摘要:

ObjectiveTo evaluate endocervical curettage (ECC) and cone margin involvement in the management of adenocarcinoma in situ of the cervix.MethodsForty-two women with adenocarcinoma in situ without any associated invasive component underwent 49 cervical conizations. The ECC, cone margin involvement, and residual endocervical glandular disease were evaluated in a retrospective descriptive study.ResultsThe patients ranged from 18 to 65 years old, with a median of 34 years and a mean of 37 years. Nineteen of 42 (45%) of the women presented with initial cervicovaginal cytology suggesting endocervical glandular abnormality. Twenty-seven patients (64%) had mixed lesions of adenocarcinoma in situ and squamous dysplasia noted in their cervical biopsy, conization, or hysterectomy specimens. Forty ECCs were performed at colposcopy or immediately after conization; 28 patients with ECCs subsequently underwent conization, and 12 underwent hysterectomy. Residual adenocarcinoma in situ was found in 18 (67%) of the 27 patients with negative ECCs and in ten of 13 women with positive ECCs. Residual adenocarcinoma in situ was found in two of seven patients with negative cone margins and seven of ten patients with positive margins.ConclusionWe found that negative ECCs and uninvolved cone margins in patients with cervical adenocarcinoma in situ were not reassuring of the absence of residual endocervical glandular disease in subsequent surgical specimens. Conservative management and subsequent surveillance of adenocarcinoma in situ should be undertaken with caution.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether postmenopausal hormone therapy is associated with high-risk human papillomavirus (HPV) infection.MethodsThe detection rate of HPV DNA was studied in cellular residue from liquid-based collection tubes taken from 180 postmenopausal hormone users attending a menopausal clinic and 126 postmenopausal nonusers. The samples were analyzed with a hybrid capture technique using a mix of high- to intermediate-risk viral RNA probes. In all patients, information on potential confounding factors for HPV infection, including sociodemographic, reproductive, and gynecologic characteristics, was obtained.ResultsThe prevalence of HPV DNA in this cohort of postmenopausal women was 1% (three of 306); only two of the 180 current users and one of the 124 nonusers tested positive. Only one of the three women with HPV-positive tests had lesional tissue (ie, vulvar condylomata acuminata). The remaining two HPV-positive women had negative cytology, colposcopy, and biopsy. In all three cases, viral burden was low, about 10 pg per cellular sample. The very low HPV prevalence precluded the analysis of correlation with age, ethnicity, education, sexual history, smoking, history of abnormal Papanicolaou smear, therapy for HPV-related lesions, and contraceptive use.ConclusionIdentification of high-risk HPV types in post-menopausal women is rare, as detected by hybrid capture in cellular residue from the liquid-based cytology-collection system. Postmenopausal hormone therapy does not appear to promote viral replication or the risk of carrying high-risk HPV DNA or related lesional tissue in the lower genital tract.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify factors predicting bone mineral loss during anticancer chemotherapy.MethodsFifteen women (mean age 38.2 ± 7.8 years; range 30–46 years) with ovarian cancer who had been treated with cisplatin-adriamycin-cyclophosphamide for six cycles every 4 weeks following surgical cytoreduction were studied. Bone mineral density (BMD) of the lumbar spine (L2-L4) was measured by dual-energy x-ray absorptiometry before and after chemotherapy. Fifteen age-matched women whose ovaries had been removed surgically for other reasons served as controls. None of the patients had received hormonal treatment. The two groups were compared for percentage change of BMD (BMD%) over the same period. In the chemotherapy group, total fat mass, body fat ratio, total lean mass, percent lean, and ratio of trunk fat to leg fat were measured by dual-energy x-ray absorptiometry. Lean loss during chemotherapy was also calculated. These variables were compared before and at the end of chemotherapy. Possible correlations of baseline variables with BMD% were determined in univariate and stepwise regression analysis.ResultsMean (± standard deviation) BMD decreased to 87.4 ± 2.1% after six cycles of chemotherapy and 97.6 ± 0.4% after 6 months in controls, but the greatest decrease was observed in the chemotherapy group (P< .001). Although baseline lean mass, baseline BMD, body weight, and lean loss during chemotherapy were correlated with BMD% in univariate analysis, baseline lean mass was still significant in stepwise regression analysis.ConclusionBaseline lean mass predicts bone mineral loss with anticancer chemotherapy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify and assess differences in cancer screening patterns among women 55–64, 65–74, 75–84, and over 84 years of age.MethodsNationally representative data reported in the 1990 Health Promotion and Disease Prevention Supplement to the National Health Interview Survey of 28,584,574 women were analyzed secondarily. The dependent variables were a knowledge of breast self-examination, ever having had a mammogram, and a Papanicolaou smear within the last 3 years. Independent variables were age and various sociodemographic, health-status, and health-belief measures.ResultsMore than half (58%) of the women had ever had a mammogram, and of these, 91% had had between one and five mammograms. Over a third (35%) of those who had not had a mammogram attributed the omission to a lack of a recommendation by a physician. Almost half (45%) had had a breast examination by a physician within the last year, and 84% knew how to examine their own breasts. Approximately 87% had a Papanicolaou smear within the last 3 years. Age, race, education, and living in a large city were significantly associated with all three screening measures, but prevalent health beliefs were significantly associated only with breast-cancer screening.ConclusionLack of mammogram screening in a substantial number of women, attributed to lack of physician recommendation, decreased screening in the older age groups, and the negative association of all three screening tests with race and residence in a large city suggest that new interventions are needed by health care providers and the public health community to increase older women's use of effective cancer screening techniques.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the effects of estrogen on the size of low-density lipoprotein (LDL) particles in postmenopausal women.MethodsWe treated 20 postmenopausal women with 0.625 mg of conjugated equine estrogen daily for 3 months and measured the plasma levels of total cholesterol, triglyceride, high-density lipoprotein (HDL), and apolipoproteins A-I, A-II, and B before and after therapy. We also analyzed concentrations of LDL cholesterol and LDL apolipoprotein B. The diameter of LDL particles was determined by gradient gel electrophoresis.ResultsEstrogen caused significant decreases in the plasma levels of total cholesterol and apolipoprotein B and significant increases in the plasma levels of triglyceride, HDL cholesterol, and apolipoprotein A-I and A-II. Mean levels of LDL cholesterol and LDL apolipoprotein B were reduced significantly (by 16.31%,P< .001, and 16.91%,P< .001, respectively) after estrogen treatment. Estrogen also significantly reduced the size of LDL particles, from 25.74 ± 0.66 (mean ± standard deviation) to 24.95 ± 0.78 nm (P< .001). The LDL particle diameter correlated negatively with the plasma level of triglyceride (pre-treatment:r= 0.87,P< .001; post-treatment:r= 0.88,P< .001). Estrogen significantly increased the prevalence of LDL subclass pattern B, from 30 to 65% (P< .03).ConclusionEstrogen affects lipid metabolism favorably by reducing the plasma concentration of LDL particles. Estrogen-induced increase in the plasma level of triglyceride appears to reduce the size of LDL particles.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo review the experience of the Milan University First Department of Obstetrics and Gynecology in patients with double, didelphic, or bicornuate uterus, blind hemivagina, and ipsilateral renal agenesis, and to consider the frequently unsatisfactory surgical approach.MethodsThirty-six women with double, didelphic, or bicornuate uterus, blind hemivagina, and ipsilateral renal agenesis were identified from clinical records for the period 1962 to 1992. We evaluated demographic data, disease, symptoms, correctness of therapeutic approach, and definitive treatment.ResultsSeventeen patients previously had undergone incomplete surgery in other hospitals and 19 were treated by us for the first time. Total hysterectomy was performed on two of the 36 women and hemihysterectomy and hemicolpectomy were performed on four. In the other 30, the vaginal septum was excised and marsupialization was done. The pregnancy rate in the 15 women wanting children was 87% and the live birth rate was 77%. Serial biopsy specimens were obtained from the lateral fornix after the excision of the septum in 13 of the 30 non-hysterectomized patients over 1–9 years and revealed progressively more extensive areas of squamous metaplasia of müllerian epithelium. In some isolated cases, papillary hyperplasia, mild dysplasia, and vaginal adenosis were found. At the end of follow-up, 16 patients still did not want children. Follow-up was possible in 34 cases.ConclusionEarly accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. Partial morphologic changes are evident but metabolic modifications comparable to those of the adjacent normal vagina have not yet been documented.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine differences in the characteristics and type of genital prolapse in young women compared with older women.MethodsA retrospective analysis was performed, identifying 647 women who underwent surgical repair of various types of genital prolapse for the years 1979–1991. One hundred ninety-one patients met our inclusion criteria, having well-documented genital prolapse to or beyond the hymen. Patients were stratified into two age groups, those over 35 years and those 35 or younger. The patients were compared regarding “complexity” of prolapse (ie, the total number of deficient sites per patient), grade of prolapse, parity, and coexistent medical conditions.ResultsDuring the study period, 27 young women (mean age ± standard deviation [SD] 30.3 ± 3.4 years) and 164 older women (mean age ± SD 60.6 ± 11.9 years) met our criteria. Young women were more likely than older women to have 1) potential predisposing medical conditions (congenital anomalies or neurologic or connective tissue diseases) (22.2% versus 6.7%,P< .05), 2) lower mean parity (2.8 versus 3.4,P< .05), 3) only one site of prolapse (56% versus 23%,P< .01), and 4) lower grade of prolapse (33% versus 87% grade 3 or higher,P< .001).ConclusionYoung patients undergoing surgery for genital prolapse were more likely to have lower parity and single-site and lower-grade prolapse. A higher than expected prevalence of congenital anomalies, as well as rheumatologic and neurologic diseases in the younger women is intriguing, but further study is necessary before these conditions can be implicated in the genesis of genital prolapse.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse.MethodsThe charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990, and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery.ResultsOf 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 ± 10.2 years (range 35–93) and median parity was 3.0 (range 0–10). Of the 323 patients, 25 (7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis, and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. Two patients with hydronephrosis had evidence of renal insufficiency (creatinine ≥ 1.6), and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower in patients with vaginal vault prolapse versus uterine prolapse (3.9% compared with 12.6%,P< .01).ConclusionThe prevalence of hydronephrosis in patients undergoing surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse, and is lower in patients with vaginal vault prolapse than in those with uterine prolapse.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the surgical morbidity, postoperative course, and hospital charges of Burch colposuspension performed in conjunction with abdominal versus vaginal hysterectomy.MethodsPower analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a β error of 20% and and α error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight, and operative and total hospital charges were obtained for each group.ResultsThere was no statistically significant difference in demographics, surgical history, postoperative hemoglobin and hematocrit decrease, postoperative complications (10 versus 23%), operative charges ($4417 ± 1200 versus $4731 ± 1453), mean uterine weight (113.5 ± 45 versus 125.8 ± 45 g), and operative times (3.0 ± 0.8 versus 2.9 ± 0.7 hours) between the vaginal and abdominal groups, respectively. A post hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for postoperative complication rates. The abdominal group had significantly longer hospital stays (3.1 ± 1.0 versus 2.6 ± 0.7 days) and higher hospital charges ($7337 ± 1828 versus $6342 ± 1123) than the vaginal group.ConclusionWhen hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveEctopic pregnancy continues to be a leading cause of maternal morbidity and of reduced childbearing potential among women of reproductive age. Because of tubal rupture, it is still the main cause of pregnancy-related death during the first trimester. The purpose of our study was to evaluate factors that may predispose a woman to rupture of a tubal ectopic pregnancy.MethodsIn this retrospective study of 693 ectopic pregnancies from three McGill University teaching hospitals, we compared risk factors, preoperative ultrasound, and serum hCG levels between cases with ruptured and unruptured tubal ectopic pregnancy.ResultsThe age and the number of pregnancies among the two groups of women were similar. The gestational age of women with an unruptured tube was 6.9 ± 1.9 weeks, and of those with a ruptured tube, the gestational age was 7.2 ± 2.2 weeks. Tubal rupture was encountered more often in women with at least one child than in childless women. History of ectopic pregnancy was found in 35% of women with an unruptured tubal pregnancy and in 26% of those with a ruptured tube. Serum hCG levels at the time of treatment were not significantly different among the two groups of women. Eleven percent of women with a ruptured tube had serum β-hCG levels of less than 100 IU/L.ConclusionTubal rupture is encountered more often in women with no history of ectopic pregnancy and in those with at least one child. This suggests that ectopic pregnancy is less suspected in these women. Tubal rupture is encountered less often in ampullary pregnancy and in small ectopic pregnancies. There is no correlation between serum β-hCG levels and tubal rupture, and rupture can occur even when serum β-hCG levels are very low.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID