摘要:

ObjectiveTo determine whether secondary closure or secondary intention results differ with respect to time for complete healing and number of postoperative visits in patients with superficial wound dehiscence.MethodsA randomized trial involved 33 obstetric and gynecologic patients at the University of Mississippi Medical Center who experienced superficial wound dehiscence. Subjects were assigned to secondary-closure or secondary-intention groups. The two groups were similar in age, absolute body weight, percent ideal body weight, length of the primary surgical procedure, estimated blood loss at the primary surgical procedure, portion of the wound that opened, preoperative hemoglobin concentration, and pre-operative hematocrit.ResultsPatients randomized to secondary closure required a mean (± standard deviation) of 17.6 ± 7.2 days from dehiscence to complete healing, whereas those assigned to secondary intention required 61.2 ± 35.8 days (P< .001). The secondary-closure group required a mean of 2.0 ± 0.7 postoperative visits, compared with 8.4 ± 6.2 visits in the secondary-intention group (P< .001).ConclusionSecondary closure of superficial wound dehiscence is superior to healing by secondary intention.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveWe assessed laparoscopic oophorectomy using three techniques.MethodsFrom January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatic stapling devices. The patients were aged 18–57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatic stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18.ResultsTotal anesthesia time ranged from 45–123 minutes, with means of 77 minutes for pretied ligatures, 84 minutes for bipolar coagulation, and 84 minutes for automatic stapling devices. Sixty-two patients were discharged within 23 hours, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series.ConclusionAll three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope.MethodsFrom April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Telephone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. All patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation.ResultsThe average operative time was 31.6 minutes, and an average of 304 mL of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At follow-up, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy.ConclusionEndometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a cost-effective, minimally invasive alternative to hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine the effect of douching on the quantitative and qualitative makeup of the vaginal microflora.MethodsWe first evaluated the effect of douching with a solution of physiologic saline to determine the effect of washing the vaginal surface. Two douche preparations, one containing 0.04% acetic acid and one containing 0.30% povidone-iodine, were evaluated subsequently to determine whether any effects occurred in addition to those noted with saline. Duplicate vaginal swab samples were obtained at predetermined intervals from ten healthy volunteers for three sampling cycles before and after use of the douche preparations for various periods of time. Samples were analyzed for total facultative and obligately anaerobic bacterial populations.ResultsThe use of a douche preparation containing acetic acid caused a transient reduction of the total bacterial counts, with most of the change attributable to the effect of washing the surface of the vaginal vault as noted with physiologic saline. In contrast, the povidone-iodine preparation caused a significant reduction in total counts compared with those obtained after use of a physiologic saline solution by the same subjects (P= .02). Little change in the qualitative makeup of the vaginal microflora occurred.ConclusionThe use of povidone-iodine douches decreases the numbers of the dominant bacterial species beyond those expected with other douches. In some individuals, such changes may allow rapid proliferation of potential pathogens during this altered state, increasing the risk of associated infections.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveAlthough its etiology is unknown, it has been hypothesized that premenstrual syndrome (FMS) is linked to a deficiency of central serotoninergic activity. In the present study, we evaluated the effect of fluoxetine, a specific serotonin uptake inhibitor, on PMS symptoms.MethodsFollowing extensive screening, including several psychological inventories, eight women with severe persistent PMS participated in a 6-month double-blind, placebo-controlled, crossover study which included three months each of daily fluoxetine 20 mg or placebo, administered in a randomized order. Symptoms were evaluated using the Calendar of Premenstrual Experiences and other psychometric measures.ResultsCompared with placebo, treatment with fluoxetine was associated with an improvement in PMS symptoms as judged by highly significant decreases in behavioral (P< .005), physical (P< .05), and total (P< .005) Calendar of Premenstrual Experiences scores; Beck Depression Inventory scores (P< .005); Profile of Mood States subscales scores including depression (P< .005), tension (P< .005), and anger (P< .01); and State-Trait Anxiety Inventory scores. The use of fluoxetine was associated with a greater mean reduction in behavioral (75%) than in physical scores (40%), with a mean decrease in total Calendar of Premenstrual Experiences scores of 62%, which rendered these scores similar to follicular phase values. Thus, the luteal phase symptomatology of PMS was effectively abolished. At this dose, no significant side effects or complications were noted during treatment.ConclusionFluoxetine appears to be a highly effective, well-tolerated treatment for the psychological and physical symptoms accompanying severe PMS.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate expectant management in selected cases of ectopic pregnancy.MethodsTransvaginal sonography and estimation of serum hCG concentrations were used in the evaluation and follow-up of ectopic pregnancy. Entry criteria for expectant management were: decreasing level of serum hCG, diameter of the ectopic pregnancy less than 4 cm, and no signs of rupture or acute bleeding by vaginal sonography.ResultsExpectant management was studied in 83 patients, representing 26% of all ectopic pregnancies during a 2-year period. In 57 patients (69%), spontaneous resolution occurred, corresponding to 18% of all ectopic pregnancies. Laparoscopy was performed in 26 because of clinical symptoms or a rise in hCG level after expectant management for 1–18 days. One patient had a tubal rupture requiring tubal resection by laparoscopy. No serious complications occurred. With increasing experience, the rate of expectant management and spontaneous resolution increased during study period.ConclusionExpectant management with repeated vaginal sonography and estimations of serum hCG concentrations is a useful form of treatment for ectopic pregnancy in selected cases.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo address the evolving trends in the choice of transabdominal or transcervical chorionic villus sampling (CVS) at a teaching hospital and to evaluate the influence of gestational age on the approach chosen.MethodsWe analyzed our CVS data base, which contained information from 1986–1991. The proportions of transabdominal and transcervical CVS were tabulated for each year. In addition, the distribution of the CVS approaches over the various gestational ages was examined.ResultsDuring the study period, 4290 CVS procedures were performed. The rate of the transabdominal technique was stable at about 15% per year except for the first 2 years, when essentially all procedures were transcervical. Use of transabdominal CVS increased with advancing gestational age, from 3.6% at less than 10 weeks' gestation to 97.6% at greater than 14 weeks (χ2= 120,P< .001;r= 0.791).ConclusionsThe choice between the transabdominal and transcervical approach to CVS largely reflects the route emphasized during the physician's training. When choice is based strictly on technical limitations due to placental position, the overall transabdominal CVS rate is approximately 15%. A shift from transcervical to transabdominal CVS occurs with increasing gestational age as the placenta gains bulk and moves away from the cervix. After 14 weeks' gestation, most procedures are performed transabdominally.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate prospectively maternal serum screening with alpha-fetoprotein (AFP), hCG, and unconjugated estriol (uE3) as a screen for fetal Down syndrome.MethodsWomen less than 35 years of age were offered screening between 15–20 weeks' gestation. Screening results calculated by an algorithm to be equal to or greater than 1:274 (the risk of a 35-year-old for fetal Down syndrome at the second trimester) were considered positive. If gestational age was confirmed by ultrasonography, genetic counseling and amniocentesis were offered.ResultsIn the first 2 years of our program, 9530 women were screened, of which 686 (7.2%) were found to be screen-positive. Ultrasonographic examination explained the abnormal values in 379 (4.0%). The remaining 307 (3.2%) received genetic counseling and 214 (2.2%) elected amniocentesis or CVS. Four cases of fetal Down syndrome and one de novo chromosomal marker were detected. In three additional cases of fetal Down syndrome, triple-analyte screening failed to identify the pregnancies to be at increased risk. None of the seven cases of fetal Down syndrome would have been detected through screening with maternal serum alpha-fetoprotein (MSAFP) and age alone.ConclusionsMeasurement of MSAFP, hCG, and uE3 in women less than 35 years old is an effective screening test for fetal Down syndrome, with a sensitivity of 57% in our study and an amniocentesis rate (false-positive rate) of 3.2%.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo identify risk factors for disorders of fetal growth and thyroid function in the presence of maternal Graves disease.MethodsTwo hundred thirty pregnancies in gravidas with Graves disease were analyzed. Maternal thyroid status was evaluated by serum free thyroxine (T4) or free T4 index, TSH, and TSH-receptor antibody; personal history of thyrotoxicosis and total dose of antithyroid drugs during pregnancy were also noted. Neonatal thyroid function was assessed at birth and on the fifth day after birth.ResultsFifteen neonates (6.5%) were small for gestational age (SGA), and this occurrence was significantly associated with thyrotoxicosis lasting for 30 weeks or more of pregnancy, TSH-receptor antibody level of 30% or more at delivery, history of Graves disease of 10 years or longer, and onset of Graves disease before 20 years of age. However, no significant correlation was found between maternal thyroid hormone level and SGA neonates. Thyroid dysfunction developed in 38 infants (16.5%), of whom only four were SGA; development of this dysfunction was significantly related to the mother's total dose of antithyroid drugs, duration of thyrotoxicosis in pregnancy, and/or TSH-receptor antibody level at delivery.ConclusionsDuration of maternal Graves disease or thyrotoxicosis, either mild chemical or overt, in pregnancy is significantly associated with SGA neonates. Neonatal thyroid dysfunction is associated with the maternal thyroid condition, especially the serum TSH-receptor antibody level.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine the rate of neonatal and childhood medical complications in the offspring of women with the antiphospholipid syndrome who are treated during pregnancy.MethodsWe compared 29 infants born to 23 mothers with antiphospholipid syndrome with a group of control children matched for year and gestational age at birth and route of delivery. During pregnancy, mothers with antiphospholipid syndrome were treated with accepted therapeutic regimens, including prednisone and low-dose aspirin, heparin and low-dose aspirin, and others.ResultsNeonatal complications in the study infants included hyperbilirubinemia (14), respiratory distress syndrome (three), bronchopulmonary dysplasia (two), necrotizing enterocolitis (two), intraventricular hemorrhage (two), neonatal sepsis (one), coarctation of the aorta (one), hypothyroidism (one), hypoglycemia (one), and death (one). Two children had feeding problems, four had delayed psychomotor development, and eight were small for their age. However, the overall rate of neonatal or childhood complications did not differ from that in the control children.ConclusionsOur data indicate that prematurity and neonatal problems are common, but the childhood course for these offspring is similar to that of other premature infants.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID