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PubMed2006

Women's stories of birth: a suitable form of research evidence?

In the past one to two decades, midwifery care has taken a new direction, which encompasses a valuing of women's birth experiences. This move has been contingent upon, and congruent with the adoption of 'woman centred' care and a renewed emphasis on normal birth. In line with these developments, women's stories and anecdotes of birth and midwives stories of experience increasingly form the basis of presentations at midwifery conferences and forums. Overall, this philosophical realignment, which commenced in Australia in the early 1990s, has been applauded by many midwives in terms of a greater valuing of the wishes and experiences of childbearing women and as being consistent with a greater promotion of normal birth. Nonetheless, it also gives rise to several questions, regarding the suitability of this form of research evidence. In a bid to answer some of those questions, this paper aims to evaluate the use of stories and anecdotal evidence within midwifery. First, an overview is presented of the way in which stories of pregnancy and birth appear in the literature. Secondly, the value of stories as evidence is critiqued and, finally, the ratio of story based publications, compared to traditional research methodologies, is reviewed. This review aims to address an area poorly attended in the literature and asks specifically: Are women's birth stories a suitable form of research evidence in midwifery?

Anecdotes as Topic↗
PubMed2000

Dietary fat, fat subtypes, and breast cancer in postmenopausal women: a prospective cohort study.

BACKGROUND: The intake of total dietary fat and of certain fat subtypes has been shown to be strongly associated with breast cancer in international comparisons and in animal experiments. However, observational epidemiologic studies have generally reported either weak positive or no associations. To extend the prospective epidemiologic evidence on this question, we examined the association between adult dietary intake of fat, fat subtypes, and breast cancer in a large, prospective cohort of postmenopausal women. METHODS: Participants were selected from a national breast cancer mammography screening program conducted from 1973 through 1981 at 29 centers throughout the United States. From 1987 through 1989, 40022 postmenopausal women satisfactorily completed a mailed, self-administered questionnaire that included a 60-item National Cancer Institute/Block food-frequency questionnaire. Women were then followed for an average of 5.3 years; 996 women developed breast cancer. Risk was assessed by use of Cox proportional hazard regression, with age as the underlying time metric. All statistical tests were two-sided. RESULTS: Compared with women in the lowest quintile (Q1) of percentage of energy from total fat, the adjusted risk ratio (RR) and 95% confidence interval (CI) for women in the highest quintile (Q5) was 1.07 (95% CI = 0.86-1.32). In analyses stratified by history of benign breast disease (BBD), a positive association was observed among only women with no history of BBD (RR (Q5 versus Q1) = 2.20; 95% CI = 1.41-3.42; test for trend, P =.0003). The increased risk in these women appeared to be attributable to unsaturated fat intake and oleic acid in particular. CONCLUSIONS: In this study, there was no overall association between fat intake during adulthood and breast cancer risk; however, among women with no history of BBD, there appeared to be a positive association between total and unsaturated fat intake and breast cancer risk.

Breast Neoplasms↗
PubMed1991

Personality, alcohol consumption, and menstrual distress in young women.

There has been a longstanding hypothesis that some women develop alcohol dependence as a result of drinking to alleviate premenstrual dysphoria. This study investigated the relationship between personality factors, alcohol consumption, and menstrual distress symptoms in nonalcoholic drinking young women. Normally menstruating women monitored their alcohol intake and physical and affective distress symptoms daily for two consecutive menstrual cycles. Subjects were unaware that their menstrual cycles and symptoms were being monitored. Subjects also completed the Minnesota Multiphasic Personality Inventory (MMPI), the Eysenck Personality Questionnaire (EPQ), Cattel's Sixteen Personality Factor Questionnaire (16PF), and the Vando Reducer-Augmenter Scale. The MMPI scales were factor analyzed to reduce the number of variables. Four derived MMPI factors were added to the VANDO, the three EPQ factors, and the four higher order factors of the 16PF to provide a total of twelve personality predictors. Separate regression analyses were carried out between personality factors and both alcohol consumption and menstrual distress. The results revealed that the women who drank more tended to be significantly more extroverted, spontaneous, carefree, and open to change. By contrast, women who reported greater over-all menstrual distress tended to be less capable, secure, and well-adjusted and reported a greater number of emotional and psychological problems. There was no correlation between alcohol consumption and menstrual distress. It was concluded that the results contradict the alcoholism-menstrual cycle hypothesis.

Adult↗
PubMed1985

Comparison of three methods of teaching women how to perform breast self-examination.

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.

Adolescent↗
PubMed1986

Joint forces in extension of the knee. Analysis of a mechanical model.

A two-dimensional model of the tibio-femoral joint was constructed by using the results of cadaver knee dissections together with radiographic landmarks on healthy knees loaded at various angles of flexion. The tibio-femoral compressive force during isometric knee extension had the same magnitude as the patellar tendon force. The tibio-femoral shear force changed direction from posterior at full flexion to anterior when the knee was extended, indicating that high forces may arise in the anterior cruciate was extended, indicating that high forces may arise in the anterior cruciate ligament in the straight knee. Women developed some 20 per cent higher knee joint forces than men for the same extending muscular moment higher knee joint forces than men for the same extending muscular moment, since women's patellar tendon moment arms were found to be shorter. The model presented may be used for quantifying tibio-femoral forces during knee extending activities.

Adult↗
PubMedDate not supplied

[Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases].

BACKGROUND: Radiodermatitis following invasive radiographic procedures has been reported recently in the literature, mainly after cardiac catheterization. Only two publications are related to transjugular intrahepatic portosystemic shunt (TIPS), a recently introduced angiographic technique for achieving portal decompression. CASE REPORTS: We report four cases of radiodermatitis following a transjugular intrahepatic portosystemic shunt. A 63-year-old woman developed in 1997 a chronic radiodermatitis under the right scapula; a shunt was placed in 1992; from 1992 to 1997, she had a second transjugular intrahepatic portosystemic shunt and thereafter four dilatations. A 50-year-old man developed in 1994 a radio-induced ulceration in the same area, one week after a transjugular intrahepatic portosystemic shunt; the same year the shunt was expanded. The patient had a second transjugular intrahepatic portosystemic shunt in 1995; at that time, the cutaneous lesions evolved into chronic radiodermatitis. In 1995 a 67-year-old man developed chronic radiodermatitis under the right scapula; a transjugular intrahepatic portosystemic shunt was placed in 1992; endoprosthesis was dilated four times from 1992 to 1995. A 82-year-old women developed in 1993 an ulcerated radiodermatitis, five days after a transjugular intrahepatic portosystemic shunt. DISCUSSION: The major advantage of the transjugular intrahepatic portosystemic shunt is the ability to provide portosystemic decompression without major surgery. However, radiation exposure during the procedure is sometimes very high. Otherwise the prosthesis is readily blocked up; this side-effect requires repeated angiographic dilatations. The procedures were very long by all our patients. This explains the high absorbed radiation doses. Transjugular intrahepatic portosystemic shunt and cardiac catheterization are not the only procedures at risk. A lot of invasive radiographic techniques can result in high radiation exposure and hence radiodermatitis.

Aged↗
PubMed2001

Obstetric admissions to the intensive therapy unit of a tertiary care institution.

INTRODUCTION: Between 0.1% and 0.9% of women develop pregnancy complications which require admission to an intensive therapy unit. The aim of this study was to review all obstetric admissions to the intensive therapy unit at the KK Women's and Children's Hospital from 1998 to 1999 with respect to indications for admission, interventions employed and clinical outcome. METHOD: The medical records of all obstetric patients admitted to the intensive therapy unit during the 2-year period were analysed retrospectively. Subjects were included if they were admitted during pregnancy up to 42 days postpartum. RESULTS: There were 31,725 deliveries in our hospital during the study period of which there were 239 admissions to the intensive therapy unit. Of these, 42% were Malays, 41% Chinese, 12% Indians and 5% other races. 65% stayed 1 day, 24% 2 days, 7% 3 days and 4% more than 3 days. The patients' ages ranged from 18 to 44 years. The indications for admission were hypertension (50%), haemorrhage (24%), respiratory insufficiency (10%), neurological problems (11%) and sepsis (3%). Intervention-wise, 43% of patients required vasoactive infusions, 35% had arterial line placement, 22% central venous pressure monitoring, 21% ventilatory support and 2% pulmonary artery catheter placement. The maternal mortality and stillbirth rates were 1.3% and 3.7% of intensive therapy unit admissions, respectively. CONCLUSION: The admission rate to the intensive therapy unit in our institution was 0.73% of all deliveries during the 2-year study period. Hypertensive disease and haemorrhage were the predominant admitting diagnoses.

Adolescent↗
PubMed2005

Short-term effects of axillary lymph node clearance surgery on lymphatic physiology of the arm in breast cancer.

It is not known why some women develop breast cancer-related lymphedema (BCRL) of the arm, whereas others having similar treatment do not. We speculated that increased uptake of protein into local blood may protect against BCRL. Sixteen women were given bilateral subcutaneous hand webspace injections of polyclonal immunoglobulin (HIgG), (99m)Tc-HIgG on one side and (111)In-HIgG on the other, before and 3 mo after axillary clearance surgery. The rates of clearance of activity from the depot (k) and accumulation in central blood (b(contra)) were measured using a scintillation probe and bilateral antecubital vein blood sampling, respectively. Activity accumulating in blood ipsilateral to the injected side, in excess of central blood activity (b(ipsi)) was also calculated as a measure of local vascular uptake. The k correlated with b(contra), but neither changed in response to surgery. However, b(ipsi) for injections of (99m)Tc-HIgG into the affected arm increased in all seven patients in whom data were available (0.018 +/- 0.006 to 0.038 +/- 0.007%/min; P < 0.05); indeed, in five of these seven, b(ipsi) paradoxically exceeded b(contra), and none developed BCRL at 3-yr follow-up. We conclude that uptake of protein into local blood and/or proteolysis increases after axillary surgery and may protect against BCRL.

Adult↗
PubMed2003

Amniotic fluid and maternal serum leptin levels in pregnant women who subsequently develop preeclampsia.

OBJECTIVES: To study the correlation between amniotic fluid leptin levels and maternal serum leptin levels during the early second trimester, and to determine whether the ratios of amniotic fluid leptin levels to maternal serum leptin levels are elevated in pregnant women who subsequently develop preeclampsia. STUDY DESIGN: Samples from 120 pregnant women were included in this prospective study, of which 20 were from pregnant women who subsequently developed preeclampsia and 100 were from normal pregnant women. Both the amniotic fluid and the maternal serum leptin levels were ascertained by radioimmunoassay (RIA). RESULTS: A strong correlation between amniotic fluid leptin levels and maternal serum leptin levels was observed in both preeclamptic and normal pregnant women. In addition, the ratios of amniotic fluid leptin levels to maternal serum leptin levels were positively correlated to amniotic fluid leptin levels, but negatively correlated to maternal serum leptin levels. Furthermore, the ratios of amniotic fluid leptin levels to maternal serum leptin levels in preeclamptic women were significantly higher than those in normal pregnant women. CONCLUSIONS: Amniotic fluid leptin levels correlated with maternal serum leptin levels during the early second trimester. The ratios of amniotic fluid leptin levels to maternal serum leptin levels were elevated in preeclamptic women. However, the maternal serum leptin levels themselves showed no such elevation. Therefore, this elevated ratio may be a marker at the early stage of pregnancy in preeclamptic women.

Adult↗
PubMed2007

Diet and risk of ovarian cancer in the California Teachers Study cohort.

Dietary phytochemical compounds, including isoflavones and isothiocyanates, may inhibit cancer development but have not yet been examined in prospective epidemiologic studies of ovarian cancer. The authors have investigated the association between consumption of these and other nutrients and ovarian cancer risk in a prospective cohort study. Among 97,275 eligible women in the California Teachers Study cohort who completed the baseline dietary assessment in 1995-1996, 280 women developed invasive or borderline ovarian cancer by December 31, 2003. Multivariable Cox proportional hazards regression, with age as the timescale, was used to estimate relative risks and 95% confidence intervals; all statistical tests were two sided. Intake of isoflavones was associated with lower risk of ovarian cancer. Compared with the risk for women who consumed less than 1 mg of total isoflavones per day, the relative risk of ovarian cancer associated with consumption of more than 3 mg/day was 0.56 (95% confidence interval: 0.33, 0.96). Intake of isothiocyanates or foods high in isothiocyanates was not associated with ovarian cancer risk, nor was intake of macronutrients, antioxidant vitamins, or other micronutrients. Although dietary consumption of isoflavones may be associated with decreased ovarian cancer risk, most dietary factors are unlikely to play a major role in ovarian cancer development.

Adult↗
PubMed1991

Endometrial carcinoma; ovarian dysfunction--a risk factor in young women.

From a referral area comprising one-fifth of the Swedish female population we investigated possible risk factors for endometrial cancer (EC) in different age groups. Seventy-seven women aged 31-45 with EC were collected retrospectively, and 99 women aged 46-65 were consecutively collected. Both groups were compared to referents randomly selected from a population based study from the city of Göteborg. The referents consisted of 1746 women aged 39-65 years. All cases were studied by hospital record and 82% of the women aged 31-45 years and 85% of those aged 46-65 years were studied by an extensive questionnaire. Among the referents 1409 (81%) were investigated by the above-mentioned questionnaire. Hirsutism, increased body mass index (BMI) and hypertension were significantly more common in both EC groups compared to referents. Nulliparity and infertility were significantly more common in the young EC group. Referents used combined oral contraceptives significantly more often than women developing EC. There was, however, no difference between the groups with respect to the duration of medication with combined oral contraceptives. There was a significant negative correlation between cigarette smoking and the development of EC. These findings indicate that untreated ovarian dysfunction like that present in polycystic ovarian disease (PCO) with unopposed estrogen action on the endometrium is associated with EC in younger women, and that smoking may protect against EC by an 'anti-estrogenic' effect.

Adult↗
PubMed2006

Satisfaction with medical information in women with hypertensive disorders in pregnancy.

OBJECTIVE: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal death and fetal prematurity. The purpose of this study was to examine HDP patients' reported satisfaction with the medical information provided by their health care providers. METHODS: A convenient sample of N=620 patients with a diagnosis of HDP within 24 months prior to the study period completed a self-administered questionnaire dealing with the medical information received and their reported satisfaction. Chi-square, Fisher's Exact, and Student's t tests were used to determine the differences in sociodemographic data and potential confounders between HDP patients who were satisfied and dissatisfied with medical information. RESULTS: Of the women, 68.6% were not satisfied with the medical information. Women were particularly dissatisfied when they suffered from preeclampsia (PE), were informed of their actual situation, including eventual consequences only after delivery, and in case of fetal disorders resulting from HDP. CONCLUSION: Based on the background information reported on the importance of medical information to the patient, women developing HDP should be informed of their disease and potential sequelae as early and as differentiated as possible. Doctors need to be convinced of the role of the provider in counseling women with HDP. Information has to be repeated and health care providers are supposed to check whether the women understood the information received.

Adult↗
PubMed2001

Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations.

STUDY OBJECTIVE: To evaluate the feasibility, limits, and complications of laparoscopic myomectomy, assess time to full recovery, and evaluate uterine wound healing by ultrasound in the early postoperative period. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: General hospital. PATIENTS: Three hundred sixty-eight women undergoing laparoscopic myomectomy. INTERVENTION: Laparoscopic myomectomy and laparoscopic and/or hysteroscopic treatment of associated pathologies. MEASUREMENTS AND MAIN RESULTS: In these women 768 myomas were removed laparoscopically. Mean operating time was 100.78 +/- 43.83 minutes, mean decreases in hemoglobin and hematocrit were 1.38 +/- 0.93 g/100 ml and 4.8 +/- 2.9 g/100 ml, respectively, and mean length of hospital stay was 2.89 +/- 1.3 days. Intraoperative complications occurred in 12 patients (3.34%) and intraoperative transfusion of autologous blood was required in 10. Main postoperative complications were continuing hemorrhage requiring blood transfusion in three women and second laparoscopy in two. Pyrexia occurred in 12 patients. Average time to full recovery was 10.58 +/- 6.68 days. At 1-month follow-up 12 of 282 women developed further complications: abdominal pain 5, vaginitis 4, metrorrhagia 2, and dysuria 1. Sonographic evaluation of the uterine scar showed a highly echogenic area with ill-defined margins. In 81 women who had sonographic evaluation 30 days postoperatively, the uterine scar was reduced by an average of 44.1% (p <0.001). Of 176 patients screened at day 30, 6 (3.4%) had anechoic areas adjacent to the uterine scar, possibly due to hematoma. A previously unknown myoma, two ovarian cysts, and two pelvic hematoma were also discovered. CONCLUSION: . Laparoscopic myomectomy is effective and relatively safe. In skilled hands it has a low risk of complications and appears to be a valid alternative to the open procedure. Sonographic assessment allows detection of alterations in muscular echotexture, but its effectiveness in identifying women at risk of uterine rupture or dehiscence has to be proved.

Adult↗
PubMed2004

Maternal and perinatal outcomes of eclampsia: Nova Scotia, 1981-2000.

OBJECTIVE: To determine the prevalence of eclampsia and the associated maternal and perinatal outcomes in the province of Nova Scotia. METHODS: From the Nova Scotia Atlee Perinatal Database, the population-based rates of preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome for the period 1988 to 2000 were determined. A retrospective case review was then performed of all women with eclampsia at the tertiary maternity hospital in Halifax, Nova Scotia, Women's Hospital, IWK Health Centre, for the years 1981 to 2000. RESULTS: In the province of Nova Scotia from 1988 to 2000, there were 142,362 births. Thirty-nine women developed eclampsia (0.27/1000). Over this time interval, the prevalence of severe preeclampsia fell from 2.08% to 1.63%, and the diagnosis of HELLP syndrome increased from 0.03% to 0.31%. At the Women's Hospital, IWK Health Centre, between 1981 and 2000, there were 31 cases of eclampsia in 105,651 deliveries (0.29/1000). Sixty-one percent of first convulsions occurred antepartum, 13% occurred intrapartum, and 26% occurred postpartum. Eighty-one percent of women reported prodromal symptoms. Sixty-one percent of the women received anti-hypertensive therapies, 48% received antiepileptic therapies, and 97% received magnesium sulfate. Ten percent of the women had convulsions while on magnesium sulfate therapy. Antepartum eclampsia was associated with increased rates of general anaesthesia (26%) and Caesarean section (79%). There were no maternal deaths, but the rate of major maternal complications was 32%. The perinatal mortality rate was 64 in 1000 deliveries, and the rate of severe perinatal complications was 56%. CONCLUSION: The incidence of eclampsia in Nova Scotia is 0.27 per 1000 deliveries. Although rare, this condition is associated with significant maternal and perinatal morbidity.

Adult↗
PubMedDate not supplied

Analysis of false-negative and underreported smears in the Florence district screening program for cervical carcinoma.

AIMS AND BACKGROUND: To review false-negative or underreported (reactive changes, squamous or glandular atypia) smears performed in women developing histologically proven CIN2 or more severe lesions within 24 months and evaluate error causes. The study setting was the Florence District cervical cancer population-based screening: about 60,000 women age 25-60 years screened per year. METHODS: 118 false-negative or underreported cases were identified at screening files-cancer Registry matching, and the original smears were reviewed by six independent readers to judge smear adequacy and error type. RESULTS: Sampling errors (reported as inadequate, negative or less severe than CIN1 at review) accounted for 74% and screening/interpretation errors (reported as CIN1 or more severe at review) accounted for 26% of studied cases. Screening/interpretation errors were more likely ascribed to misinterpretation and underreporting than to misperception of cellular abnormalities. CONCLUSIONS: Quality control should above all address the problem of sampling adequacy. Due to the rarity of misperceived abnormalities (true screening errors), manual or automated rescreening of negative smears would not be an effective procedure for quality control.

Adult↗
PubMed1989

[In vitro fertilization and embryo transfer. 2. The first 44 deliveries of 55 infants].

During the period 1.9.1985-21.2.1988, 143 patients commenced and completed treatment with in vitro fertilization and embryo-transfer (IVF-ET) in Rigshospitalet, Copenhagen. Forty-four out of the 143 patients were delivered of a total of 55 infants. There were 35 single deliveries, seven twin deliveries and two triplet deliveries. Seven women were admitted with threatened abortion and three women developed preeclampsia, one of these was severe. On an average, the deliveries occurred in the 38th week of pregnancy and the average weight of the singletons was 3,020 g. Ten women were delivered preterm and seven of the singletons had birth weights under 2,500 g. The frequency of caesarean section was 34% for singleton deliveries and 43% for all of the deliveries. Thirty-one boys and 24 girls were delivered, all of whom had normal karyotypes. One infant had a cleft lip but no other malformations. Three premature infants required brief respirator treatment. All of the infants were thriving on discharge. This material is still too limited to permit drawing of definite conclusions but it suggests, however, just as in other IVT-ET investigations, that the infants are born slightly earlier and weigh slightly less than average neonates, but that they are otherwise normal. In order to illustrate these problems further, the authors have commenced a more extensive prospective investigation with matched control persons.

Denmark↗
PubMed1993

Contractile elements and myosin light chain phosphorylation in myometrial tissue from nonpregnant and pregnant women.

Smooth muscle contraction is initiated primarily by an increase in intracellular Ca2+, Ca(2+)-dependent activation of myosin light chain kinase, and phosphorylation of myosin light chain. In this investigation, we identified pregnancy-associated alterations in myosin light chain phosphorylation, force of contraction, and content of contractile proteins in human myometrium. Steady-state levels of myosin light chain phosphorylation and contractile stress were correlated positively in both tissues, but the myometrial strips from pregnant women developed more stress at any given level of myosin light chain phosphorylation. During spontaneous contractions and during conditions that favor maximal generation of stress, the rate and extent of myosin light chain phosphorylation were attenuated in myometrial strips from pregnant women. The content of myosin and actin per milligram of protein and per tissue cross-sectional area was similar between myometrium of nonpregnant and pregnant women. Although cell size was significantly increased in tissues obtained from pregnant women, the amounts of contractile proteins per cellular cross-sectional area were similar. In addition, myosin light chain kinase and phosphatase activities were similar in the two tissues. The content of caldesmon was significantly increased in myometrium of pregnant women, whereas that of calponin (a smooth muscle-specific protein associated with the thin filaments) was not different. We conclude that adaptations of human myometrium during pregnancy include (a) cellular mechanisms that preclude the development of high levels of myosin light chain phosphorylation during contraction and (b) an increase in the stress generating capacity for any given level of myosin light chain phosphorylation.

Actins↗
PubMed2001

Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer.

The aim of this study was to investigate the occurrence of (pre)neoplastic lesions in overtly normal Fallopian tubes from women predisposed to developing ovarian carcinoma. The presence of (pre)neoplastic lesions was scored in histological specimens from 12 women with a genetically determined predisposition for ovarian cancer, of whom seven tested positive for a germline BRCA1 mutation. A control group included 13 women. Immunohistochemistry was used to determine the expression of p21, p27, p53, cyclin A, cyclin D1, bcl-2, Ki67, HER-2/neu, and the oestrogen and progesterone receptors. Loss of heterozygosity (LOH) analysis on the BRCA1 locus was also assessed on dysplastic tissue by PCR studies. Of the 12 women with a predisposition for ovarian cancer, six showed dysplasia, including one case of severe dysplasia. Five harboured hyperplastic lesions and in one woman no histological aberrations were found in the Fallopian tube. No hyperplastic, dysplastic or neoplastic lesions were detected in the Fallopian tubes of control subjects. In the cases studied, morphologically normal tubal epithelium contained a higher proportion of Ki67-expressing cells (p=0.005) and lower fractions of cells expressing p21 (p<0.0001) and p27 (p=0.006) than in the control group. Even higher fractions of proliferating cells were found in dysplastic areas (p=0.07) and accumulation of p53 was observed in the severely dysplastic lesion. Expression patterns of other proteins studied, including the hormone receptors, were similar in cases and controls. One subject, a germline BRCA1 mutation carrier, showed loss of the wild-type BRCA1 allele in the severely dysplastic lesion. In conclusion, the Fallopian tubes of women predisposed to developing ovarian cancer frequently harbour dysplastic changes, accompanied by changes in cell-cycle and apoptosis-related proteins, indicating an increased risk of developing tubal cancer.

Adult↗