摘要:

In a controlled single blind study to determine the minimal effective dose of estrogen for protection against bone loss, conjugated equine estrogens in doses of 0.625 and 1.25 mg per day were equally effective in reducing bone loss in postmenopausal and oophorectomized women when bone mass was estimated by single-photon absorptiometry or radiogrammetry. Daily dose levels of less than 0.625 mg were essentially ineffective. Fifty percent response level was calculated to be 0.45 mg per day. Concomitant biochemical effects, reduction in urine calcium and hydroxyproline, were compatible with the observed effects on bone mineral.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

One hundred sixty-nine healthy women, aged 17 to 29 years, nonsmokers or light smokers (fewer than ten cigarettes per day), were assigned randomly to take one of five oral contraceptives: 1) 100 μg mestranol plus 0.5 mg ethynodiol diacetate (100 M + 0.5 ED); 2) 100 μg mestranol plus 1.0 mg ethynodiol diacetate (100 M + 1.0 ED); 3) 50 μg ethinyl estradiol plus 1.0 mg ethynodiol diacetate (50 EE + 1.0 ED); 4) 30 μg ethinyl estradiol plus 2.0 mg ethynodiol diacetate (30 EE + 2.0 ED); or 5) 30 μg ethinyl estradiol plus 0.15 mg levonorgestrel (30 EE + 0.15 NG). One hundred forty-seven women completed the study. When assessed for within-group differences, all preparations caused a statistically significant increase in total triglyceride (from 17.0 to 46.4 mg/dL), total cholesterol (from 6.3 to 24.4 mg/dL), and low density lipoprotein (LDL) cholesterol (from 7.0 to 10.3 mg/ dL). Effects on high-density lipoprotein (HDL) cholesterol varied widely. The product 100 M + 0.5 ED markedly increased (9.9 mg/dL) HDL cholesterol. Neither 100 M + 1.0 ED nor 50 EE + 1.0 ED altered HDL cholesterol levels, whereas both preparations containing 30 μg estrogen showed decreases: the preparation containing 2.0 mg ethynodiol diacetate lowered HDL cholesterol by 3.6 mg/dL and that containing 0.15 mg levonorgestrel lowered it by 6.9 mg/dL. Specific between-group comparisons revealed no statistically significant differences between differing amounts of estrogen (50 EE + 1.0 ED versus 100 M + 1.0 ED). Women receiving less progestogen (100 M + 0.5 ED). however, had significantly higher total cholesterol, HDL cholesterol, and HDL triglyceride when compared with 100 M + 1.0 ED, containing more progestogen. As there was less variation from baseline in the 100 M + 1.0 ED group, the higher dose of progestogen in this group more closely balanced the effects of 100 μg of mestranol. Although the differences between 30 EE + 2.0 ED and 30 EE + 0.15 NG were not statistically significant, the adjusted mean HDL cholesterol levels in the 30 EE + 2.0 ED group were higher (57.6 mg/dL) than in the 30 EE + 0.15 NG group (54.0 mg/dL). Thus, oral contraceptives should be regarded as differing in their potential for altering lipoprotein lipid levels, and the absolute steroid content of an oral contraceptive is not the only indicator of its effects upon lipid metabolism.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A group of 95 women with unexplained hyperprolactinemia (over 20 ng/mL) underwent radiologic examination of the sella turcica with hypocycloidal polytomography (N= 58), computed axial tomography (N= 8), or both (N= 29). All patients also underwent a thyrotropin-releasing hormone (TRH) stimulation test, with serum prolactin (PRL) measurement before and 20 and 30 minutes after a 500-μg intravenous bolus of TRH. Their PRL responses were compared with those of two control groups, nine normal women in the follicular phase of the menstrual cycle, and 13 women in the first five months of gestation with pregnancy-related hyper-prolactinemia. Both control groups exhibited PRL increases with 95% confidence limits at least 200% above baseline levels. In all, 12 patients from the study group also had a normal PRL response (more than a 200% increase) to TRH, and none of these women had tomographic findings consistent with a pituitary tumor. The remaining 83 women all had diminished or absent PRL increases after TRH administration; 46 (55%) of these patients had radiographic evidence of an adenoma, whereas 37 (45%) had no clear signs of a tumor on either polytomography or computed axial tomography. No patient with a baseline PRL level in excess of 60 ng/mL had a normal PRL response to TRH. The results of the study indicate that 1) in patients with PRL between 20 and 60 ng/mL, a normal TRH test can be relied upon to avoid the expense and radiation of tomography (computed axial tomography or polytomography), 2) there is no benefit to be obtained in performing a TRH test in patients with a baseline PRL level over 60 ng/mL, and 3) about 45% of patients with hyperprolactinemia and an abnormal TRH test have a normal computed tomography or polytomography. These patients may have a small adenoma, and thus warrant closer follow-up than patients with a normal TRH test.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The oral glucose tolerance test is an unreliable test in screening for diabetogenic fetal disease. In diabetogenic fetopathy due to gestational diabetes (White class A diabetes), the insulin content in the umbilical cord blood as well as in the fetal urine is considerably raised. As increased amounts of insulin pass into the amniotic fluid via the fetal urine, the fetal disease can be diagnosed from the amniotic fluid insulin content. In 75 pregnant women with potential diabetes, the blood sugar value was below 160 mg/dL at maximum under glucose loading in 28 patients; it was over 200 mg/dL in 25 patients. However, diabetogenic fetopathy was present in only 14 patients. The endangered and the healthy fetus could be distinguished in each case by amniotic fluid insulin content. The mean amniotic fluid insulin values in diabetogenic fetopathy were about seven times the normal.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The objective of this investigation was to develop a rapid diagnostic test to identify patients at exceptionally high risk for postcesarean endomyometritis. Intraoperative samples of endometrium, chorioamniotic membrane, and amniotic fluid were obtained from 70 patients undergoing nonelective cesarean section and were processed for bacterial culture, Gram stain, and histologic examination. Endomyometritis occurred in 57% of patients. Women with positive bacterial cultures (growth of high virulence organisms on the primary plates), positive Gram stains (bacteria in any oil immersion field), and histologic evidence of leukocytic infiltration in the chorioamniotic membrane and endometrium (greater than or equal to ten white blood cells per high-power field) were more likely than were patients with negative findings to develop endomyometritis. All of the laboratory tests evaluated were specific but insensitive predictors of infection. Assessment of duration of ruptured membranes and length of labor provided a diagnostic test that was as clinically useful in predicting postoperative infection as were any of the laboratory studies evaluated.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Despite recent enthusiasm for antibiotic prophylaxis by uterine irrigation at the time of cesarean section, no data exists comparing the efficacy of this technique with standard intravenous antibiotic administration. Therefore, 124 patients about to undergo cesarean section were entered into a prospective, randomized, double-blind evaluation of uterine irrigation versus intravenous administration of either normal saline or cefoxitin. All women were considered to be at increased risk for postoperative infection because of the presence of labor or ruptured membranes. The incidence of endometritis and the fever index in patients receiving intravenous cefoxitin (3.2%, 4.6 degree hours) was significantly less than in patients receiving intravenous normal saline (21.2%, 22.3 degree hours). There was no significant difference between the use of intravenous normal saline and uterine irrigation with either cefoxitin (18.9%, 16.6 degree hours) or normal saline (17.4%, 24.6 degree hours). These results suggest that intravenous infusion is the most effective means of administering cefoxitin as a prophylactic antibiotic.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors retrospectively studied 13,870 singleton fullterm consecutive live births at a major teaching hospital and assessed the frequency of brachial plexus injury, clavicular fracture, and facial nerve injury in newborns delivered from January 1974 through December 1977 and from January 1979 through September 1981. Predisposing factors relating to mechanical birth trauma were defined, and a risk assessment profile was developed to identify the fetus at risk. Mechanical injuries were identified according to the International Classification of Diseases codes 761. The incidence of selected birth injuries in the study group were: brachial plexus injury, 2.6 per 1000 or 1 in 385 single full-term live births; fractured clavicle, 2.0 per 1000 or 1 in 495 single fullterm live births; and facial nerve injury, 7.5 per 1000 or 1 in 133 single full-term live births. There were 162 full-term infants born with 168 injuries relevant to this study. Of the six infants who incurred more than one injury, three had a combined fractured clavicle-brachial plexus injury, and three had facial nerve-brachial plexus injuries. Logistic regression analysis of fetal, maternal, and intrapartum complications in labor and delivery revealed that midforceps, shoulder dystocia, low forceps, infants greater than 3500 g, and second stage labor exceeding 60 minutes were the predominant events associated with fetal injury. The authors then applied a risk assessment profile to successfully identify over 50% of the injured and 84% of the uninjured groups. From their results, the authors suggest that obstetricians should alert the pediatricians when these predisposing factors exist to aid in the recognition and early treatment of these birth injuries.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Previous reports suggest an association between maternal serum complement component (C3and C4levels and perinatal outcome. Eighteen women with systemic lupus erythematosus (21 pregnancies) were prospectively studied. C3and C4levels were measured monthly unless more frequent data were needed for acute medical management. Perinatal outcome was then correlated with both maternal clinical and serologic status before and during pregnancy. Twelve pregnancies were carried to term, 11 of which began in clinical remission. Eight of these 12 had normal C3and C4levels at the onset of pregnancy, and 11 were normal at delivery. Four pregnancies were delivered prematurely (with one neonatal death from septic meningitis); all began pregnancy in clinical remission but three had low C3and C4levels before delivery. Three pregnancies beginning in clinical remission ended in spontaneous first- or early second-trimester abortions; all had low C3and C4levels before aborting. Normal complement component levels were observed in the remaining two pregnancies that were terminated electively; they had no evidence of fetal or placental abnormality. The correlation of maternal serum complement levels and pregnancy outcome in this series suggests that these parameters may help in the assessment of fetal as well as maternal prognosis in lupus-complicated gestations.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The study reports blood velocity and blood flow in the descending aorta and the umbilical vein of 20 normal human fetuses by application of combined B-mode ultrasound and pulsed Doppler technique. All pregnancies and newborns were clinically normal. The echographic examination was performed between 37 and 40 weeks' gestation by an ADR real-time linear scanner 2130 coupled with the Kranzbühler pulsed Doppler system 8105. The diameter of the vessels was measured by B-mode echogram, and the Doppler beam was directed to form an incident angle between 30 and 65 degrees with the axis of the vessel. The Doppler shift frequency was measured electronically with a spectrum analyzer 8106. Fetal blood velocity waveforms were calculated following the Doppler equation. In the descending aorta, the calculated velocity was 27.7 ± 6.7 cm/second (mean ± SD) and the blood flow was 679 ± 106 ml/minute or 216 ml/kg/minute. In the umbilical vein, the same parameters were 18.3 ± 4.0 cm/second, 366 ± 65 ml/minute, and 117 ± 16 ml/kg/minute, respectively. The average umbilical flow: aortic flow ratio was 0.54 ± 0.07.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Presented is a three-year study using a 15-methyl analogue of prostaglandin F2α, in the management of severe postpartum hemorrhage due to uterine atony in patients who were unresponsive to conventional therapies. Fifty-four patients were entered into the study, but 51 were analyzed for efficacy. Successful control of postpartum hemorrhage occurred in 86%. Of the seven in whom therapy failed and who subsequently required surgical therapy, four had chorioamnionitis. Six subjects had intramyometrial injection of the agent, with dramatic results in five. Mild transient side effects occurred in less than 10% of subjects.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID