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1. |
α2–Adrenergic Mechanism in Menopausal Hot Flushes |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 573-578
ROBERT FREEDMAN,
SUZANNE WOODWARD,
SUBHASH SABHARWAL,
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摘要:
It has been hypothesized that hot flushes are triggered within the hypothalamus by α2-adrenergic receptors on noradrenergic neurons. We administered intravenous clonidine (an α2-adrenergic agonist) and yohimbine (an α2-adrenergic antagonist) to nine menopausal women with hot flushes and to an asymptomatic comparison group. Hot flushes were defined objectively by skin conductance responses recorded from the sternum; finger temperature recordings and symptom reports were also evaluated. The subjects were prescreened using ambulatory skin conductance monitoring. A significantly greater number of hot flushes occurred during yohimbine sessions than in corresponding placebo sessions (six versus zero). Clonidine significantly increased the amount of peripheral heating needed to provoke a hot flush (40.6 versus 33.6 minutes) and reduced the number of hot flushes that did occur (two versus eight). No hot flushes occurred in the asymptomatic women. These findings support the role of a central α2-adrenergic mechanism in the initiation of hot flushes.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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2. |
Effect of Estrone Sulfate on Postmenopausal Bone Loss |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 579-584
HARRY GENANT,
DAVID BAYLINK,
J C GALLAGHER,
STEVEN HARRIS,
PETER STEIGER,
MARILYN HERBER,
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摘要:
Estrogen replacement therapy confers many beneficial effects to postmenopausal women, such as slowing the rate of bone loss and decreasing the risk of coronary artery disease. This multicenter, placebo-controlled study evaluated the lowest effective daily dose of estrone sulfate (0.3, 0.625, or 1.25 mg) combined with 1000 mg elemental calcium supplementation for preventing bone loss in the immediate postmenopausal period. Spinal bone mineral density was measured using quantitative computed tomography. Compared with baseline, bone mineral density increased significantly (P<.05) after 12 months of 0.625 mg daily (+1.9%) or 1.25 mg daily (+2.5%). The difference between the 0.625-mg and 1.25-mg doses was not statistically significant. Estrone sulfate administration (0.625 and 1.25 mg) produced significant changes in various lipid measurements at both the 6- and 12-month observation points. The prevalence rates for adverse events were comparable among the estrone sulfate groups and the placebo group. Estrone sulfate 0.625 mg daily, combined with 1000 mg elemental calcium supplementation, was the minimum effective dosage to prevent loss of spinal bone mineral density in postmenopausal women over a 12-month period.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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3. |
Estrogen Deficiency in Adolescents and Young Adults: Impact on Bone Mineral Content and Effects of Estrogen Replacement Therapy |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 585-592
S JEAN EMANS,
ESTHERANN GRACE,
FREDERIC HOFFER,
CAREN GUNDBERG,
VERONICA RAVNIKAR,
ELIZABETH WOODS,
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摘要:
Because the long-term effects of estrogen replacement in adolescents with ovarian failure and hypothalamic amenorrhea have not been previously studied, we conducted a 2-year study of 35 patients to determine factors contributing to baseline bone density measures (bone density, bone mineral content, and bone width) and the response to estrogen therapy. Estrogen-deficient patients were often profoundly osteopenic by single-photon absorptiometry of the radius and dual-photon absorptiometry of the spine, despite estrogen replacement. Variables that were significant predictors of better initial single-photon absorptiometry measurements included increased age, increased body mass index, spontaneous pubertal development, lack of radiation therapy, and lower serum osteocalcin. Patients treated with estrogen/progestin had stable cortical bone mineral content and bone density at the distal one-third of the radius, a slight improvement in bone density at the distal one-tenth of the radius, and an encouraging, but marginal, improvement in the z score (standard deviation from the mean) of bone mineral content at the distal onetenth. The z scores for cortical bone width and bone density decreased, suggesting a possible relative worsening over time. In untreated estrogen-deficient girls, bone mineral content and bone density decreased (but not significantly); the z score of cortical bone width showed a significant decrease. Using dual-photon absorptiometry, a history of radiation therapy was found to be a predictor of lower bone density compared with age-matched controls. Estrogen/ progestin therapy did not result in changes in serum levels of lipids and antithrombin HI, weight, or blood pressure. This study suggests that because most adolescent/young adult patients with estrogen deficiency may not achieve normal bone density with current therapy, earlier and more aggressive intervention may be necessary.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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4. |
Magnetic Resonance Imaging in Mayer- Rokitansky-Kuster-Hauser Syndrome |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 593-596
LUIGI FEDELE,
MILENA DORTA,
DIANA BRIOSCHI,
MARIA GIUDICI,
GIOVANNI CANDIANI,
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摘要:
Six girls with suspected Rokitansky syndrome underwent magnetic resonance imaging (MRI) and then sonography and laparoscopy to confirm the clinical diagnosis and define the precise characteristics of the malformation. The uterus was missing in all; four had mullerian rudiments in place of the uterus, which were cavitary in two as shown by sonography and in one by MRI. Both ovaries were present in all cases, normally located in four and extrapelvic in two; they were correctly identified by MRI in all cases and by sonography in four. Partially canalized vaginal rudiments were recognized by MRI in two girls and by sonography in one. One patient had unilateral renal agenesis, demonstrated by both MRI and sonography. Magnetic resonance imaging was more precise than laparoscopy and sonography in defining the anatomical characteristics of Rokitansky syndrome, and is less invasive and expensive than laparoscopy.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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5. |
Reclosure of Disrupted Abdominal Incisions |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 597-602
MARK WALTERS,
RAYMOND DOMBROSKI,
SUSAN DAVIDSON,
PETER MANDEL,
RONALD GIBBS,
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摘要:
We evaluated prospectively a technique of delayed reclosure of disrupted abdominal incisions. Forty-one consecutive postoperative obstetric and gynecologic patients with abdominal incisions that had opened because of infection, hematoma, or seroma and had intact fascia participated in the study. All wounds were first managed identically, with surgical drainage and debridement, for a minimum of 4 days. The patients then were randomized to either wound reclosure by a standardized en bloc technique (35) or healing by second intention (six). Reclosure was successful in 30 of 35 cases (85.7%). The mean time to complete healing was 15.8 days in successful cases, 67.2 days in failed cases, and 23.2 days for all patients who were reclosed. Failure to heal after reclosure was due to subcutaneous infection in two patients and seroma in three; these women were significantly heavier than those in whom reclosure was successful. There were no other major complications of wound reclosure. Patients randomized to healing by second intention required a mean of 71.8 days of wound care. The time to complete healing in the wound-reclosure group was significantly shorter compared with the group that healed by second intention (P=.002, log rank test). We conclude that en bloc reclosure of disrupted surgical incisions, compared with nonsurgical treatment, significantly decreases the time required for wound healing and has minimal morbidity.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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6. |
Cefazolin for Hysterectomy Prophylaxis |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 603-606
DAVID HEMSELL,
EDWARD JOHNSON,
PATRICIA HEMSELL,
BRENDA NOBLES,
MOLLY HEARD,
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摘要:
Efficacy data for single-dose cefazolin prophylaxis at hysterectomy are meager, and there are none evaluating the impact of route of administration on efficacy. For these reasons, 772 women undergoing elective abdominal or vaginal hysterectomy for benign diseases were given 1 g cefazolin either intramuscularly or intravenously in a randomized clinical trial. Preoperative diagnoses and clinical, surgical, and outcome variables were similar by route of administration for each surgical approach. Risk factors for infection after abdominal hysterectomy included younger age, lower postoperative hemoglobin concentration, and pelvic hematoma; women who developed infection after vaginal hysterectomy were heavier than those who remained uninfected and were more likely to have a pelvic hematoma. The overall incidence of major operative site infection requiring parenteral antimicrobial therapy in evaluable women was 7.2%: 7.6% for 539 women undergoing abdominal hysterectomy and 6.3% for 207 women undergoing vaginal hysterectomy. Postoperative infection was unrelated to route of cefazolin administration.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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7. |
Intraoperative Radioimmunodetection of Ovarian Cancer Using Monoclonal Antibody B72.3 and a Portable Gamma-Detecting Probe |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 607-611
JEFFREY BELL,
CATHY MOJZISIK,
GEORGE H1NKLE,
HERBERT DERMAN,
JEFFREY SCHLOM,
EDWARD MARTIN,
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摘要:
To assess the value of radioimmunoguided surgery in the intraoperative detection of ovarian cancer, we used monoclonal antibody B72.3, radiolabeled with125I, and a handheld gamma-detecting probe in 13 women with ovarian cancer undergoing exploratory laparotomy. B72.3, which recognizes a tumor-associated glycoprotein, TAG 72, was injected 12-29 days preoperatively (intraperitoneally in four cases, intravenously in nine, and by both routes in one). Intraoperatively, the abdomen was surveyed with the probe and probe counts were correlated with biopsies and excised specimens studied by routine histologic stains. Probe counts were positive in four of seven evaluable patients with histologically confirmed disease. In three of these four patients, the probe detected cancer in specimens interpreted as normal on frozen histologic sections. The probe also identified microscopic cancer in the one patient who had no gross disease. The specificity of the probe was 70%. Preoperative computed tomography was normal in all patients, including those with tumors as large as 3 cm. This pilot study shows the ability of radioimmunoguided surgery to detect occult ovarian cancer.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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8. |
Computed Tomography-Guided Fine-Needle Aspiration of Retroperitoneal Lymph Nodes in Gynecologic Oncology |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 612-616
MATTHEW KOHLER,
ANDREW BERCHUCK,
MARK BAKER,
CHERYL SZPAK,
JOHN SOPER,
DANIEL CLARKE-PEARSON,
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摘要:
Computed tomography& guided fine-needle aspiration was performed on 30 retroperitoneal lymph nodes in 29 patients with gynecologic cancer. There were no serious complications. Review of the cytologic material demonstrated malignant cells in 83% of the aspirates. Because the predictive value of a positive aspirate approaches 100%, therapy for metastatic disease can be initiated in these patients without the need for an open biopsy. Among five aspirates in which malignant cells were not seen, the cellularity of the specimen appeared to be the critical factor determining the predictive value of the aspirate. Whereas neither of two patients with negative aspirates of adequate cellularity has developed recurrent disease, two of three patients with hypocellular negative aspirates have. Because a hypocellular negative aspirate from a retroperitoneal lymph node may not be a true reflection of disease status, either repeat aspiration or open biopsy is advisable.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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9. |
Prognostic Factors for Outcome of and Survival After Second-Look Laparotomy in Patients With Advanced Ovarian Carcinoma |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 617-622
BIRTHE LUND,
PAULA WILLIAMSON,
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摘要:
In ovarian cancer stages IIB& IV, pre& treatment variables and variables obtained intraoperatively at second-look laparotomy were investigated for their prognostic influence on the outcome of 109 patients and survival after second-look laparotomy in 131 patients. The subjects came from a randomized trial of sequential versus alternating combination chemotherapy. The overall median survival after secondlook laparotomy was 62 months. Logistic regression analysis identified stage and hysterectomy plus bilateral salpingooophorectomy and omentectomy as significant prognostic covariates for second-look laparotomy outcome. Based on a Cox multivariate stepwise analysis, independent prognostic factors for survival after second-look laparotomy were secondary residual tumor size, pre& treatment histologic differentiation grade, and performance status. A high differentiation grade and a good performance status at the start of therapy thus still had a prolonging effect on survival after second-look laparotomy. The prognostic power of these pre-treatment variables was increased substantially by the addition of the secondary residual tumor size variable. The 3& year survival rate after second-look laparotomy for high and low& risk patients was 15 and 87% respectively. Second& look laparotomy thus provides prognostic information in patients with advanced ovarian carcinoma, but the benefit in terms of survival is still unclear.
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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10. |
Ovarian Metastases Are Rare in Stage I Adenocarcinoma of the Cervix |
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Obstetrics & Gynecology,
Volume 76,
Issue 4,
1990,
Page 623-626
JOHN BROWN,
YAO FU,
JONATHAN BEREK,
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摘要:
Over a 32-year period at the University of California, Los Angeles Medical Center, all cases of adenocarcinoma and adenosquamous carcinoma of the uterine cervix were reviewed to determine the incidence of ovarian metastases in stage I disease. One of 25 patients (4.0%) who underwent an exploratory laparotomy and radical hysterectomy had a microscopic ovarian metastasis. A literature review identified nine additional patients who had ovarian metastases and stage I adenocarcinoma of the cervix. Including our series, the overall reported rate of ovarian metastases is 1.8%. AH ten patients had at least one of the following additional characteristics: They were postmenopausal, they had adnexal pathology, or they had positive pelvic lymph nodes. Thus, ovarian preservation is warranted in premenopausal patients who do not have ovarian pathology or evidence of other metastatic disease at surgery. Bilateral oophorectomy may be performed if frozen-section examination of enlarged or suspicious nodes documents metastases. If the ovaries are left in the pelvis at the completion of the surgical procedure and microscopic spread to other pelvic tissues is documented, pelvic irradiation can be administered
ISSN:0029-7844
出版商:OVID
年代:1990
数据来源: OVID
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