Clinical profile of vulvodynia patients. A prospective study of 300 patients

OBJECTIVE: To define the demographic and clinical characteristics of women presenting with vulvodynia. STUDY DESIGN: Vulvodynia patients seen by the author between September 1996 and June 1999 were included in the study. Patients completed a standardized questionnaire and were interviewed and clinically examined. RESULTS: Three hundred one patients completed the questionnaire. The average age was 38 years old, 72% reported postsecondary education, 54% were nulligravid, and 55% were married. Average duration of symptoms was 38 months. Patients reported dyspareunia (71%), vulvar burning (57%) and vulvar itching (46%). One-third reported problems with sexual response. The majority (64%) reported a "history" of yeast infections. Over 64% of the time all therapeutic interventions tried by patients made the vulvar symptoms no better or worse. Approximately 55% reported another chronic health condition. Positive physical findings were often limited to inflammation in the vestibule (25%) and pain on palpation of the posterior vestibule (69%). Patients reported that their vulvodynia limited their physical activities. CONCLUSION: Physicians should approach management of vulvodynia using a chronic pain model that emphasizes multidisciplinary health care and "improvement" in health, rather than single interventions and cure of disease.     

Comparing uterine electromyography activity of antepartum patients versus term labor patients

OBJECTIVE: The purpose of this study was to compare uterine electromyography of patients delivering>24 hours from measurement with laboring patients相似文献   

Parenteral nutrition of injured patients

Injured patients treated with fructose 1,6-diphosphate (1 millimole of phosphate per kilogram per day) together with parenteral nutrition had a better nitrogen balance than patients treated with isocaloric nutrition and an inorganic source of phosphate. Excretion of 3-methylhystidine was similar while tyrosine and alanine output from the extremities was lower in the group of patients given fructose 1,6-diphosphate. The data indicates that the protein sparing action of fructose 1,6-diphosphate is exerted through an increased protein synthesis.     

Evaluation of patients for microsurgery

Prior to undergoing conservative pelvic surgery for improvement of fertility, there must be meticulous preoperative evaluation. This evaluation involves a history, all previous records and operative reports, psychologic evaluation, physical examination, hysterosalpingogram, laparoscopy, and tests for male factor and ovulation. In history taking, the physician is most interested in past evidence of infection. The emotional status of the patient must be considered, especially for those individuals who are seeking sterilization reversal. Often, with a history of previous pelvic surgery the rate of success is lowered. Physical examination is usually not useful in predicting final outcome of microsurgery; however, it does determine the patient's general preoperative status. Hysterosalpingography and laparoscopy are complementary procedures which are the cornerstone of the preoperative evaluation. The 1st gives evidence of the status of the uterus and the tube proximal to the block, if 1 exists. If the block is in the isthmic portion, the hysterosalpingogram will indicate how much of the tube is patent next to the corpus. Preoperative laparoscopy is necessary for proper and complete evaluation of pelvic status; it allows the operator to visualize the distal segment of the tube. Laparoscopy indicates the extent of pelvic adhesion, ovary and tube involvement, mobility of the tube, extent of fimbrial involvement, and presence of disease. When all factors are taken are into consideration, the surgeon must determine whether the benefits of surgery will outweigh the risks. Patient age, emotional needs, other parameters of fertility, status of tubes and ovaries, etc. must all be taken into consideration.     

Comparison of early onset breast cancer patients to older premenopausal breast cancer patients

Background  

The objective of this study was to show differences between breast cancer patients ≤35 and >35 years with regard to tumor characteristics and to present the patient-relevant outcomes overall survival (OAS) and recurrence-free survival (RFS).     

The obstetrical history in patients with Pfannenstiel scar endometriomas--an analysis of 81 patients

INTRODUCTION: The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. MATERIALS AND METHODS: We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. RESULTS: In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21-3.83; OR = 2.18, 95% CI = 1.22-3.89]. CONCLUSIONS: Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.     

Long-term management of vasovasostomy patients

Follow-up of 54 patients undergoing modified single-layer bilateral vasovasostomies are presented with attention to semen quality, pregnancy rates, and postoperative findings potentially inhibiting fertility. The technical success rate was 98%, but 3-month semen analyses varied from "poor" (less than 20(6)/ml; greater than 50% normal motility) of 20% to "excellent" (greater than 26(6)/ml; greater than 50% normal motility) of 35% without effect on long-term pregnancy rates, 50% and 54.5%, respectively. Other factors, such as sperm clumping, prostatitis, and immunologic interference, appear to decrease motility. Close follow-up with attention to factors affecting fertility other than simple concentration and motility are rewarding.     

Impact of neoangiogenesis on the survival of patients of patients with stage Ib-IIb cervical carcinoma

The survival of patients with cervical cancer has not improved much over the past few years. Cervical cancer is characterised by a degree of heterogeneity. Some patients undergoing surgery die a few months after diagnosis and treatment, whereas others live for longer and metastases only occur at a later stage. Over the past few years a new prognostic factor of cervical cancer has been identified. Neoangiogenesis can predict the possible metastasization of lymph nodes, disease-free survival, recidivation and therefore which patients require specific postoperative adjuvant therapies. This oncogenetic model, which also correlates the degree of neoangiogenesis with metastasization, and hence the level of tumour aggression, has been well demonstrated in lung cancer and skin melanoma. The microscopic discovery of increased tumour vascularization might be a useful independent prognostic factor in patients otherwise regarded as low risk. Cervical cancer with intense neoangiogenesis at an early phase may undergo rapid growth, early invasion and an increased capacity for metastasization. Neoangiogenesis is expressed as the density of microvessels inside the stroma of the neoplasm in invasive cervical cancer. It is predictive of recurrent disease and mortality independent of other prognostic factors. Patients with a high density of microvessels have a risk of fatal recidivation. The quantification of angiogenesis in primary tumours may be a useful prognostic factor in patients with cervical cancer. The quantification of neovascularization in neoplasms today is made easier by immunohistochemical staining procedures with greater specificity and sensitivity compared to conventional stains. It is to be hoped that this method will be used systematically by pathologists in biopsies to identify the most appropriate surgical and adjuvant therapies.     

Incidence of B streptococci in gynecologic patients, pregnant patients and newborn infants

821 patients have been examined with regard to the presence of B streptococci. We isolated B streptococci in 5.4 per cent in gynaecologic outpatients, in 0.4 per cent in 236 pregnant women and in 5.8 per cent in 156 newborns. From 78 to these newborns we were able to examine the mothers during their stay in the delivery room, too. Only in one parturient and her newborn we could detect B streptococci. In three B streptococci positive newborns is was not possible to prove this germ in the vaginal content of their mothers. Clinical symptoms were not present in no case. Antibiograms were not peculiar.     

Comparison of complications of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis

We reviewed 1246 vaginal hysterectomies performed at Handa City Hospital between January 1984 and December 1996. We divided the patients into 2 groups: those with leiomyomas (n=893) and those with adenomyosis (n=353). There was no difference in operative time and estimated blood loss between the 2 groups when analyzed by uterine weight. However, adenomyosis was associated with an increased risk of bladder injury. Accepted: 7 April 1998