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 investigate the factors contributing to the elevated level of CA-125 in endometriosis and to study whether CA-125 assay is useful to identify women who require preoperative bowel preparation.METHODSA total of 685 women undergoing surgery for endometriosis between July 1988 and June 1999 were studied. Preoperative serum CA-125 levels were compared between various pelvic conditions usingFstatistics. Multiple regression was employed to determine significant correlates of elevated serum CA-125, and the receiver operating characteristic curve was applied to assess the utility of serum CA-125 in preoperative preparation. Based on the two-sample Studentttest, the sample size required to detect a difference in mean serum CA-125 levels of one-half of one standard deviation with a power of 90% when the sample size ratio of the two groups was 1:50 was 675 with a significance level of 5%.RESULTSThe mean serum CA-125 levels (IU/mL) for American Society of Reproductive Medicine stages I, II, III, and IV endometriosis were 18.8 ± 0.9, 40.3 ± 2.8, 77.1 ± 3.5, and 182.4 ± 14.0, respectively. CA-125 levels were significantly increased with advanced stages (P< .001,Ftest). Furthermore, serum CA-125 levels were significantly higher in patients with more extensive adhesions to the peritoneum, omentum, ovary, fallopian tube, colon, and cul-de-sac, or with ruptured endometrioma (P< .001,Ftest). We then classified patients with at least one of the three factors including dense omentum adhesion, ruptured endometrioma, and complete cul-de-sac obliteration as the high-risk group that required preoperative bowel preparation, and the others as the low-risk group. Receiver operating characteristic curve analyses set a cutoff point of 65 IU/mL, which gave a sensitivity of 76%, a specificity of 71%, a positive predictive value of 76%, and a negative predictive value of 93.2%.CONCLUSIONOur results suggest that preoperative CA-125 assay is useful to decide which women should receive preoperative bowel preparation. Endometriosis patients with preoperative CA-125 levels higher than 65 IU/mL are at high risk for severe pelvic adhesions that warrant thorough preoperative bowel preparation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine whether premenopausal social subordination in female monkeys predicts postmenopausal atherosclerosis, and whether any such effect is altered by chronic exposure to contraceptive steroids or postmenopausal hormone replacement.METHODSOne hundred seventy-seven (177) premenopausal cynomolgus monkeys (Macaca fascicularis) housed in social groups of five or six were fed an atherogenic diet that, for half of the animals, also contained an oral contraceptive (OC). Individuals were judged socially dominant or subordinate based on behavioral observations. After 26 months animals were oophorectomized, biopsied for iliac atherosclerosis, and for the next 36 months were fed one of three atherogenic diets containing soy protein: 1) phytoestrogen-free; 2) phytoestrogens intact; and 3) phytoestrogen-free plus conjugated equine estrogens. Plasma lipids and menstrual cyclicity were also assessed. Finally, all animals were necropsied and the extent of atherosclerosis measured in the coronary and iliac arteries.RESULTSThe interaction of premenopausal social status and OC exposure predicted postmenopausal coronary artery atherosclerosis (P= .02). Subordinate animals not receiving OCs developed twice the coronary atherosclerosis of similarly untreated dominants (P< .01), an outcome mitigated by premenopausal OC exposure (P< .01). These effects occurred across postmenopausal treatment groups and independent of variation in plasma lipids. The same associations were observed in the iliac arteries, and, to a similar extent, both pre- and postmenopausally. Hormone data suggest that untreated premenopausal subordinates may have been estrogen deficient.CONCLUSIONPremenopausal social subordination exacerbates postmenopausal atherosclerosis, an effect possibly mediated by estrogen deficiency and shown here to be prevented by premenopausal OC exposure. These results occur irrespective of postmenopausal treatment.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo examine the change in menopausal symptoms and cardiovascular risk factors in response to 4 months of daily 100-mg soy isoflavone in postmenopausal women.METHODSIn this double-blind, placebo-controlled study, 80 women were randomly assigned to isoflavone (n= 40) and placebo (n= 40) treatment. The menopausal Kupperman index was used to assess change in menopausal symptoms at baseline and after 4 months of treatment. Cardiovascular risk factors were assessed by evaluating plasma lipid levels, body mass index, blood pressure, and glucose levels in the participants. To examine the effects of this regime on endogenous hormone levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and 17β-estradiol were measured. Transvaginal sonography was performed to quantify endometrial thickness.RESULTSThe data showed a decrease in menopausal symptoms (P< .01, pairedttest, two-tailed, between baseline and isoflavone groups, andP< .01, unpairedttest, between placebo and isoflavone groups). Total cholesterol and low-density lipoprotein decreased significantly in the isoflavone group compared with the baseline or placebo group (P< .001, pairedttest, two-tailed, between baseline and isoflavone groups, andP< .01, unpairedttest, between placebo and isoflavone groups). The isoflavone treatment appeared to have no effect on blood pressure, plasma glucose, and high-density lipoprotein and triglyceride levels.CONCLUSIONThis study suggests that isoflavone 100-mg regime treatment may be a safe and effective alternative therapy for menopausal symptoms and may offer a benefit to the cardiovascular system.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy.METHODSAn electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models.RESULTSOverall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95% CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95% CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95% CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95% CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95% CI 0.54, 0.64).CONCLUSIONThere was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo document current use of antenatal corticosteroid therapy in a large cohort of Canadian preterm infants admitted to neonatal intensive care units, and to assess the impact of variations in use on neonatal outcomes.METHODSThe study subjects included 11,440 infants less than 38 weeks' gestation who were admitted to 17 Canadian Neonatal Network intensive care units from January 1996 to October 1997. Data analyses were conducted separately for infants less than 24 weeks' gestation, 24–34 weeks' gestation, and over 34 weeks' gestation. Logistic regression analysis was used to model the examined relationships, controlling for patient characteristics.RESULTSThe incidence of antenatal corticosteroid treatment was 42% for infants less than 24 weeks' gestation, 59% for infants 24–34 weeks' gestation, and 10% for infants over 34 weeks' gestation. Antenatal corticosteroid treatment was associated with reduced risk for neonatal mortality and respiratory distress syndrome, but not for infants over 34 weeks' gestation. Significant institutional variations in antenatal corticosteroid use were present among both inborn and outborn infants. Increased antenatal corticosteroid treatment for infants 24–34 weeks' gestation can potentially reduce the number of neonatal deaths by 41 cases (10%) and respiratory distress syndrome by 90 cases (3%) among participating hospitals.CONCLUSIONWide institutional differences persist in the incidence of antenatal corticosteroid treatment for women expected to give birth preterm. Increased use of antenatal corticosteroids for preterm deliveries can reduce neonatal mortality in Canada by up to 10%.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo identify risk factors for difficult delivery among nulliparas in the second stage of labor with continuous epidural analgesia, and to develop a multivariable model that is predictive of difficult delivery.METHODSThe database is derived from a multicenter randomized trial of delayed pushing for nulliparous women under continuous infusion epidural. Members of this cohort (n= 1862) were randomly divided into two groups: a “Model Development” and a “Model Validation” group. We used univariate and multivariable techniques to assess associations between anthropometric, sociodemographic, and obstetric variables and difficult delivery.RESULTSWith the referent defined as the category of lesser risk, the developed model showed that the risk of difficult delivery was increased for women with height less than 160 cm (odds ratio [OR] 2.1, 90% confidence interval [CI] 1.2, 3.4), prepregnancy weight greater than 65 kg (OR 1.6, 90% CI 1.0, 2.6), age greater than or equal to 35 years (OR 3.0, 90% CI 1.1, 8.1), and gestational age greater than or equal to 41 weeks (OR 1.8, 90% CI 1.1, 2.8). Induction of epidural analgesia late in labor (greater than or equal to 6 cm) was associated with a higher risk of difficult delivery than induction between 3 and 5 cm (OR 1.9, 90% CI 1.3, 2.8). An interval of greater than or equal to 360 minutes between epidural induction and full dilatation increased the risk of difficult delivery (OR 3.8, 90% CI 1.5, 9.5). Fetal station above +2 at full dilatation and a posterior fetal position were both strongly associated with difficult delivery (OR 2.7, 90% CI 1.4, 5.0, and OR 11.2, 90% CI 4.9, 25.6, respectively). For the multivariable predictive model, when the sensitivity was 57%, the specificity was 75%, and the positive predictive value was 35%.CONCLUSIONOur observations concerning maternal characteristics and obstetric variables are consistent with previous observations with the exception of time of induction of the epidural. The predictive model may be useful in defining high-risk populations for subsequent intervention studies designed to assess approaches to reduce difficult delivery.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate what proportion of symptomatic women purchasing over-the-counter antifungal products for immediate treatment of presumed vulvovaginal candidiasis have vulvovaginal candidiasis or other genitourinary conditions.METHODSA time-location sample of 95 symptomatic women who purchased and presented with an over-the-counter antifungal product for immediate and personal treatment of presumed vulvovaginal candidiasis were evaluated by clinical examination and pertinent laboratory tests. The percentage of women diagnosed having vulvovaginal candidiasis or other conditions, proportions of women with vulvovaginal candidiasis compared between groups with and without a prior diagnosis of vulvovaginal candidiasis, and groups that read or did not read the over-the-counter package label were assessed.RESULTSThe actual diagnoses for women who self-diagnosed vulvovaginal candidiasis were: vulvovaginal candidiasis 33.7%, bacterial vaginosis 18.9%, mixed vaginitis 21.1%, normal 13.7%, other diagnoses 10.5%, and trichomonas vaginitis 2.1%. Women with a previous clinically based diagnosis of vulvovaginal candidiasis were not more accurate in diagnosing vulvovaginal candidiasis than women without a prior clinical diagnosis (χ2= 0.27,P= .6). Women who read the package label were no more likely to have vulvovaginal candidiasis than were women who did not read the label (Fisher exact test,P= .39).CONCLUSIONMany women who self-diagnose and use an over-the-counter product for treatment of presumed vulvovaginal candidiasis do not have vulvovaginal candidiasis. A history of a previous clinically based diagnosis of vulvovaginal candidiasis and reading the package label do not help women self-diagnose vulvovaginal candidiasis properly. Ready access to these products is associated with wasted financial expenditures, unfulfilled expectations, and a delay in correct diagnosis for a substantial number of women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy.METHODSWe followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 ± 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery.RESULTSWomen with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5).CONCLUSIONWomen with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID