ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo explore whether significant differences exist between bleeding patterns with common regimens of hormone replacement therapy using two different progestogens.METHODSA total of 875 women in the Postmenopausal Estrogen and Progestin Interventions Trial took either placebo, conjugated equine estrogen 0.625 mg, conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg in a continuous fashion, or conjugated equine estrogen 0.625 mg daily plus either cyclical medroxyprogesterone acetate 10 mg or cyclical micronized progesterone 200 mg/day for 12 days per month. Bleeding days, amounts, and episodes were recorded in diaries and aggregated by 6-month intervals for 3 years for the 596 participants with a uterus. Any bleeding for women on continuous regimens, or more than 6 episodes of bleeding per 6-month period for cyclical regimens, was considered excess.RESULTSConjugated equine estrogen plus micronized progesterone cyclical was associated with fewer excess episodes of bleeding than conjugated equine estrogen plus medroxyprogesterone acetate continuous in the first 6 months. Quantities of bleeding for conjugated equine estrogen plus micronized progesterone cyclical were less than for conjugated equine estrogen plus medroxyprogesterone acetate cyclical through 30 months and for the number of bleeding days through study end. The 3-year cumulative quantities, days, and episodes of bleeding were significantly lower for conjugated equine estrogen plus micronized progesterone cyclical than for conjugated equine estrogen plus medroxyprogesterone acetate cyclical. Placebo treated women had scant bleeding and conjugated equine estrogen had modest amounts relative to the combination therapies.CONCLUSIONThe bleeding measures for conjugated equine estrogen plus micronized progesterone cyclical showed consistent advantages over those for cyclical conjugated equine estrogen plus medroxyprogesterone acetate in terms of quantity, length, and episodes of bleeding. In the first 6 months, conjugated equine estrogen plus micronized progesterone cyclical had fewer excess bleeding episodes than continuous conjugated equine estrogen plus medroxy-progesterone acetate.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare long-term outcomes of uterine artery embolization and abdominal myomectomy in patients with symptomatic uterine myomas.METHODSAt a single institution in an 18-month time, 59 patients had bilateral uterine artery embolization and 38 patients had abdominal myomectomy to treat symptomatic uterine myomas. We reviewed medical records and surveyed patients 3 or more years after their procedures to assess how many needed further surgical procedures in the intervening years, to what extent symptoms remained improved, and how satisfied the patients were with the long term results of the index procedure.RESULTSFollow-up was available on 51 embolization and 30 myomectomy patients and ranged from 37 to 59 months. Patients who had embolization were older (44 versus 38 years,P< .001) and more likely to have had previous surgical procedures (P< .001) than those who had myomectomy. Taking into account the variable follow-up period, embolization patients were more likely to have had further invasive treatment for myomas (29% versus 3%) (P= .004). Among women not needing further surgery, overall symptoms improved in 92% (33/36) of embolization and 90% (26/29) of myomectomy patients (P= .78). Ninety-four percent (34/36) of embolization patients and 79% (23/29) of myomectomy patients were at least somewhat satisfied with their choice of procedure (P= .06).CONCLUSIONWomen who had embolization were more likely than those who had myomectomy to need further invasive treatment (surgery or repeat embolization) in the 3–5 years after the index procedure. Among women who did not need such treatment, satisfaction and relief of symptoms were similar. Large, randomized trials are needed to more accurately compare these two procedures.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUNDUterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial.CASESA primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy. A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%).CONCLUSIONWomen who become pregnant after uterine artery embolization are at risk for malpresentation, pre-term birth, cesarean delivery, and postpartum hemorrhage.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine the frequency and severity of complications that occur as a result of uterine artery embolization for leiomyomas.METHODSAs part of an ongoing study of outcome after uterine embolization, prospective data regarding complications that occurred in 400 consecutive patients were gathered. Each patient had a minimum of a 3-month interval from the procedure at the time of analysis. Each complication was categorized and graded as to severity and outcome using the complication classification developed by the Society of Cardiovascular and Interventional Radiology (SCVIR) and a modified set of The American College of Obstetricians and Gynecologists (ACOG) criteria for complications of hysterectomy and myomectomy. All adverse events that occurred during the follow-up period were included, including those that occurred after the 3-month minimum interval. Confidence intervals (CIs) were calculated for each complication.RESULTSThere were no deaths and no major permanent injuries. One patient required hysterectomy as a result of a complication, and one patient had an undiagnosed leiomyosarcoma. There were ten in-hospital complications and an additional 27 complications within the first 30 days, with 34 patients experiencing a periprocedural complication for a rate of 8.5% (95% CI 6.0%, 11.7%). There were five serious complications (SCVIR class D), comprising 1.25% (95% CI 0.3%, 2.5%) of the study group. Using ACOG definitions for perioperative complications, the overall morbidity was 5% (95% CI 3.1%, 7.7%).CONCLUSIONThe short-term complication rate was low in women undergoing uterine embolization.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUNDUterine artery embolization is increasingly used as an alternative to myomectomy, hysterectomy, and medical treatment for the management of symptomatic leiomyomata.CASEA woman with an 18-week–size fibroid uterus who underwent uterine artery embolization developed a 3-cm, exquisitely tender, hypopigmented, necrotic-appearing area on the right labium minus. Spontaneous resolution occurred over 4 weeks.CONCLUSIONLabial necrosis is a possible complication of uterine artery embolization and may be successfully managed with conservative therapy.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUNDAdverse events after uterine artery embolization, including hysterectomy and premature ovarian failure, are concerning for women who desire future fertility.CASEA 39-year-old woman underwent emergency hysterectomy after uterine artery embolization embolic microspheres found within the ovarian arterial vasculature.CONCLUSIONUterine artery embolization for the treatment of uterine fibroids has been associated with loss of ovarian function in up to 14% of patients. This case report demonstrates that embolic microspheres injected into the uterine artery can unintentionally migrate through anastomotic channels into the ovarian arterial vasculature and potentially compromise ovarian blood flow. Hypoxic tissue injury may be the mechanism of premature ovarian failure observed after uterine artery embolization. Understanding the etiology of premature ovarian failure after uterine artery embolization might allow better patient selection.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo test the hypothesis that lubrication of the vaginal introitus and external speculum does not adversely affect Papanicolaou interpretation.METHODOne hundred eighty-two patients presenting for Papanicolaou smears as part of their visit were randomly assigned to have either only warm water or a water soluble lubricant to assist speculum insertion. Cytotechnicians and pathologists were blind to the cohort from which smears were obtained.RESULTSTwo unsatisfactory smears were found among 93 patients with the lubricant and two were found among 89 using only warm water. No significant difference was found using thettest for continuous variables and χ2for categoric variables.CONCLUSIONUse of a water soluble lubricant on the vaginal introitus and external speculum facilitates examination with no adverse effect on Papanicolaou smear interpretation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID