摘要:

The impedance to blood flow was examined by transvaginal color flow imaging in 53 ovarian masses before exploratory laparotomy. Serum CA 125 levels were measured in all subjects. Thirty-six had benign ovarian tumors and 17 had malignant ovarian tumors confirmed by histopathologic examination. Intratumoral blood vessels, detected in 16 of the malignant tumors, consistently demonstrated low impedance to flow, with a pulsatility index (PI) always below 1. The PI of the intraovarian or intratumoral blood vessels was greater than 1 in 35 of the 36 benign tumors, although 11 had suspicious sonographic findings (P <.01) and 14 had elevated CA 125 levels (P <.001). The sensitivity and specificity of the preoperative PI in detecting malignant ovarian tumors were 94 and 97%, respectively. The sensitivity and specificity of preoperative suspicious sonographic findings in detecting malignant ovarian tumors were 94 and 69%, and those of elevated preoperative serum CA 125 levels were 82 and 61%, respectively. Our results suggest that transvaginal color flow imaging may be a useful clinical tool in the preoperative evaluation of ovarian masses.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Transvaginal Doppler ultrasound with color flow imaging is a new technique for the evaluation of gynecologic diseases. This method was used for the diagnosis of ovarian tumors in 24 women treated in the Department of Obstetrics and Gynecology, Nagoya University Hospital, Japan. Waveforms of the parenchymal tumor arteries or tumor surface arteries were compared using values of the pulsatility index (PI). The value for 1/PI was 0.69 ± 0.05 in benign tumors and 1.87 ± 0.65 in malignant tumors (P <.01). When the cutoff value of 1/PI was set at 0.8 (cutoff value of PI was 1.25), the accuracy of diagnosis was 95.8% (23 of 24). Among 11 tumors with low CA 125 (less than 35 U/mL), all five malignant tumors had high 1/PI (above 0.8), and all benign tumors had low 1/PI (less than 0.8) or nondetectable waveforms. Based on the findings of this study, color flow Doppler proved to be useful for diagnosis of ovarian cancer.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Aggressive surgery may improve the outcome of patients with ovarian cancer. To assess the risk of operative complications, we analyzed 472 primary and 299 repeat operations for ovarian cancer in 536 women between 14-91 years of age. Intraoperative bleeding estimated to be over 1000 mL (N=107) was more common after primary (21%) than repeat surgery (3%). Urinary tract infection accompanied 113 operations (18% of primary and 9% of repeat), bowel complication 51 operations (7% of primary and 6% of repeat), fever 23 operations (4% of primary and 1% of repeat), wound complication 17 operations (3% of primary and 1% of repeat), and thromboembolism 11 operations (2% of primary and 0.3% of repeat). Patient age had no effect on the rate of complications. Pelvic and para-aortic lymphadenectomy in connection with primary operations caused substantial blood loss. Five subjects (1%) died after primary operations. On the whole, the surgical procedures, especially repeat operations, were well tolerated and should not be avoided for fear of complications.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In selected patients with cervical intraepithelial neoplasia (CIN), outpatient ablative procedures represent a readily accepted and highly effective treatment modality. The recently introduced loop electrosurgical excision procedure offers a quick and simple alternative to cryotherapy and laser ablation for treating CIN, and has the distinct advantage of allowing both diagnosis and treatment of selected patients at a single visit. This report presents our clinical experience treating 432 patients with CIN using the loop electrosurgical excision procedure on an outpatient basis. Small loop electrodes were used to excise CIN lesions in 275 patients, and large loop electrodes were used in 157. When performed on an outpatient basis under local anesthesia, loop excision was well tolerated by patients with only minimal discomfort. Post-treatment bleeding occurred in less than 2% of the subjects and responded to either recauterization or packing of the cervix. Post-treatment stenosis occurred in less than 1%. The success rate of the loop electrosurgical excision procedure, as defined by absence of cytologic, histologic, or colposcopic lesions 4-48 months after therapy, was 80% for women treated using the small loop electrodes. Ninety percent of all patients treated using the large loop electrodes were free of disease during 6-12 months of follow-up. For women being treated for primary (as opposed to recurrent) disease, the success rate with large loop electrodes was 94%.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A prospective, blinded study was conducted to test the hypothesis that antimicrobial prophylaxis failure after cesarean delivery is associated with incipient infection of the uterus, as determined by histologic evaluation of bacterial invasion and acute inflammatory cell response. One hundred nineteen patients undergoing cesarean delivery and receiving antibiotic prophylaxis were included in this study. At the time of the operation, a hysterotomy biopsy was obtained for hematoxylin and eosin staining. Marked histologic differences were noted in decidual inflammation, myometrial inflammation, and myometrial polymorphonuclear cell invasion in those patients who subsequently developed endometritis (N=7) compared with subjects without postpartum endometritis. Using two techniques for in situ identification of bacteria within myometrial tissue (acridine orange and fluorescein DNA probe to bacterial ribosomal RNA), all clinically infected parturients demonstrated large numbers of organisms in the myometrial layer of the biopsy specimen, compared with few organisms seen in a matched subset of noninfected controls. These data support the concept that incipient infection at the time of cesarean delivery may limit the effectiveness of antimicrobial prophylaxis. Use of rapid-diagnosis methodologies may allow timely identification of these at-risk patients so that therapeutic antibiotics can be initiated.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A group of 72 term infants with significant respiratory complications were compared with 11,428 term infants delivered during the same time period and without respiratory morbidity. Compared with controls, the study group had a higher incidence of postdatism (36 versus 7%), intrauterine growth retardation (33 versus 8%), meconium-stained amniotic fluid (AF) (90 versus 9%), fetal heart rate (FHR) abnormalities upon admission to labor and delivery (58 versus 7%), and low 5-minute Apgar scores (46 versus 1.4%). Even in the presence of normal intrapartum FHR and 5-minute Apgar scores, infants with meconium-stained AF had an incidence of respiratory complications 100 times higher than those with clear AF. Of infants with a low 5-minute Apgar score at birth, only 20% went on to develop respiratory complications. The remaining 80% had a significantly lower incidence of postdatism, intrauterine growth retardation, and meconium-stained AF.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

An anonymous survey was administered to clinical clerks rotating through obstetrics and gynecology during weekly ethics rounds. Students were asked to judge the moral acceptability as participants and as referring physicians of 11 reproductive technology scenarios ranging from artificial insemination using a husband's sperm in a conjugal relationship to instances involving in vitro fertilization, uterine donation, surrogacy contracts, self-insemination, and single or lesbian parenthood. Positive judgments regarding personal moral acceptability ranged from 30-100% and as a referring physician from 36-99%. Though most students were consistent in their judgments about personal and professional moral acceptability, some (1-15%) could see themselves acting as referring physicians for something they personally found morally unacceptable. Those students who were opposed to contracting for children (more women than men) were more likely to find the reproductive scenarios morally unacceptable. This survey seemed to be a useful tool for discussing where students draw the line morally and why, and whether they would distance themselves from actions they found morally unacceptable. This technique for teaching applied analytic ethics is especially applicable to obstetrics and gynecology because it addresses fundamental questions involving day-to-day practice in the specialty.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Sixty postmenopausal women were enrolled in a 2-year randomized unmasked trial to determine the long-term safety of estradiol (E2) administration by a transdermal therapeutic system. Group I subjects received 0.1 mg of transdermal E2 for 24.5 days of each 28-day cycle for 96 weeks. Group II subjects received the same dosage of transdermal E2 plus 10 mg of medroxyprogesterone acetate, given orally from days 13-25 of each cycle. Vaginal bleeding patterns and endometrial histology were characterized. The subjects recorded bleeding patterns daily. Endometrial biopsies were performed during scheduled follow-up visits at 48 and 96 weeks or as needed to evaluate abnormal bleeding. Data were analyzed by intention to treat. Ten and four subjects dropped out of the study from groups I and II, respectively. A total of 575 and 627 treatment cycles were observed in the same respective groups. Vaginal bleeding was observed in 980 cycles: 381 of 575 cycles in group I (66.3%) and 599 of 627 cycles in group II (95.5%). Bleeding onset, duration, and quantity were similar for both groups. The incidence of hyperplasia was 42 and 4% for groups I and II, respectively, over the 96-week study period. All cases of hyperplasia in group I were treated with sequential medroxyprogesterone acetate for 12 weeks, followed by rebiopsy. In ten of 11 cases, the progestin therapy converted the hyperplasia to a normal endometrium. In one case, the endometrium became hyperplastic again at 96 weeks, but reverted to normal with 12 weeks of medroxyprogesterone acetate. Twelve weeks of continuous progestin converted the refractory case in group I and the case in group II to a normal endometrium. These data suggest that transdermal E2 is safe with respect to endometrial histology if administered with a cyclic progestin.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Bone mass, calcium and lipid metabolism, climacteric symptoms, bleeding, blood pressure, and weight changes were studied in 62 healthy postmenopausal women at 3-month intervals throughout 2 years of treatment with continuous estradiol valerate (2 mg) plus cyproterone acetate (1 mg), sequential estradiol valerate (2 mg) plus levonorgestrel (75 µg), or placebo. During the 2 years of the study, bone mineral content of the distal and ultradistal regions of the forearm (measured by single-photon absorptiometry) remained unchanged in the hormone groups, whereas bone mineral content at these sites decreased by 5 and 6%, respectively, in the placebo group. Bone mineral density in the spine (measured by dual-photon absorptiometry and dual-energy x-ray absorptiometry) increased by 3-4% in the hormone groups and decreased by 2% in the placebo group. Biochemical estimates of bone turnover (serum alkaline phosphatase and fasting urinary calcium/creatinine) decreased significantly to premenopausal levels in the hormone groups, but remained unchanged in the placebo group. Serum concentrations of total and low-density lipoprotein cholesterol were significantly reduced by 5-10% (P <.05-.01) in the estradiol + cyproterone acetate group and by 10-15% (P < .001) in the estradiol valerate + levonorgestrel group. There were no significant changes in highdensity lipoprotein cholesterol in the hormone groups. Virtually no changes were observed in the placebo group. Climacteric symptoms and hot flushes were significantly reduced in both hormone groups compared with the placebo group. Episodes of uterine bleeding occurred in all women in the estradiol valerate + levonorgestrel group, occurring regularly in 84% of the women. Two women (11%) in the estradiol valerate + cyproterone acetate group did not bleed at all; six women (32%) had more than six bleeding episodes during the 2 years. No changes in blood pressure and weight were observed. The results of this study suggest that these new estrogen and progestogen combinations adequately prevent postmenopausal bone loss and normalize bone turnover. Alterations in serum lipoproteins were compatible with decreased risk of cardiovascular disease. Both combinations provided relief from climacteric symptoms. The regimen with levonorgestrel brought bleeding under control, whereas the regimen with cyproterone acetate did not produce amenorrhea in an acceptable number of women.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cultures of the fallopian tube, cul-de-sac, and cervix were obtained from 50 patients undergoing exploratory laparotomy for ectopic pregnancy.Chlamydia trachomatiswas cultured from the cervix in four patients (8%). All the cultures from the fallopian tube or cul-de-sac were negative. Immunofluorescent stain of deparaffinized cross-sections of fallopian tube at the site of tubal involvement with the ectopic pregnancy failed to reveal anyC trachomatisinclusions.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID