ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Fifty-two patients with objective evidence of pressure equalization incontinence and detrusor instability were evaluated retrospectively to compare nonsurgical modes of therapy with retropubic surgery. Based on the patient's desire for surgery and her overall medical condition, 27 women were treated primarily with retropubic urethropexy (modified Burch procedure) and 25 with various combinations of oxybutynin, imipramine, and estrogen. Thirty-two percent of the patients treated medically were cured and 28% were markedly improved, whereas 59% of patients treated surgically were cured and 22% improved. There was no statistically significant difference in the results between medical and surgical therapy. AH failures in the surgically treated group were due to persistent detrusor instability after surgery. We identified no preoperative urodynamic criteria that consistently and accurately predicted surgical outcome in patients with combined stress and urge incontinence. Patients with combined stress incontinence and detrusor instability should initially be managed medically, as this will reduce the incidence of surgical intervention

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Often ovarian cancer does not present clinically until the advanced stages. In the past, the presence of any cystic adnexal enlargement in postmenopausal women was an indication for surgical exploration. The ultrasound scans of 42 postmenopausal women with simple adnexal cysts were reviewed. We included only patients who were available for follow-up and who had cysts that were less than or equal to 5 cm in maximum diameter, unilocular (ie, without septations or solid components), and without ascites. Of these patients, 26 underwent prompt surgical exploration. All exhibited benign histopathology. In 16 patients, serial sonographic surveillance was performed every 3-6 months. Two of these patients had exploratory laparotomy at 6 and 9 months of observation; the first operation, for increasing size and septation, demonstrated a cystadenofibroma, and the second, for increasing pain, demonstrated a degenerating myoma. The remaining 14 patients were followed from 10-73 months without any change in size or character of the cyst. Small (less than 5 cm), unilocular postmenopausal cysts had a low incidence of malignant disease (0%) in this series of 28 surgical specimens. Therefore, serial ultrasound follow-up without surgical intervention may play a role in the clinical management of such patients

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Little has been published about adnexal torsion among postmenopausal women. To address this question, we reviewed the records of all postmenopausal women with a postoperative diagnosis of ovarian neoplasm over a 10-year period. Among 301 tumors, 19 (6%) underwent torsion. Serous cystadenoma was the most frequent tumor type. No malignant neoplasm underwent torsion in this series. Adnexal torsion is not limited to women of reproductive age

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

To ascertain the significance of squamous atypia encountered during routine Papanicolaou smear screening in an older population, we reviewed 115 consecutive patients over age 50 seen during a 3-year period. Evaluation included repeating the smear and performing colposcopy in all patients. Colposcopically directed biopsy and endocervical curettage were performed when appropriate. Sixty-seven patients (58.3%) had atrophy, 43 (37.4%) were normal, two (1.7%) had cervical intraepithelial neoplasia grade 1, two (1.7%) had cervical intraepithelial neoplasia grade 2, and one (0.9%) had human papillomavirus (HPV) infection. There was a strong association between squamous atypia and estrogen deficiency. With the correction of the estrogen deficiency, the squamous atypia reverted to normal in a statistically significant percentage of patients. A Papanicolaou smear report of squamous atypia in women over age 50 should not be considered normal; further evaluation is required. The incidence of cervical or vaginal intraepithelial neoplasia and HPV infection is much lower than reported in studies involving younger patients

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Hysteroscopic evaluation of 187 patients with abnormal uterine bleeding is reviewed. One hundred fifty-one patients had recent tissue sampling by a blind method. The hysteroscope with selected endometrial sampling was more accurate in 9.1% and less accurate in only 0.5% of patients. The specificity of both techniques with selected biopsies was 100%, but the sensitivity of hysteroscopy was greater (98%) than that of D&C (65%). Endometritis was the only condition missed by hysteroscopic viewing and selected biopsy. Those lesions missed by blind tissue sampling were uterine fibroids and endometrial polyps. Among 91 patients whose hysteroscopic view was negative, an abnormality was identified by tissue sampling in only one patient with endometritis

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The marked increase of ectopic pregnancy in Finland was studied in 5-year age groups from 1968-1984. In the early 1970s, the overall increase was attributable to women under 30 years of age, and in the early 1980s to women aged 30 years or more. The increase in the incidence rate of ectopic pregnancy per 100,000 women has taken place somewhat successively since the late 1960s in women aged 20-24, 25- 29, 30-34, and 35-39 years. The incidence of ectopic pregnancy per 100,000 women increased by every successive 5-year cohort born since the late 1930s up to the cohort born in 1954-1958; thereafter, the birth cohorts have experienced an equal or even lower risk of ectopic pregnancy. The findings suggest that the large “baby boom” cohort (born in 1945-1954), with its high risk of ectopic pregnancy, is mainly responsible for the overall increase in the number of ectopic pregnancies seen in the past decade. When these cohorts end their reproductive years, the marked increase in the number of ectopic pregnancies in Finland may decrease, but the incidence rates will probably stay stable

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This study examined the use of extended carbon dioxide laser vaporization in 25 women with histologically confirmed, multicentric subclinical papillomavirus infection of the lower genital tract to determine whether carbon dioxide laser can eradicate subclinical papillomavirus infection. An extended carbon dioxide laser procedure involved vaporization of the epithelium of the entire lower genital tract. We performed the procedure under colposcopic guidance. Vaporization was carried out in continuity, to an appropriate tissue depth, while using recommended power densities for the respective target tissue. For sexually active study patients, male consorts were evaluated and treated concurrently to reduce the risk of recurrent infection. Postoperative morbidity was considerable, with moderate to severe vulvar pain and febrile reactions occurring in 100 and 76% of patients, respectively. Histologic persistence of subclinical papillomavirus infection was documented in 88% of study patients at follow-up examination. Neither treatment of the male consort nor sexual abstinence significantly improved treatment outcome. These data suggest that extended carbon dioxide laser procedures cause significant short-term morbidity without effectively eradicating subclinical papillomavirus infection of the female lower genital tract

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

These studies were conducted to determine whether human decidua produces interleukin-1 in response to bacterial endotoxin. Explants of human decidua were incubated with and withoutEscherichia coliendotoxin for 20 hours. When tested for interleukin-1-Iike activity with the D10.G4.1 Tcell bioassay, supernatants from endotoxin-stimulated decidua contained significantly more interleukin-1 activity than did supernatants from unstimulated decidua. This activity could not be attributed to interleukin-2, as determined in the CTLL/2 assay for interleukin-2. Interleukin-1-like activity was due to interleukin-1, as demonstrated by the blockade of this bioactivity with antibodies against interleukin-1: interleukin-i alpha and interleukin-1 beta. Antibodies against interleukin-1 alpha blocked the activity in five of six cases. In one instance, the bioactivity could be attributed to a mixture of interleukin-1 alpha and interleukin-1 beta. These data demonstrate that human decidua can produce interleukin-1 in response to bacterial endotoxin

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We examined the relationship between pain and cognitive activity during the latent (≤ 3 cm), mid-active (5-7 cm), and transition (≥ 8 cm) phases of labor and the concomitant efficiency of the latent, active, and descent phases in 115 nulliparous women. Patients provided subjective pain ratings and described their thoughts during each of the three phases. Higher levels of pain during the latent phase of labor were predictive of longer latent (r=0.58) and active (r=0.50) phases of labor. Distress-related thoughts during latent labor were predictive of longer latent (r=0.31, P<.01), active (r=0.67), and second-stage (r=0.61) labor. We found no relationships between pain and cognitive activity measured during active labor and efficiency of active labor or second stage of labor. Pain and cognitive activity assessed during the latent phase were also prognostic of obstetric outcome. Thirteen of 19 women (68.4%) who reported “horrible” or “excruciating” pain required instrumental delivery, compared with eight of 27 women (29.6%) in the “discomforting” pain group. Subjects in the “distressrelated” cognitive group had 2.6 times the incidence of instrumental delivery, five times the incidence of abnormal fetal heart rate patterns, and four times the requirement for pediatric assistance for the neonate than subjects in the “coping” group. We conclude that latent labor is a critical phase in the psychobiology of labor and that pain and cognitive activity during this phase are important contributors to labor efficiency and obstetric outcome

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID