ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A standard surveillance program for cervical carcinoma patients treated with radical hysterectomy is reviewed. Between 1962-1984, 249 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy were entered in the surveillance program. Of the 27 patients (11%) diagnosed with recurrent carcinoma, 17 (63%) were identified by clinical history, 22 (81%) by physical examination, five (18%) by vaginal cytology, six (22%) by chest radiography, and eight (30%) by renal contrast imaging. Combined clinical history and physical examination identified 24 patients (89%) with recurrent carcinoma. Disease recurrence was detected by vaginal cytology in one asymptomatic patient with a normal examination. The recommended surveillance procedures for patients with cervical carcinoma after radical hysterectomy include clinical history, physical examination, and vaginal cytology. Chest radiography and renal contrast imaging should be reserved for symptomatic patients.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fourteen patients with stage IB or IIA neuroendocrine small-cell cervical cancer were treated either by operation alone or operation in combination with postoperative radiotherapy at the University of California, Irvine Medical Center, and Memorial Medical Center of Long Beach, between January 1979 and February 1986. Patients were included in the study only if they met characteristic light and electron microscopic criteria for neuroendocrine small-cell cancer. Thirteen patients underwent radical hysterectomy and one a simple hysterectomy. All patients underwent pelvic lymphadenectomy, with 57% found to have nodal metastases. Twelve of 14 patients are dead of disease eight to 31 months after treatment, and the two living patients had recurrence at 38 and 44 months. One is without evidence of disease 18 months after radiation for a pelvic recurrence, and the other has survived five months after recurrence without treatment. The interval from treatment to recurrence was substantially longer in patients with tumors up to 2 cm in diameter as compared with those greater than 2 cm. Despite the early stage of cancer in these patients, the dismal outcome indicates that traditional modes of therapy for cervical cancer are not effective in cases of neuroendocrine small-cell carcinoma.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Forty-two patients treated for in situ vulvar cancer at two institutions participated in structured assessment interviews and completed questionnaires to examine postoperative sexual, marital, and psychological adjustment. Patient responses were compared with a matched sample of gynecologically healthy women. The results indicated a specific pattern of sexual disruption for the women treated for preinvasive disease. Sexual behavior patterns appeared to be maintained, as was the desire phase of the sexual response cycle. However, there was specific disruption of the phases of excitement and resolution and, to a lesser extent, orgasm. In addition to a two- to threefold increase in the frequency of sexual dysfunction, 30% of the sample was sexually inactive at follow-up. Although replication of these findings is necessary, this investigation suggests that sexual functioning correlates with the magnitude of treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Serum samples obtained from 133 patients with gynecologic malignancies were assayed for two tumor-associated antigen markers: CA125, an ovarian marker, and lipid-associated sialic acid, a nonspecific marker. In the patient population, there were 77 papillary serous and 19 unspecified ovarian adenocarcinomas, and 24 miscellaneous ovarian carcinomas. Thirteen patients had nonovarian malignancies. Sixty-nine percent (74 of 108) of the patients with known disease had abnormal CA125 levels, whereas only 32% (20 of 63) had abnormal lipid-associated sialic acid levels. Changes in CA125 serum levels reflected the disease status of the patients for whom there were serial serum samples. Normal levels of CA125 corresponded to no evidence of disease in 100% (six of six) surgically evaluated patients and 75% (30 of 40) of clinically evaluated patients. Changes in CA125 levels from normal to abnormal corresponded to disease progression in 80% (12 of 15) of the patients. Decreases in CA125 levels from abnormal to normal corresponded to complete clinical response in 55% (11 of 20), and partial clinical response in 45% (nine of 20). No such correlations were available for lipid-associated sialic acid antigen levels. For tumors that express CA125 antigen, serum levels appear to be a good marker for the extent of malignant gynecologic disease. Levels of CA125 that rose from normal to abnormal were usually associated with recurrent disease.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The purpose of this study was to analyze hospital resource consumption by age for gynecology patients and to examine whether the assumptions made when the Diagnostic Related Groups payment was structured appear to be valid for our hospital. All gynecology admissions (N = 2232) at a large academic medical center during a 15-month period were analyzed by age using the Diagnostic Related Group format. Older patients generally consumed a disproportionately higher share of resources. Length of hospital stay, intensive care unit use, blood transfusion requirements, and overall hospital cost generally increased with age. Although mean Diagnostic Related Group reimbursement per patient also rose with age, it plateaued for patients 65 years of age and older. However, our hospital did not sustain a loss in providing care under Diagnostic Related Groups for older patients, except for the group of patients between the ages of 75-79 years. Although older gynecology patients generally had higher hospital resource consumption than younger patients, the current Diagnostic Related Group system seemed to adequately reimburse our hospital for their care.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine the effects of oral contraceptives on lipids and Iipoproteins over a six-month period, we randomized 266 women into four oral contraceptive groups: ethinyl estradiol 35 µ/g plus ethynodiol diacetate 1 mg, ethinyl estradiol 30 µg plus levonorgestrel 0.15 mg, ethinyl estradiol 35 µg plus norethindrone 1 mg, and ethinyl estradiol 35 fig plus norethindrone 0.5 and 1 mg (biphasic). For all groups, total cholesterol increased 5.9-9.1% from baseline values over the six months. Triglycerides increased with all preparations, with the ethynodiol diacetate group (37.6%) and the biphasic norethindrone group (45.3%) showing the greatest increase. Low-density lipoprotein cholesterol increased 10-15.6% among the groups; low-density lipoproteinapolipoprotein B changed proportional to the low-density lipoprotein cholesterol increases. All groups except the ethynodiol diacetate group showed a decrease of highdensity lipoprotein cholesterol, with the levonorgestrel group (8.7%) and biphasic norethindrone group (4.5%) showing the largest declines. ApolipoproteinA-l increased in all groups, with the ethynodiol diacetate preparation (19.3%) showing the greatest increase and the levonorgestrel preparation (3.2%) showing the smallest increase from baseline values. The changes in apolipoproteinA-l were out of proportion to the changes in high-density lipoprotein cholesterol, suggesting that the high-density lipoprotein particle may be undergoing some type of metabolic alteration.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To minimize the cyclic menstrual bleeding associated with the sequential administration of estrogen and progestin in menopausal women, medroxyprogesterone acetate at the daily dose of 10 mg orally was administered, either sequentially for ten days of each 25-day treatment cycle or continuously with conjugated equine estrogen for three months. Cyclic menstrual bleeding occurred in all ten patients on sequential therapy; their endometrial histology was secretory in six, proliferative in two, and adenomatous hyperplasia in one. Of the ten patients on continuous therapy, four were amenorrheic and six experienced acyclic bleeding, but the endometrial histology was atrophic or inactive in all ten. The continuous treatment group experienced a statistically significant decrease in the mean serum levels of total cholesterol, whereas the serum levels of both low- and high-density cholesterol fractions decreased slightly. However, the sequential group experienced no change in serum levels of total cholesterol, a slight rise in high-density lipoprotein, and a significant decrease in low-density lipoprotein cholesterol fractions. Our data suggest that the combined and continuous use of conjugated equine estrogen and medroxyprogesterone acetate effectively relieves menopausal symptoms, decreases the frequency of uterine bleeding, induces endometrial atrophy, and significantly decreases serum levels of total cholesterol.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Other studies of plasma gonadotropin-releasing hormone profiles after bolus injection have revealed earlier, sharper peaks and higher blood gonadotropin-releasing hormone levels with the intravenous (IV) than with the subcutaneous route of administration. We used both routes to administer gonadotropin-releasing hormone by bolus injection to thin and obese subjects. Plasma gonadotropin-releasing hormone profiles after IV administration were similar in both groups. The subcutaneous route produced flatter, delayed, and lower peaks, an effect markedly exaggerated in obese subjects, who demonstrated 95% lower peak gonadotropin-releasing hormone levels compared with the IV route and 64% lower levels than thin subjects after subcutaneous administration. These findings may be relevant to therapeutic failures observed in obese subjects using the subcutaneous route.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The purpose of this study was to investigate the potential relationship between the salivary electrical resistance, as measured by the Cue Fertility Monitor, and the time of ovulation. Twenty-seven cycles in 18 volunteers were analyzed. A slight correlation could be demonstrated between the day of salivary electrical resistance peak and the day of luteinizing hormone (LH) peak. However, the changes in salivary electrical resistance values, arranged to the day of LH peak, were not statistically significant. The days of salivary electrical resistance peak in relation to the day of LH peak were not reproducible in individual women. The apparent relationship between the day of salivary electrical resistance peak and the day of LH peak might be explained by the methodology used. It is concluded that measuring the salivary electrical resistance is of no use in predicting the day of ovulation.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID