摘要:

ObjectiveTo investigate the cost advantages and complication rates associated with surgical routes of uncomplicated hysterectomies in which uteri weigh less than 280 g and benign diseases are confined to the uterus.MethodsData were collected prospectively from 1988 to 1993 from 4609 consecutive women who had hysterectomies at a single institution. Women who had abdominal hysterectomies, laparoscopically assisted vaginal hysterectomies, or vaginal hysterectomies were selected if they had benign diseases confined to the uterus (adenomyosis, leiomyomas, abnormal uterine bleeding, cervical carcinoma in situ, and prolapse) and uterine weights less than 280 g. We compared length of stay, hospital charges, and associated complications between groups.ResultsA total of 1427 women met the study criteria. Length of stay was longer after abdominal hysterectomies than laparoscopically assisted vaginal hysterectomies or vaginal hysterectomies (3.99 ± 1.16 days, 2.45 ± 1.58 days, and 2.76 ± 0.94 days, respectively;P< .001). Hospital charges for vaginal hysterectomies were significantly lower than for either abdominal or laparoscopically assisted vaginal hysterectomies (P< .001). The median charge for vaginal hysterectomies was $4166; the median charges for laparoscopically assisted vaginal hysterectomies and abdominal hysterectomies were 71% and 35% higher than this, respectively. There was a higher risk of one or more complications after abdominal hysterectomies (9.3%) than after laparoscopically assisted vaginal hysterectomies (3.6%;P< .001) or vaginal hysterectomies (5.3%;P< .001). The incidence of postoperative infection or fever was higher after abdominal than after vaginal hysterectomies (4.0% versus 0.8%;P= .029).ConclusionThis study supports the vaginal route of hysterectomy when disease is confined to the uterus and uterine weight is less than 280 g.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo determine the frequency of lower urinary tract injury detected by routine intraoperative cystoscopy after anti-incontinence surgery.MethodsWe reviewed charts from women who had anti-incontinence surgery and routine intraoperative cystoscopy done by a single surgeon from June 1, 1995, to June 1, 1998, and assessed preoperative and intraoperative variables.ResultsWe reviewed 351 patient records. Four records were incomplete and there were nine injuries in the other 347 cases (2.6%, 95% confidence interval [CI] 1.2, 4.9). Four cystotomies occurred during laparoscopic Burch procedures and were detected before cystoscopy. Five injuries were detected at cystoscopy, a rate of 1.5% (95% CI 0.5, 3.4). Four injuries occurred during 161 pubovaginal sling procedures (2.5%, 95% CI 0.7, 6.2). One woman had sutures in her bladder from a prior procedure detected at cystoscopy. In 186 Burch procedures (48 laparoscopic, 138 open), there were no previously unrecognized injuries detected by cystoscopy. All injuries were repaired during original surgery. It was not possible to assess preoperative and intraoperative risk factors because of the low rate of injury.ConclusionThe rate of injury to the lower urinary tract during anti-incontinence surgery in this series was 2.6% (95% CI 1.2, 4.9). Injuries during Burch procedures were all detected before cystoscopy.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo analyze the quantity and distribution of intramuscular nerves within the striated urogenital sphincter and test the hypothesis that decreased nerve density is associated with decreased striated sphincter muscle and cadaver age.MethodsThirteen cadaveric urethras (mean age 47 years, range 15–78 years) were selected for study. A sagittal histologic section was stained with S100 stain to identify intramuscular nerves. The number of times that a nerve was seen within the striated urogenital sphincter (nerve number) was counted. The number of axons within each nerve fascicle was also counted. Regression analysis of nerve density against muscle cell number and age was performed.ResultsRemarkable variation was found in the quantity of intramuscular nerves in the striated urogenital sphincter of the 13 urethras studied. The number of nerves ranged from 72 to 543, a sevenfold variation (mean 247.1 ± standard deviation 123.2), and the range of number of axons was 431 to 3523 (2201 ± 1152.6). The larger nerve fascicles were seen predominantly in the distal (13.1 ± 5.7 axons per nerve) compared with the proximal part of the striated urogenital sphincter (1.2 ± 2). Reduced nerve density throughout the striated urogenital sphincter correlated with fewer muscle cells (P= .02). Nerve density also decreased with advancing age (P= .004).ConclusionRemarkable variation in the quantity of intramuscular nerves was found. Women with sparse intramuscular nerves had fewer striated muscle cells. Intramuscular nerve density declined with age.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo estimate the incidence of endocervical dysplasia in women with cervical cytology of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (SIL) who have a satisfactory and normal colposcopic examination.MethodsAn electronic colposcopy database was reviewed and women with satisfactory colposcopic examinations and original cervical cytology of ASCUS on two consecutive Papanicolaou smears, ASCUS favor SIL, or low-grade SIL were selected. Exclusion criteria were pregnancy, insufficient endocervical curettage (ECC), or colposcopic examination that showed an abnormality that required cervical biopsy. Subjects also were excluded if they were postmenopausal or had surgical or ablative therapy for cervical dysplasia within the past year. A computerized review of 2517 patient records found 860 that met the search criteria. A manual review of those records using the exclusion criteria isolated a study group of 159 women.ResultsFour of 159 subjects (2.5%, 95% confidence interval [CI] 0.69, 6.3) had dysplastic cells in endocervical curettings. In these four, the ECC specimens had benign endocervical cells and separate fragments of squamous cells with mild dysplasia. In three women, loop electrosurgical excision procedures showed mild dysplasia limited to the transformation zone. The fourth subject was believed to have contamination from an unrecognized ectocervical lesion and was treated conservatively. A repeat ECC found benign endocervical cells. Involvement of the endocervix by dyplasia was excluded in all but one of 159 patients (0.63%, 95% CI 0.02, 3.5).ConclusionIncidence of endocervical dysplasia was extremely low in women with cervical cytology of consecutive ASCUS, ASCUS favor SIL, or low-grade SIL who have a satisfactory and normal colposcopic examination. Our findings suggest that endocervical curettage might be safely avoided in those women.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the association of hot flushes during postmenopause with oxidative stress and to determine whether hormone replacement therapy (HRT) affects the plasma redox status of postmenopausal women.MethodsWe conducted a prospective clinical study of 49 postmenopausal women who have (n= 29) or do not have (n= 20) hot flushes. Twelve of the postmenopausal women with hot flushes and six without were treated with HRT (estradiol patches and medroxyprogesterone acetate) for 4 months. Plasma level of estradiol, total antioxidant status, reduced sulfhydryl groups, lipoperoxides, total cholesterol, and triglycerides were measured at 4-month intervals in both groups, before and after treatment.ResultsPostmenopausal women who have hot flushes, had lower total basal antioxidant status in plasma (.9 ± .01 compared with 1.14 ± .01 mmol/L), lower concentration of reduced sulfhydryl groups (145 ± 4 compared with 200 ± 3 μmol/L), and higher concentration of lipoperoxides (2.88 ± .04 compared with 2.61 ± .04 μmol/L) than women without hot flushes. After HRT, total antioxidant status and reduced sulfhydryl groups increased, and lipoperoxides decreased similarly in both groups. Hormone replacement therapy decreased the frequency of hot flushes per day from 11.2 ± 0.8 to 1.4 ± 0.3.ConclusionHot flushes in postmenopausal women were associated with the oxidative process. Hormone replacement therapy decreases oxidative stress and the number of episodes of hot flushes. Because oxidative stress is associated with a high risk for cardiovascular diseases, HRT might protect women with hot flushes.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo determine the effects of treatment with danazol and leuprolide acetate depot on serum-soluble CD23 concentrations in women with endometriosis.MethodsThis randomized trial involved 20 women 18–42 years old with regular menses and known pelvic endometriosis who were recruited from a university hospital between 1993 and 1998. Ten women took 200 mg of danazol three times daily for 6 months, and the remaining ten were given 3.75 mg of leuprolide acetate depot every 28 days for 6 months. Blood-soluble CD23 levels were measured before treatment, during the last 15 days of the 6-month treatment course, and 3 months after treatment. Only one blood sample was taken from ten women without endometriosis, between the 5th and 7th days of their menstrual cycles. For statistical analysis, we used independent and pairedttests with the Pearson correlation coefficient.ResultsSoluble CD23 levels were significantly higher in women with endometriosis before treatment than in ten normal controls. Levels decreased significantly during treatment with either danazol or leuprolide acetate. Three months after treatment, soluble CD23 values remained lower than before treatment. There was no correlation between soluble CD23 concentrations and severity of endometriosis.ConclusionOur findings suggest that endometriosis increases soluble CD23 levels, which can be suppressed with either danazol or leuprolide acetate injection.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the influence of postnatal factors on the development of clear cell adenocarcinoma in women exposed to diethylstilbesterol (DES), particularly factors related to exogenous or endogenous hormone exposures, and to reassess the relation of season of birth.MethodsFor the analysis of postnatal factors, 244 cases were compared with 244 age-matched DES-exposed women. Information was obtained from telephone interviews, with questions asked in reference to an index age, the age at which clear cell adenocarcinoma was diagnosed. For the analysis of season of birth, 604 cases, living or deceased, were compared with 1749 DES-exposed women.ResultsNeither oral contraceptive (OC) use nor pregnancy was associated with risk of clear cell adenocarcinoma: the odds ratios (OR) were 1.1 (95% confidence interval [CI] 0.7, 1.8) for OC use and 1.3 (95% CI 0.7, 2.3) for pregnancy. The OR for fall season of birth relative to all other seasons was 1.2 (95% CI 0.9, 1.4).ConclusionPregnancy and OCs do not increase risk of DES-associated clear cell adenocarcinoma. In addition, season of birth does not appear to be a material factor; the previous finding of an increased risk for fall season of birth is most likely not valid and probably a chance finding due to small sample size.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficiency of human papillomavirus (HPV) testing by Hybrid Capture II (Digene Diagnostics Inc., Silver Spring, MD) with regard to detecting biopsyconfirmed cervical intraepithelial neoplasia (CIN) or high-grade CIN in women with mild atypia, compared with the efficiencies of polymerase chain reaction (PCR), Southern blot hybridization, and cytology.MethodsWe prospectively studied 378 women with atypical squamous cells of undetermined significance (ASCUS) (n= 111) or low-grade squamous intraepithelial lesions (SILs) (n= 267) demonstrated by referral cytology. We did repeat cytology, sampling for detection of HPV DNA by Hybrid Capture II, PCR, and Southern blot hybridization, and colposcopic evaluation with cervical biopsies.ResultsAll participants underwent the Hybrid Capture II test and 320 underwent the three HPV tests. Sensitivities of Hybrid Capture II for detecting CIN and high-grade CIN (0.81 and 0.86, respectively) were similar to those of cytology (0.83 and 0.82, respectively) and PCR (0.77 and 0.95, respectively), and higher than those of Southern blot hybridization (0.48 and 0.45, respectively). Compared with cytology, combined triage with Hybrid Capture II improved sensitivities for detecting CIN (0.94 versus 0.83,P< .001) and high-grade CIN (0.96 versus 0.85), though the latter difference was not significant (P= .17). In women with ASCUS, sensitivities of combined triage and cytology for detecting CIN were 0.94 and 0.71, respectively (P= .01), and sensitivities of the two methods for detecting high-grade CIN were 0.92 and 0.66, respectively (P= .13). The increase in sensitivity was lower among women with low-grade SILs; for these women, cytology had high sensitivity (0.86 for CIN and 1.00 for high-grade CIN). The specificity of combined triage was significantly lower than that of cytology in both groups.ConclusionCompared with repeat cytology, combined triage with HPV testing markedly improves sensitivity for detecting CIN in women with ASCUS, but at the expense of specificity.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo identify risk factors for residual or recurrent cervical intraepithelial neoplasia (CIN) after large loop excision of the transformation zone with clear margins.MethodsWe did a case-control study of women treated with loop excision for CIN who had adequate follow-up and in whom margins were believed to be clear. Women with clear margins in whom no subsequent lesions were found (controls) were compared with women who presented with subsequent CIN (cases). Epidemiologic and colposcopic risk factors for recurrence were analyzed. Multiple logistic regression analysis was done to identify independent risk factors.ResultsIn 31 of 635 women studied (4.9%), subsequent lesions were diagnosed. Univariate analysis identified glandular involvement, satellite lesions, and age over 40 years in cases as significant. Multiple logistic regression analysis confirmed that these three characteristics were independent risk factors, with odds ratios of 4.9 (95% confidence intervals 1.9, 12.3), 19 (7.5, 48.2), and 6.7 (2.8, 15.8), respectively. Subsequent lesions were identified by colposcopy or cytologic testing during the first postoperative year in all but one case.ConclusionAge over 40 years, glandular involvement, and satellite lesions were related to the reappearance of CIN after loop excision with clear margins. These findings could be used to define appropriate follow-up protocols.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo compare the prognoses of women diagnosed with cervical cancer during pregnancy with the prognoses of those diagnosed within 6 months after delivery and to assess the effect of vaginal delivery on recurrence risk and prognosis.MethodsA matched case-control study of women with cervical cancer diagnosed during pregnancy or within 6 months of delivery was performed. Fifty-six women had cervical cancer diagnosed during pregnancy and 27 within 6 months after delivery. Controls (cervical cancer diagnosed at least 5 years since last delivery) were matched one-to-one with cases based on age, histology, stage, treatment, and time of treatment.ResultsAmong postpartum women, four had stage IA disease, 15 had stage IB1 or IB2, and eight had stage IIA or higher disease. Eleven had radical hysterectomies and 14 had radiation therapy. Two with stage IA1 disease were treated with vaginal hysterectomies. One of seven patients who had cesareans developed a local and distant recurrence. In contrast, ten of 17 (59%) who delivered vaginally developed recurrences (P= .04). In multivariate analysis, vaginal delivery was the most significant predictor of recurrence (odds ratio [OR] 6.91; 95% confidence interval [CI] 1.45, 32.8), followed by high stage (OR 4.66; 95% CI 1.05, 20.8). The survival for patients diagnosed in the postpartum period was significantly worse than for controls.ConclusionWomen diagnosed postpartum had worse survival than those diagnosed during pregnancy and were at significant risk of recurrent disease, particularly if they delivered vaginally. Therefore, pregnant women with cervical cancer should be delivered by cesarean.

ISSN:0029-7844    

出版商:OVID    

年代:2000

数据来源: OVID