摘要:

ObjectiveTo measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief.MethodsIn a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed.ResultsSymptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy.ConclusionSignificant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo compare the use of periurethral collagen injection in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency in women with and without urethral hypermobility.MethodsA retrospective review was performed of 60 periurethral collagen injections performed on 40 consecutive women from January 1996 to December 1997. A review of the office chart and operative notes was performed to obtain demographic, urodynamic, and procedural data. Outcome data were obtained by personal or telephone interview, using patients' subjective assessments including an analog satisfaction scale.ResultsNine of 40 patients (23%) had urethral hypermobility. Compared with patients without hypermobility, patients with hypermobility required a similar number of procedures (a mean of 1.9 compared with 1.4,P= .13) and required similar amounts of collagen on the first injection (5.6 mL compared with 5.3 mL,P= .69). Preoperative urodynamic parameters were similar in both groups. Rates of subjective dryness were equivalent in patients with and without hypermobility at 1 month (76% and 46%,P= .24) and at 6 months (71% and 32%,P= .09) following initial injection. A post hoc power analysis was performed to evaluate the primary study measures of continence at 1 and 6 months, and number of collagen injections. This revealed that a sample size of 40 patients would be sufficient to detect a 2.5-fold difference in number of injections and a 3-fold difference in subjective dryness.ConclusionCoexisting urethral hypermobility should not preclude the use of collagen injections in women with stress urinary incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo determine the association between advanced pelvic organ prolapse and changes in lumbar lordosis and/or pelvic inlet orientation.MethodsLateral lumbosacral spine/pelvic x-rays were taken of women with grade 2 or greater uterovaginal prolapse and women with grade 1 or less prolapse standing in their usual upright posture. The angles of lumbar lordosis and the pelvic inlet were measured by a radiologist who was masked to the pelvic examination findings.ResultsTwenty women with prolapse were matched with 20 women without significant prolapse. There were no significant differences in the mean (± standard deviation [SD]) age (55.3 ± 9.0 years compared with 53.4 ± 9.5 years), body mass index (BMI) (28.9 ± 5.6 compared with 28.4 ± 5.2), gravidity (5.6 ± 3.5 compared with 5.0 ± 2.7), and vaginal parity (4.65 ± 3.3 compared with 4.5 ± 2.9) between the prolapse and nonprolapse groups, respectively. All participants were vaginally parous. The mean lumbar lordotic angle in women with pelvic organ prolapse (32.0° ± 9.8°) was significantly lower than that of controls (42.4° ± 10.9°) (P< .003). The mean angle of the pelvic inlet in women with pelvic organ prolapse (37.5° ± 7.0°) was significantly larger than that of controls (29.5° ± 7.3°) (P< .001). The differences in the mean angles of lumbar lordosis and the pelvic inlet, between the case and control groups, remained significant after multivariable logistic regression was performed.ConclusionWomen with advanced uterovaginal prolapse have less lumbar lordosis and a pelvic inlet that is oriented less vertically than women without prolapse.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo describe clinical presentation, etiology, and treatment of ureteral injuries recognized late in women who had gynecologic laparoscopies.MethodsWe reviewed the charts of 12 women who had delayed recognition of ureteral injuries between January 1991 and December 1998.ResultsPatients presented with fever, hematuria, flank pain, or peritonitis between 3 and 33 days postoperatively. The mechanism of ureteral injuries was electrocoagulation in seven women, laser ablation in one, and stapler ligation in four. The sites of injury were near the inferior margin of the sacroiliac joint on excretory urogram in eight women and near the ureterovesical junction in four. Three women initially treated with internal ureteral stents were subsequently treated with ureteroneocystostomy because of progression of urinary ascites in two and a delayed ureteral stricture in one. In nine patients, attempts at ureteral stenting were unsuccessful and immediate ureteral reconstruction was done. Outcomes were good in all cases.ConclusionDelayed recognition of ureteral injury after gynecologic laparoscopy was associated with serious complications, and initial treatment with ureteral stenting was not useful. We advocate early open repair for those injuries.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo evaluate the effect of delaying colposcopy in women with negative Papanicolaou smears and positive speculoscopy results.MethodsThis was a prospective study of asymptomatic women ages 13–60 years, regularly scheduled for pelvic examinations. All women had Papanicolaou smears and magnified visual examinations with speculoscopy. Women with negative Papanicolaou smears and positive speculoscopy results were quasirandomized to immediate or deferred colposcopy groups.ResultsA total of 800 women completed all phases of the study, 124 of whom had negative Papanicolaou smears and positive speculoscopy results. Among 57 women who had immediate colposcopies, 64.9% had histologic evidence of neoplasia. Sixty-seven women had their scheduled colposcopies deferred for 6 months. During this period, 21% (14) were lost to follow-up and 29% (13) of those evaluated converted from speculoscopy positive to speculoscopy negative. Among the 32 (71%) women who remained speculoscopy positive, 90% were found to have histologic evidence of neoplasia on colposcopic biopsy.ConclusionIn women with normal Papanicolaou smears and positive speculoscopy results, the diagnostic yield can be improved by deferring colposcopy for 6 months. Deferral should be considered only for women who are reliable for follow-up.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo determine the efficacy of intrauterine lidocaine for decreasing pain associated with endometrial biopsy using the Pipelle instrument (Unimar; Wilton, CT).MethodsForty-one premenopausal and postmenopausal women had 5 mL of either 2% lidocaine or saline instilled in their uteri before endometrial biopsies. Subsequently, each woman completed a 20-cm visual analogue scale for subjective pain experience. We compared histologic findings in endometrial specimens.ResultsBefore the study, analysis of specimens (n= 6) found no histologic effect on ability to interpret endometrial biopsies by pathologists who were masked to lidocaine or saline. There was no statistically significant difference in age, parity, race, history of chronic pelvic pain, menopausal status, use of tenaculum, or prior endometrial biopsy. The procedure was easy, with no clinically significant side effects. On the visual pain scale, the median (range) score for the lidocaine group (4.7, 0–19.7) compared with the placebo group (9.9, 1.6–20) showed significant reduction in pain corresponding with a decrease from moderate to mild (P< .01).ConclusionIntrauterine lidocaine is simple and effective for decreasing pain associated with the Pipelle endometrial biopsy.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the number of operations necessary to develop and standardize a laparoscopic approach to pelvic and para-aortic lymphadenectomy, with radicality and number of complications as quality markers.MethodsOver 4 years, 108 women had complete laparoscopic pelvic and para-aortic lymphadenectomies combined with laparoscopy-assisted radical vaginal hysterectomies for primary therapy of cervical cancer. Complete data and videotapes were available for 99 women. Operating time and radicality for specific anatomic subareas were measured by review of video documentation and histologic lymph node counts. Intra- and postoperative complications were recorded prospectively. To analyze the progress of surgery, we compared two groups of women, one operated on at the beginning of our study (early group, subjects 6–35) and one operated on in the final period of the study (late group, subjects 79–108).ResultsThe operating time for pelvic and para-aortic lymphadenectomy increased constantly. Comparing the early and late groups for para-aortic lymphadenectomy, there was an increase in mean operating time (34.8 versus 73.2 minutes;P< .001) and mean histologic lymph node yield (5.1 versus 10.6;P< .001). For pelvic lymphadenectomy, mean operating time increased slightly (60.7 versus 69.7 minutes; not significant) but mean histologic lymph node count decreased over time (24.3 versus 21.0; not significant). Retrospective evaluation of videotapes showed that the radicality of lymphadenectomy improved continuously in all evaluated subareas.ConclusionEstablishment of a protocol for para-aortic and pelvic lymphadenectomy took 100 operations. Video documentation was a more reliable indicator of progress in technical performance than were histologic lymph node counts.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo measure the levels of the soluble receptor for the potent angiogenic agent vascular endothelial growth factor (VEGF) in amniotic fluid (AF) in healthy and complicated pregnancies, and compare them with levels of erythropoietin, another factor upregulated by hypoxia.MethodsWe assessed amniotic fluid from the second (n= 35, gestational weeks 14–19) and third (n= 29) trimesters of healthy women, and from the third trimesters of preeclamptic (n= 22) and diabetic women with (n= 11) or without preeclampsia (n= 34) and from women with fetal growth restriction (FGR) (n= 14) for soluble VEGF receptor-1 (VEGFR-1) by enzyme-linked immunosorbent assay.ResultsIn early normal pregnancy, AF-soluble VEGFR-1 levels were higher (median 22 ng/mL, range 2.3–29.5 ng/mL) than in the third trimester (median 13 ng/mL, range 0.5–32 ng/mL;P< .05). In preeclamptic women during the third trimester, levels were higher (median 20 ng/mL, range 10.5–37 ng/mL;P< .05) than healthy controls. The lowest third-trimester levels were in diabetic women (median 11 ng/mL, range 0.5–27 ng/mL). In women with preeclampsia and diabetes, AF-soluble VEGFR-1 levels remained lower (median 13, range 6–32 ng/mL;P< .05) than in women with preeclampsia alone. Amniotic fluid levels of soluble VEGFR-1 in women with FGR (median 19.5 ng/mL, range 5–40 ng/mL) did not statistically differ from those of controls. The AF levels of soluble VEGFR-1 did not correlate with those of erythropoietin. Soluble VEGFR-1 was clearly detectable (median 14 ng/mL, range 9–22 ng/mL) in culture media from placental biopsies (n= 20).ConclusionPreeclampsia is associated with increased levels of soluble VEGFR-1, which are independent of erythropoietin, another hypoxia-inducible factor.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the feasibility and potential benefit of delaying delivery in women with advanced preterm labor.MethodsTwo hundred fifty-seven gravidas with intact membranes and preterm labor at cervical dilatations of at least 3 cm were studied. Women were excluded if they had premature rupture of membranes, gestational age less than 24 or more than 35.9 weeks, complete cervical dilatation, severe hemorrhage, chorioamnionitis, and triplets or higher-order gestations. Management consisted of tocolysis with intravenous magnesium sulfate as the primary agent, antenatal steroids, antibiotics, and amniocentesis. The primary endpoint was delay to delivery interval. Statistical analyses by cervical dilatation were performed using the Pearson χ2test and a nonparametric test of trend.ResultsEighty-one percent of pregnancies were referrals in utero from outlying hospitals. Delivery was delayed 24 hours or longer in 74% and beyond 48 hours in 60% of cases. Among 229 women who delivered at our center, 21% remained undelivered after 1 week. Evaluating delay as a function of cervical dilatation, trend analysis found a highly significant inverse relationship (P< .001). Among women dilated 5 cm, 46% delivered beyond 48 hours. Among those dilated 6 cm or more, 19% delivered beyond 48 hours. Mild pulmonary edema developed in five percent, and all responded promptly to medical interventions. Chorioamnionitis developed in eight percent.ConclusionDelaying delivery 24–48 hours to allow antenatal steroid use or other interventions is possible in women with advanced preterm labor.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo determine the concentration of endothelial cell adhesion molecules in the lower uterine segment during parturition at term.MethodsWe analyzed protein extracts from the lower uterine segments of 38 women who had nonelective cesareans at term. We measured concentrations of intercellular adhesion molecule-1, endothelial leukocyte adhesion molecule-1, vascular cell adhesion molecule-1, and platelet endothelial cell adhesion molecule-1 by enzyme-linked immunosorbent assay. Subjects were grouped according to cervical dilatation (less than 2 cm,n= 10; 2 to less than 4 cm,n= 9; 4–6 cm,n= 9; more than 6 cm,n= 10) and duration of labor (up to 6 hours,n= 14; 6–12 hours,n= 10; 12–24 hours,n= 9; longer than 24 hours,n= 5) at the time of cesarean.ResultsThe median concentration of intercellular adhesion molecule-1 increased significantly with increasing dilatation (from 2.24 ng/mg total protein at less than 2 cm to 6.73 ng/mg at 4–6 cm) and increasing duration of labor (from 2.53 ng/mg up to 6 hours to 5.90 ng/mg at 12–24 hours). However, this study did not have adequate statistical power to identify differences in concentrations of the other endothelial adhesion molecules.ConclusionThe results indicate that parturition at term is associated with expression of intercellular adhesion molecule-1.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID