共查询到20条相似文献,搜索用时 15 毫秒
1.
Objective
To explore appropriate second-line therapies for management of severe postpartum hemorrhage at cesarean delivery.Methods
A retrospective study was done of 87 women who underwent cesarean delivery and received uterotonics after placental separation at the Beijing Haidian Maternal and Child Health Hospital, China, between 2009 and 2013. Group 1 (n = 52) included patients with 500–700 mL of blood loss before application of intrauterine gauze tamponade or B-Lynch suture as second-line therapy, while group 2 (n = 35) included patients with blood loss of more than 700 mL before application of either gauze tamponade or B-Lynch suture.Results
Management was successful in all patients in group 1. In group 2, additional management was needed in three of four patients who underwent a B-lynch suture. Factors significantly associated with total blood loss were blood loss before application of second-line therapy (P < 0.001), fibrinogen levels (P < 0.001), and time from placental separation to second-line therapy (P = 0.015).Conclusion
When blood loss is 500–700 mL, compression sutures or intrauterine gauze tamponade can be used as second-line treatment of postpartum hemorrhage. When blood loss is more than 700 mL, intrauterine gauze tamponade should be used. 相似文献2.
Yunus Aydin Hikmet HassaTufan Oge V. Yavuz Tokgoz 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective(s)
To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34–36 h following hCG injection in gonadotropin-stimulated IUI cycles.Study design
Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34–36 h after hCG injection (group I) (n = 106) and IUI simultaneously with hCG administration (group II) (n = 98). The primary outcome was clinical pregnancy rates.Results
There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p = 0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34–36 h after hCG (odds ratio (OR) = 1.35, 95% CI 0.53–3.42).Conclusion(s)
There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34–36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required. 相似文献3.
Britton Trabert Ligia Pinto Patricia Hartge Troy Kemp Amanda Black Mark E. Sherman Louise A. Brinton Ruth M. Pfeiffer Meredith S. Shiels Anil K. Chaturvedi Allan Hildesheim Nicolas Wentzensen 《Gynecologic oncology》2014
Objective
Pro-inflammatory mechanisms may explain the increased ovarian cancer risk linked to more lifetime ovulations, endometriosis, and exposure to talc and asbestos, as well as decreased risk with non-steroidal anti-inflammatory drugs. Limited data are available to estimate ovarian cancer risk associated with levels of circulating inflammatory markers.Methods
We conducted a nested case–control study within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Pre-diagnostic serum levels of 46 inflammation-related biomarkers (11 with a priori hypotheses; 35 agnostic) were measured in 149 incident ovarian cancer cases and 149 matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression and adjusted for identified covariates.Results
Increased ovarian cancer risk was associated with elevated levels of C-reactive protein (CRP) [tertile (T)3 vs. T1: OR (95% CI) 2.04 (1.06–3.93), p-trend = 0.03], interleukin (IL)-1α [detectable vs. undetectable: 2.23 (1.14–4.34)] and tumor necrosis factor alpha (TNF-α) [T3 vs. T1: 2.21 (1.06–4.63), p-trend = 0.04]. Elevated IL-8 was non-significantly associated with risk [T3 vs. T1: 1.86 (0.96–3.61), p-trend = 0.05]. In analyses restricted to serous ovarian cancer (n = 83), the associations with CRP and IL-8 remained or strengthened [CRP T3 vs. T1: 3.96 (1.14–11.14), p-trend = 0.008; IL-8 T3 vs. T1: 3.05 (1.09–8.51), p-trend = 0.03]. Elevated levels of CRP and TNF-α remained positively associated with ovarian cancer risk in analysis restricted to specimens collected at least 5 years before diagnosis (n = 56).Conclusion
These results suggest that CRP, IL-1α, IL-8, and TNF-α are associated with increased risk of subsequently developing ovarian cancer. 相似文献4.
Cihangir Mutlu Ercan Mehmet Sakinci Hakan Coksuer Ugur Keskin Serkan Tapan Ali Ergun 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To find out whether tubal sterilization leads to loss of ovarian reserve, we assessed the hormonal and ultrasonographic parameters of ovarian reserve in women who underwent laparoscopic tubal sterilization by bipolar electrodesiccation and transection.Study design
In this preliminary study, laparoscopic tubal sterilization was performed on 49 healthy women who had voluntarily requested elective surgical sterilization. Among the current ovarian reserve indicators, in the early proliferative phases, preoperative (baseline) and postoperative (third month) serum follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels, ovarian volume, and antral follicle counts (AFCs) were determined. Analysis of these hormonal and ultrasonographic parameters of ovarian reserve preoperatively and postoperatively was the main outcome measure.Results
Preoperative and third-month postoperative FSH, LH, E2, and AMH levels did not reveal statistically significant differences (p = 0.101, p = 0.180, p = 0.254, and p = 0.079; respectively). The ultrasonographic indicators of ovarian reserve did not change in terms of total ovarian volume and total AFC (p = 0.793 and p = 0.098, respectively).Conclusions
Short-term follow-up study results revealed a slight but non-significant change in the current ovarian reserve markers, especially in the AMH levels. 相似文献5.
Tae-Wook Kong Hyogyeong Park Ji-Yoon Cheong Sang-Ki Min Hee-Sug Ryu 《International journal of gynaecology and obstetrics》2014
Objective
To assess the efficacy of analgesia provided by continuous ropivacaine wound infiltration after gynecologic laparoscopy.Methods
Sixty patients who underwent gynecologic laparoscopy at Ajou University School of Medicine, Suwon, Republic of Korea, between March and May 2012 were randomized to receive either intravenous fentanyl and ketorolac infusion on demand by patient-controlled analgesia (IV PCA group, n = 31) or continuous wound infiltration of local ropivacaine (CWI group, n = 29). Postoperative pain and postoperative nausea and vomiting (PONV) were assessed via a visual analog scale. The number of patients who requested rescue analgesia was recorded.Results
There was no significant difference in postoperative pain between the 2 groups, but more patients requested rescue analgesia in the CWI group than in the IV PCA group in 24 hours (18 versus 9 patients, respectively; P = 0.010). The PONV scores at 12 and 24 hours were, respectively, 0.28 and 0.27 in the CWI group, and 0.71 and 0.73 in the IV PCA group (P = 0.004). Nine patients requested cessation of IV PCA because of severe nausea or vomiting.Conclusion
Continuous ropivacaine wound infiltration was found to be as effective as patient-controlled analgesia for postoperative pain relief after gynecologic laparoscopy. This technique provides good analgesia with less opioid analgesic requirement and few adverse effects. 相似文献6.
Akira Iwase Atsuko Sugita Wakana Hirokawa Maki Goto Eiko Yamamoto Sachiko Takikawa Tatsuo Nakahara Tomoko Nakamura Mika Kondo Fumitaka Kikkawa 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
The loss of primordial follicles from gonadal damage caused by chemotherapy results in decreased ovarian reserve. To assess the impact of chemotherapy for patients with gestational trophoblastic neoplasia (GTN) on the ovarian reserve, we evaluated the post-chemotherapy serum anti-Müllerian hormone (AMH) levels.Study design
In 22 patients with GTN receiving chemotherapy, serum AMH levels were measured after the administration of chemotherapy and compared with serum AMH levels measured in patients with hydatidiform mole who did not receive chemotherapy, as a control. We also analyzed differences in the serum AMH levels following the administration of different anti-cancer agents.Results
The serum AMH levels measured in the GTN group after chemotherapy was administered (median 1.18, range 0.32–3.94 ng/mL) significantly decreased in comparison to those measured in the control group (median 4.22, range 0.77–6.53 ng/mL, P = 0.002). Serum AMH levels were significantly lower in the patients who had received a regimen including etoposide than in the patients who had not received treatment with etoposide (0.71 vs. 1.30 ng/mL, P = 0.027).Conclusion
Our results suggest that chemotherapy administered to treat GTN does indeed affect the ovarian reserve, especially in patients who receive a medication regimen that includes etoposide. Measuring their serum AMH levels might therefore be helpful for counseling GTN patients regarding their ovarian reserve. 相似文献7.
Turhan Aran Suleyman Guven Mesut A. Unsal Ahmet Alver Ahmet Mentese Esin Yulug 《European journal of obstetrics, gynecology, and reproductive biology》2010
Objective
To evaluate the effect of ovarian torsion on serum levels of ischemia-modified albumin (IMA) in an experimental model.Study design
Sixteen female adult Sprague–Dawley rats were involved in the study. Rats were allocated randomly to group I or group II on the day of the experiment. Group I (eight rats) comprised the control (sham operated) group. In group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary. At the end of a 3-h period of ischemia, the ovaries were removed. Blood was sampled before and after operation to assess serum IMA levels. Serum IMA levels (absorbance units) and histopathologic damage scores were evaluated.Results
Initial serum IMA levels were similar in both groups. After the operation, significant elevation was observed in group II in contrast to group I (0.191 ± 0.034 and 0.277 ± 0.089 ABSU, p = 0.05). Histologic specimens of the ovaries in group II had higher scores of follicular cell degeneration, vascular congestion, hemorrhage and inflammatory cell infiltration than those in group I (p < 0.001).Conclusions
The elevated serum IMA levels observed in the ovarian torsion model seem to have a potential role as a serum marker in the early diagnosis of ovarian torsion. 相似文献8.
G. Hofstetter N. Concin I. Braicu R. Chekerov J. Sehouli I. Cadron T. Van Gorp F. Trillsch S. Mahner H. Ulmer C. Grimm D. Cacsire Castillo-Tong R. Zeillinger A.G. Zeimet I. Vergote 《Gynecologic oncology》2013
Objective
Cytoreductive surgery and platinum-based systemic therapy constitute the standard treatment of patients with advanced ovarian cancer. The aim of the present study was to evaluate whether the time interval from surgery to start of chemotherapy has an impact on clinical outcome.Methods
Data of 191 patients with advanced serous (FIGO III–IV) ovarian cancer from the prospective multicenter study OVCAD (OVarian CAncer Diagnosis) were analyzed. All patients underwent primary surgery followed by platinum-based chemotherapy.Results
The 25%, 50%, and 75% quartiles of intervals from surgery to start of chemotherapy were 22, 28, and 38 days, respectively (range, 4–158 days). Preoperative performance status (P < 0.001), extent of surgery (P < 0.001), and perioperative complications (P < 0.001) correlated with intervals from surgery to initiation of chemotherapy. Timing of cytotoxic treatment [≤ 28 days versus > 28 days; hazard ratio (HR) 1.73 (95% confidence interval 1.08–2.78), P = 0.022], residual disease [HR 2.95 (95% confidence interval 1.87–4.67), P < 0.001], and FIGO stage [HR 2.26 (95% confidence interval 1.41–3.64), P = 0.001] were significant prognostic factors for overall survival in multivariate analysis. While the interval from surgery to start of chemotherapy did not possess prognostic significance in patients without postoperative residual disease (n = 121), it significantly correlated with overall survival in patients with postoperative residual disease [n = 70, HR 2.24 (95% confidence interval 1.08–4.66), P = 0.031].Conclusion
Our findings suggest that delayed initiation of chemotherapy might compromise overall survival in patients with advanced serous ovarian cancer, especially when suboptimally debulked. 相似文献9.
Catarina Policiano Ana Costa Alexandre Valentim-Lourenço Nuno Clode Luís M. Graça 《International journal of gynaecology and obstetrics》2014
Objective
To evaluate the delivery route and the indications for cesarean delivery after successful external cephalic version (ECV).Methods
A retrospective matched case–control study was conducted at a hospital in Lisbon, Portugal, between 2002 and 2012. Each woman who underwent successful ECV (n = 44) was compared with the previous and next women who presented for labor management and who had the same parity and a singleton vertex pregnancy at term (n = 88). The outcome measures were route of delivery, indications for cesarean delivery, and incidence of nonreassuring fetal status.Results
Attempts at ECV were successful in 62 (46%) of 134 women, and 44 women whose fetuses remained in a cephalic presentation until delivery were included in the study. The rates of intrapartum cesarean delivery and operative vaginal delivery did not differ significantly between cases and controls (intrapartum cesarean delivery, 9 [20%] vs 16 [18%], P = 0.75; operative vaginal delivery, 14 [32%] vs 19 [22%], P = 0.20). The indications for cesarean delivery after successful ECV did not differ; in both groups, cesarean delivery was mainly performed for labor arrest disorders (cases, 6 [67%] vs controls, 13 [81%]; P = 0.63).Conclusion
Successful ECV was not associated with increased rates of intrapartum cesarean delivery or operative vaginal delivery. 相似文献10.
Mohamed L. Mohamed Manal M. El-Behery Shymaa A.E.-A. Mansour 《International journal of gynaecology and obstetrics》2011,114(1):69-72
Objective
To compare the effects of laparoscopic bipolar electrocoagulation with laparotomic hemostatic suturing during unilateral ovarian cystectomy on the ovarian reserve.Methods
A prospective randomized trial was conducted on 59 women with unilateral benign ovarian cysts who underwent laparoscopic ovarian cystectomy by a stripping technique (n = 30) or open laparotomy with hemostatic suturing (n = 29). Serum anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian stromal peak systolic velocity (PSV) at the 1st, 3rd, and 6th postoperative cycle were used to assess the ovarian reserve.Results
Preoperative AMH levels did not differ significantly (P = 0.18) between the laparoscopy and laparotomy groups. In the laparoscopy group, there was a significant decrease in AMH levels, AFC, and PSV at the 3rd and 6th postoperative cycles compared with the 1st postoperative cycle, with an insignificant decrease between the 3rd and 6th cycles. In the laparotomy group, nonsignificant decreases in AMH levels, AFC, and PSV were detected at the 1st, 3rd, and 6th postoperative cycle and between the 3rd and 6th cycles.Conclusion
Laparoscopic ovarian cystectomy is associated with a significant reduction in ovarian reserve. This is a consequence of damage to the ovarian vascularity and the removal of an increased amount of ovarian tissue. 相似文献11.
Taek Sang Lee Jung-Yun Lee Jae-Weon Kim Sohee Oh Seok Ju Seong Jong Min Lee Tae Jin Kim Chi Heum Cho Seok-Mo Kim Chan-Yong Park 《Gynecologic oncology》2013
Objective
The aim of this study was to evaluate the impact of ovarian preservation on the recurrence and survival rates of premenopausal women with early-stage endometrial cancer.Methods
Using medical records of premenopausal women who received primary surgical treatment for stage I–II endometrial cancer, the demographics and survival rates were compared retrospectively for patients who had ovarian preservation and those who underwent bilateral salpingo-oophorectomy. Cox proportional hazards models with inverse probability of treatment weighting (IPTW) based on propensity score were performed to adjust for selection bias between the two groups.Results
A total of 495 women were identified, including 176 patients who had ovarian preservation. The ovarian preservation group was younger (P < 0.001) and had an earlier year of diagnosis (P = 0.014), a lower prevalence of lymphadenectomy (P < 0.001), and a marginally significant association with lower tumor grade (P = 0.052). The Kaplan–Meier curve and the log rank test showed no difference in either recurrence-free survival (P = 0.742) or overall survival (P = 0.462) between the two groups. In a multivariate Cox model adjusted by IPTW and covariates, ovarian preservation had no effect on either recurrence (hazard ratio [HR], 0.73; 95% CI, 0.29–1.81) or overall survival (HR, 1.33; 95% CI, 0.43–4.09).Conclusions
Ovarian preservation does not appear to be associated with an adverse impact on the outcomes of premenopausal women with early-stage endometrial cancer. The present study has useful implications for physicians counseling young women who want to preserve their ovaries. 相似文献12.
N. Yilmaz D. UygurH. Inal U. GorkemN. Cicek L. Mollamahmutoglu 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on ovarian reserve by measuring markers such as antral follicle count, serum anti-Müllerian hormone (AMH) and inhibin B in patients with diminished ovarian reserve.Study design
This prospective study was undertaken at Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. Forty-one patients with diminished ovarian reserve were included in the study and received supplementation with DHEA 25 mg, t.i.d., for at least 6 weeks. Serum AMH, inhibin B, follicle-stimulating hormone (FSH) and oestradiol, and antral follicle count were determined before and after DHEA supplementation. Baseline ovarian reserve parameters such as antral follicle count, FSH, oestradiol, AMH, inhibin B, clinical and laboratory IVF outcomes, and pregnancy rates were studied.Results
There were significant differences in day 3 FSH, oestradiol, antral follicle count, AMH and inhibin B levels before and after DHEA supplementation in all patients (p = 0.001, 0.001, 0.002, 0.001 and 0.001, respectively). The study population was divided into two age groups (<35 and ≥35 years) to determine whether there was a difference in the effect of DHEA supplementation between younger and older patients with diminished ovarian reserve. Significant differences were found in all of the parameters in both study groups (p < 0.05).Conclusions
DHEA supplementation is an effective option for patients with diminished ovarian reserve. Prior to assisted reproductive technology, patients with diminished ovarian reserve should be offered DHEA supplementation as an alternative to oocyte donation. 相似文献13.
Keng-Fu Hsu Hung-Hsueh Chou Chia-Yen Huang Hung-Chun Fu An-Jen Chiang Hsiao-Wen Tsai Jen-Ruei Chen Wen-Fang Cheng Yu-Min Ke Cheng-Chang Chang Tze-Ho Chen Sheng-Hsiang Lin Chih-Ming Ho 《Gynecologic oncology》2014
Objective
The aim of this study was to investigate the clinical and pathological characteristics of uterine clear cell carcinoma (UCCC) and the treatment of this disease in relation to patient outcomes.Methods
The clinicopathological data for and the management of all patients with UCCC who presented between 1991 and 2010 at 11 member hospitals of the Taiwanese Gynecologic Oncology Group (TGOG) were retrospectively reviewed.Results
There were no significant differences in 5-year overall survival (OS) rates between patients with pure UCCC (n = 100) and non-pure UCCC (n = 53) at the same surgical stage, with OS rates of 92.6%, and 87.7% for stage I; 83.3% and 83.3% for stage II; 64.0% and 67.8% for stage III; and 16.7% and 0% for stage IV (n = 1), respectively. Tumor stage and age independently influenced the OS rate of UCCC. For the patients with early stage UCCC, the adjuvant therapy modality was the only significant prognostic factor for recurrence-free survival. The patients with early stage UCCC who received adjuvant therapy had excellent 5-year recurrence-free survival and OS rates compared to those who received radiotherapy (100% vs. 74%, p = 0.01; 100% vs. 72%, p = 0.03).Conclusions
The 5-year survival rates of patients with pure UCCC and non-pure UCCC were similar. The prognosis for surgical staging of patients with stage I/II UCCC was encouraging. Postoperative adjuvant platinum-based chemotherapy is recommended for patients with early stage UCCC who are at a high risk of recurrence. 相似文献14.
Vanessa L. Beesley Adele C. Green David K. Wyld Peter O’Rourke Leesa F. Wockner Anna deFazio Phyllis N. Butow Melanie A. Price Keith R. Horwood Alexandra M. Clavarino Australian Ovarian Cancer Study Group Australian Ovarian Cancer Study — Quality of Life Study Investigators Penelope M. Webb 《Gynecologic oncology》2014
Objective
Most women with ovarian cancer relapse and undergo further chemotherapy however evidence regarding the benefits of this for women with platinum-resistant disease is limited. Our objective was to determine whether there was a quality of life improvement or treatment response among women treated for platinum-resistant recurrent ovarian cancer.Methods
We combined data from 2 studies where women treated with chemotherapy for recurrent ovarian cancer (n = 172) completed a quality of life questionnaire every 3 months. Cancers were classified as platinum-resistant if they progressed within 6 months of completing first-line chemotherapy. Mixed effects models were used to analyze change in quality of life during the first 6 months after second-line chemotherapy.Results
One-quarter of women (n = 44) were classified as having platinum-resistant disease. Overall, their quality of life did not significantly increase or decrease, following commencement of second-line chemotherapy (least square mean scores = 107, 105, 103 at chemotherapy start, 3 and 6 months later, respectively), although 26% of these women reported a meaningful increase and 31% reported a meaningful decline. One-third of the platinum-resistant group responded (11% complete and 21% partial response) to second-line chemotherapy, and this figure increased to 54% among the subset (36%) re-treated with platinum-based agents with or without other agents. Preliminary analyses suggest that quality of life may be higher at chemotherapy initiation in women whose disease responded (median score 121 vs 110).Conclusions
Overall, quality of life appears to be maintained in women with platinum-resistant ovarian cancer who receive further chemotherapy and some women respond to re-treatment. 相似文献15.
Pınar Kumru Oya Demirci Emre Erdogdu Resul Arısoy Arif Aktug Ertekin Semih Tugrul Oya Pekin 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa.Study design
We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents.Results
The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy.Conclusions
The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications. 相似文献16.
Ido Ben-Ami Yaakov Melcer Noam SmorgickDavid Schneider Moty PanskyReuvit Halperin 《International journal of gynaecology and obstetrics》2014
Objective
To compare the reproductive outcome of women who underwent blind dilatation and curettage (D&C) with those who underwent hysteroscopic resection of pathologically confirmed retained products of conception (RPOC).Methods
Medical records of women who underwent either D&C or hysteroscopic resection of RPOC at Assaf Harofeh Medical Center, Israel, between 2000 and 2010 were retrospectively reviewed.Results
A total of 177 women with pathologically confirmed RPOC underwent either D&C (n = 94, 53.1%) or hysteroscopy (n = 83, 46.9%). Mean time to conception was significantly shorter after hysteroscopy than after D&C (7.4 ± 7 vs 12.9 ± 16.8 months, P = 0.037). Rate of occurrence of a newly diagnosed infertility problem was significantly higher following D&C than hysteroscopy (23 [24.5%] vs 10 [12.0%]; P = 0.034). Etiology of the new problem was mechanical, including tubal occlusion and intrauterine adhesions. Logistic regression comparing both methods revealed that hysteroscopic resection was associated with a significant reduction in the occurrence of a new infertility problem compared with D&C (OR 0.42; 95% CI, 0.18–0.96, P = 0.04).Conclusion
Hysteroscopic removal of RPOC is associated with a shorter mean time to further conception and a lower rate of occurrence of newly diagnosed infertility problems than D&C. 相似文献17.
Hossam O. Hamed Asmaa F. Hasan Marwa A. Ahmed 《International journal of gynaecology and obstetrics》2010,108(2):143-1118
Objective
To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.Methods
A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n = 55) or laparoscopic ovarian drilling (group 2, n = 55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ2 test was used for comparisons of ovulation, pregnancy, and abortion rates.Results
Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P < 0.001 vs P < 0.001), and luteinizing hormone (P < 0.05 vs P < 0.001), while the glucose to insulin ratio was significantly increased (P < 0.001 vs P < 0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P < 0.04; 50.8% [131/258] vs 33.5% [94/281], P < 0.001; and 38.2% [21/55] vs 20.0% [11/55], P < 0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.Conclusion
Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy. 相似文献18.
Objective
Ovarian cancer accounts for 50% of deaths from gynecologic malignancies. We sought to determine the cost of common methods of surveillance of women with ovarian cancer in first clinical remission. The current standard for post treatment surveillance is the National Comprehensive Cancer Network (NCCN) guidelines.Methods
We retrospectively determined how recurrence was initially detected at our institution and a cost model was created and applied to the United States population to calculate surveillance costs using the Surveillance Epidemiology & End Results (SEER) database.Results
57% (n = 60) of first recurrences were identified by increasing CA 125 level. Routine office visit identified 27% (n = 29) of recurrences, and 15% (n = 16) were diagnosed initially with CT scan. In 5% (5/105), CT abnormality was the only finding. 95% (100/105) of patients had either elevated CA 125 or office visit findings at time of recurrence. Of the 22,000 women diagnosed with ovarian cancer yearly, 60% (n = 13,266) will have advanced disease and are likely to recur. The surveillance cost for this population for 2 years using our model is $32,500,000 using NCCN guidelines and $58,000,000 if one CT scan is obtained.Conclusions
Our data suggests that following NCCN guidelines will detect 95% of recurrences. An additional $26 million will be needed to identify the 5% of women with recurrence seen on CT only. Post treatment surveillance of ovarian cancer patients contributes significantly to health care costs. Use of CT scan to follow these patients largely increases cost with only a small increase in recurrence detection. 相似文献19.
Background
Ovarian cancer is a severe disease with a peak incidence in the older age groups where concurrent morbidity is common and could potentially influence mortality rates.Objectives
The aim was to study the influence of common comorbidity diagnoses on mortality in ovarian cancer patients.Methods
The study population was patients with ovarian cancer in Sweden 1993–2006 (n = 11.139) identified in the national Cancer Register. Comorbidity data was obtained from the Patient Register and mortality from Cause of Death Register. Mortality was analyzed with Cox' proportional hazards models and subgroup analyses were performed by age and tumor histology.Results
Almost all of the assessed comorbidities increased mortality in ovarian cancer patients. Thromboembolism was the most hazardous comorbidity (HR = 1.95, < 1 year after cancer diagnosis and HR = 7.83, 1–5 years after cancer diagnosis) followed by hematologic complications (HR = 1.84 and 7.11 respectively) and infectious disease (HR = 1.48 and 5.28 respectively). The occurrence of diabetes mellitus and hypertension had less impact on mortality.Conclusion
Thromboembolism, hematologic complications and infections had a pronounced effect on mortality rates in women with ovarian cancer. The impact of comorbidity was mainly apparent among those with a more prosperous prognosis, such as longer time since cancer diagnosis, less aggressive tumors and younger age. 相似文献20.
Rasheed M. Salah Abdelmonem M. Allam Amin M. Magdy Abeer Sh. Mohamed 《European journal of obstetrics, gynecology, and reproductive biology》2013