摘要:

Data from the provincial cytology program has shown a progressive increase in the number of cases of cervical carcinoma in situ detected in the general population and a doubling of disease rate in third decade women, with most of the cases now in the 25- to 29-year-old age group. The introduction of a colposcopy service has led to a significant decrease in the number of diagnostic conizations performed over a 5-year period. Conization was still used for therapy in a substantial number of women despite the availability of cryotherapy and laser surgery. Eighty-five percent of all patients undergoing cone biopsy had severe dysplasia or carcinoma in situ (CIN III) on pathological examination. In 25% of patients, the conization specimen revealed either dysplasia or carcinoma in situ extending to resection margins. During review of 2249 patients, 1174 were spared a conization and were treated by either hysterectomy, cryotherapy, or laser surgery. It would appear that, although colposcopy can reduce dramatically the number of diagnostic cone biopsies, conization will still be required for therapy in a substantial number of patients.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Twenty specimens of uterus and vagina removed because of clear cell adenocarcinoma of the cervix or vagina in women exposed prenatally to diethylstilbestrol were serially blocked and sectioned to study the topographic relation between the carcinoma and the cervical ectropion and vaginal adenosis. Three tumors were cervical; 17 were vaginal. Iodine staining performed on 8 specimens indicated that the carcinoma developed consistently just above the distal limit of the cervical or vaginal surface that failed to stain with iodine, a location that usually corresponds to the distal limit of abnormality visible by colposcopic examination. Microscopic examination disclosed the presence of both cervical ectropion and vaginal adenosis in all the specimens. Mucinous glands were abundant above the tumor. In 18 of the 20 cases, tuboendometrial glands were intimately related to the carcinoma, either surrounding it or abutting its inferior border. These data, in addition to other evidence, suggest that tuboendometrial epithelium, whether in the ectocervix or vagina, provides the bed from which clear cell adenocarcinoma develops.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Characteristic alterations of urethral pressure and length occur in patients with stress urinary incontinence. Urodynamics in this group of 50 patients revealed a significant decrease in urethral functional length under the stress of bladder filling and change of position from supine to sitting. A decrease in urethral closure pressure was present in individual patients and was significant. All patients with stress urinary incontinence demonstrated a decreased ability to voluntarily increase urethral pressure and also had evidence of pressure equalization on Valsalva maneuver and coughing. Cough pressure profiles also demonstrated equalization of urethral and bladder pressures. These profiles also were performed in a subgroup of 12 patients with genuine stress incontinence after treatment of incontinence by retropubic urethropexy. These profiles became normal after surgery and correlated with the clinical cure of stress urinary incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Sampson's concept of endosalpingiosis is reexamined in light of histologic findings in the fallopian tubes of 54 women who underwent elective sterilization and subsequent hysterectomy and bilateral salpingo-oophorectomy. It was not possible by careful examination of the proximal and distal lumens to identify islands of epithelium consistent with surviving transplanted elements of surgically fragmented tubes or proliferating tubal epithelium (endosalpingiosis). Lesions compatible with endometriosis were found in 20 of the 54 patients (22 of 106 tubes, or 21%) but could not be related to post-tubal ligation pelvic pain.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Five Japanese women with regular menstrual cycles (control group) and 5 sulpiride-induced hyperprolactinemic women (sulpiride group) were given a 100-/iig synthetic luteinizing hormone releasing factor (LRF) intravenously, on the 20th day of the menstrual cycle and on the 10th day of the next cycle. The mean responses of luteinizing hormone and follicle-stimulating hormone to LRF in the sulpiride group were higher than those in the controls. Despite enhancement of the gonadotropin levels, the mean response of estradiol was suppressed significantly in the sulpiride group in the luteal and follicular phase of the menstrual cycle. However, the mean response of progesterone was not statistically different, in either group, in the luteal phase. The results suggest that sulpiride-induced hyperprolactinemia exerts an inhibitory effect on steroidogenic activity in estradiol but not in progesterone in the ovary.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Serial follicular growth was studied using real-time ultrasound scanning in 26 anovulatory patients in 55 cycles stimulated with exogenous human pituitary gonadotropin (hPG) and human chorionic gonadotropin (hCG). Dosage was monitored with urinary total estrogen estimations. The ultrasound findings were not made known to the attending physician. Forty-four cycles (80%) were ovulatory, and conception occurred in 13. The mean follicular diameter of 17 to 25 mm at ovulation corresponded with the range observed in spontaneous cycles, although the rate of follicular growth was faster with hPG. On the day the ovulatory dose of hCG was given, as determined by the first urinary estrogen value greater than 50 jug/24 hours, estrogen excretion was similar whether single or multiple follicles of potential ovulatory size were present, but mean follicular diameters were significantly smaller when there was more than 1 follicle. During the last 4 days before ovulation, the mean diameters in conceptual cycles increased from 14.2 mm to 19.7 mm, values similar to those observed in spontaneous cycles, but different growth patterns occurred in some nonconceptual cycles. Ovarian hyperstimulation was identified by ultrasound scan in 4 of 5 cycles before urinary estrogen excretion exceeded the normal range. Although ultrasound scan does not supplant estrogen monitoring, it can assist in the early detection of hyperstimulation, in the more accurate timing of the ovulatory dose of hCG, and in the withholding of hCG when 3 or more ovulations are possible. It is recommended that ultrasound examination be performed in all patients before the ovulation-inducing dose of hCG is given to provide information on the number of follicles that are likely to ovulate and thus avoid conception of more than twins.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effectiveness of clonidine in suppressing the occurrence of postmenopausal hot flashes was examined using a doseresponse study design and objective recordings of hot flashes. Patients with frequent flashes were studied before and after oral administration of placebo and 0.1, 0.2, and 0.4 mg of clonidine daily for 2 weeks at each dose level. Finger temperature and skin resistance were recorded as indices of hot flash episodes. Four of 10 subjects beginning the study withdrew because of drug-related side effects. Clonidine was found to reduce significantly the frequency of hot flashes as compared with baseline (P<.005) and with effects of the placebo (P<.05). At the maximum dosage the mean rate of hot flash occurrence decreased 46%. It was concluded that clonidine does reduce the frequency of postmenopausal flashes.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A retrospective study of 165 Jehovah's Witnesses and 164 control patients compared the morbidity and mortality associated with major obstetric and gynecologic surgery in the 2 groups. There were no deaths and few complications in either group. There were few differences in preoperative and postoperative hemoglobin values. Medicolegal implications of performing major surgery without blood transfusions are discussed. The study adds evidence that major operative procedures can be carried out on Jehovah's Witness patients without blood transfusions or blood products.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Lower urinary tract injury at the time of cesarean section is an uncommon complication. During a 5-year period, the incidence of bladder and ureter injuries at the Los Angeles County/University of Southern California Medical Center was.31 and.09%, respectively. When bladder injury occurs, it usually is due to surgical difficulty encountered while developing the bladder flap over the lower uterine segment. The difficulty is caused usually by scar tissue from previous surgery. Ureteral injury is a rare complication of cesarean section. It is attributable most often to ureteral transection or ligation associated with uterine incision extensions in the lower uterine segment or the vagina, and to attempts to achieve hemostasis. The data presented in this report indicate that cystotomy, when adequately repaired, is not associated with any complications. Furthermore, diagnostic cystotomy with intravenous injection of indigo carmine is a rapid, safe method of evaluating ureteral patency.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effect of cesarean section on the production of the antiaggregatory prostacyclin and proaggregatory thromboxane A2 was studied in 12 women by measuring the stable metabolites of prostacyclin and thromboxane A2, 6-ketoprostaglandin FIa and thromboxane B2, respectively, from serial maternal blood samples collected before, during, and after the operation. The plasma 6-keto-prostaglandin ¥la concentration was similar to the initial concentrations before the start of anesthesia (mean 121.6 ± SE 11.5 pg/ml), at the time of skin incision (148.0 ± 21.0 pg/ml), and at delivery of the infant (136.3 ± 11.2 pg/ml), but was elevated at the end of the operation (454.8 ± 56.2 pg/ml) (P<.001) and one hour later (233.1 ± 39.5 pg/ml) (P<.01). These increases were similar whether the patients were operated on under general (N=6) or epidural (N=6) anesthesia. The serum thromboxane B2 concentration did not change, indicating no influence of cesarean section on the capacity of the platelets to produce thromboxane B2 during spontaneous clotting. The increased output of prostacyclin may originate from the myometrium and/or intrauterine tissues, which are manipulated during cesarean section. The increased output may play a role in preventing thromboembolic complications during and after cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID