ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine the role of the steroid hormones, progesterone and glucocorticoids, and the viral hormone response elements, in the episomal expression of human papillomavirus (HPV) type 16 in primary human ectocervical cells.Methods:In situ hybridization and mutagenesis were used to assess the requirements of these hormones and the HPV 16 glucocorticoid/progesterone response elements in the induction of HPV 16 expression in ectocervical cells.Results:The assays detected a marked increase in viral messenger RNA only after treatment of the cells with either of the steroid hormones. This response was inhibited by the anti-progestin RU 486 in a concentration-dependent manner. Mutagenesis of the previously identified hormone response element in the regulatory region of the HPV 16 genome had no effect on hormone-induced HPV gene expression. We have now identified two additional hormone response elements. Different combinations of mutations in the three hormone response elements showed that all three were independently sufficient for the hormone-mediated induction of viral transcription.Conclusions:Steroid hormones induce HPV 16 gene expression in cervical keratinocytes directly through three hormone response elements in the regulatory region of the viral genome. The anti-progestin RU 486 inhibits this induction. Because the physical state of HPV DNA in this in vitro system and in premalignant cervical lesions is extrachromosomal, steroid hormones may have a critical role in modulating HPV expression in such lesions. (Obstet Gynecol 1993;81:5-12)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine whether vulvar squamous cell carcinomas associated with certain morphologic features and/or human papillomavirus (HPV) nucleic acids were more likely to be associated with other genital primary squamous neoplasms.Methods:We surveyed 169 invasive squamous cell carcinomas of the vulva and correlated associated vulvar intraepithelial neoplasia (VIN), invasive growth patterns resembling VIN (intraepithelial-like or basaloid), and the presence of HPV nucleic acids by in situ hybridization with a history of a second primary squamous neoplasm of the genital tract.Results:Twenty-two patients (13%) had a history of a second primary. An intraepithelial growth pattern or an associated VIN correlated significantly with HPV, at P=.0005 and P=.007, respectively, and with a second primary, at P=.077 and P=.009, respectively. When HPV-positive, the same histologic variables correlated with a second primary at P=.099 and P=.25, respectively. Compared with cases lacking both these histologic features and HPV, they correlated with multifocal disease at P=.01 and P=.003.Conclusions:The findings of HPV nucleic acids, tumor growth patterns, and associated VIN are interrelated and confer risk of other genital primary neoplasms in women with vulvar carcinoma. This supports the concept that subsets of vulvar carcinoma may be distinguished not only by morphology and HPV DNA, but also by a distinctly different risk of a second genital primary neoplasm. (Obstet Gynecol 1993;81:13-8)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine the influence on survival from cervical cancer of human papillomaviruses (HPVs) and other factors including age, herpes simplex virus type 2 (HSV-2) antibody status, and number of pregnancies.Methods:We followed 196 women diagnosed with invasive cervical cancer in Panama for an average of 32 months. Clinical and risk-factor information was obtained from these women through an interview and review of medical records. We assessed HPV DNA status by testing tumor specimens using polymerase chain reaction. Southern blot, and slot blot techniques. Kaplan-Meier survival curves and Cox proportional hazards model were used to assess the risk of mortality associated with selected variables.Results:Eighty-one percent (N=144) of the women tested for HPV were positive. Absence of HPV DNA was associated with a 1.9-fold excess risk of mortality (95% confidence interval [CI] 1.1-3.3) after controlling for age, clinical stage at diagnosis, number of pregnancies, and HSV-2 seropositivity. Women diagnosed with cervical cancer before the age of 30 had a ninefold excess risk of dying compared with those diagnosed at age 50 or older (relative risk [RR] 9.3, 95% CI 3.4-25.5). Parity was also an independent prognostic factor. Women with six or more pregnancies had a 2.5-fold excess risk of dying compared with women with three or fewer (95% CI 1.2-5.3). Years of education, presence of HSV-2 antibodies, age at first intercourse, number of sexual partners, oral contraceptive use, and cigarette smoking were not significantly associated with prognosis.Conclusion:These findings suggest that women negative for HPV DNA, those who are diagnosed at an early age, and those who have multiple pregnancies might have more aggressive tumors.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To assess the feasibility of using cyst fluid CA 125 levels to distinguish between benign and malignant ovarian cystic neoplasms.Methods:CA 125 levels were measured in ovarian cyst fluid and in serum obtained at surgery in 44 women with ovarian cystic tumors of epithelial origin (25 benign, malignant, and seven borderline).Results:The median cyst fluid CA 125 level in malignant neoplasms (671 U/mL) was higher than in benign tumors (175 U/mL), and 86% of the malignant tumors contained levels higher than 100 U/mL in the cyst fluid, compared with only 62% of the benign tumors. However, these differences were not statistically significant.Conclusion:Cyst fluid levels of CA 125 cannot be used distinguish between benign and malignant ovarian cysts of epithelial origin. (Obstet Gynecol 1993;81:25-8)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine whether the decline in CA 125 level after surgery can predict the extent of residual disease.Methods:In a prospective, nonrandomized clinical trial, 27 women with advanced ovarian cancer (stage III or IV) underwent primary or secondary cytoreductive surgery. CA 125 levels were measured before surgery and 3-14 days postoperatively. The mean postoperative decline was compared by size of residual disease.Results:In women with all visible cancer resected, mean (± standard error of the mean) decline in CA 125 was 91 ± 4% (1032 ± 473 U/mL preoperatively to 90 ± 31 U/mL postoperatively). With less than 2.0 cm residual, there was an 85 ± 2% decline in CA 125 after surgery (3061 ± 835 U/mL preoperatively to 456 ± 146 U/mL postoperatively). In patients with residual disease larger than 2.0 cm, the levels dropped 36 ± 10% (2958 ± 1587 to 1904 ± 708 U/mL). If CA 125 declined less than 60% from the preoperative level, sensitivity, specificity, and positive and negative predictive values for residual disease larger than 2.0 cm were all 100%.Conclusion:By using the ratio of CA 125 levels before after cytoreductive surgery, one can predict the likelihood that the patient was left with less than 2.0 cm residual disease. (Obstet Gynecol 1993;81:29-32)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To evaluate prospectively the 1989 Centers for Disease Control recommendations for treatment of gonorrhea in pregnancy.Methods:Two hundred fifty-two women referred with probable endocervical gonorrhea had pre-treatment endocervical, rectal, and oral cultures for Neisseria gonorrhoeae and direct fluorescent antibody testing for Chlamydia trachomatis. They were assigned randomly to receive ceftriaxone 250 mg intramuscularly (IM), spectinomycin 2 g IM, or amoxicillin 3 g orally plus probenecid 1 g orally. Treatment was unblinded and in a 1:1:1 distribution.Results:Two hundred forty-five women (97%) had endocervical infection, 68 (27%) had rectal infection, and 17 (7%) had pharyngeal infection. One hundred two of 252 women (40%) had concomitant endocervicalC trachomatis. The overall efficacy was 235 of 252 subjects (93%) (95% confidence interval [CI] 90.1-96.4%). Ceftriaxone was effective in 80 of 84 cases (95%) (95% CI 90.6-99.9%), amoxicillin with probenecid was effective in 75 of 84 cases (89%) (95% CI 82.5-96%), and spectinomycin was effective in 80 of 84 cases (95%) (95% CI 90.6-99.9%). No significant difference was noted in overall efficacy or by site of infection. There was no increased incidence of congenital malformations in the offspring of any treatment group.Conclusions:Ceftriaxone and spectinomycin are safe and effective for the treatment of gonorrhea in pregnancy. Amoxicillin with probenecid has lower efficacy and is not recommended for treatment of gonococcal infection in pregnancy. (Obstet Gynecol 1993,-81:33-8)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To develop current birth weight norms by gestational age for singleton and twin births in Canada.Methods:Birth weight data were obtained from vital statistics and health department birth registrations for over one million live births in Canada from 1986-1988. Unlikely combinations of birth weight and gestational age were defined within each stratum of multiplicity, gender, gestational age as records with birth weights more than interquartile ranges above the 75th percentile or below 25th percentile. Birth weight percentiles (from first to 99th) by gestational age and sex were calculated for singleton and twin live births.Results:Of the total records, 0.4% were missing data on birth weight or gestational age, and an additional 0.4% were identified as extreme outliers and were excluded from the analysis. Charts of birth weight by gestational age show percentiles 1, 3, 5, 10, 25, 50, 75, 90, 95, 97, and 99 by sex singleton and twin live births.Conclusions:The large data base assembled for this analysis provides current, stable birth weight-gestational age percentiles for classifying newborns from a developed country as small, appropriate, or large for gestational age. Compared with birth weight distributions from the 1970s, these current norms are heavier for full-term infants and the interdecile range for preterm infants is narrower. We recommend that birth weight norms be updated every 5-10 years.(Obstet Gynecol 1993;81:39-48)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To test the hypothesis that maternal oral hydration would increase the amniotic fluid (AF) index in pregnancies with normal AF.Methods:Forty women with a normal AF index (7.0-24.0 cm) were randomized to either the control or hydration group. Women in the hydration group drank 2 L of water and returned for the post-treatment AF index in 4-6 hours, whereas women in the control group drank only 100 mL of water during the same time period. The investigator performing the AF index was blinded to the subject's group. The pre- and post-treatment AF indexes and maternal urine specific gravities were compared between the groups.Results:The mean AF index in the hydration group increased significantly by 3.0 ± 2.4 cm (P≤ .0001) whereas it declined significantly by 1.5 ± 2.7 cm in the control group (P≤ .02). The maternal urine specific gravities also changed significantly in the expected direction, with those in the hydration group decreasing and those in the control group increasing (P≤ .0001). There was a regression coefficient of —0.6 (P≤ .0001) between the change in urine specific gravity and the change in AF index. The mean time between the pre- and post-treatment AF indexes was not different between the groups.Conclusions:Maternal oral hydration increased the AF index by approximately 16%, whereas fluid restriction decreased the AF index by 8% in women with normal AF. These findings support previous data that maternal hydration increased the AF index by 31% in women with decreased AF and suggest that maternal fluid volume or osmolality may have a role in maintaining the AF volume. (Obstet Gynecol 1993/81:49-52)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine which sonographic findings predict intestinal damage in fetuses with gastroschisis, and to develop objective criteria that may be useful in selecting candidates for preterm delivery.Methods:Twenty-four consecutive fetuses at two perinatal centers were assessed retrospectively or prospectively. Maternal, perinatal, and sonographic data were recorded and correlated with postnatal outcome.Results:Bowel diameter of at least 18 mm was associated with a significantly longer time to oral feeding and with significantly greater need for bowel resection. When gestational age was plotted against bowel diameter, a threshold curve was generated, above which all patients had prolonged hypoperistalsis and below which only 30% had prolonged hypoperistalsis. Two infants were delivered at weeks' gestation, both of whom had complications potentially related to prematurity. Only one of 22 patients who delivered later than 33 weeks had similar complications.Conclusions:Bowel dilatation may be a marker of prenatal bowel damage in fetuses with gastroschisis, especially when it presents late in gestation. Prenatal sonography may be useful in selecting appropriate fetuses for preterm delivery.(Obstet Gynecol 1993;81:53-6)

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID