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PubMed2004

Body mass index and the risk of development of end-stage renal disease in a screened cohort.

BACKGROUND: Obesity is associated with proteinuria and could be a risk factor for end-stage renal disease (ESRD). However, few studies have examined the significance of body mass index (BMI) as a risk factor for the development of ESRD in the general population. METHODS: We examined the relationship between BMI and the development of ESRD using data from a 1983 community-based screening in Okinawa, Japan. Screenees who developed ESRD by the end of 2000 were identified through the Okinawa Dialysis Study registry. BMI data were available for 100,753 screenees (47,504 men and 53,249 women) aged >/=20 years. The cumulative incidence of ESRD was analyzed according to the quartile of BMI: <21.0, 21.0 to 23.1, 23.2 to 25.4, and >/=25.5 kg/m(2). RESULTS: The mean (SD) BMI of the screenees was 23.4 (3.3) kg/m(2) (range 7.9 to 59.1 kg/m(2)); the mean was 23.4 kg/m(2) for both men and women. During the follow-up period, 404 screenees (232 men and 172 women) developed ESRD. The cumulative incidences of ESRD per 1000 screenees were, from the lowest to highest BMI quartile, 2.48, 3.79, 3.86, and 5.81. The odds ratio (95% CI) of BMI for developing ESRD, after adjustment for age, sex, systolic blood pressure, and proteinuria, was 1.273 (1.121-1.446, P= 0.0002) for men and 0.950 (0.825-1.094, not significant) for women. CONCLUSION: We found that BMI was associated with an increased risk of the development of ESRD in men in the general population in Okinawa. The maintenance of optimal body weight may reduce the risk of ESRD.

Adult↗
PubMed1989

Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa.

Osteoporosis is a known consequence of anorexia nervosa (AN) in adults, but the mechanism of bone loss is not established, and there have been no studies of bone mass in women developing AN before attaining peak bone mass. To investigate the causes of bone loss in AN and to determine the consequences of developing AN during adolescence on bone mass, we compared the effects of AN on cortical and trabecular bone in 26 women with AN (19 adults, 18-42 yr old, and 7 adolescents, 14.9-17.0 yr old) using direct radial photon absorptiometry and both single and dual energy spinal computed tomography. The adult AN patients had marked spinal osteopenia [mean bone density, 120 +/- 28 (+/- SD) mg K2HPO4/cm3] compared with age-matched normal women (mean, 176 +/- 26 mg K2HPO4/cm3; P = 0.0001), which was severe (greater than 2 SD below the normal mean) in 50% of patients. Adult AN patients with the onset of amenorrhea before age 18 yr had significantly (P = 0.04) lower spinal bone density than those developing amenorrhea later (mean, 103 +/- 25 vs. 129 +/- 25 mg K2HPO4/cm3) independent of other variables correlated with bone density (duration of amenorrhea or urinary cortisol excretion). We found a negative correlation between spinal bone density and duration of amenorrhea (P = 0.006; r = -0.53). To determine the contribution of endogenous cortisol excess to the pathogenesis of the osteoporosis, urinary cortisol was measured. Urinary cortisol/creatinine clearance was significantly (P = 0.001) higher in AN patients than in normal women (mean, 2.7 +/- 1.2 vs. 1.0 +/- 0.3 nmol/L) and was negatively correlated (P = 0.03; r = -0.43) with bone mass. We conclude that AN affects trabecular bone and that both the onset of AN before attainment of peak bone mass and prolonged duration of amenorrhea result in more severe osteopenia. In addition to the significant contribution of hypogonadism, the cortisol excess that occurs in AN patients may contribute to the development of osteoporosis in these patients.

Adolescent↗
PubMed1999

Atypical and typical cranial dystonia following dental procedures.

It is generally recognized that focal dystonia of the limbs or cervical region and blepharospasm sometimes follow, and in these cases may be caused or triggered by, peripheral injury. However, the association between peripheral injury and lower cranial dystonia is rare. We report eight cases who developed cranial dystonia within hours to months following a dental procedure. One group of five cases, all women, developed atypical dystonia associated with painful paresthesias at the site of dystonia. Two of these five cases had fixed jaw-deviating dystonia, whereas the remaining three had additional tremor and spread of their dystonia to involve the tongue in all three, and the lips and neck in two cases. These five patients are reminiscent of cases of limb causalgia-dystonia syndrome, which occurs after minor peripheral trauma and can spread. The remaining three cases developed more typical cranial dystonia following the dental procedure. There was no family history of dystonia or prior use of neuroleptics in any of the patients. The close association in time and location of the procedure and onset of symptoms suggests that the onset of the dystonia may have been caused by the dental intervention, but whether there is a causal relationship between the dental intervention and the development of the dyskinesias requires further epidemiologic studies.

Adult↗
PubMed1998

Organochlorine exposure and risk of breast cancer.

BACKGROUND: Some organochlorine compounds may have weak oestrogenic effects and are, therefore, suspected of increasing the risk of breast cancer. We assessed prospectively the risk of breast cancer in relation to serum concentrations of several organochlorine compounds. METHODS: In 1976, serum samples from 7712 women were obtained from participants in the Copenhagen City Heart Study as part of physical examinations and interviews about lifestyle factors. During 17 years of follow-up, 268 women developed invasive breast cancer. Each woman with breast cancer was matched with two breast-cancer-free women from the remaining cohort. We analysed in 1996-97 the serum samples from 240 women with breast cancer and 477 controls. FINDINGS: Dieldrin was associated with a significantly increased dose-related risk of breast cancer (adjusted odds ratio 2.05 [95% CI 1.17-3.57], p for trend 0.01). Beta-hexachlorocyclohexane increased risk slightly but not significantly (p for trend 0.24). There was no overall association between risk of breast cancer and p,p'-dichlorodiphenyltrichloroethane or metabolites or for polychlorinated biphenyls. Exclusion of women with breast cancer diagnosed within 5 years of blood sampling strengthened the result for dieldrin, but did not affect the other results. INTERPRETATION: These findings support the hypothesis that exposure to xeno-oestrogens may increase the risk of breast cancer.

Adult↗
PubMed1997

A critical evaluation of follow-up of women treated for endometrial adenocarcinoma.

A retrospective review of all women diagnosed with endometrial adenocarcinoma over a 5-year period was performed. One hundred and eleven women had not defaulted from follow-up and were thought to be disease-free following primary treatment. Seventeen (15.3%) of this group of women developed recurrent disease; four of these being detected in asymptomatic patients at routine follow-up visits. Women with asymptomatic recurrences had a significantly better survival than those presenting with symptoms (25% vs. 8%, P = 0.048). On the basis of previous findings, a limited hospital surveillance protocol was applied retrospectively to these patients with an estimated financial saving of over 2500 per annum. However, as one asymptomatic recurrence was detected by vault cytology during the 2 years after primary treatment, it may be worthwhile continuing to perform vault cytology during this period.

Journal Article↗
PubMed2006

Risk of second primary malignancies in women with papillary thyroid cancer.

Second malignancies in women diagnosed with thyroid cancer are of concern given the young average age at diagnosis and excellent survival. Data from the California Cancer Registry were used to evaluate the risk of second primary cancers among a retrospective population-based cohort of 10,932 women diagnosed with papillary thyroid cancer between 1988 and 1999. Follow-up was calculated from 2 months until the diagnosis of a second primary cancer, death, loss to follow-up, or December 31, 1999, whichever occurred first. Standardized incidence ratios, based on age-specific cancer incidence rates for California women, were calculated. During a total of 50,938 person-years of follow-up (mean: 4.7 years), 279 women developed a second primary cancer. The incidence of invasive breast cancer was not elevated compared with California women overall (standardized incidence ratio (SIR) = 0.9, 95% confidence interval (CI): 0.7, 1.1) or when stratified by age, race/ethnicity, follow-up, or radiation treatment. An excess of in situ breast cancer (SIR = 1.6, 95% CI: 1.0, 2.4), kidney cancer (SIR = 3.9, 95% CI: 2.2, 6.3), and melanoma (SIR = 2.1, 95% CI: 1.3, 3.2) limited to the first 5 years after diagnosis was observed. Women with papillary thyroid cancer are at increased risk of in situ, but not invasive, breast cancer, kidney cancer, and melanoma.

Adenocarcinoma, Papillary↗
PubMed2006

Increasing our understanding of breast self-examination: women talk about cancer, the health care system, and being women.

The author engaged 13 women, aged 30 to 59, in a collaborative research project over several months to explore the meaning of breast self-examination (BSE) to them. Through a series of 11 group discussions, the women developed a critical consciousness of the commonality of their personal experiences in relation to BSE. Although these women valued BSE, their reluctance to perform it was influenced by their perceptions of breast cancer as a lethal disease, the perceived threat it posed to their femininity, and their ability to negotiate an increasingly medical and technological health care system. This study provides insight into the importance of the social environment and shared understandings in influencing women's individual behavioral choices for BSE. It also illustrates the particular value of collaborative health research.

Adult↗
PubMed1987

Morbidity after termination of pregnancy in first trimester.

The outcome of termination of pregnancy was observed in relation to the preoperative clinical and microbiological findings in 167 women attending a day care abortion unit in Liverpool. Before termination, Chlamydia trachomatis was isolated from the cervix of 19 (11%) of the patients and high counts (greater than 10(4) colour changing units (ccu) per ml of specimen) of mycoplasmas were found in 30 (18%). Coexistent infections with chlamydiae and high counts of mycoplasmas occurred in only seven (4%) women. Trichomonas vaginalis, yeasts, or pathogenic bacteria were found in vaginal swabs from 30 (18%) women. After undergoing termination, seven (4%) women developed pelvic inflammatory disease (PID), five (71%) of whom had yielded C trachomatis before undergoing termination. A further 13 (8%) patients developed minor morbidity of the upper genital tract; high count mycoplasmal infection had been found in seven (54%) and chlamydial infection in three (23%) of these women before termination. In contrast, C trachomatis had been isolated from only 11 (8%) and high counts of mycoplasmas from 23 (16%) of the 147 women who had uneventful recoveries after undergoing termination. No correlation was apparent between the presence of vaginal pathogens before termination and the development of untoward sequelae postoperatively. Neither the history nor clinical examination before termination would have indicated that chlamydial or mycoplasmal infections were present, or that postoperative complications were likely to occur. Abnormal cervical cytology, however, was found in 86 (52%) of women overall, including 15 (79%) of the 19 women with chlamydial infection.

Abortion, Induced↗
PubMed2005

Changes in antithrombin activity and platelet counts in the late stage of twin and triplet pregnancies.

It is possible that women with triplet pregnancies are more likely to exhibit pregnancy-induced antithrombin deficiency, gestational thrombocytopenia, and perinatal elevation in serum aspartate aminotransferase (AST) than women with twin pregnancies. We retrospectively reviewed changes in antithrombin activity, platelet count, and blood chemistry in 23 twin and seven triplet pregnancies in which the mothers received antenatal care and gave birth in our hospital during 1999 and 2001. Both antithrombin activity and platelet counts gradually decreased until delivery, then promptly increased after delivery in both twin and triplet pregnancies. A significantly larger number of women developed gestational thrombocytopenia of < 100 x 10 (9)/L (43% [three of seven] versus 4.3% [one of 23]; p < 0.01) and pregnancy-induced antithrombin deficiency of < 60% of normal activity (57% [four of seven] versus 17% [four of 23]; p < 0.05) in triplet than in twin pregnancies. Eight women with pregnancy-induced antithrombin deficiency, including three women with gestational thrombocytopenia, were significantly more likely to develop perinatal elevations of AST, lactate dehydrogenase, serum creatinine, fibrin/fibrinogen degradation products, and D-dimer than were those without pregnancy-induced antithrombin deficiency. These findings suggest that women with triplet pregnancies are at an increased risk of the HELLP syndrome and acute fatty liver of pregnancy compared with women with twin pregnancies.

Adult↗
PubMed2001

Postpartum thyroid dysfunction and postpartum depression: are they two linked disorders?

OBJECTIVE: Postpartum has been considered as a period of risk for developing postpartum depression (PD) by some but not all authors, and this PD has been linked with postpartum thyroid dysfunction (PPTD). The major aim of this study was to evaluate the relation between the presence of PPTD and PD. DESIGN AND PATIENTS: Six hundred and forty-one healthy Caucasian women recruited between their 36th week of pregnancy and fourth day postpartum underwent clinical and laboratory evaluation and were checked again at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months postpartum. MEASUREMENTS: At baseline and at each clinical evaluation, Beck Depression Inventory (BDI) was administered to screen PD. The definitive diagnoses of PD was performed by a psychiatrist according to the DSM-III-R criteria. At each visit, we determined serum free T4 and TSH concentrations. Thyroperoxidase and thyroglobulin antibodies were determined only in patients with abnormal hormone concentrations. Postpartum thyroiditis (PPT) was considered to be present in women with overt or subclinical transient hyperthyroidism between 1 and 3 months postpartum and/or overt or subclinical hypothyroidism between 3 and 6 months postpartum. RESULTS: Fifty-six women developed postpartum thyroid dysfunction (PPTD), corresponding to an incidence rate of 11%: 45 with PPT [incidence rate 7.8%; confidence interval (CI) 5.6-10%], eight with Graves' disease (incidence rate 1.5%; CI 0.5-2.5%) and three with nonpalpable toxic thyroid adenoma (incidence rate 0.5%; CI 0-1.5%). Five hundred and eighty of the evaluated women (incidence rate 90.5%; CI 95% 88.2-92.8) presented BDI scores below 21 and therefore the PD diagnoses was excluded. In 50 cases (incidence rate 7.8%; Cl 95% 5.7-9.8), we detected a BDI score over 21 in some evaluations, but the PD diagnosis was not confirmed. Another 11 (incidence rate 1.7%; CI 95% 0.7-2.7) were diagnosed as having PD and required psychiatric treatment. None of the PPTD was diagnosed as having PD. The BDI scores frequency over 21 was similar between healthy women and those with PPTD. Patients with a previous history of depression developed PD more often (P < 0.0001). One hundred and ninety women breast fed their babies for more than 2 months, without observing a higher PD rate or BDI scores over 21 (P = 0.5). CONCLUSIONS: We found a general PD incidence rate of 1.7% in our group of patients. This figure is not higher in women with hormone abnormalities caused by PPTD. Women with a past history of depression present a higher risk of PD while those who breast fed did not have an increased risk.

Adenoma↗
PubMed2004

Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a Chinese population with high post-prandial glucose.

AIMS: To ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in both men and women in a high-risk non-diabetic population. METHODS: The screening survey for type 2 diabetes was conducted in 1994, and a follow-up study of 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. A total of 70 men and 76 women developed diabetes during the 5-year follow-up. RESULTS: After adjustment for age, body mass index, smoking, systolic blood pressure, family history of diabetes, total cholesterol, triglycerides, antihypertensive medication, occupation, education, urine albumin excretion rate, and fasting insulin, the odds ratios for incidence of diabetes were 1.00, 2.04 (95% CI 0.84-4.97), 7.82 (2.66-23.00), 9.38 (3.30-26.69) in men with normal glucose, isolated IFG, isolated IGT, and both IFG and IGT, respectively. In women, the corresponding odds ratios were 1.00, 2.19 (0.91-5.30), 1.62 (0.72-3.67), and 8.79 (2.98-25.93), respectively. CONCLUSIONS: This study shows that combined IFG and IGT at baseline is a strong risk predictor for the development of diabetes in both men and women. Isolated IGT is also a predictor of diabetes in Chinese men.

Asian People↗
PubMed2005

Fruits, vegetables and risk of renal cell carcinoma: a prospective study of Swedish women.

Findings of epidemiologic studies on the relationship between fruit and vegetable consumption and renal cell carcinoma (RCC) risk have been inconclusive. To study the association between fruits and vegetables and risk of RCC in a population-based prospective cohort study of Swedish women, we collected dietary information from 61,000 women age 40-76 years by a food-frequency questionnaire. During 13.4 years of follow-up 122 women developed RCC. Cox proportional hazards models were used to estimate relative risks (RR) with 95% confidence interval (CI). Women consuming 5 or more servings of fruit and vegetables daily had a relative risk of 0.59 (95% CI = 0.26-1.34) in comparison to them consuming less than once daily. When fruits and vegetables were examined separately, those who consumed more than 75 servings per month of fruits or vegetables had multivariate relative risk of 0.59 (95% CI = 0.27-1.25) and 0.60 (95% CI = 0.31-1.17) respectively, compared to those consuming 11 or less servings per month. Within the group of fruits, the strongest inverse association was observed for banana (p = 0.07 by Wald test). The risk of RCC increased monotonically with increasing intake frequencies of fruit juice (p-value for trend = 0.10). Within the group of vegetables, the strongest inverse association was observed for root vegetables (p = 0.03 by Wald test). The risk of RCC decreased with increasing consumption frequencies of white cabbage (p for trend = 0.07). Frequent consumption of salad vegetables (once or more per day) decreased the risk by 40% (RR = 0.60; 95% CI = 0.30-1.22), in comparison to no consumption. Our results suggested that high consumption of fruits and vegetables might be associated with reduced risk of RCC.

Aged↗
PubMed2003

Incident vertebral fractures and mortality in older women: a prospective study.

Older persons who have prevalent vertebral fractures have an increased risk of mortality. It is not known whether incident vertebral fractures are also associated with an increased risk of mortality. To determine whether older women with incident vertebral fractures have an increased risk of mortality, we conducted a prospective cohort study of 7233 community-dwelling older women aged 65 years or older who were enrolled in the Study of Osteoporotic Fractures. We measured incident vertebral fractures by radiographic morphometry of paired lateral spine X-rays taken an average of 3.7 years apart. We also collected information on baseline prevalent vertebral fractures; calcaneal bone density; anthropometric measures; and demographic, medical history, and lifestyle variables. Overall mortality was assessed and confirmed by receipt of death certificates. Over an average of 3.7 years, 389 (5.4%) women developed at least one incident vertebral fracture. During an additional 8 years of follow-up, 1617 (22%) women died. Women with at least one new fracture had an age-adjusted 32% increased risk of mortality (RH=1.32; 95% CI=1.10-1.58, P=0.003) compared to those without incident vertebral fractures. After adjustment for weight loss, physical frailty markers, and nine other predictors of mortality, there was no longer an independent association between incident vertebral fractures and mortality (RH=1.06; 95% CI=0.88 1.28). Older women with incident vertebral fractures have an increased risk of mortality that may be explained by weight loss and physical frailty.

Aged↗
PubMed1997

Hyperprolactinemia in postmenopausal women.

OBJECTIVE: To study the clinical cause and course of hyperprolactinemia in postmenopausal women. DESIGN: Retrospective case-note study. SETTING: Tertiary care hospital. PATIENT(S): Six postmenopausal women with hyperprolactinemia. MAIN OUTCOME MEASURE(S): Clinical history and physical examination, serum levels of PRL, LH, FSH, computed tomography (CT) of the pituitary gland before and after treatment with bromocriptine. RESULT(S): At presentation, the mean age was 57.5 +/- 7.5 SD years. The mean level of PRL was 1,427 +/- 1,599 ng/mL (1,427 +/- 1,599 micrograms/L). All women suffered from secondary amenorrhea for a mean duration of 31.8 +/- 5.6 years. Five of six had galactorrhea at some time in the past. Pituitary imaging revealed a pituitary macroadenoma in four women, an enlarged sella suggestive of a pituitary macroadenoma in one woman, and a microadenoma in one. After treatment with bromocriptine, the PRL level decreased in all women to within normal limits. Five of six women developed hot flushes after the PRL level returned to normal. CONCLUSION(S): Most cases of hyperprolactinemia in postmenopausal women are due to macroadenoma rather than microadenoma, the common finding in younger women. The clinical course is suggestive of a prolonged disease that was not detected earlier, although clinical signs were present. These findings are suggestive of an enlargement of microadenomas to macroadenomas as time passes.

Adenoma↗
PubMed2000

Thiamine supplementation to prevent induction of low birth weight by conventional therapy for gestational diabetes mellitus.

Conventional treatment for gestational diabetes mellitus increases the proportion of infants born with a low birth weight, a risk factor for cardiovascular disease and diabetes mellitus in later life. Thiamine supplementation during pregnancy may be shown to be a safe preventive measure. During pregnancy, approximately 50% of the women develop a biochemical thiamine deficiency, whereas the thiamine status falls, but remains within normal limits, in most other women. Thiamine is essential for glucose oxidation, insulin production by pancreatic beta-cells and cell growth. It is therefore likely that thiamine supplementation in pregnant women not only improves their glucose tolerance but also stimulates the intra-uterine growth, thereby preventing a low birth weight to ensue from conventional therapy which only improves glucose tolerance.

Diabetes, Gestational↗
PubMed1976

Haematological changes during normal pregnancy: iron induced macrocytosis.

Haematological indices in 300 pregnant and 50 non-pregnant women were obtained by Coulter Counter analysis. In 47 women who did not receive iron supplements during pregnancy, haemoglobin concentration fell from a mean of 12-23 g/dl in early pregnancy to 11-04 g/dl at 34 weeks gestation, a level which was maintained until term. In the 153 women to whom iron supplements were given during pregnancy, the initial fall in haemoglobin concentration was less, was arrested by 28 weeks gestation and then rose to a level equivalent to the booking level. This different pattern in iron supplemented pregnancies was due to an increase in the red cell count together with a change in mean cell volume. Although the changed mean cell volume usually remained within the normal range in the group who did not take iron, a few women developed microcytosis which could reflect iron deficiency; a macrocytic change was noted in a small number of the women who received routine iron supplements and this could reflect iron "over sufficiency". The results are discussed in relation to the possible effects of giving routine oral iron to all pregnant women.

Anemia, Macrocytic↗
PubMedDate not supplied

Primary melanoma of the female genital system: a report of 10 cases and review of the literature.

BACKGROUND: Primary melanoma of the female genital system are extremely rare (2-3%). PATIENTS AND METHODS: A retrospective review was undertaken of patients with primary melanoma of the female genital system treated from 1990-2003 at Rostock University Hospital, Germany. Different treatments (sentinel node biopsy, inguinofemoral lymphadenectomy, en bloc resection, adjuvant Interferon-alpha-therapy, adjuvant chemotherapy) are discussed. The complicated classification is reduced to a clinical path for daily use (UICC stage and invasion depth of Breslow, Clark's level and Chung's level). RESULTS: We report on 10 patients, aged 26 to 76 years, with primary melanoma of the female genital tract. Seven women developed a vulvar melanoma and one woman a malignant melanoma of the cutaneous inguinal region, while another 2 women had an unusual primary location of the malignant melanoma, the cervico-vaginal region (n=1) and the left ovary (n = 1). CONCLUSION: Initial surgical modality did not influence long-term survival, but affected disease-free survival significantly.

Adult↗