摘要:

Objective:To determine the feasibility of intraoperative lymphatic mapping in patients with vulvar cancer.Methods:Isosulfan blue was injected inttadermally at the junction of tumor and normal skin in nine patients. We then attempted to identify the dye in the superficial lymphatic channels and in a superficial groin lymph node.Results:The sentinel node was identified in seven of 12 groins in seven of the nine subjects studied. Six of the successful cases had unilateral lesions. The cases in which a sentinel node was not identified were both patients with midline lesions, including one whose scar was injected following a prior wide local excision of a perineal tumor and one who appeared to have direct drainage to the deep pelvic nodes. There were no technique-related complications. In no case was there a positive non-sentinel node in the presence of a negative sentinel node.Conclusion:Intraoperative lymphatic mapping is technically feasible in patients with vulvar cancer, particularly those with unilateral disease. Further experience is needed to evaluate the reliability of the technique in identification of groin node metastases.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To evaluate three common instruments for sampling the endocervical canal: the Q-tip applicator, the Cytobrush, and the Cervex brush.Methods:Clinical, cytologic, and histologic data were collected from patients enrolled in the colposcopy clinic at the National Naval Medical Center. Subjects were assigned to one of three techniques: a combination of spatula and swab, a combination of spatula and Cytobrush, and the Cervex brush alone.Results:There was no significant difference in the ease of use or the amount of patient discomfort among the three methods, although the Cytobrush caused an increase in mild cervical bleeding. The Cytobrush yielded the greatest number of endocervical cells. The swab produced the lowest number of endocervical cells and the greatest cellular distortion. The ability to identify patients with biopsy-proven dysplasia was comparable for each of the three methods.Conclusion:The Cytobrush was the best device for sampling the endocervical canal, but it was no more sensitive in detecting cervical dysplasia.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine the efficacy of the different modalities used to evaluate an initial abnormal Papanicolaou smear.Methods:The study population comprised 214 nonpregnant women referred with a Papanicolaou smear diagnosis of cervical intraepithelial neoplasia. Each patient was evaluated by a repeat Papanicolaou smear, colposcopy, and colposcopically directed cervical biopsies. Immediate loop excision was performed to remove the entire transformation zone in all patients. Kappa statistics were calculated to determine agreement among the modalities, and logistic regression was used for determining relative risks (RR).Results:There was 53% agreement between the initial and repeat Papanicolaou smears. When low-grade squamous intraepithelial lesion (SIL) was diagnosed by Papanicolaou smear, there was 89% agreement with the colposcopic impression. However, a colposcopic impression of high-grade SIL was found in only one-third of the women diagnosed with high-grade SIL by Papanicolaou smear. A comparison of the histology of the cervical biopsy and the loop specimen revealed 57% agreement. Univariate analysis indicated that each modality was able to predict the RR of high-grade dysplasia in the loop specimen at a statistical significance level of .05. A colposcopic impression of high-grade dysplasia conferred an RR of 7.43 (95% confidence interval [CI] 2.17-25.49) for high-grade dysplasia in the loop specimen. An initial Papanicolaou smear diagnosis of high-grade SIL did not contribute to the multivariate model for calculating the risk of high-grade dysplasia, as the RR was 1.6 (95% CI 0.68-3.81).Conclusion:Patients with an initial Papanicolaou smear showing low-grade SIL would benefit from a repeat Papanicolaou smear and colposcopically directed biopsies before proceeding with loop diathermy. In contrast, patients with a colposcopic impression of high-grade dysplasia combined with high-grade SIL on Papanicolaou smear appear to be candidates for immediate loop excision.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the optimal diagnostic and therapeutic modalities relevant to episiotomy site recurrence of cervical cancer after vaginal delivery.Methods:Records from the past 30 years were reviewed to identify patients treated at the Mayo Clinic with episiotomy site recurrence of cervical cancer complicated by pregnancy with vaginal delivery.Results:Four patients with episiotomy site recurrence of squamous cell carcinoma of the cervix were treated primarily at the Mayo Clinic. These cervical cancers were originally diagnosed at delivery or in the immediate postpartum period and were treated by radical hysterectomy. Episiotomy site recurrences were detected less than 12 weeks after surgery in three patients and at 2 years in one patient. Three patients have died of recurrent cancer and one is disease-free at 1 year.Conclusions:Careful screening and examination of cervical abnormalities during pregnancy is required. The primary cancer was not diagnosed until delivery or postpartum in all patients who developed episiotomy site recurrences. If vaginal delivery is elected in a patient with cervical cancer, perineal inspection becomes critical. Including other cases reported in the literature, six of nine with stage IB disease were diagnosed with episiotomy site recurrence within 12 weeks of primary therapy. Consideration should be given to colposcopy of the episiotomy site or random biopsy in these women preoperatively to rule out occult implantation, and this site warrants careful postoperative surveillance.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the prevalence of the symptom of urinary incontinence during athletic endeavors among a group of nulliparous, elite college varsity female athletes.Methods:All women currently participating in varsity athletics at a large state university were asked to fill out a questionnaire about the occurrence of urinary incontinence while participating in their sport and during activities of daily life. One hundred forty-four of 156 eligible women (92%) responded.Results:The mean age was 19.9 years, and all women were nulliparous. Overall, 40 athletes (28%) reported urine loss while participating in their sport. The proportions in different sports were: gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%, swimming 10%, volleyball 9%, Softball 6%, and golf 0%. Two-thirds of the women who noted urine loss during athletics were incontinent more often than rarely. There were no statistically significant relations between incontinence and amenorrhea, weight, hormonal therapy, or duration of athletic activity. Activities most likely to provoke incontinence included jumping, high-impact landings, and running. Forty percent and 17% of the women first noted incontinence during their sport while in high school and junior high school, respectively.Conclusions:Incontinence during physical stresses is common in young, highly fit, nulliparous women. This suggests that there is a continence threshold which, when exceeded, can result in urine loss, even in the absence of known risk factors for incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether specific clinical characteristics can be used to identify women with stress urinary incontinence due to intrinsic urethral sphincter dysfunction without the aid of urodynamic testing.Methods:A retrospective analysis was performed of 263 consecutive patients who underwent complete urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincter dysfunction was defined as a maximum urethral closure pressure of 20 cm H2O or less in the sitting position at maximum cystometric capacity. Women with sphincter dysfunction were then compared to the group with normal pressure (greater than 20 cm H2O) usingttest, χ2and logistic regression analyses for 13 clinical indices, endoscopic appearance of the proximal urethra, and eight urodynamic criteria.Results:The group with intrinsic sphincter dysfunction totaled 132 women (50.2%). Univariate analysis revealed that women in this group were older and were more likely to have undergone a hysterectomy and at least one antiincontinence procedure compared to the women with normal urethral pressure. However, multivariate analysis revealed that age greater than 50 years was the only independent variable that could predict the presence of intrinsic sphincter dysfunction in women with stress incontinence (odds ratio 1.6, 95% confidence interval 1.2-2.2). The two groups were similar in all other preoperative clinical characteristics.Conclusion:The only preoperative clinical index that predicted the presence of intrinsic urethral sphincter dysfunction, as defined by low urethral closure pressure, was age over 50 years. In view of previous studies reporting a higher rate of surgical failure in women with low urethral pressure, urodynamic testing should be considered in surgical candidates over age 50 to allow adequate preoperative counseling.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To compare the prevalences of childhood and adult physical and sexual abuse in women with chronic pelvic pain to those in women with chronic nonpelvic pain (headache) and pain-free women.Methods:Using a structured interview, we assessed the prevalence rates of both sexual abuse and physical abuse in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 pain-free women. Abuse histories were stratified by age at occurrence and severity. Demographic characteristics of the three groups were also assessed.Results:Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other contact with the unclothed genitals or anus (ie, major sexual abuse), than either comparison group. Further, more women in the chronic pelvic pain group had experienced major sexual abuse in both childhood and adulthood than women in the headache group, but there was no difference with the pain-free group. With respect to physical abuse, women in the chronic pelvic pain group had a higher lifetime prevalence than pain-free women, but not compared to those with chronic headache. In addition, more women with chronic pelvic pain reported physical abuse in both childhood and adulthood and both major sexual abuse and physical abuse at some time in their lives than did either comparison group.Conclusion:These results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain. Moreover, the global nature of the abuse histories of the women in the chronic pelvic pain group suggests that more rigorous studies of the relation between abuse history and chronic pelvic pain are needed.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women.Methods:We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety, and somatization.Results:This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety.Conclusion:The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine the relation between oral contraceptives (OCs), body mass index (BMI), weight change, alcohol use, parity, smoking, and symptomatic gallstones in women less than 45 years of age.Methods:In this prospective study, associations between the various self-reported exposures and symptomatic gallstones were assessed in 96,211 female United States nurses with 425 cases of gallstones, using multiple logistic regression.Results:We found little relation between ever-use of OCs and symptomatic gallstones (relative risk [RR] 1.2, 95% confidence interval [CI] 0.9-1.6), although there was a modest elevation in risk for long-term use (RR 1.5, 95% CI 1.0-2.2 for 10-14 years; RR 1.6,95% CI 1.0-2.4 for 15 or more years). There was also an increased risk in current users of OCs (RR 1.6, 95% CI 1.1-2.4). The risk of symptomatic gallstones increased with increasing BMI and weight gain since age 18. Women with four or more births had an elevated risk of symptomatic gallstones (RR 2.0, 95% CI 1.3-3.2), and current cigarette smokers had a slightly higher risk than never-smokers (RR 1.3, 95% CI 1.0-1.7). The risk decreased with increasing alcohol intake.Conclusion:We found no substantial increase in the risk of symptomatic gallstones among ever-OC users, although current and long-term users had somewhat elevated risks. Body mass index remains the strongest predictor of symptomatic gallstones among young women.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To test the hypothesis that a very-low-dose regimen of vaginal estrogen would provide effective relief from atrophic vaginitis without endometrial proliferation.Methods:Twenty postmenopausal women with symptoms, signs, and cytologic evidence of atrophic vaginitis were enrolled. Each subject was treated with 0.3 mg of conjugated estrogens, administered vaginally 3 nights per week for 6 months. We examined the following outcomes: symptoms, vaginal cellular (cytologic) maturity, endometrial histology, sonographic evaluation of endometrial thickness, Doppler measures of uterine artery blood flow, and serum levels of estrone and estradiol. Pre- and posttreatment data were compared for each subject.Results:Satisfactory relief of symptoms occurred in 19 of 20 cases. Vaginal cellular maturation improved significantly with therapy (P<.01). There were no significant changes in endometrial thickness, uterine artery blood flow, or serum estrogen levels. Endometrial proliferation was observed in one case.Conclusion:Relief from atrophic vaginitis can be achieved with 0.3 mg of conjugated estrogens administered vaginally three times per week. Endometrial proliferation may occur at this low dose, albeit rarely.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID