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PubMed2003

Clinical and immunologic progression in HIV-infected US women before and after the introduction of highly active antiretroviral therapy.

OBJECTIVE: To examine factors associated with clinical and immunologic HIV disease progression in a cohort of US women. DESIGN: Analysis of data from a prospective, longitudinal, case-control study of HIV-infected women followed every 6 months for 7 years. SETTING: Four urban clinical centers in the United States. PARTICIPANTS: 648 HIV-infected women who did not have AIDS at time of entry into the study. MEASUREMENTS: Structured clinical and behavioral interviews; protocol-directed physical examinations; CD4 lymphocyte counts; plasma HIV RNA; infectious pathogen serologies. RESULTS With 2304 women-years of follow-up, 46.1% of the women developed AIDS; however, 93.3% of the diagnoses were based on CD4 counts dropping to <200 cells/mm(3). Only 10.6% of the women with CD4 counts <200 cells/mm(3) developed an opportunistic infection. Baseline CD4 count was the strongest predictor of subsequent clinical progression. Illicit substance use, multiple pregnancies, demographic variables, and other infections were not associated with progression. Among women with CD4 counts >500 cells/mm(3) at baseline, those who were anemic or had hepatitis C were more likely to progress to AIDS. By the end of the study, only 52% of the participants were on highly active antiretroviral therapy (HAART). CONCLUSIONS: Despite underutilization of HAART in this multicenter cohort of urban women, opportunistic infections were uncommon, despite CD4 declines.

AIDS-Related Opportunistic Infections↗
PubMed1997

Integrins and other cell adhesion molecules in endometrium and endometriosis.

Endometriosis is a disease that affects about 5% of women of reproductive age, but is found much more frequently in those with pelvic pain and/or infertility. In affected individuals, shed endometrium is thought to attach and spread within the pelvis through specific cell adhesion receptors. To understand why some women develop endometriosis while others do not, researchers have begun to examine these receptors and their extracellular matrix ligands. Cell adhesion molecules fall into 4 major groups including cadherins, selectins, members of the immunoglobulin superfamily, and integrins. Based on our current understanding, each may potentially play a role in the development or progression of this disease. In addition, the use of integrins as markers of the normal endometrial phenotype may be useful for the diagnosis of endometriosis and may identify women with defects in endometrial function leading to infertility or recurrent pregnancy loss. As more information becomes available, it may be possible to develop better treatments for endometriosis based on these concepts and to identify those women at risk for development of this common yet serious disorder.

Biomarkers↗
PubMed1999

Biological behavior and etiology of inflammatory cervical smears.

Two hundred and fifty-seven consecutive women attending a major maternal and child health (MCH) center were studied clinically, colposcopically, cytologically, and microbiologically for different gynecologic infections. Out of 257 cases, 207 (80.5%) had inflammatory cervical smears, of which 183 (88.4%) were infected with one or more genital tract infections. Bacterial vaginosis (risk, 22.6-fold), chlamydia (risk, 21.6-fold), and human papillomavirus (HPV) (risk, 13.5-fold) were independently associated with inflammatory smears. In addition, significantly higher proportions of women with inflammatory smears had cervical ectopies (28.5% vs. 10.2%) and bleeding ectopies (30.9% vs. 4.1%) as compared to noninflammatory smears. Women infected with bacterial/parasitic genital infections were given specific treatment. These women were followed up at regular intervals to assess the efficacy of antimicrobial therapy. During follow-up examination, only 26 women (12.6%) showed negative smears. Sixteen women developed squamous intraepithelial lesions (SIL) during follow-up, and 163 women had persistent inflammatory smears. Multivariate analysis revealed that persistent inflammatory smears were associated with herpes simplex virus (HSV) infection, as revealed through detection of IgA antibodies to HSV (risk, 11.5-fold). Progression of SIL was associated with HPV infection (risk, 17.6 fold). Thus, inflammatory smears are associated with different types of infection, most of which do not respond to antimicrobial therapy.

Colposcopy↗
PubMed2006

Promising practices in preconception care for women at risk for poor health and pregnancy outcomes.

OBJECTIVES: Two programs targeting urban African-American women are presented as promising models for preconception care, which includes interconception care. METHODS: The Grady Memorial Hospital Interpregnancy Care (IPC) Program in Atlanta, Georgia, and the Magnolia Project in Jacksonville, Florida, are described. The IPC program aims to investigate whether IPC can improve the health status, pregnancy planning and child spacing of women at risk of recurrent very low birthweight (VLBW). The Magnolia Project aims to reduce key risks in women of childbearing age, such as lack of family planning and repeat sexually transmitted diseases (STDs), through its case management activities. RESULTS: Seven out of 21 women in the IPC were identified as having a previously unrecognized or poorly managed chronic disease. 21/21 women developed a reproductive plan for themselves, and none of the 21 women became pregnant within nine months following the birth of their VLBW baby. The Magnolia Project had a success rate of greater than 70% in resolving the key risks (lack of family planning, repeat STDs) among case management participants. The black to white infant mortality (IM) ratio was better for the babies born to women managed in the Magnolia Project compared to the same ration for the United States. CONCLUSIONS: Preconception care targeted to African-American women at risk for poor birth outcomes appears to be effective when specific risk factors are identified and interventions are appropriate. Outreach to women at risk and case management can be effective in optimizing the woman's health and subsequent reproductive health outcomes.

Adolescent↗
PubMed1983

Sex steroids and endurance running in women.

The effects of endurance training on body composition, menstrual cycles, and sex steroids were studied in 19 healthy, regularly menstruating women. Body composition and midfollicular plasma concentrations of estradiol (E2), estrone (E1), and testosterone (T) were examined at baseline and after each subject's weekly mileage had increased 30 miles (delta 30) and 50 miles (delta 50) above baseline. Total body weight did not change, but the subjects became leaner. Mean +/- standard error of the mean E2 decreased from 70.6 +/- 13.9 pg/ml at baseline to 33.6 +/- 4.8 pg/ml at delta 50 (P = 0.03). Mean E1 decreased progressively, but not significantly, while T did not change. Eighteen women developed menstrual changes (mainly oligomenorrhea), but not amenorrhea. Endurance running in women results in frequent menstrual dysfunction and is associated with a significant decrease in E2 concentrations.

Adult↗
PubMed2000

[Effectiveness, strategies and successes in weight loss in function of anthropometric parameters].

OBJECTIVES: To find the variability in women's appearance at three moments of their life cycle and its relationship with practices aiming at weight loss, analysing the efficacy of this behaviour. DESIGN: Cross-sectional. SETTING: Women from the Community of Madrid who formed part of an investigation by the Unit of Anthropology of the Department of Biology of the Autonomous University of Madrid (UAM) into perception of image and associated behaviour as a function of age, body mass index, and social and economic conditions. PARTICIPANTS: 535 women in three age groups: 200 adolescents belonging to two secondary schools in Madrid; 202 university students from the Biology Faculty of the UAM, and 135 women aged between 45 and 65 and living in the Madrid area of Alcobendas, who were taking part in a women's health programme run by the Alcobendas town council. MATERIAL AND METHODS: Information was collected on body measurements, self-perception and image assessment, with perception indicators and body form indicators contrasted. RESULTS: There were a great many attempts to lose weight by adolescents and women over 45, with the starting age for such practices much earlier in the adolescents' and students' groups. It was particularly striking that 44% of the adolescents within the thin category had tried to lose weight. Among the students and women over 45 this percentage rose in consonance with their overweight. The older women were more effective at losing weight, but it was very difficult for them to maintain this loss. The speed of weight loss was higher in women with higher body mass index. CONCLUSIONS: Physical appearance varies between young women and women over 45, in that the former are taller, thinner and with a straighter figure. Despite this, young women develop behaviour designed to lose weight much more often than older women, with an earlier starting age and more rapidly, which can have serious health consequences.

Adolescent↗
PubMed2001

Prognostic and predictive factors in breast cancer.

Around 570 000 women develop breast cancer worldwide. In the U.K. it affects 33 000 women and causes 16 000 deaths each year. Treatment of early breast cancer is surgical, comprising breast conserving surgery (followed by radiotherapy) for small unifocal tumours, or mastectomy for larger or multifocal tumours. Survival of patients with breast cancer depends on two different types of prognostic factors: tumour size reflecting how long the tumour has been present, and biological factors (i.e. grade) which represent tumour aggressiveness. In women with a tumour that has adverse features predicting early recurrence (i.e. lymph node positivity, large size, high grade) adjuvant systemic chemo- or hormonal therapy is given to reduce the risk of relapse. Chemotherapy is given to pre-menopausal women for oestrogen receptor negative post-menopausal breast cancer, whereas hormone therapy is reserved for oestrogen receptor positive cancer. Since 50% of patients will never relapse, identification of which women are at high risk of recurrence is necessary so as to offer treatment with adjuvant therapy. The use of hormone therapy and chemotherapy has been aided by factors predicting the likelihood of response, e.g. oestrogen receptor status. The value of newer prognostic and predictive markers is addressed.

Breast Neoplasms↗
PubMed2005

Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies.

OBJECTIVE: To review different treatment strategies for women with groin pain after tension-free vaginal tape (TVT) or similar suburethral sling procedures. PATIENTS AND METHODS: The series comprised 450 women who had a TVT procedure, with a follow-up of 3-50 months. Five women (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another centre and received treatment. RESULTS: Women with pain were initially treated conservatively, and in most the pain resolved and required no further treatment. Persistent or severe discomfort was treated with a combined steroid (methyl prednisolone, 2 mL, 80 mg) and local anaesthetic (bupivacaine, 10 mL, 0.5%) injection in four women. There were no side-effects from the treatment. One woman was relieved of her pain and required no further treatment. In one woman the local injections failed to improve her symptoms but the pain was not severe enough to warrant further treatment. Two women developed recurrent pain after an initially successful injection, and in these women the TVT was excised. One woman referred from another centre was primarily treated with TVT excision. In the three women treated with distal tape excision, the mean pain scores decreased from 8.7 before excision to 0.7 afterward. One woman is awaiting tape excision. CONCLUSION: If conservative management fails to relieve the symptoms of groin pain it can be treated by injecting a mixture of steroid and local anaesthetic. However, local injection failed to provide long-term relief in three of four women. More severe symptoms might require TVT mesh dissection and excision, which provided significant pain relief.

Anesthetics, Local↗
PubMed2004

Epidural hematoma after spinal anesthesia in a patient with undiagnosed epidural lymphoma.

UNLABELLED: The incidence of hemorrhagic complications after neuroaxial anesthesia is very infrequent. We report a case of a woman developing epidural bleeding 3 wk after performing an uneventful spinal anesthesia at the lumbar level L3-4 for removal of a wire loop in her left knee. No hemostasis altering medication had been taken before and after spinal puncture. The hematoma presenting at the lumbar level L2-3 had to be removed via laminectomy. Pathological examination of the hematoma revealed a highly vascularized centroblastic non-Hodgkin's lymphoma that was not diagnosed before surgery. The patient did not develop any neurological deficits. IMPLICATIONS: We report a case of a women developing epidural bleeding 3 wk after performing an uneventful spinal anesthesia for removal of a wire loop in her left knee. Pathological examination of the neurosurgically removed hematoma revealed a highly vascularized epidural centroblastic non-Hodgkin lymphoma.

Anesthesia, Spinal↗
PubMed2002

Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer.

BACKGROUND: Physiologic evidence suggests that use of alcohol increases the risk for breast cancer through a hormonal mechanism, but the relationship among breast cancer, alcohol, and postmenopausal hormones (PMH) remains unclear. OBJECTIVE: To examine the relation between concurrent use of alcohol and PMH and invasive breast cancer. DESIGN: Prospective cohort study SETTING: Nurses' Health Study. PARTICIPANTS: 44 187 postmenopausal women. MEASUREMENTS: Self-reported data on PMH use and breast cancer obtained from biennial questionnaires completed from 1980 to 1994 and average alcohol consumption in 1980, 1984, 1986, and 1990. RESULTS: 1722 women developed invasive breast cancer. Risk for breast cancer was elevated in women who currently used PMH for 5 or more years and did not drink alcohol (relative risk, 1.32 [95% CI, 1.05 to 1.66]) and those who never used PMH but drank 20 or more g (1.5 to 2 drinks) of alcohol daily (relative risk, 1.28 [CI, 0.97 to 1.69]). Current users of PMH for 5 or more years who consumed 20 or more g of alcohol daily had a relative risk for breast cancer nearly twice (1.99 [CI, 1.42 to 2.79]) that of nondrinking nonusers of PMH. A hypothetical postmenopausal woman whose lifetime risk for breast cancer is 4% could increase her risk to 8% with 5 or more years of current PMH use and consumption of more than one alcoholic drink daily. CONCLUSIONS: Both alcohol consumption and PMH use were associated with an increased incidence of breast cancer. Women who are currently taking PMH may want to consider the added risks of regular alcohol consumption.

Alcohol Drinking↗
PubMed1999

Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden.

Normal pregnancy is associated with alterations of the hemostatic system towards a hypercoagulable state and an increased risk of venous thromboembolism. The risk of venous thrombosis is higher in pregnant women with factor V Leiden (FVL) than in those with wildtype factor V. Routine laboratory assays are not useful to detect hypercoagulable conditions. A prospective and systematic evaluation of hemostatic system activation in women with and without FVL during an uncomplicated pregnancy employing more sensitive markers of hypercoagulability, such as prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), D-Dimer, or the endogenous thrombin potential (ETP), an indicator of the plasma's potential to generate thrombin, has not been performed. We prospectively followed 113 pregnant women with (n = 11) and without (n = 102) FVL and measured F1+2. TAT, D-Dimer and the ETP at the 12th, 22nd and 34th gestational week as well as 3 months after delivery (baseline) in each subject. None of the women developed clinical signs of venous thromboembolism during pregnancy or postpartum. Pregnant women with and without FVL exhibited substantial activation of the coagulation and fibrinolytic system as indicated by a gradual increase of F1+2, TAT and D-Dimer throughout uncomplicated pregnancy up to levels similar to those found in acute thromboembolic events (p < 0.0001 by analysis of variance for each parameters). Levels of F1+2 and TAT were comparable between women with and without FVL, but levels of D-Dimer were significantly higher in women with FVL than in those without the mutation (p = 0.0005). The ETP remained unchanged in both women with and without FVL at all timepoints. Our data demonstrate a substantial coagulation and fibrinolytic system activation in healthy women with and without FVL during uncomplicated pregnancy. An elevated F1+2, TAT or D-Dimer level during pregnancy is not necessarily indicative for an acute thromboembolic event. The normal ETP in both women with and without FVL suggests that the capacity of the plasma to generate thrombin after in vitro activation of the clotting system is not affected by pregnancy. Higher levels of D-Dimer in women with FVL than in women with wildtype factor V at baseline as well as during pregnancy indicate increased fibrinolytic system activation in carriers of the mutation.

Adult↗
PubMed1991

Intrapartum bacteriuria and postpartum endometritis.

Ten gravidas with bacteriuria in the immediate antepartum period subsequently delivered vaginally and did not receive antibiotic therapy. Four of these women developed postpartum endometritis and in three of them, the same Enterobacteriaceae recovered from the urine was present in the endometrial cultures. Of the 1233 study subjects whose screening urine cultures were negative and who delivered vaginally, 27 (2.2%) developed endometritis. Intrapartum bacteriuria was significantly associated with postpartum endometritis in women delivering vaginally (P less than .001). Monitoring for asymptomatic bacteriuria and eradicating it in pregnancy should diminish the occurrence of endometritis and possible endomyometritis in the postpartum period.

Bacteriuria↗
PubMed1998

The mucosal immune system in the human female reproductive tract: potential insights into the heterosexual transmission of HIV.

Using isolated cell suspensions and in situ techniques, we have partially characterized the organization, functional capacity, and sex hormone regulation of the mucosal immune system in the human female reproductive tract. Isolated cells suspensions have been used to demonstrate that the uterus contains antigen-presenting cells that are functionally able to present antigen to autologous tetanus toxoid-specific T cells. Immunophenotypic analyses of the female reproductive tract by three-color immunofluorescent staining has been used to show that lymphoid aggregates, which are absent in postmenopausal women, develop in the uterine endometrium during the menstrual cycle in premenopausal women. Lymphoid aggregates are composed of a B lymphocyte core surrounded by numerous CD8+CD4- T lymphocytes and an outer halo of macrophages. Macrophages, CD4+ and CD8+ T cells, and CD56+ NK cells are distributed throughout the uterine endometrium. In contrast, the Fallopian tube, cervix, and vagina, which lack lymphoid aggregates, contain CD8+ and CD4+ T cells as well as macrophages. The female reproductive tract has also been analyzed for the presence of antigen-independent CD3+ T lymphocyte cytolytic function by an anti-CD3 MAb-mediated redirected lysis assay. High levels of CD3+ T lymphocyte cytolytic activity were demonstrated in cervix and vagina and independent of stage of the menstrual cycle. In the uterus, cytolytic activity changed with endocrine state. In postmenopausal women the uterine endometrium had CD3+ T lymphocytes with high cytolytic activity, whereas premenopausal women had CD3+ T lymphocytes with moderate cytolytic potential during the proliferative phase to low/no cytolytic activity during the secretory phase of the menstrual cycle. In studies to determine whether the upper reproductive tract could be infected with HIV-1, we found on the basis of nef expression and p24 release that epithelial cells from the Fallopian tube, and from the uterus and cervix, are infectable. These studies demonstrate that the human female reproductive tract is an inductive site for immune responses and the cell-mediated immunity is present throughout the female reproductive tract. These studies further indicate that the Fallopian tube and uterus are potential entry sites for HIV-1 infection and that uterine immune cell architecture as well as cytolytic activity are under hormonal control.

Antigen Presentation↗
PubMed1980

Five years private practice experience of nulliparous women using copper IUD's.

This is a study of 296 nulliparous women who used Copper IUD's as their method of contraception. At the time of first insertion the women had an average age of 21.6 years. The gross cumulative pregnancy rate rose to 11.8 over 5 years. The gross cumulative expulsion rate rose to 13.6 over 5 years and the removal rate for bleeding and pain to 20.4. The net rates were lower over 5 years (pregnancy 8.6, expulsion 11.2 and bleeding and pain 17.3). 29 women expelled their IUD's, of whom 20 underwent reinsertion. 43 women requested removal of their IUD's because of bleeding and pain, of whom 6 requested a reinsertion at a later date. Taking reinsertions into account, the continuation rate over 5 years was 55.2. Inability to insert the IUD was encountered in 28 women (8.6%). In 20 of the women cervical stenosis precluded the insertion of the IUD without local anesthetic, and in the other 8, the pain and/or syncope encountered during sounding the uterus precluded the continuation of the procedure. Insertion problems were encountered in 31 women (10.5%). Syncope occurred in 4 women and one of the women developed a 'grand mal' seizure. Clinically significant pelvic infection occurred within 30 days of insertion in 5 women (approximately 1% of insertions), and one woman developed pelvic infection from gonorrhoea.

Adolescent↗
PubMed1988

The successful development of a women's diagnostic center.

Health care organizations must meet new demands for prompt, quality service or be left behind, maintains Mr. Kilmartin. He describes several innovative programs in women's health care developed at his institution and discusses issues such as market research, pricing and facility design.

Breast Neoplasms↗
PubMed1998

Follow-up of patients with low back pain during pregnancy.

OBJECTIVE: To identify the long-term risk for low back pain among women with previous severe low back pain during pregnancy. METHODS: In a previous prospective study, 79 pregnant women developed low back pain severe enough to require sick leave. Twelve years later a questionnaire was sent to 62 of these women and 84 controls who did not develop severe low back pain during pregnancy. The questionnaire asked about occupation, low back pain in general and during later pregnancies, and sick leave due to low back pain. There were also questions regarding use of oral contraceptives and its possible relation to low back pain. RESULTS: The response rate was 84% in the back pain group and 80% among controls. The two groups were similar according to the percentage of women having had another pregnancy (33 of 52 [63%] versus 39 of 67 [58%]) but ten (19%) of the women with previous low back pain stated they had refrained from another pregnancy because of their fear of low back pain compared with only one control. Almost all women (31 of 33) with previous severe low back pain experienced the same symptoms in a subsequent pregnancy, compared with 17 of 39 (44%) controls. Even when they were not pregnant, women with previous low back pain suffered more often and used more sick leave due to low back pain (44 of 52 versus 43 of 67, chi2 = 5.68, P < .05). The location (sacroiliac joint or lumbar affection) of the previous low back pain did not affect the long-term prognosis. In a logistic regression model, previous low back pain during pregnancy was the only independent risk factor for low back pain during a subsequent pregnancy, whereas an occupation involving physical demand did not affect the results. However, together with previous low back pain during pregnancy, heavy occupation increased the risk for current nonpregnant low back pain. CONCLUSION: Women with severe low back pain during pregnancy have an extremely high risk for experiencing a new episode of severe low back pain during another pregnancy and when not pregnant.

Adult↗
PubMed2005

The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up.

BACKGROUND: Opportunities to study the natural history of ductal carcinoma in situ (DCIS) are rare. A few studies of incompletely excised lesions in the premammographic era now recognized as DCIS have provided critical insights into its proclivity for local recurrence in the original site. At the time the biopsies in the current study were originally examined, small DCIS was not diagnosed and, by default, these women were treated by biopsy only. METHODS: The authors report the latest results from a follow-up study, which was published originally in 1982, of 28 women with low-grade DCIS who were treated by biopsy only. These women were from a large, prospectively identified, completely characterized cohort. RESULTS: Eleven of 28 women developed invasive breast carcinoma (IBC), all in the same breast and quadrant from which their low-grade DCIS biopsy was taken. Seven IBCs were diagnosed within 10 years of the DCIS biopsy, 1 was diagnosed within 12 years of the DCIS biopsy, and the remaining 3 IBCs were diagnosed over 23-42 years. Five of these women, including 1 woman who developed IBC 29 years after her DCIS biopsy, developed distant metastasis, which resulted in death 1-7 years after the diagnosis of IBC. CONCLUSIONS: The natural history of low-grade DCIS can extend greater than 4 decades, with IBC developing at the same site as the previous DCIS in the majority of women. This natural history differs markedly from that of patients with high-grade DCIS and from the outcome of patients with any completely delimited DCIS excised to negative margins.

Adult↗