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PubMed2006

Risk of breast, ovary, and uterine corpus cancers among 85,268 women with AIDS.

By linking HIV/AIDS and cancer surveillance data in 12 US regions, breast and reproductive cancer risks with AIDS were compared to those in the general population. Trends in standardized incidence ratios (SIRs) were assessed by CD4 count, AIDS-relative time, and calendar time. Standardized incidence ratios were indirectly adjusted for cancer risk factors using data from AIDS cohort participants and the general population. With AIDS, 313 women developed breast cancer (SIR 0.69, 95% confidence interval (CI) 0.62-0.77), 42 developed ovary cancer (SIR 1.05, 95% CI, 0.75-1.42), and 31 developed uterine corpus cancer (SIR 0.57, 95% CI, 0.39-0.81). Uterine cancer risk was reduced significantly after age 50 (SIR 0.33). Breast cancer risk was reduced significantly both before (SIR 0.71) and after (SIR 0.66) age 50, and was lower for local or regional (SIR 0.54) than distant (SIR 0.89) disease. Breast cancer risk varied little by CD4 count (Ptrend=0.47) or AIDS-relative time (Ptrend=0.14) or after adjustment for established cancer risk factors. However, it increased significantly between 1980 and 2002 (Ptrend=0.003), approaching the risk of the general population. We conclude that the cancer deficit reflected direct or indirect effects of HIV/AIDS and that anti-HIV therapy reduced these effects.

Acquired Immunodeficiency Syndrome↗
PubMed2001

beta-Thalassaemia intermedia in a Turkish girl: homozygosity for G-->A substitution at +22 relative to the beta-globin cap site.

We provide the first description of a homozygote patient for the G-->A substitution in the 5' UTR of the beta-globin gene. The proband was a 17-year-old girl with beta-thalassaemia intermedia who had never received a blood transfusion. The physical examination revealed a well-developed women with no facial or bony abnormalities. There was mild paleness and mild splenomegaly which was 2 cm below the costal margin. The haemoglobin (Hb) was 7.6 g/dl, Hb A(2) 5.4% and Hb F 14.6% of the total Hb. The Hb A(2) of both parents was 3.5%. The Hb F level in the mother and father were 0.9, 1.2% and the mean cell volume (MCV) value was 70 and 72 fl respectively. DNA analysis of the beta-gene region of the propositus revealed homozygosity for a G-->A substitution at nucleotide +22 relative to the beta-gene cap site, within a functional downstream region that was referred to as the DCE (downstream core element). In addition to the data obtained previously from in vitro transcription assays, clinical findings and in vivo expression studies gave some valuable clues about the effect of +22 G-->A mutation on the expression of beta-gene. Phenotypic expression of this homozygous patient is highly suggestive that G-->A substitution at nt +22 confers a relatively mild (silent) beta(+)-thalassaemia phenotype.

5' Untranslated Regions↗
PubMed2003

Childbirth expectations of Chinese first-time pregnant women.

BACKGROUND: This topic had not been researched previously and the information gained could have implications for midwives working with Chinese women everywhere. AIMS: To explore the specific childbirth expectations of Hong Kong Chinese first-time pregnant women. METHODS: This was a cross-sectional descriptive survey study and a Chinese version of the Childbirth Expectations Questionnaire was used to collect data. The sample consisted of 186 first-time pregnant women who first attended the antenatal clinic at a large public hospital in a major geographical region of Hong Kong. RESULTS: Results showed that the Chinese pregnant women, the majority of who had not attended childbirth education classes, had high expectations of support from both their partners and midwives during labour and delivery. Conversely, expectations toward their own ability to cope with pain were relatively low. In addition, the pregnant women expressed concerns about the severity of labour pain and indicated low expectations about minimal use of medical interventions during labour. CONCLUSIONS: This study results add to the existing literature about childbirth expectations of first-time pregnant Hong Kong Chinese women. Midwife educators should incorporate the findings into childbirth education classes to help pregnant women develop realistic and positive expectations.

Adaptation, Psychological↗
PubMed2003

Pregnancy outcome in Type 1 diabetes mellitus treated with insulin lispro (Humalog).

AIMS: The use of insulin lispro in pregnancy has not been systematically investigated despite its increasing use. Pooled data from seven centres with experience in the use of insulin lispro were accumulated to evaluate pregnancy outcome in women with Type 1 diabetes. METHODS: Seven units with specialist obstetric diabetes services were recruited to describe their total experience with insulin lispro in pregnancy. Outcomes with respect to the rate of miscarriage, congenital abnormality, perinatal mortality and maternal parameters were recorded in a standardized format. RESULTS: Outcomes on 71 babies from 76 pregnancies were documented. There were six (7.8%) early miscarriages. All 71 babies were liveborn with a mean gestational age of 37.2 weeks, and median birthweight of 3230 g. Seven babies weighed > 4 kg. There were four congenital abnormalities (5.6%). There was a 72% increase in the mean insulin dose (0.75-1.29 IU/kg per day). Maternal glycaemic control improved throughout pregnancy. No women developed retinopathy de novo during pregnancy and six with established retinopathy required laser therapy during pregnancy. CONCLUSIONS: The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy.

Adult↗
PubMed2000

Diagnosis of abdominal tuberculosis by transabdominal ultrasound-guided needle biopsy.

Laparotomy and laparoscopy have been used for biopsy of pelvic masses in the differential diagnosis between abdominal tuberculosis and ovarian cancer. We suggest the use of transabdominal needle biopsy under ultrasound guidance in such cases. Two women developed abdominal distention, one of whom had been receiving medical treatment for known tuberculosis. In both cases, ultrasonography showed a pelvic mass and ascites associated with high levels of CA 125. A transabdominal ultrasonographically-guided biopsy of the masses with a trucut needle established their tuberculous origin. The transabdominal sonographic needle biopsy is a reliable diagnostic procedure in the differential diagnosis between abdominal tuberculosis and ovarian malignancy. This minimally invasive procedure saves the patient with tuberculosis from unnecessary laparotomy.

Adult↗
PubMed2001

Improved early prediction of pre-eclampsia by combining second-trimester maternal serum inhibin-A and uterine artery Doppler.

OBJECTIVE: To evaluate the screening efficacy of second-trimester maternal serum inhibin-A combined with uterine artery Doppler studies performed at 20 weeks' gestation for the prediction of pre-eclampsia. METHODS: Six hundred and eighty-nine consecutive unselected women who had inhibin-A levels measured between 15 and 19 weeks' gestation subsequently had color flow pulsed Doppler of both uterine arteries at the time of the anomaly scan (mean 20.5, range 18-22 weeks' gestation). The main outcome measures were pre-eclampsia and pre-eclampsia requiring delivery before 37 weeks' gestation. The presence or absence of notches in the flow velocity waveform was noted, and the resistance index measured. Receiver operator curves were created for inhibin-A and uterine artery Dopplers alone and in combination. Sensitivities for each method were compared at false-positive rates of 3% and 7%. RESULTS: Thirty-five women developed pre-eclampsia, of whom 15 required delivery before 37 weeks' gestation. For a false-positive rate of 7%, the sensitivity using bilateral notches/mean resistance index > or = 0.65 was 60% with a positive likelihood ratio of 8.6 (confidence interval 5.7-12.6). For the same false-positive rate, when bilateral notches/mean resistance index > or = 0.55 and unilateral notches/mean resistance index > or = 0.65 were combined with inhibin-A > or = 1.0 multiples of the median, the sensitivity improved to 71% and the positive likelihood ratio to 10.8 (confidence interval 7.4-15.4). For pre-eclampsia requiring delivery before 37 weeks for a false-positive rate of 3%, the sensitivity for bilateral notches improved from 27% to 60% and the positive likelihood ratio improved from 9.2 to 20.8 when uterine artery notch data was combined with inhibin-A. The improvement in sensitivity for the combined method, compared to either inhibin-A or uterine artery Dopplers alone, was statistically significant for both pre-eclampsia ( P < 0.05) and preterm pre-eclampsia ( P < 0.02). CONCLUSION: Combination of second-trimester serum inhibin-A and uterine artery Doppler at 20 weeks improves the screening efficacy for the prediction of pre-eclampsia especially when this necessitates early delivery. This combination might form the basis of an effective and practical early screening test for the condition.

Adult↗
PubMed1999

Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case.

A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. Perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.

Acute Disease↗
PubMedDate not supplied

Risk contribution of sexual behavior and cigarette smoking to cervical neoplasia.

Infection with high-risk human papillomavirus (HPV) is considered a "necessary cause" for cervical cancer (CC); however, only some HPV-infected women develop CC. We report on the differential risk contribution of sexual behavior and cigarette smoking to cervical neoplasia in the US and Venezuela. A total of 142 patients and 158 matched-controls were recruited from both countries using the same recruitment protocol, the same pathologists for case verification, and the same experimental procedures for analysis. HPV infection was significantly associated with CC for both populations as expected, but the Venezuelan controls were twice as likely to be infected with HPV as the US controls. Having >2 lifetime sexual partners (OR = 4.7, 95% CI = 1.7-13.1) and initiation of sexual activities before the age of 18 (OR = 4.7, 95% CI = 1.6-13.7) were significant risk factors in a multivariate model for CC in Venezuela. In contrast, current cigarette smoking was a significant risk factor only in the US (OR = 3.6, 95% CI = 1.7-7.7). The observed differences in risk factors support the need for additional studies in different geographic regions and the information can be used to develop country-specific CC prevention programs.

Adolescent↗
PubMed2004

[Mastitis puerperalis - causes and therapy].

Between 1995 and 2003 a total of 1 827 women suffering from puerperal mastitis was studied. Etiology of the disease was defined, white cell counts and microbiologic cultures were obtained. According to the results the illness was classified and treated. Since in all cases we found either simple congestion or non-infectious inflammation of the breast treatment consisted of intensified emptying of the breast by breast feeding every 2 hours and in some cases additional manual expression of milk. Antibiotics and bromocriptine were not used. In 1 826 cases fever and flue symptoms had resolved within 25-36 hours. Redness and soreness had resolved within 2-3 days. Relapse did not occur and none of the women developed an abscess. One woman had to be treated with antibiotics because the baby refused to nurse at the diseased breast and emptying had to be done by hand.

Breast Feeding↗
PubMed2004

[End-to-end anastomosis in the primary repair of anal sphincter laceration occurring during delivery].

PURPOSE: To assess the quality of end-to-end anastomosis in the primary repair of anal sphincter laceration occurring during delivery. METHODS: Forty-nine women with third degree perineal laceration (PL III) and 42 controls were included in a 3-year postpartal follow-up study. RESULTS: Ultrasound showed end-to-end anastomosis to be inadequate in 22 (48.1 %) women. Thirty-one (63.2 %) women developed grade I-III anal incontinence. DISCUSSION: There was no correlation between ultrasound findings and the presence of anal incontinence. The unsatisfactory sonomorphometric outcome after 6 weeks results from inadequate repair with retraction of the sphincter ends. Defects newly demonstrated after 36 months indicate dedifferentiating atrophy with damage to peripheral motor nerves.

Adult↗
PubMed1995

Course of Crohn's disease during pregnancy and its effect on pregnancy outcome: a retrospective review.

The purpose of our study was to review the effects of Crohn's disease on pregnancy outcomes. Over a 6-year period, we identified 17 women with pregnancies complicated by Crohn's disease. The mean age of the women was 26 years, with a mean age of diagnosis at 17 years. Crohn's disease worsened only slightly during the pregnancy. Exacerbations of diarrhea were the main problems. Weight gain, unadjusted for gestational age at delivery, was 18 pounds. Three babies had low birthweight; two were both premature and growth retarded. One woman with active disease and no prenatal care had a fetal death at 30 weeks' gestation with subsequent disseminated intravascular coagulation. Among women with active perianal disease, one was delivered vaginally without exacerbation of symptoms. Four women with histories of perianal disease had prophylactic primary elective cesarean sections to avoid worsening of symptoms. Three of these women developed recurrent perianal disease despite the abdominal delivery. One of these developed an abdominal fistula trait in the wound. Our findings suggest that active disease at the onset of pregnancy tends to remain active, and quiescent disease tends to remain quiescent. Mode of delivery in our series was not protective against perineal disease. Although our series is small, it suggests that delivery may occur vaginally, with operative delivery reserved for obstetric indications.

Adolescent↗
PubMed1988

[Results following anterior levator-plasty].

In this study we report about 172 patients who underwent modified anterior repair in the time from october 1983 up to april 1985 because of vaginal prolapse and/or incontinence. 125 patients could be examined clinically, in the middle 14.2 months after operation. In 64% the modified anterior repair was combined with a colporrhaphia anterior and hysterectomy, and in 20% a colporrhaphia posterior was made additionally. Dehiscence of the anterior vaginal wall occurred in 19.2%, severe pelvic infections in 8.8%. Because of bleeding complications a chirurgical intervention was necessary in 5.6%. A descent of the anterior vaginal wall was seen in 30.4%, 76.8% of the women developed a descent of the posterior vaginal wall, and 8% a stenosis of the vagina. Problems at sexual intercourse were frequent, followed by pain in the lower abdomen. The principle of the operation is presented including the changed anatomy. Many of the adverse effects can be understood and the necessity of prophylaxis of a descensus of posterior vaginal wall was described.

Adult↗
PubMed1981

[Aminoglutethimide in metastasizing carcinoma of the breast resistant to hormonal and cytostatic treatment (author's transl)].

Aminoglutethimide (Elipten), at a dosage between 250 and 1500 mg/d by mouth, was administered in a clinical phase II study to 17 patients with metastasizing carcinoma of the breast resistant to hormones and cytostatic drugs. Results of this treatment were available for 14 patients. Nine women were given the drug alone, eight in combination with cytostatic drugs. In 11 women the drug significantly decreased pain within 3-14 days. Used alone aminoglutethimide produced objective regression of the metastases in two women, two further instances of regression occurred when the drug was combined with cytostatic agents. Five women developed urticarial rash, while six had somnolence and nausea or lethargy. Aminoglutethimide is suitable for symptomatic treatment of metastasizing treatment-resistant carcinoma of the breast, either alone or in combination with cytostatic drugs.

Adult↗
PubMed1999

An overlap syndrome with features of atypical Cogan syndrome and Wegener's granulomatosis.

A 48 year old women developed serous otitis, scleritis, myalgia, vertigo, polyneuropathy, crescentic glomerulonephritis, general cerebral dysrythmia, hilar adenopathy, and retroorbital granulomatous inflammation. Pulmonary manifestations were absent and antibodies against neutrophilic cytoplasmic antigens (ANCA) could not be detected. The clinical picture was classified as an overlap syndrome with features of both atypical Cogan syndrome and Wegener's granulomatosis. The patient responded to treatment with high dose corticosteroids and pulse cyclophosphamide.

Cyclophosphamide↗
PubMedDate not supplied

Perinatal care: the Kuranko context of choice.

The ethnomedical aspects of childbirth and factors that influence Kuranko women in the northern Sierra Leone center of Kabala (a multiethnic town of some 15,000 inhabitants) in making decisions regarding perinatal care are the focus of this article. I found that Kuranko women develop perinatal care strategies from services available in the formal and informal health-care sectors. The discussion is situated within a context that values primary health care and health promotion and advocates the use of these frameworks in ways that are informed by Kuranko social organization and concepts of development.

Attitude to Health↗
PubMed2002

Social support protects against the negative effects of partner violence on mental health.

OBJECTIVES: Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women. METHODS: A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview. RESULTS: IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9). CONCLUSIONS: Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.

Adolescent↗
PubMed2003

Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginitis.

OBJECTIVE: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. METHODS: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. RESULTS: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p </= 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). CONCLUSIONS: Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.

Adult↗