摘要:

AbstractSome 7 million perinatal deaths occur throughout the world each year, 98% in developing countries. Most of these are preventible. The underlying socio‐economic, ethical and medical problems are reviewed in terms of their prevention and the optimal use of scarce resources. In particular, there is an urgent need to control population growth by raising the status of women and providing better and more accessible family planning services. Greater emphasis needs to be given to the development of primary health care in developing countries. In the foreseeable future, community maternal and newborn care is likely to rely on trained traditional birth attendants, with referral medical facilities when required. Breast feeding remains the most important priority in newborn care. Education of parents and young children holds the key to progress.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80002-6

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjective: To elucidate whether microbial infections are involved in the etiology of intrauterine death. Methods: One hundred four cases of stillbirth of unknown etiology and 96 age‐ and parity‐matched referents with live births were analyzed with respect to microbial infection by cultures from the placenta, endocervix and internal organs of the fetuses, exteral sites of the babies and fetuses, and by serology for bacteria, viruses and Toxoplasma gondii. Results: In 17 cases in whom no other infectious agent was diagnosed, Escherichia coli was isolated from the placenta and one or more internal fetal organs. Tests for Treponema pallidum and Toxoplasma gondii were more frequently positive in cases than in referents (O.R. 8.3 and 3.9, respectively). There was no increased risk for intrauterine death in women with human immunodeficiency virus, cytomegalovirus, herpes simplex virus or rubella virus. Conlusions: Our findings indicate that infections remain an important case of intrauterine death in Zimbabwe.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80004-2

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjective: Intrauterine growth retardation (IUGR) is likely to recur ina subsequent pregnancy. We investigated the obstetric features of recurrent cases and the severity of IUGR by comparing initial and subsequent deliveries. Methods: From a total of 12 567 deliveries, 95 women who were delivered of small‐for‐gestational‐age (SGA) infants and who became pregnant again within 5 years, were enrolled. A retrospective, comparative study of recurrent and non‐recurrent groups was performed. Results: Twenty‐two of ninety‐five women gave birth to SGA infants again, and a relatively high risk of recurrence was confirmed, but no single recurrence‐associated features were revealed. Within the recurrent group, the degree of IUGR was more severe in only five cases in the subsequent pregnancy. Conclusions: IUGR tends to recur, but does not increase in severity in most cases. We conclude that there is no need for excessive concern about the recurrence of IUGR.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80006-9

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjective: Chlamydia trachomatis is an important etiological agent in female genital infection and may result in infertility. In recent years rapid diagnostic methods have become widely used as alternatives to cell culture. Our objective was to evaluate the technique of direct fluorescence assay (DFA) in estimating the presence of C. trachomatis. Method: Specimens taken from 40 infertile and 20 fertile women were examined by DFA for the presence of C. trachomatis. Results: Six of forty (15%) infertile women were found to be positive whereas no positive specimens were detected in the control group. When the specimens were grouped into those which were adequate or inadequate, 19 and five specimens, respectively, were adequate in the infertile and healthy groups. If only adequate specimens are included in estimating the presence of Chlamydia, the percentage is 31.6%. Conclusions: In order to use DFA as a more reliable and rapid diagnostic test of C. trachomatis in female genital infection, false‐negativity must be eliminated. Specimens must be collected adequately and concentrated in order to achieve optimal diagnostic success.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80008-5

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjectives: The aims of this study were to evaluate the difference between benign and malignant ovarian tumors through measurement of preoperative serum neopterin and CA 125 levels and to evaluate the correlation between serum neopterin levels and prognosis. Methods: Preoperative serum neopterin levels were measured in 55 ovarian tumors. Of these, 29 malignant tumors were studied over a 3‐year follow‐up period. Results: Statistical analysis demonstrated significant differences in neopterin levels between those with benign or malignant ovarian tumors, and different survival rates between the 11 patients whose preoperative neopterin levels were ≥ 7.9 nM/l and the 18 patients whose preoperative neopterin levels were<7.9 nM/l (P<0.01). The sensitivity of preoperative serum neopterin levels (≥ 7.9 nM/l) in detecting malignant ovarian tumors was 37.9%, the specificity was 96.1%, the positive predictive value 72.0%, the negative predictive value 63.3% and the diagnostic efficiency 65.4%, and those of preoperative serum CA 125 levels (≥ 35 U/ml) in detecting malignant ovarian tumors were 62.1%, 73.1%, 91.7%, 58.1% and 85.5%, respectively. Conclusions: Measurement of preoperative serum neopterin levels helped to discriminate between benign and malignant ovarian tumors and was related to ovarian cancer survival. In particular the combination of CA 125 and neopterin measurements showed a better sensitivity for the diagnosis of ovarian cancer than neopterin alone.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80010-7

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the efficacy of medical treatment in patients with lichen sclerosus (LS), squamous hyperplasia (SH) and lichen sclerosus with associated squamous hyperplasia. Methods: Forty‐eight patients with non‐neoplastic epithelial disorders of the vulva, SH in 23 (47.9%), LS in 20 (41.6%) and LS with associated SH in five (10.5%) were diagnosed and treated in our clinic. Patients with LS were treated with 2% testosterone ointment. Topical fluorinated corticosteroids was the treatment of choice in patients with SH. Patients with LS with associated SH were treated with topical fluorinated corticosteroid application followed by testosterone propionate ointment. Results: The clinical response rate of SH to first‐line therapy was 95.6% with a correlation of 90.5% with histological reversal; this rate was 80% with a histological correlation of 81.3% in LS. The remission rates of SH and LS patients following a full course of therapy were 100% and 90%, respectively. In LS with associated SH patients, 90% responded to standard therapy with a remission rate of 100% after completion of a full course of therapy. Conclusion: Medical therapy of lichen sclerosus and squamous hyperplasia was very effective with a good clinical and histologic correlation.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80012-3

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractObjective: To elucidate the effects of lymphadenectomy on the prognosis for ovarian cancer. Method: A retrospective study of 69 patients with stage‐III serous cystadenoarcinoma was performed. Results: Among the 69 patients, 36 were not treated by lymphadenectomy. Both pelvic and para‐aortic lymphadenectomies were performed on 13 patients at the initial operation and on 11 at the second operation. The group (n = 13) treated by both pelvic and para‐aortic lymphadenectomies at the initial operation had a disease‐free survival rate that was significantly higher than the nonlymphadenectomy group (n = 36) or the group (n = 5) treated by pelvic or para‐aortic lymphadenectomy alone (P<0.04). These 54 patients were subjected to multivariate analysis for lymphadenectomy at the initial operation, and a significant correlation was found between disease‐free survival rate and both pelvic and para‐aortic lymphadenectomies (P<0.05). Conclusion: These results suggest that systematic lymphadenectomy can reduce the rate of recurrence.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80014-X

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractPersistent ectopic pregnancy, often a sequelae of conservative surgical procedures, is characterized by a residual trophoblastic activity site with rising or plateauing ß‐human chorionic gonadotropin (hCG) titers after the initial treatment. Chronic ectopic pregnancy is a different entity which may be seen after expectant management of ectopic pregnancy and contains no active trophoblast with low or absent ß‐hCG titers. A rare with features of a chronic ectopic pregnancy, which followed successful methotrexate medical treatment of a persistent ectopic pregnancy, is presented.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80018-2

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractA primipara with an uncomplicated pregnancy was induced for labor. As uterine contractions commenced, an antepartum bleeding occured, followed by fetal distress. An anemic fetus was delivered by cesarean section. The placenta was annular in shape with velamentous blood vessels, one of which was ruptured and sealed off by fresh thrombus. A zonary or ring‐shaped placenta is extremely rare: to our kwoledge, this is the first case to be published.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80020-4

出版商:Wiley    

年代:2003

数据来源: WILEY

摘要:

AbstractEndometrial ablation has been recently introduced as a surgical alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. The procedure itself is reasonably safe. However, if occult endometrial cancer is present before the procedure and is not detected, it may be more difficult to diagnose later. Endometrial cancer may also arise de novo from endometrial tissue. Two cases of endometrial cancer following endometrial ablation have been reported, but its overall incidence is unknown. A 58‐year‐old woman was treated with endometrial ablation for dysfunctional uterine bleeding. Three years later she underwent hysterectomy and Marshall‐Marchetti‐Krantz procedure for urinary incontinence; incidental, asymptomatic endometrial adenocarcinoma was discovered. The final pathology was grade 1 adenocarcinoma, invading more than 50% of the myometrium (FIGO stage Ic). Endometrial cancer may occur following endometrial ablation and it may be asymptomatic. Careful patient selection and close follow‐up are essential.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)80022-0

出版商:Wiley    

年代:2003

数据来源: WILEY