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PubMed1999

Standardization of the PFA-100(R) platelet function test in 105 mmol/l buffered citrate: effect of gender, smoking, and oral contraceptives.

The PFA-100(R) (PFA) diagnostic system for the detection of platelet dysfunction was evaluated to determine reference ranges in a normal population. The PFA determines the primary haemostasis capacity (PHC) of anticoagulated whole blood, expressed by the system's closure time (CT). In this study the CT reference ranges were determined for blood samples collected in 105 mmol/l (3.2%) buffered citrate and the effect of gender, smoking, and use of oral contraceptives on reference ranges was assessed. Each of the 309 healthy blood donors from five blood centres was confirmed to have normal platelet function before inclusion in the study. Blood samples were tested in duplicate with both the collagen/epinephrine (Col/Epi) and collagen/ADP (Col/ADP) test cartridges. PFA reference ranges (90% central intervals of measured closure times) for both cartridge types were similar for all groups. Subgroup analysis showed that neither gender nor oral contraceptive usage had any effect on PHC. The 95% cut-off value for the Col/Epi CT was slightly higher for smokers than for non-smokers, an effect more pronounced in female than in male donors. However, the small difference did not justify establishment of specific reference ranges for smokers. Data from all included subjects were pooled to calculate the CT reference ranges for blood samples collected in 105 mmol/l buffered citrate (Col/Epi 82-150 s; Col/ADP 62-100 s). Normal levels of fibrinogen, as well as normal platelet counts and normal haematocrit levels, appeared not to influence the PHC. Because slight but significant differences of the reference ranges were observed between some of the participating sites, in-house confirmation of these reference range guidelines is recommended.

Adolescent↗
PubMed1993

Urinary incontinence and related urogenital symptoms in elderly women.

The aims of this study were to investigate the prevalence of urinary incontinence (UI), urinary tract infections (UTI) and related urogenital symptoms (UGS) in a representative sample of elderly women (Papers I & II), and to investigate factors (Papers II & III) influencing the prevalence of UI in these women. The effects of treatment with oral estriol and placebo on the vaginal bacterial flora, vaginal cytology and urogenital symptoms in elderly women suffering from the urogenital estrogen deficiency syndrome were compared (Paper IV). A health care programme, based on an algorithm model, for the investigation and treatment of elderly women suffering from UI and related UGS, was designed and applied to a large group of elderly women (Paper V). The prevalence of UI increased in a linear fashion from 12% in the 1940 birth cohort to 25% in the 1900 birth cohort (Papers I & II). There was similar increase in the prevalence of UTI from 14% in the 1920 birth cohort to 23% in the 1900 birth cohort. In contrast, the reported prevalence of UGS such as vaginal discomfort, discharge and pruritus did not increase with age. The prevalence of UI increased with increasing parity and after hysterectomy, but was unaffected by the duration of previous oral contraceptive usage. There was no evidence to suggest that the prevalence of UI increased at the time of the last menstrual period. Neurological illnesses were an uncommon cause of UI in women < or = to 75 years of age (Paper III). Oral estriol (3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks) had a positive influence on vaginal pH, cytology and the vaginal bacteria flora, and on UGS in elderly women suffering from the urogenital estrogen deficiency syndrome (Paper IV). Using objective techniques of evaluation (Paper V) it was possible to demonstrate successful treatment of elderly women with urge and mixed incontinence using a simple health care programme. There was however no evidence of improvement in women suffering from stress incontinence when using the same treatment regime. Women with all types of incontinence, treated according to this algorithm model, displayed an improvement in vaginal pH, vaginal cytology and the vaginal bacterial flora.

Administration, Oral↗
PubMed2000

Update on cancer control in women.

The global cancer burden in women appears to have stabilized according to the most recent estimates available although the distribution of cancer types appears to be changing with a sharp contrast between the increase in the absolute numbers of breast cancers and a decline in cervix cancers. Prospects for cancer control in women appear to be good within our current knowledge and deserve close attention. Rates of lung cancer in women are increasing substantially in many countries and seem set to overtake breast cancer as the commonest form of cancer death in women in many parts of the world. These changes are due to the effects of cigarette smoking, a habit which women widely embraced during the second half of the last century. The high levels of smoking currently in young women, which have yet to have their full impact on death rates, constitute an important hazard not only for future cancer risks but for several other important causes of death. There is strong and consistent evidence that increased consumption levels of fruit and vegetables is associated with reduced risks of many common forms of cancer including breast cancer. Although the breast is the commonest form of cancer in women in most western countries, the etiology of this disease remains elusive and preventable causes remain to be identified. Endogenous hormones also appear to have a role in cancer risk in women: oral contraceptives seem to increase slightly the risk of breast cancer in users in the use and in the immediate post-use period, but 10 years after cessation the risk again returns to that of never users. Oral contraceptive usage also appears to be protective against ovarian and endometrial cancer. The use of hormonal replacement therapy (HRT) appears to increase the risk of endometrial cancer and a positive association with breast cancer risk appears to exist. Within our current knowledge of the epidemiology of cancer in women, the most important preventive strategies would appear to be the prevention of cigarette smoking and increased dietary intake of vegetables and fruits. Screening has also shown to be effective in reducing incidence and mortality of cervix cancer and mortality from breast cancer. Although more work is needed, it is becoming clear that there could be an important role of HPV testing to further enhance cervix cancer screening. There are important variations in survival from a variety of cancers which are due to factors unrelated to the tumor behavior and that there are significant variations in survival from cancer. Reduction of these gaps could lead to a reduction in cancer mortality and contribute towards increased prospects for cancer control in women.

Breast Neoplasms↗
PubMed1996

Estrogen replacement therapy and risk of epithelial ovarian cancer.

Estrogen replacement therapy (ERT), in common use among menopausal women, has been inconsistently related to risk of ovarian cancer. Part of the inconsistency may be due to differences in risk according to tumor histology. We therefore compared, within histologic groups, 367 cases of invasive epithelial ovarian cancer to 564 population controls on history of ERT practices. In multivariate logistic regression analyses adjusted for age, parity, oral-contraceptive usage, and other factors, the relative odds of nonmucinous ovarian cancer increased by 5.1% for each year of ERT use [i.e., adjusted odds ratio, 1.051; 95% confidence interval (CI), 1.01-1.09, as a multiplicative factor for each year of use]. In particular, compared to never use, women who employed ERT for a total of 5 years or longer had a relative odds of 2.03 (95% CI, 1.04-3.97) of having a serous carcinoma and 2.81 (95% CI, 1.15-6.89) of having an endometrioid carcinoma. Mucinous tumors were not associated with use. ERT usage may contribute to the development of nonmucinous types of ovarian cancer, and additional histology-specific analysis of this association in other studies is warranted.

Adenocarcinoma, Mucinous↗
PubMed2002

A slow acetylator genotype associated with an increased risk of advanced cervical cancer.

PURPOSE: Human papillomavirus (HPV) is the major etiological agent associated with cervical cancer. However, other risk factors have been indicated, including carcinogen exposure, oral contraceptive usage, certain nutritional deficiencies, and genetic factors. N-acetyltransferase 2 (NAT2) has an important role in the metabolism of several carcinogens. NAT2 polymorphism modulates the activity of the enzyme, by activation, via O-acetylation, or through detoxification, via N-acetylation. This case-control study was designed to evaluate the association between NAT2 polymorphism and genetic susceptibility to cervical cancer. METHODS: Genomic DNA was obtained from 125 women with advanced cervical cancer and 170 healthy women. PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphisms) was used to analyse two common mutant alleles at NAT2 loci. RESULTS: The NAT2*6/NAT2*6 genotype, which corresponds to a slow acetylator genotype, was found to be associated with a 3.41-fold (95% CI: 1.35-8.94; P= 0.007) increase in the risk of cervical cancer. For the entire case groups the proportion of cervical cancer cases attributable (attributable proportion) to the NAT2*6/NAT2*6 genotype was 10.2%. CONCLUSIONS: The results reported in this study suggest that NAT2 polymorphism is a genetic susceptibility factor involved in the carcinogenesis of cervical cancer, and also that the analysis of the allelic profile of populations in different geographic locations may help to understand the incidence of cervical cancer worldwide.

Acetylation↗
PubMed1988

Carcinoma of the cervix uteri in Zaria: etiological factors.

The study conducted at Ahmadu Bello University Teaching Hospital, Zaria from January to December, 1984 showed that carcinoma of the cervix uteri occurred in 4.18% of new gynecological attendances; 68.9% of the cases occurred in the age range 40-55 years. Early age at marriage (80.0%), and at first pregnancy (77.8%) as well as multiple marriages (48.9%) and low contraceptive usage were identifiable associated factors. The parity of the patient did not seem to be of significance. The earliest presenting symptom was post-coital bleeding occurring 10.8 months prior to attendance for medical advice. However, late presentation (in Stages IIb-IV) in 86.7% of cases was due to illiteracy, shyness, male dominance and non-recognition of the importance of early warning symptoms.

Adult↗
PubMed1996

Estrogen deprivation, rather than age, is responsible for the poor lipid profile and carbohydrate metabolism in women.

UNLABELLED: The protective effect of estrogen against cardiovascular diseases (CVD) in women disappears after menopause. However, it is not clear whether the change in risk factors after menopause is related to aging or estrogen deprivation. OBJECTIVE: To assess the risks for CVD and the contribution of aging in estrogen-deprived women. METHODS: Forty-one patients with premature ovarian failure (POF) (group 1) and 30 patients with natural menopause (group 2) were investigated with respect to well-known risk factors for CVD. Fifteen young women at reproductive age (group 3) were taken as controls. The median ages (ranges) of the groups were 31 (19-40), 52 (46-67) and 26 (24-29) years, respectively. Family and personal history for CVD, smoking, oral contraceptive usage, physical examination, blood pressure measurement, body mass index (BMI), blood level of fasting insulin, diabetes mellitus, and the levels of lipoprotein proteins were the examined parameters regarding the risks for CVD. RESULTS: The levels of triglycerides and very low density lipoprotein (VLDL) cholesterol were not different in the 3 groups. The levels of fasting insulin (11.3 +/- 6.6 vs. 10.2 +/- 5.8 IU/ml), the ratio of fasting insulin to fasting blood glucose (12.2 +/- 6.3% vs. 10.5 +/- 5.4%), high density lipoprotein (HDL) cholesterol (51.9 +/- 12.9 vs. 51.6 +/- 9.7 mg/d), low density lipoprotein (LDL) cholesterol (113 +/- 47 vs. 127 +/- 37 mg/dl) and the ratio of HDL to total cholesterol (27.2 +/- 9.8% vs. 24.1 +/- 6.9%) were not different in women with POF and natural menopause. These parameters were all better in controls with respect to risk for CVD (respectively, 6.5 +/- 2.0 IU/ml, 7.4 +/- 2.2%, 37.9 +/- 5.3 mg/dl, 80 +/- 40 mg/dl, P < 0.05). CONCLUSION: Risk factors for CVD are related to estrogen deprivation. Aging does not have an important impact on CVD within the age range of this study group.

Adult↗
PubMed1996

The factor V Leiden mutation may predispose women to severe preeclampsia.

OBJECTIVE: A recent study showed that resistance to activated protein C may underlie some cases of severe preeclampsia. A common missense mutation in the factor V gene, the Leiden mutation, is the most frequent genetic cause of resistance to activated protein C. Our objective was to determine whether this mutation is more prevalent in patients with severe preeclampsia than in normotensive controls. STUDY DESIGN: Deoxyribonucleic acid was extracted from whole blood of 158 gravid women meeting criteria of The American College of Obstetricians and Gynecologists for severe preeclampsia and 403 normotensive gravid women. The polymerase chain reaction was used to amplify exon 10 of the factor V gene, followed by allele-specific restriction with Mnl 1 for mutation detection. Results were analyzed with a chi(2) contingency table. RESULTS: No patients were homozygous for the Leiden mutation. Fourteen of 158 women with severe preeclampsia (8.9%) were heterozygous for the Leiden mutation compared with 17 of 403 normotensive gravid controls (4.2%). The difference in frequency between women with severe preeclampsia and normotensive controls was statistically significant, chi(2) 4.686, p = 0.03. CONCLUSIONS: Our data suggest that carriers of the factor V Leiden mutation are at increased risk for severe preeclampsia. Deoxyribonucleic acid analysis for the factor V Leiden mutation could serve as one component of a genetic screening profile for preeclampsia and other adverse pregnancy outcomes. Women who carry this mutation are at increased risk for deep venous thrombosis. Carriers of this common thrombophilic mutation may be identified so that adequate counseling regarding future contraceptive usage and effective thromboembolic prophylaxis during pregnancy and surgical procedures may be offered.

Adult↗
PubMed2003

Cancer control in women. Update 2003.

The global cancer burden in women appeared to be increasing quickly at the end of the twentieth century with notable increases in the absolute numbers of cases of breast, cervix, lung and colorectal cancer of concern. However, prospects for cancer control in women appear to be good within our current knowledge and deserve close attention. Rates of lung cancer in women are increasing substantially in many countries and seem set to overtake breast cancer as the commonest form of cancer death in women in many parts of the world. These changes are due to the effects of cigarette smoking, a habit which women widely embraced during the second half of the last century. The high levels of smoking current in young women, which have yet to have their full inpact on death rates, constitute an important hazard not only for future cancer risks but for several other important causes of death. Although the breast is the commonest form of cancer in women in most western countries, the etiology of this disease remains elusive and preventable causes remain to be identified. Endogenous hormones also appear to have a role in cancer risk in women: oral contraceptives seem to increase slightly the risk of breast cancer in users in the use, and in the immediate post-use, period, but ten years after cessation the risk returns to that of never users. Oral contraceptive usage also appears to be protective against ovarian and endometrial cancer. The use of Hormonal Replacement Therapy (HRT) appears to increase the risk of endometrial cancer and a positive association with breast cancer risk appears to exist. Within the current knowledge of the epidemiology of cancer in women, the most important Cancer Control strategy is the prevention of cigarette smoking and the increase in the prevalence of adult women quitting smoking. Screening has also shown to be effective in reducing incidence and mortality of cervix cancer and mortality from breast and colorectal cancer. Although more work is needed, it is becoming clear that there could be an important role of HPV testing to further enhance cervix cancer screening.

Breast Neoplasms↗
PubMed2002

Increased risk of early-stage breast cancer related to consumption of sweet foods among women less than age 45 in the United States.

OBJECTIVES: To evaluate the associations of dietary macronutrients, food groups, and eating patterns with risk of breast cancer in a population-based case-control study. METHODS: In this study among women 20-44 years of age, 568 cases with breast cancer and 1451 population-based controls were included. They completed a detailed in-person interview, a self-administered food-frequency questionnaire and were measured for anthropometric indices. Logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of breast cancer, adjusted for age, study site, race, education, alcohol consumption, oral contraceptive usage, smoking status, and body mass index. RESULTS: There was no association between breast cancer risk and intake of calories, macronutrients, or types of fat. Risk of breast cancer was unrelated to intakes of a variety of food groups, including red meats, dairy, high-fat snacks and desserts, or foods high in animal fat. Increased risk was observed for high intake of a food group composed of sweet items, particularly sodas and desserts. Risk increased linearly with percent of calories from sweets and frequency of sweets intake. Consumption of sweets 9.8 or more times per week compared with <2.8 times per week was associated with an adjusted OR of 1.32 (95% CI = 1.0-1.8). This association did not appear to be due to the high-fat foods or carbonated beverages that comprised the food group. Compared with women reporting one or two meals and snacks per day, reduced risks were noted for women reporting six or more (OR = 0.69, 95% CI = 0.4-1.1). CONCLUSIONS: These data suggest a modest relationship between intakes of sweet items with risk of in-situ and localized breast cancer in young women. This relation is consistent with the hypothesized link of high insulin exposure and risk of breast cancer. There was some suggestion that women who ate many times during the day were at reduced risk of disease, which is also consistent with an insulin-related mechanism.

Adult↗
PubMed1992

Ageing and the response of plasma insulin, glucose and C-peptide concentrations to intravenous glucose in postmenopausal women.

1. Eighty-six apparently healthy postmenopausal women not receiving hormone replacement therapy were given an intravenous glucose tolerance test. Plasma glucose, insulin and C-peptide concentrations were determined in fasting and post-glucose challenge samples. 2. Using a multivariate regression model, with predictor variables of chronological age, menopausal age and body mass index, neither chronological age nor menopausal age correlated with fasting or post-challenge plasma glucose or C-peptide concentrations. In contrast, menopausal age was positively associated with fasting plasma insulin concentration (P = 0.038, model r2 = 0.107), insulin area (P = 0.01, model r2 = 0.236) and incremental insulin area (P = 0.024, model r2 = 0.243). This relationship could not be explained by differences in lifestyle variables of alcohol consumption, physical activity, previous duration of oral contraceptive usage, history of cigarette smoking or body mass index. 3. Our findings suggest that loss of ovarian function is associated with hyperinsulinaemia, possibly via alterations in the clearance of circulating insulin from the plasma. The hyperinsulinaemia observed may contribute to the increased risk of cardiovascular disease seen in postmenopausal women.

Adult↗
PubMed1992

Pelvic inflammatory disease: a clinical syndrome with social causes.

Prevalence of pelvic inflammatory disease (PID) reflects community and individual risk factors. Cultural and behavioural factors influence community prevalence of sexually transmitted disease (STD), illegal abortion, puerperal sepsis and contraceptive usage--all of which influence risk of PID. The relative importance of these factors will vary by region. Individual risk factors for the ascent of a lower genital tract infection are still poorly understood but are thought to be behavioural and immunological. Prevention of PID must be undertaken at several levels. At primary level, it requires a reduction in community risk. At secondary level, individual risk can be modified by ensuring diagnosis and treatment of STD before damage of the upper genital tract occurs. More attention to cultural factors should increase the potential for prevention at both levels.

Female↗
PubMed2000

Pattern of morbidity and mortality following illegal termination of pregnancy at Nnewi, Nigeria.

Seventeen women were treated for complications of illegal termination of pregnancy over a 2-year period, January 1996 to December 1997. Important characteristics of the women include a mean age of 21 years (mode 18 years) and being unmarried (100%, n=17), nulliparous (94%, n=16) and unemployed (76%, n=13). There was a tendency towards late termination as 50% of women had a termination after 13 weeks. Serious complications were cervical laceration, pelvic abscess/peritonitis, ruptured uterus, transection of the sigmoid colon and ileal/jejunal lacerations. The mortality rate was 6% (n=1). Most of the terminations were performed through instrumental cervical dilatation without prior medical or hydrophilic treatment. This study shows that illegal abortions are still commonly performed in Nigeria with an unacceptably high incidence of morbidity and mortality. Modernisation of abortion laws, wider contraceptive usage, adoption of modern methods of termination of pregnancy (RU 486 and prostaglandin E(1) analogues) and prophylactic antibiotics are recommended in order to reduce the problems of unsafe abortion in Nigeria and other developing countries.

Journal Article↗
PubMed1988

Candida concentrations in the vagina and their association with signs and symptoms of vaginal candidosis.

Among 106 women harbouring yeasts in the vagina and with other causes of genital pathology excluded, there was a statistically significant association between numbers of yeasts recovered semi-quantitatively from vaginal swabs and symptoms of pruritus and signs of abnormal vaginal discharge but no association between yeast numbers and other individual symptoms or signs of vaginal candidosis, including patients' own subjective assessment of abnormal vaginal discharge. The presence of yeasts detectable by direct microscopic examination was statistically associated with pruritus, discharge and vaginitis. There was no relationship between numbers of vaginal yeasts and histories of antibiotic or oral contraceptive usage or the stage of the menstrual cycle. Distributions of Candida species and Candida albicans biotypes were not statistically related to any symptoms, signs or other factors. The results of this study suggest that vaginal pathology caused by Candida species may be related to the quantity of the fungus in the vagina and that only pruritus and objectively assessed vaginal discharge are firm clinical indicators of Candida infection.

Candida↗
PubMed1981

Serum and hair concentrations of copper during pregnancy.

Serum and hair concentration of copper were measured in 28 nonpregnant women and 60 pregnant women at 20 to 22 wk gestation (2nd trimester), 36 to 37 wk gestation (3rd trimester), and 3 days postpartum. The serum copper concentration in pregnant women was approximately twice (1.71 to 1.79 micrograms/ml) the normal nonpregnant values (0.98 micrograms/ml). These high levels persisted throughout pregnancy and early postpartum. The mean concentration of serum copper in maternal serum was about five times those in umbilical cord blood (0.33 microgram/ml) and a strong relationship was noted between maternal and cord copper concentration. Hair copper levels were similar in pregnant and nonpregnant subjects. No significant relationship was noted between serum and hair copper concentrations. Serum copper levels were higher and hair copper concentration was lower in primigravida. Previous history of oral contraceptive usage and alcohol intake during pregnancy had no effect on serum or hair copper levels. The effect of smoking was not consistent and showed a significant lowering effect on serum copper values only in the 2nd trimester. The 3rd trimester levels of hair copper and serum copper demonstrated a significant correlation with neonatal weight and head circumference, respectively. Further studies are indicated to understand the implication of such changes in copper metabolism.

Adult↗
PubMed1981

Riboflavin status during pregnancy.

The riboflavin status of 20 nonpregnant and 60 pregnant women (in the 2nd trimester, 3rd trimester, and early postpartum) was determined by the erythrocyte glutathione reductase activation test. None of the nonpregnant subjects but 26 pregnant subjects (21.7% in the 2nd trimester, 20.8% in the 3rd trimester, and 29.6% in early postpartum) had an activity coefficient greater than 1.20, indicative of biochemical deficiency of riboflavin. The deficiency developed at any of the three stages of pregnancy under study. Follow-up of individual cases revealed no progressive deterioration in riboflavin nutriture with advancement of pregnancy. The mean intake of riboflavin was higher than the recommended intake and revealed a significant negative correlation with activity coefficient values at the 3rd trimester. No significant correlation of riboflavin status with the outcome of pregnancy was noted. The effect of numbers of previous pregnancies, history of oral contraceptive usage, smoking, and alcohol showed no consistent effect on the percentage incidence of deficiency at all the three periods.

Adolescent↗
PubMed1986

The Inter-Regional, Epidemiological Study of Childhood Cancer (IRESCC): case-control study in children with germ cell tumours.

In 1980-1983 members of IRESCC interviewed parents of 555 children with newly diagnosed cancer on topics of possible aetiological significance. Identical questions were asked of the parents of 1100 control children chosen from hospital admissions and general practitioner lists. Medical information was confirmed whenever possible by cross-checking with NHS records. Data for the 41 children with germ cell tumours and their 82 controls are reported here. The cases had more major congenital malformations than controls, including one neural tube defect. More case than control mothers and fathers reported occupational exposure to chemicals. Nine close relatives of cases had multiple primary tumours, which were often benign or of low-grade malignancy, compared with 1 hospital control and 3 general practitioner control relatives. Cases and controls differed with respect to birth weight and paternal age. No case-control differences were shown for: birth rank, maternal age, chronic illnesses and smoking, mothers' reproductive histories and oral contraceptive usage. In index pregnancies there were no case-control differences for maternal illness, infections, alcohol intake and X-ray and ultrasound exposure. There was no difference between cases and controls for the frequency of twinning the families.

Adolescent↗
PubMed1997

Idiopathic granulomatous mastitis: case report and review of the literature.

We report a case of idiopathic granulomatous mastitis in a 35-year-old Japanese woman, who came to our hospital complaining of a tender mass in her right breast. Because the results of initial aspiration cytology were considered highly suspicious for carcinoma, modified radical mastectomy was performed. However, the final histological diagnosis was granulomatous lobular mastitis with no evidence of malignancy. Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown etiology. Since the clinical manifestations are similar to those of mammary carcinoma, this condition has been misdiagnosed as carcinoma and treated as such. A review of the literature revealed that idiopathic granulomatous mastitis has tended to occur in young patients with a history of childbirth or oral contraceptive usage. Clinical or imaging diagnosis has often been difficult. Complete resection or corticosteroid therapy can be recommended as the optimal treatment. Since 38% of patients experience recurrence, long-term follow-up is indicated.

Adrenal Cortex Hormones↗