The objective of this retrospective study was to identify the ability of preoperative endoscopy of the lower gastrointestinal tract and other tests to predict large bowel resection in patients with an adnexal mass. We reviewed 573 patients with a suspected adnexal mass admitted for surgery between 1987 and 1997. Two hundred fifty four patients (44%) had preoperative sigmoidoscopy (n = 97) or colonoscopy (n = 157). We identified patients who underwent a colorectal operation as part of their surgery and correlated surgical findings with the results of preoperative endoscopy, preexisting clinical symptoms, preoperative pelvic exam and ultrasonography, and the CA125 level. The sensitivity and positive predictive value of bowel endoscopy for predicting large bowel surgery were 18% and 59%, respectively. Multivariate analysis showed preexisting bowel-related symptoms, a pelvic exam suggestive of malignancy, a CA125 value >1000 U/ml, and infiltration of the colorectal wall at bowel endoscopy to be independently associated with subsequent colorectal surgery. We conclude that preoperative bowel endoscopy cannot accurately predict colon resection in patients with a suspected adnexal mass. Preexisting bowel-related symptoms, a pelvic exam suggestive of malignancy and a CA125 value >1000 U/ml are associated with subsequent colorectal surgery.

Adnexal Diseases↗

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The distribution of haemoglobin concentration in a sample of native high-altitude women.

Two hundred and twenty-two indigenous women living in La Paz, Bolivia at an altitude of 3700 m were screened for the haematological parameters of haemoglobin, transferrin saturation, haematocrit and total iron-binding capacity. The data from 152 nonpregnant healthy women under 45 years of age were utilized in both distributional and maximum likelihood analyses in order to evaluate the prevalence of abnormal haemoglobin levels. The prevalence of anaemia and polycythaemia in the population was low and not considered to be a public health problem. Eleven per cent of the population was found to be iron deficient (less than 15% transferrin saturation).

Adult↗

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Predicting total body water from bioelectrical impedance in children.

Explore the source record for details and available documents.

Adolescent↗

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Does timely assessment affect the anxiety associated with an abnormal mammogram result?

Anxiety following an abnormal mammogram result can be substantial. We examined whether the time to the first diagnostic test was associated with anxiety. We surveyed 449 women at 2 and 8 months after an abnormal mammogram result, and we reviewed their medical records. Twenty-six percent of women reported being very anxious about their abnormal mammogram result at the time of the two-month interview, and 22% reported persistent anxiety after 8 months. After adjustment, the number of days until the first diagnostic test was not associated with anxiety at the 2-month interview. By the second interview, women who received their first diagnostic test within the first week were significantly more anxious, as were women who did not receive their first test for at least 60 days after their results. Further work is needed to ascertain how to minimize the anxiety associated with the evaluation of an abnormal mammogram.

Aged↗

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The brain-dead pregnant woman: finding meaning to help cope.

Caring for brain-dead pregnant women is a new critical care challenge. Rather than the usual life/death situations involving catastrophic events, critical care nurses have the added burden of caring for a life in suspension to maintain the viability of the fetus. Nurses struggle with keeping the brain-dead patient alive and yet know that as soon as the infant is delivered the mother will be allowed to die. These authors use interviews with clinical nurses to show how they used the coping strategy of creating meaning to successfully cope with this difficult situation.

Adaptation, Psychological↗

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Serum progesterone patterns in male subfertility.

Serum progesterone was evaluated in 455 men attending the infertility clinic, Department for Gynecology and Obstetrics, University of Graz, Austria. The progesterone values of azoospermic, oligozoospermic, teratozoospermic and asthenozoospermic patients were compared to a group of normozoospermic men. No significant differences were found between normozoospermic men and patients with impaired semen quality, in subgroups of oligozoospermia and between obstructive azoospermia and azoospermica due to primary testicular failure.

Adult↗

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Treatment of asthenozoospermia with HCG.

30 patients with isolated asthenozoospermia received a treatment with 5000 I.U. Human-Chorionic-Gonadotropin (HCG) a week intramuscularly for twelve weeks. Pretreatment basal levels of FSH, LH and testosterone were in normal or low normal range. 16 males responded to therapy, the total motility of spermatozoa increased significantly from 34% to 40%. In spite of a decreased sperm density and morphologic quality 6 pregnancies occurred. This result strengthens the interpretation, that sperm motility is the most important factor for fertilization. HCG therapy must be considered as an additional approach for treating motility disturbances, especially in cases with high sperm densities.

Adult↗

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Does the hemoglobin concentration in fetal blood interfere with the accuracy of fetal reflection pulse oximetry?

OBJECTIVE: Our goal was to investigate the influence of the fetal hemoglobin (Hb) concentration on the accuracy of reflection pulse oximetry. METHODS: 179 fetuses were monitored by a reflection pulse oximetry system (RPOX MK2). Pulse oximetry measurements (SO2POX) were compared with the oxygen saturation and pH of umbilical artery and vein (UA-, UV-SaO2) immediately after delivery. Correlation and linear regression analyses were performed. Because it is unknown whether low or high Hb concentrations might interfere with the SO2POX measurements, the influence of the Hb level on the correlations was evaluated by weighting the linear regression in both ways; by Hb concentrations as weighting factor and as an inverse weighting factor (1/Hb). RESULTS: There was a significant correlation between SO2POX and UV-SaO2 (for the last 10 min of delivery, r = 0.45, p < 0.0005) but not with pH or UA-SaO2. Linear regression analysis between SO2POX and UV-SaO2 showed a multiple R of 0.45. Hb concentration in fetal blood ranged from 9.2 to 20.5 mg/dl. The weighted regression indicated a multiple RHb of 0.49, which did not differ by the inverse weighting (multiple Rinverse Hb: 0.49). CONCLUSIONS: Pulse oximetry measurements seem to reflect oxygen saturation in fetal blood, however further improvement is necessary. The Hb concentration in fetal blood does not interfere with the accuracy of fetal pulse oximetry and need not be taken into consideration in calibration curves.

Female↗

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Course of maternal serum magnesium levels in low-risk gestations and in preterm labor and delivery.

OBJECTIVES: To describe the course of total and ionized magnesium and total calcium levels in maternal serum during low-risk pregnancies and to compare women who developed preterm labor and delivery with those who delivered at term. METHODS: 209 women with low-risk pregnancies were enrolled in a prospective trial before the 18th week of gestation. No woman received oral magnesium supplementation. The ionized and total magnesium and total calcium levels in maternal serum were measured every 4-6 weeks. The data were grouped into 3 gestational periods (</=18, 19-27 and >/=28 weeks of gestation) for overall comparison and analyzed with the general linear model for repeated measurements and ANOVA. p values of < 0.05 were considered statistically significant. RESULTS: 145 gestations were available for analysis. 27 women were hospitalized for preterm labor and in 16 of these preterm delivery occurred. Ionized and total magnesium and calcium levels were significantly lower after the 18th week of gestation than before. The cation levels in women with preterm labor and delivery did not differ from those with term delivery. CONCLUSION: Ionized and total magnesium and calcium levels decrease with increasing gestational age. Preterm labor and delivery do not seem to be related to changes in serum cation levels.

Adult↗

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Preoperative thrombocytosis is an independent prognostic factor in stage III and IV endometrial cancer.

BACKGROUND: To identify prognostic factors in stage III and IV endometrial cancer with special attention to pretreatment platelet count. MATERIALS AND METHODS: 59 patients with FIGO stage III or IV disease operated on between 1983 and 1993 were analyzed. Patients with preoperative thrombocytosis were compared with those without thrombocytosis. Prognostic factors were analyzed with a Cox proportional hazard model. RESULTS: With the exception of age, there were no significant differences between patients with or without thrombocytosis. At multivariate analysis, five-year disease-free survival was influenced significantly by FIGO stage (stage III vs stage IV; p = 0.009), thrombocytosis (p = 0.02) and cervical involvement (p = 0.024). Similarly, overall five-year survival was significantly influenced by stage (p < 0.001), cervical involvement (p = 0.005) and thrombocytosis (p = 0.01). Age, histology, grade, myometrial invasion, lymph-vascular space involvement or spread to adnexae were not significantly associated with survival. CONCLUSION: Thrombocytosis is an independent prognostic factor in stage III and IV endometrial cancer.

Adult↗

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Stage IV ovarian cancer: prognostic factors and survival beyond 5 years.

BACKGROUND: Ovarian cancer continues to be the leading cause of death due to gynecologic malignancies and most patients still present with advanced disease. In the present study we evaluated long-term survival and prognostic factors in patients with stage IV ovarian cancer. PATIENTS AND METHODS: The charts of 62 consecutive women with FIGO stage IV epithelial ovarian cancer were reviewed. RESULTS: Chemotherapy was the only factor associated with longer survival. Three patients (5%) survived for longer than 5 years. One died of disease at 6.3 years and two are alive without evidence of disease at 12.4 and 14.9 years, respectively. CONCLUSION: Survival seemed to correlate with the possibility of administering chemotherapy. Patients with verified stage IV ovarian cancer, in whom due to the initial tumor load, operative extent and concomitant illness, the possibility of postoperative chemotherapy administration seems questionable, might be considered for primary chemotherapy followed by surgery.

Adult↗