摘要:

Objective:To determine the outcome of 113 women with vulvar intraepithelial neoplasia (VIN), particularly in reference to the later development of invasive vulvar carcinoma.Methods:All cases of VIN III seen between 1961 and 1993 were reviewed.Results:Seven of eight untreated cases of VIN III progressed to invasive vulvar cancer within 8 years, and the eighth regressed spontaneously. Four women developed invasive vulvar carcinoma 7-18 years after treatment. Thus, 3.8% of treated patients later developed invasive vulvar carcinoma, and 87.5% of untreated patients progressed to invasive carcinoma.Conclusion:There is a substantial risk that untreated VIN III will progress to invasive cancer.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To test the hypothesis that clinical variables, such as patients' symptoms, symptom severity, and co-morbidity, affect the survival rate of patients with invasive cervical cancer.Methods:From the medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course.Results:Three-year survival data were available for 250 (99%) of the 251 cases. For a composite clinical predictive system based on symptom status and co-morbidity, the 3-year survival rates were as follows: 85% (64 of 75) for the patients who were asymptomatic without co-morbidity; 63% (58 of 92) for the group that was either symptomatic or co-morbid, but not both; and 40% (33 of 83) for symptomatic patients with co-morbidity or patients with systemic, metastatic, or severe symptoms (P<.0001, x2for linear trend). When entered into a Cox proportional hazards model along with other variables that might affect prognosis, including International Federation of Gynecology and Obstetrics stage, the composite symptom-co-morbidity stage remained statistically significant.Conclusions:Our findings demonstrate the importance of clinical variables, such as symptoms and co-morbidity, in estimating prognosis in cervical cancer, even after stage and other factors are controlled. Unless the clinical variables are suitably analyzed, prognostic estimates based on morphology alone will be imprecise and therapeutic evaluations may be misleading.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To compare thermal injury zones produced with laser and diathermy loop conization.Methods:Excisional cervical specimens (cones and cervices) were obtained from 40 consecutive women who underwent abdominal hysterectomy. The subjects were assigned to have either laser or diathermy loop conization (20 in each group). The duration of each procedure was recorded. Histopathologic measurements of thermal injury zones were performed in all specimens.Results:The techniques produced cone specimens of similar depth. The mean depth of thermal injury produced with laser conization in cone specimens (mean ± standard deviation 0.49 ± 0.16 mm) and cervical craters (0.58 ± 0.24 mm) was significantly greater (P<.001) than the corresponding depth in cone specimens (0.22 ± 0.09 mm) and cervical craters (0.27 ± 0.11 mm) obtained by diathermy loop excision. The mean time of the two procedures was also significantly different (P<.001): laser conization 11 ± 4.5 minutes and loop conization 2 ± 1.2 minutes.Conclusion:For routine conization, loop diathermy causes less thermal damage to the specimen and is a faster procedure than laser.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the relation between the detection of genital human papillomavirus (HPV) DNA and the number of new sexual partners in the last year, 1-5 years, and 5-10 years.Methods:In a cross-sectional study, 298 women collected tampon specimens and completed self-answer questionnaires on the known risk factors for HFV infection, including the number of sexual partners during the last 1, 5, and 10 years. The tampons were analyzed for the presence of HPV DNA by polymerase chain reaction using L1 consensus primers.Results:Ninety-two (30.9%) tampons were positive for HPV DNA. In univariate analysis, the presence of HPV DNA was associated with a younger age, single marital status, a previously abnormal or currently abnormal Papanicolaou smear, and one or more new sexual partners in the last year, 1-5 years, and 5-10 years. The presence of HPV DNA was not associated with education level, past pregnancy, current or past oral contraceptive use, or the age at first intercourse. In multivariate analysis, only the number of sexual partners during the last year and 1-5 years, and a previously abnormal Papanicolaou smear were associated with HPV.Conclusion:The presence of HPV DNA is best predicted by the number of new sexual partners in the last 5 years. Transiently detectable HPV DNA is one possible explanation for this observation.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To provide estimates of the age-adjusted incidence and lifetime risk of ovarian cancer in subgroups of women defined by key risk factors.Methods:We combined data from seven case-control studies (1122 cases and 5359 controls) with Surveillance, Epidemiology, and End Results incidence data to estimate the incidence rate and probability of developing ovarian cancer within subgroups of women defined according to the three major known risk factors: a history of ovarian cancer in the mother or sister, years of oral contraceptive (OC) use, and number of term pregnancies.Results:Among women with no family history of ovarian cancer, the risk at age 65 varied from 0.3% among those who had had three or more term pregnancies and 4 or more years of OC use, to 1.6% among nulliparous women with no OC use. Among women with a positive family history, the risk of developing ovarian cancer by age 65 was estimated as 4.4% and the lifetime risk as 9.4%. The data were too sparse to estimate the risks associated with OC use and pregnancy among women with a positive family history.Conclusions:The risk of developing ovarian cancer within the total population of white women can be divided informatively into component risks within subpopulations. At birth, the estimated risk of developing ovarian cancer before age 65 for the total population is 0.8%, but the component risks vary 15-fold, from 0.3 to 4.4%.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the incidence of abdominal-wall tumor implantation after laparoscopic procedures in patients with known malignancies.Methods:We reviewed 557 laparoscopic procedures performed by the Gynecologic Oncology Service between November 1990 and February 1994. In 105 procedures, malignancy was documented cytologically or histologically, 88 with intraperitoneal disease and 17 with retroperitoneal disease. Ovarian cancer represented 80% (70 of 88) of the procedures with intraperitoneal malignancy, and the remaining cases consisted of carcinoma of the fallopian tube (two), endometrium (11), cervix (one), breast (three), and stomach (one). Histologically, ovarian carcinomas ranged from low malignant potential to poorly differentiated. Among 88 patients with intraperitoneal disease, 77 had gross disease and 11 had microscopic disease. Four hundred thirty-seven different abdominal-wall puncture sites were used (38 Veress needle sites and 399 laparoscopic ports).Results:One of the 437 (0.2%) abdominal-wall puncture sites developed implantation, a frequency of 1.0% (one in 105) per procedure; this developed after a second-look laparoscopic procedure for ovarian carcinoma in which only microscopic disease was present. If only intraperitoneal disease is considered, the incidence of implantation was 0.3% (one in 363) per abdominal puncture and 1.1% (one in 88) per procedure.Conclusion:Tumor implantation at the abdominal-wall puncture site is an infrequent occurrence after laparoscopy in patients with intraperitoneal and retroperitoneal carcinoma.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the efficacy of postural changes, such as crossing the legs, in reducing urine leakage in women with stress urinary incontinence.Methods:Sixty-five women with urodynamically proven stress incontinence underwent a series of standing cough stress tests in each of four postures: standing, crossing the legs, bending forward from the hips, and a combination of crossing the legs and bending forward. The bladder volume and strength of coughing were standardized, and the volume of leakage in each test was measured as the change in pad weight.Results:The mean loss was 12.3 g (95% confidence interval [CI] 8.5-16.1) in the standing position; this was significantly reduced to 1.3 g (95% CI 0.5-2.1,P<.001) with crossed legs and to 4.7 g (95% CI 1.4-7.7,P<.01) by the combination of crossing the legs and bending forward. Bending forward alone did not reduce fluid loss (mean loss 10.2 g, 95% CI 6.5-13.9). The mean reduction in fluid loss was – 14.7 g (95% CI –21.2 to –8.2) using the best posture compared to the standing position. Seventy-three percent of the subjects became continent using one or more postural changes.Conclusion:Postural changes are an effective means of reducing urine leakage in women with stress urinary incontinence and should be an integral part of the management of this condition.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To compare pituitary and ovarian hormone levels in women complaining of unexplained menorrhagia with objectively heavy menstrual blood loss (greater than 80 mL) to those with normal loss, and to determine whether there is any relation between menstrual volume and important cyclic endocrine events.Methods:Over the course of 1 month, daily plasma LH, FSH, and estradiol (E2), and salivary progesterone concentrations were determined in 20 women with a measured menstrual loss exceeding 80 mL. These were compared with values in 22 women whose loss was less than 80 mL. For all participants, we calculated correlation coefficients for measured menstrual blood loss and the mean LH peak concentration, the mean FSH peak concentration, the mean of plasma E2 concentrations from day LH –3 to +1, and the mean of salivary progesterone concentrations from day LH +2 to +10.Results:There were no significant differences in the plasma concentrations of LH, FSH, or E2 or in the salivary concentrations of progesterone between those with objectively heavy loss and those with normal loss. We did not find significant relations between the measured menstrual blood loss and the mean LH and FSH peak concentrations, the plasma E2 concentrations daily around ovulation, or the salivary progesterone concentrations during the luteal phase.Conclusion:There does not appear to be a relation between ovarian and pituitary hormones and menstrual loss.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether depot leuprolide is effective in premenstrual syndrome (PMS) and whether symptom type or severity affects therapeutic or hormonal responses and the incidence of adverse events.Methods:Twenty-five women who met strict diagnostic criteria for FMS completed a double-blind, placebo-controlled, 6-month crossover trial at a university medical center. Depot leuprolide (3.75 mg/month) or saline was administered intramuscularly for three consecutive treatment cycles. Efficacy, adverse events, and hormone concentrations were assessed at each visit. Repeated-measures analysis of variance was used to analyze continuous data, and ordinal and binary data were analyzed using nonparametric techniques.Results:Depot leuprolide treatment was significantly more effective than placebo on all rating scales. Irritability, neurologic symptoms, breast tenderness, and fatigue were most responsive to treatment. Symptoms were reduced to follicular phase levels only in women without premenstrual depression. Those with moderate premenstrual depression improved but remained clinically symptomatic, whereas the group with severe premenstrual depression showed no improvement on any efficacy measure. Adverse events were lowest in those without premenstrual depression and highest in those with severe depression. Leuprolide suppressed estradiol and progesterone in most premenstrual depression groups but had varying effects on gonadotropins.Conclusions:Leuprolide treatment reduced both behavioral and physical symptoms and was well tolerated in the absence of severe premenstrual depression. Women should be evaluated for depression severity before receiving a GnRH agonist. The differential response to leuprolide suggests that it may possess diagnostic value in determining distinct subtypes of PMS.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To study progestin administration at less than monthly intervals in postmenopausal women given continuous estrogen replacement.Methods:Eighty postmenopausal women received 0.625 mg/day of conjugated equine estrogens for 48 weeks. Using a double-masked design, the subjects were randomized to medroxyprogesterone acetate 10 mg/day for 14 days every 28 or 84 days, or the same dosage for 28 of 84 days. Bleeding patterns, endometrial histology, and serum lipids were assessed.Results:The total days of bleeding during the 48-week study were significantly reduced (P<.05) in the women given the progestin for 14 days every 3 months (mean ± standard deviation 29 ± 16 days) than with the other two regimens. In all groups, secretory endometrium was reported in 17–39%. At 24 but not 48 weeks, simple hyperplasia was observed in one subject in each of the less than monthly progestin groups. Significant increases (P<.05) of high-density lipoprotein cholesterol were observed before but not after medroxyprogesterone acetate in the women receiving it less than monthly. No change was seen with monthly progestin.Conclusions:In this direct comparison, medroxyprogesterone acetate given for 14 days every 3 months elicited less vaginal bleeding than standard monthly administration. Only a single woman had simple hyperplasia with each regimen of progestin given every 84 days. Medroxyprogesterone acetate given for 14 days every 3 months represents a possible alternative to standard monthly therapy if coupled with regular assessment of the endometrium.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID