Accuracy of tumor grade assigned at initial endometrial sampling.
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Biopsy↗
Biomedical subjects
C Westhoff
Publications and source records attributed to C Westhoff.
Past intrauterine device use and risk of tubal pregnancy.
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Contraceptive Devices↗
Detection of ovaries by transvaginal sonography in postmenopausal women.
A total of 230 apparently healthy postmenopausal women underwent transvaginal sonography and pelvic examination. The mean ovarian volume was 3.1 cm(3) with a range of 0.4-57.4 cm(3) and fewer than 5% (4.8%) of the subjects had a mean volume exceeding two standard deviations of the sample mean. Transvaginal sonography successfully imaged 64% of reported ovaries overall, although the proportion of ovaries imaged varied by sonographer. The poorer imaging rates found in this study, as compared with some previous investigations using transabdominal sonography, could be due to several factors including the type of sonography, the type of sample, the scanning time, and/or the criteria used to identify an ovary. Transvaginal sonography offers practical advantages over transabdominal sonography, but the potential loss in sensitivity, due to non-visualization of a substantial proportion of ovaries, must be formally assessed before adopting transvaginal sonography more widely as the primary screening modality.
Journal Article↗
Is ovarian cancer associated with an increased frequency of germinal inclusion cysts?
It has been proposed that epithelial ovarian cancers arise in germinal inclusion cysts of the ovary, which are thought to form as stigmata of ovulation. To evaluate whether the frequency of germinal inclusion cysts is associated with ovarian cancer, the authors counted the germinal inclusion cysts in single slides of sections from ovaries of 148 women who underwent incidental oophorectomy and from the contralateral ovaries of 37 women with unilateral ovarian cancer at Columbia-Presbyterian Medical Center, New York, New York, in 1985-1991. The mean number of germinal inclusion cysts was 2.7 for cases and 3.6 for controls. Conditional logistic regression analysis showed that germinal inclusion cysts were not associated with ovarian cancer (odds ratio = 0.98, 95% confidence interval 0.92-1.04). These findings do not support the hypothesis that increased formation of inclusion cysts is a risk factor for ovarian cancer.
Case-Control Studies↗
The impact of family planning on women's health.
Approximately half a million women in developing countries die each year as a result of complications during pregnancy. Sadly, illegal abortion is one of the five major causes of these deaths. International data suggest that maternal mortality is decreasing in regions where the use of family planning is increasing because of the consequent avoidance of unwanted pregnancies, although accurate data on maternal mortality are difficult to obtain in most developing countries. Use of family planning to delay first births and to increase interpregnancy intervals has the potential to decrease infant mortality by at least 20%. Data from developing countries show that some of this potential has already been realized during the past 20 years, but additional improvement is possible. In countries where maternal mortality is low, women may avoid using contraceptives because of the perceived dangers of the most effective methods. Recent analyses show that cardiovascular risks associated with oral contraceptives are low, and that the net effect of oral contraceptives on cancer of the ovary and endometrium is one of protection. While there remain unanswered questions regarding cervical and breast cancer, the net effect is small at worst.
Abortion, Illegal↗
Profiles of women age 30-39 and age less than 30 with epithelial ovarian cancer.
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Adult↗
Residency training in contraception, sterilization, and abortion.
Obstetrics and gynecology residency program directors and chief residents were surveyed, and 80% responded to a questionnaire regarding training in contraception, sterilization, and abortion. Most program directors reported that teaching and clinical experience is provided in these areas. The chief residents, however, reported having less clinical experience than was estimated by their program directors. Most residents reported experience prescribing oral contraceptives and performing tubal ligations, but had little experience with other methods. Thirty-eight percent of graduating chief residents reported never having inserted an intrauterine device, 47% had never performed a first-trimester abortion, and 43% had never performed a dilation and evacuation. Residency programs need to set competency goals in these areas so that new practitioners will be well prepared to care for American women who wish to control their fertility.
Abortion, Induced↗
Benign ovarian cysts in England and Wales and in the United States.
OBJECTIVE: To compare the rates of hospital admission for management of ovarian cysts in England and Wales and the United States between 1972 and 1974 and 1984 and 1986; and to determine whether these rates are related to rates of early diagnosis of ovarian cancer. DESIGN: Analysis of published and unpublished hospital discharge data based on national samples, the Hospital In-patient Enquiry (HIPE), a 10% hospital discharge sample for England and Wales, and the National Hospital Discharge Survey (NHDs), a 5% sample for the United States. MAIN OUTCOME MEASURES: Age-specific discharge rates for primary and secondary diagnoses of ovarian cyst or benign ovarian tumour. RESULTS: There was an age-adjusted increase in discharge rates of about 8% in both countries; discharge rates in the United States were approximately double those in England and Wales in both time periods. There was no difference in the rates of early diagnosis of ovarian cancer. CONCLUSIONS: Ovarian cysts are a common cause of hospital admission in both countries. The higher rates in the United States are not associated with earlier diagnosis of ovarian cancer.
Adult↗
Ovarian cancer screening: potential effect on mortality.
Serum tumor markers and ultrasonography are being investigated as possible ovarian cancer screening tests. Data from the United States on ovarian cancer incidence and survival were used to estimate the potential benefit on ovarian cancer mortality from screening tests of various sensitivities. A test with 80% sensitivity could reduce ovarian cancer mortality by 50% if all screening-detected cases were to experience current stage I survival rates; the benefit would be greatest among women aged 45 or older. For each cancer detected there would be at least 50 false-positive screening tests unless test specificity is greater than 98%. If our most optimistic assumptions about screening could be met, then universal periodic screening of women aged 45 to 74 would result in about 5000 additional 5-year survivors of ovarian cancer annually. Uptake of existing screening tests is far less than universal; thus we would expect the impact of any ovarian cancer screening program to fall short of these projections.
Adult↗
The effect of the New York State restrictions on resident work hours.
New York state has recently restricted the hours that residents may work to an average of 80 hours per week. We have complied with these regulations through the addition of nonresident personnel, including attending physicians, a physician assistant, and nurse midwives. This study was designed to assess the effect of these changes on our residents. A questionnaire covering the effects of our new system was distributed to both attending and resident staff. Surgical case load and Council on Resident Education in Obstetrics and Gynecology (CREOG) scores since the change were compared with those of previous years. A marked improvement in resident life-style was noted. Although residents commented that they had increased time for reading, this was not reflected in an improvement in the CREOG scores. The quality of patient care was not felt to be improved, and the continuity of care was considered to be adversely affected. Resident surgical case load was unchanged. The assignment of emergency room coverage to attending physicians and gynecologic floor coverage to a physician assistant was seen as having a detrimental effect on resident experience. We conclude that the new restrictions on resident work hours in New York have improved resident quality of life. However, there does not appear to be an improvement in patient care, which was the original intent of the statute. Concerns are discussed about the effect of this decrease in hours worked on resident experience and education. Further research is needed to assess the long-term effects of reduced resident work hours on both patient care and resident education.
Attitude of Health Personnel↗
Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy.
With the advent of high-frequency transvaginal ultrasonography, new opportunities are presented to better define ovarian lesions. The goal of this study was to develop a scoring system using transvaginal sonographic characterization of pelvic/ovarian lesions. Our purpose was to maximize the discrimination between benign and malignant entities. Transvaginal sonographic pelvic images of 143 patients were correlated with surgical findings or histopathology. Of 281 ovaries, 108 had benign lesions (30 endometriomas, 24 teratomas, 21 simple cysts, and 33 other abnormalities) and 20 had malignancies. The scoring system devised was useful in distinguishing benign from malignant masses, with a specificity of 83%, sensitivity of 100%, and positive and negative predictive values of 37 and 100%, respectively. Further experience and refinements of this method of scoring should maximize the benefit of high-resolution transvaginal sonography of ovarian lesions.
Adult↗
Nuclear mutation restores the reduced CO2/O2 specificity of ribulosebisphosphate carboxylase/oxygenase in a temperature-conditional chloroplast mutant of Chlamydomonas reinhardtii.
The Chlamydomonas reinhardtii temperature-sensitive mutant 68-4PP results from a mutation within the chloroplast gene that encodes the large subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase. When grown at the permissive temperature (25 degrees C), the mutant has a reduced level of holoenzyme protein, and the purified enzyme has a lower CO2/O2 specificity than the wild-type enzyme. At the nonpermissive temperature (35 degrees C), the holoenzyme level is greatly reduced, and the mutant is unable to grow photosynthetically. When photosynthesis-competent revertants of 68-4PP were selected at 35 degrees C, a nuclear mutation was identified that suppresses the temperature-sensitive phenotype by enhancing both the activity and amount of the mutant enzyme. More significantly, the reduced CO2/O2 specificity of the 68-4PP enzyme is restored to the wild-type value. However, the nuclear suppressor mutation alone does not produce a phenotype different from wild type, and the CO2/O2 specificity of the suppressor strain's enzyme is normal. We have cloned and completely sequenced the two small-subunit genes from the suppressor strain, but no mutation has been found. These results suggest that some other nuclear-encoded protein is able to influence the structure of the holoenzyme, which in turn influences the CO2/O2 specificity factor.
Base Sequence↗
CA 125 levels in menopausal women.
To assess the use of CA 125 as a potential screening test for ovarian cancer, it is necessary to understand how the test performs among cancer-free women, who would constitute the overwhelming majority of those being tested at any time. Two hundred fifty-eight menopausal volunteers who were not seeking gynecologic care had CA 125 measured on two occasions and also underwent transvaginal ultrasonography to measure ovarian volumes. Only one subject had a CA 125 level greater than 35 U/mL. The mean value for CA 125 was 5.6 +/- 3.5 U/mL. Within women, the correlation between two tests was very high (r = 0.82). Among women with apparently normal ovaries, CA 125 values were low, tightly distributed, and reproducible; these findings indicate that the test may prove to be useful and cost-effective in a screening program. The correlation between CA 125 values and ovarian volume determined by sonogram was low (r = 0.11). The independence of these two tests would also be desirable in any screening program. Other studies have found normal women to have higher levels of CA 125 with wider distributions than found here; further evaluation of test performance at these low levels is needed.
Adult↗
Benign ovarian teratomas: a population-based case-control study.
We attempted to identify all cases of benign ovarian teratoma which occurred in two health districts in the UK during a 56 month period. The crude incidence was 8.9 cases/100,000 women. One hundred and twenty cases and 119 age-matched controls were interviewed to identify risk factors for this disease. In addition, 137 mothers completed postal questionnaires. Cases were older at leaving school, had higher social class occupations, were more often unmarried or married late, and had fewer children than controls. Oral contraceptive use was similar for both. Cases reported more exercise at all ages, and more alcohol consumption 1 year before diagnosis. Cases' mothers reported slightly less nausea during pregnancy than controls' mothers, and none of the mothers reported exogenous hormone exposure during the index pregnancy. In this study benign ovarian teratomas strongly resemble testicular cancer in their age distribution in the population. They also resemble testicular cancer in their association with educational status and marital status. There was, however, no similarity regarding prenatal hormone exposure. The increased risks associated with exercise and alcohol use were unexpected; we need further information about how these exposures affect the ovary, and whether they affect the testis.
Adult↗
Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.
The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.
Adult↗
Effects of age, cigarette smoking, and other factors on fertility: findings in a large prospective study.
Of 17 032 women taking part in the Oxford Family Planning Association contraceptive study, 4104 stopped using a birth control method to plan a pregnancy on a total of 6199 occasions. The influence of various factors on fertility in these women was assessed by measuring the time taken to give birth to a child. An appreciable inverse relation was observed between age at stopping contraception and fertility both in nulliparous and parous women, but the effect was much greater in the nulliparous women. The most important finding was a consistent and highly significant trend of decreasing fertility with increasing numbers of cigarettes smoked per day; it was estimated that five years after stopping contraception 10.7% of smokers smoking more than 20 cigarettes a day, but only 5.4% of non-smokers, remained undelivered. Some relation was found between fertility and social class, age at marriage, and a history of gynaecological disease, but weight, height, and Quetelet's index were without noticeable effect.
Adult↗
Sources of variability in normal CA 125 levels.
Two hundred eighty-eight serum specimens from 144 asymptomatic menopausal women were assayed two times each for CA 125. The specimens were randomly assigned to sixteen CA 125 kits. Our purpose was to quantitate the biological variability and the assay variability that occurs at low levels of this tumor marker. All of the subjects had CA 125 values less than 35 units/ml. The total error from all sources was about 13% of the observed values. These findings suggest that single, low CA 125 values are reliable indicators of a woman's true CA 125 value. Clinical trials of ovarian cancer screening that incorporate CA 125 measurements should evaluate the performance of this test at thresholds lower than the usual 35 units/ml.
Adult↗
Abortion training in residency programs.
Following the expanded legalization of abortion in 1973, obstetrics/gynecology residency programs began to include training in these techniques. Due to a lack of specific requirements, however, many programs have never offered this training. Because most abortions are provided in freestanding clinics rather than in hospitals, many residents have not had an opportunity to learn abortion techniques. Since the 1970s, the number of residency programs that offer or require abortion training has decreased; currently, only about 12% of US obstetrics/gynecology residency programs require it. The development of collaborative programs where gynecology residents can go to learn abortion outside the hospital is one way to improve the proportion of residents who are trained. Training physicians from other specialties and midlevel clinicians is also being used to increase the number of abortion providers. New requirements specifying that obstetrics/gynecology training programs must include training in abortion techniques are under consideration. If adopted, these requirements may improve access to safe abortion for US women.
Abortion, Induced↗