asymptomatic. The mean tumor size was 6.4 ± 3.5 cm. The bilaterality rate was 10.8%. The rate of torsion was 3.5%; larger tumors underwent torsion more frequently than smaller tumors (P= .029). The rate of malignant transformation was 0.17%. The mean cyst diameter for patients undergoing cystectomy was 5.7 ± 2.4 cm; for oophorectomy, 8.0 ± 4.1 cm; and for hysterectomy, 6.1 ± 3.8 cm. Oophorectomies were performed for larger tumors when compared to cystectomies (P= .01). The number of hysterectomies was stable throughout the study period, whereas the number of oophorectomies decreased and the number of cystectomies increased markedly. Contralateral ovarian biopsy was common (48.5%) early in the study period. By 1989, the biopsy rate was less than 1%.ConclusionsWe found the prevalence rates of symptomatic tumors, torsion, and malignant degeneration to be less than those previously reported by most other investigators. In addition, there has been an important change over the past 14 years in the management of these neoplasms, with an increased tendency for ovarian preservation, as evidenced by the more frequent use of cystectomy and a decrease in contralateral ovarian biopsy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo find predictors of hot flashes at natural menopause.MethodsA cross-sectional sample of 334 black and white, naturally menopausal women was selected from a control group in a population-based study of reproductive cancers in central North Carolina. Women reported whether they had experienced hot flashes at the time of menopause. Life-style factors and reproductive histories of those with and without hot flashes were compared.ResultsCompared to women who were older at menopause, those reporting natural menopause before age 52 years had a significantly increased probability of having hot flashes (prevalence ratio 1.5,P= .04). Less than a high school education was significantly related to an increased probability of hot flashes (prevalence ratio 1.4,P= .02). There was significant interaction between cigarette smoking and body mass index (BMI), so that thin women who smoked in the premenopausal period were most likely to experience hot flashes (prevalence ratio 1.9,P= .03). Among non-smokers, BMI appeared to have no effect on the probability of hot flashes. Alcohol use, although not statistically significant, suggested a positive relation with hot flashes over and above that incurred from smoking. In addition, menarche before the age of 12 (prevalence ratio 0.6,P= .08) and a history of irregular menstrual cycles (prevalence ratio 0.6,P= .08) were marginally related to a decreased prevalence of hot flashes. Race, parity, and age at first and last pregnancy had no relation to hot flashes.ConclusionSocioeconomic factors and those related to the decline of estrogen production are related to the occurrence of hot flashes at the time of menopause.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo describe the prevalence of, and indications for, antenatal hospitalization among women who delivered live and stillborn infants.MethodsWe reviewed the records of a cohort of 1825 black and white enlisted women who delivered from 1987–1990 at the four largest Army medical centers in the United States. Women with multiple gestations and those whose pregnancies ended before 20 weeks' gestation were excluded. Records of all women with preterm deliveries and a one-third sample of women with term deliveries were abstracted.ResultsOverall, 26.8 ± 1.6% (mean ± standard error) of the women were hospitalized antenatally. Of the estimated 702 antenatal hospitalizations, 44.0 ± 3.4% were related to preterm labor, 10.3 ± 1.9% to preeclampsia, 5.5 ± 1.5% to hyperemesis, and 4.7 ± 1.5% to urinary tract or kidney infection. The prevalence of hospitalization was lowest before 20 weeks (5.0 ± 0.8%) and highest at 33–36 weeks (12.2 ± 1.2%). Small and probably clinically insignificant differences between black and white women were noted in the overall prevalence of antenatal hospitalization and in the indications for hospitalization.ConclusionAs measured by hospitalization, severe antenatal morbidity is common in this population of healthy enlisted women.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo improve the accuracy of the diagnosis of preterm labor by comparing transvaginal sonography to digital examination of the cervix.MethodsWe performed transvaginal sonography in women with preterm labor who had completed a course of parenteral tocolysis. Cervical length was measured according to criteria reported previously. Cervical sonographic findings were not used in diagnosis or management. Sonographic cervical length was compared to digital assessment of dilation and effacement to assess the risk of preterm birth after treatment for preterm labor.ResultsForty-eight singleton and 12 twin gestations were studied. Thirty women were nulliparous and 30 were parous. The mean (± standard deviation) gestational age was 31.1 ± 2.7 weeks (range 24–35) at the examination and 35.6 ± 2.9 weeks (range 26–43) at delivery. Twenty-four subjects delivered before 36 weeks' gestation and 36 delivered at or after 36 weeks. Cervical sonography was distinctly superior to digital assessment of dilation and effacement as a test for delivery before 36 weeks, when compared using receiver operating characteristic curves. This analysis indicated a cervical length of 30 mm as the best cutoff to maximize sensitivity and specificity. All 24 subjects who delivered preterm had cervical lengths less than 30 mm. Cervical sonography was especially useful in selecting women with preterm labor who would not deliver prematurely, ie, a high negative predictive value. None of 15 women whose cervical length was 30 mm or more delivered spontaneously before 36 weeks.ConclusionsAmong women treated for preterm labor, a cervical length of at least 30 mm predicted a low likelihood of preterm birth. Cervical sonography may improve the accuracy of diagnosis in women treated for preterm labor.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo determine the characteristics and consequences of short labor.MethodsNinety-nine term pregnancies with singleton vertex presentation and labor lasting 3 hours or less were compared with controls with longer labor, matched to the index cases by maternal age, parity, and birth weight.ResultsShort labor occurred mostly in multiparas. Both the first and second stages of labor were found to be shortened in these cases. There was significantly more placental abruption, uterine tachysystole, and maternal cocaine use among short-labor cases. Major perineal lacerations, postpartum hemorrhage, birth trauma, and low Apgar scores were distributed approximately equally between cases and controls. A preponderance of the bad outcomes in the short labors occurred in the subgroup of those with rates of dilatation and descent that exceeded established 95th percentile limits.ConclusionsLabors of 3 hours or less in duration were strongly associated with placental abruption, but were otherwise not major contributors to maternal and fetal morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo determine which of four types of catheters would be the least likely to become displaced spontaneously when employed as a fetoamniotic shunt, by testing the force required to remove the catheters from a lamb's bladder.MethodsThe catheter designs tested were unfeathered straight, unfeathered pig-tailed, superficially feathered, and deeply feathered. The catheters were placed percutaneously into the urinary bladders of recently euthanized newborn lambs. The force required to withdraw the catheters was determined, employing nine measurements for each catheter design.ResultsThe mean force required to remove the straight catheter was 12 g (95% confidence interval [CI] 2–21 g), the pig-tailed catheter 22 g (95% CI 13–32 g), and the superficially feathered catheter 149 g (95% CI 139–160 g). Extracting the deeply feathered catheter consistently required a force greater than 300 g, which was the upper limit of detection for our instruments.conclusionFeathering the catheter increases the force required to extract it from a fetal viscus. We believe that use of feathered catheters will significantly reduce the incidence of unwanted spontaneous displacement.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID