C. W. Moniak, S. Kutzner, E. Adam, J. Harden, R. Kaufman
{"title":"Endocervical curettage in evaluating abnormal cervical cytology.","authors":"C. W. Moniak, S. Kutzner, E. Adam, J. Harden, R. Kaufman","doi":"10.1097/00006254-200008000-00015","DOIUrl":"https://doi.org/10.1097/00006254-200008000-00015","url":null,"abstract":"OBJECTIVE\u0000To determine the role of endocervical curettage (ECC) in the evaluation of women with abnormal cervical cytology and following treatment for cervical intraepithelial neoplasia.\u0000\u0000\u0000STUDY DESIGN\u0000A retrospective chart review using the records of 2,126 patients who were seen at the Colposcopy Clinic, Baylor College of Medicine, between 1980 and 1995. All patients were referred because of an abnormal cervical smear and underwent repeat Pap smear, colposcopic examination in each case with biopsies as indicated, endocervical curettage and treatment, consisting of either cryotherapy, laser vaporization or a LOOP electrosurgical excision procedure. Following treatment, Pap smears were performed on a scheduled basis, and ECC was performed annually.\u0000\u0000\u0000RESULTS\u0000The ECC was negative in 1,849 (87%) of the women. It was abnormal in 33% of women with unsatisfactory colposcopy and 10% of women with satisfactory colposcopy. ECC was abnormal in 21% of patients with a negative biopsy result and 42% of patients who did not have a biopsy performed. There was a significant increase in abnormal ECC results with increasing age. ECC had a high positive predictive value for ectocervical disease (86%) and a high negative predictive value for endocervical disease (90%). One year following treatment, < 4% of patients with a negative cervical smear had a high grade lesion detected on ECC.\u0000\u0000\u0000CONCLUSION\u0000The use of ECC is helpful in detecting disease missed by routine colposcopy and biopsy and is most likely to detect ectocervical disease rather than true endocervical disease. Following treatment, ECC does not appear to be significantly more reliable than the Pap smear in detecting the presence of significant residual disease.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"25 1-2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114012244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Birth outcome in incarcerated, high-risk pregnant women.","authors":"K. Kyei-Aboagye, O. Vragovic, D. Chong","doi":"10.1097/00006254-200011000-00011","DOIUrl":"https://doi.org/10.1097/00006254-200011000-00011","url":null,"abstract":"OBJECTIVE\u0000To compare birth outcomes in incarcerated women with a recent history of drug use to those of nonincarcerated women in a methadone maintenance program.\u0000\u0000\u0000STUDY DESIGN\u0000We retrospectively analyzed pregnancy outcome in 149 women who delivered at full term between 1993 and 1996. Thirty-one patients incarcerated during pregnancy (group 1) were compared with 47 patients enrolled in our methadone maintenance program (group 2) and with a control group of 71 randomly chosen patients (group 3). Drug use, age, parity, number of visits, infant birth weight, low birth weight and Apgar scores were compared.\u0000\u0000\u0000RESULTS\u0000The methadone maintenance group had significantly fewer clinic visits. All the patients in groups 1 and 2 were cigarette smokers, whereas 12.5% of the control group smoked. Over 78% of incarcerated women admitted using drugs immediately prior to imprisonment as compared to 4.11% in group 3 and 100% in group 2 (P < .001). The three groups differed significantly with respect to infant birth weight (P < .001).\u0000\u0000\u0000CONCLUSION\u0000Cessation of drug use followed by adoption of a health-promoting lifestyle and adequate prenatal care of incarcerated women leads to an improvement in birth outcome. Furthermore, provision of prenatal care on site is a suitable alternative for the care of incarcerated pregnant women and eliminates the need to bring patients in chains to outside clinics.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130510428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response of vulvar lichen sclerosus and squamous cell hyperplasia to graduated topical steroids.","authors":"T. J. Clark, I. Etherington, D. Luesley","doi":"10.1097/00006254-200003000-00017","DOIUrl":"https://doi.org/10.1097/00006254-200003000-00017","url":null,"abstract":"OBJECTIVE\u0000To determine whether symptomatic remission could be obtained equally effectively in patients with vulvar lichen sclerosus, squamous cell hyperplasia or mixed disease in response to a standardized course of graduated topical steroids.\u0000\u0000\u0000STUDY DESIGN\u0000A retrospective analysis of 137 patients with biopsy-proven lichen sclerosus (84), squamous cell hyperplasia (42) or mixed disease (11) treated between 1990 and 1997 with a standard, three-month regimen of graduated topical steroids was carried out. Presence or absence of symptoms and side effects of treatment were recorded three and six months following induction of the initial graduated topical steroid regimen.\u0000\u0000\u0000RESULTS\u0000On completion of the graduated topical steroid course, 59% of patients were asymptomatic (P = .035), and at six months, 58% were asymptomatic (P = .11). Remission of symptoms was more easily achieved in patients with lichen sclerosus as compared to patients with squamous cell hyperplasia and mixed disease at both three and six months (P = .09 at three and P = .035 at six). Four cases of local reactions to the steroids were recorded, as were two cases of vulvar malignancy.\u0000\u0000\u0000CONCLUSION\u0000Symptomatic remission was significantly easier to achieve in patients with vulvar lichen sclerosus as compared to those with squamous cell hyperplasia following treatment with graduated topical steroids.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125264096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Analyzing prior clinical events at presentation in 102 women with vulvar carcinoma. Evidence of diagnostic delays.","authors":"Ronald W. Jones, E. Joura","doi":"10.1097/00006254-200002000-00017","DOIUrl":"https://doi.org/10.1097/00006254-200002000-00017","url":null,"abstract":"OBJECTIVE\u0000To evaluate the clinical events preceding the diagnosis of squamous cell carcinoma of the vulva.\u0000\u0000\u0000STUDY DESIGN\u0000One hundred two women presenting with squamous cell carcinoma of the vulva to a gynecologic oncology unit between 1989 and 1996 were prospectively evaluated by a single investigator. History, clinical findings, previous physician contact, investigations and treatment were analyzed.\u0000\u0000\u0000RESULTS\u0000Vulvar symptoms were present for more than six months in 88% and for more than five years in 28% of women. Eighty-five percent of patients had clinical evidence of abnormal skin adjacent to the cancer. Thirty-one percent of women had three or more medical consultations for vulvar symptoms prior to the diagnosis of cancer. Twenty-five percent of women had had a previous diagnostic vulvar biopsy, and 27% gave a history of having applied topical estrogen or corticosteroid to the vulva. Patients with a history of a preceding biopsy were more likely to present with stage 1 disease.\u0000\u0000\u0000CONCLUSION\u0000Avoidable factors appear to be present in many women who present with vulvar cancer. A more active approach to the diagnosis and management of precursor lesions may often prevent the development of vulvar cancer.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130381449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Herman, N. Janz, M. Becker, D. Charron-Prochownik
{"title":"Diabetes and pregnancy. Preconception care, pregnancy outcomes, resource utilization and costs.","authors":"W. Herman, N. Janz, M. Becker, D. Charron-Prochownik","doi":"10.1097/00006254-199908000-00005","DOIUrl":"https://doi.org/10.1097/00006254-199908000-00005","url":null,"abstract":"OBJECTIVE\u0000To describe and compare pregnancy outcomes, resource utilization and costs among women with diabetes who receive and do not receive preconception care.\u0000\u0000\u0000STUDY DESIGN\u0000A multicenter, prospective, observational study of women with type 1 diabetes who received preconception care (PC), became pregnant and delivered (PC women) and women with type 1 diabetes who received prenatal care (PC) only and delivered (PN women).\u0000\u0000\u0000RESULTS\u0000As compared to PN women (n = 74), PC women (n = 24) were seen earlier in gestation and had significantly lower glycosylated hemoglobin levels. The combined number of outpatient visits for PC women was not greater than for PN women. PC women were hospitalized significantly less during pregnancy and tended to have shorter inpatient stays. The mean length of stay after delivery was significantly shorter for PC women. Intensity of care tended to be lower and length of stay shorter for infants of mothers who received PC care. The net cost saving associated with PC care was approximately $34,000 per patient.\u0000\u0000\u0000CONCLUSION\u0000PC achieves its major intended health benefits and is associated with reduced resource utilization and substantially reduced costs. For both health and economic reasons, clinical practice and public policy should embrace PC.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"59 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128991445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. M. Ryan, S. Lencki, B. Elder, W. I. Northern, H. Khamis, J. Bofill
{"title":"DNA probe for beta-hemolytic group B Streptococcus. Diagnostic accuracy in threatened preterm labor.","authors":"K. M. Ryan, S. Lencki, B. Elder, W. I. Northern, H. Khamis, J. Bofill","doi":"10.1097/00006254-200002000-00012","DOIUrl":"https://doi.org/10.1097/00006254-200002000-00012","url":null,"abstract":"OBJECTIVE\u0000To determine the diagnostic accuracy of a DNA probe for beta-hemolytic group B Streptococcus (GBS) in women with threatened preterm labor.\u0000\u0000\u0000STUDY DESIGN\u0000Two identical vaginal/perianal samples were collected from 75 pregnant women who were being evaluated for threatened preterm labor. One sample was managed in the traditional manner, with direct plating onto blood agar followed by plating after 8 and 24 hours of LIM broth enhancement. The \"gold standard\" was 24 hours of LIM broth enhancement followed by blood agar plating. The second sample was placed in LIM broth, and DNA probe testing was performed after incubation for 8 and 24 hours.\u0000\u0000\u0000RESULTS\u0000The prevalence of GBS colonization by the gold standard culture was 32%. After 8 hours of incubation in LIM broth, the DNA probe had poor sensitivity (79%); however, after 24 hours of incubation in LIM broth the DNA probe sensitivity rose to 96%. The DNA probe demonstrated only one false negative result after 24 hours of LIM broth enhancement. All DNA probe results were known 25 hours after sample collection.\u0000\u0000\u0000CONCLUSION\u0000This DNA probe gave results nearly identical to those of standard cultures and allowed a substantial saving of time.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129397487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Laser-assisted intracytoplasmic sperm injection in human oocytes.","authors":"A. Eroğlu, R. Nahum, K. Isaacson, T. Toth","doi":"10.1093/HUMREP/14.SUPPL_3.171","DOIUrl":"https://doi.org/10.1093/HUMREP/14.SUPPL_3.171","url":null,"abstract":"OBJECTIVE\u0000To explore potential applications of a non-contact, 1,480-nm diode laser to intracytoplasmic sperm injection (ICSI) of human oocytes.\u0000\u0000\u0000STUDY DESIGN\u0000Human oocytes obtained from in vitro fertilization (IVF) patients and failed to fertilize 24-48 hours after conventional IVF were used for ICSI along with discarded sperm. A noncontact, 1,480-nm diode laser was employed to immobilize sperm, to open a hole in the zona pellucida (ZP) and to perform ICSI through the hole. After ICSI and its simulation, oocytes were examined for formation of pronuclei, cleavage and normality of the cytoskeleton.\u0000\u0000\u0000RESULTS\u0000The 1,480-nm diode laser permitted fast and easy sperm immobilization and microdrilling of ZP to facilitate microinjection. Of the 78 injected oocytes, 53 (68%) survived the procedure, and 13 (25%) of them formed two pronuclei by 18 hours. Further culture of two fertilized eggs resulted in cleavage up to the eight-cell stage before cease of culture. Four oocytes were fixed after simulation of the procedure without injecting sperm. None of them showed gross abnormalities in cytoskeletal organization.\u0000\u0000\u0000CONCLUSION\u0000A noncontact, 1,480-nm diode laser can be used for the immobilization of sperm and for opening a hole in the ZP to facilitate ICSI, biopsy manipulation toward preimplantation genetic diagnosis and assisted hatching.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132425764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chaperone use by obstetrician/gynecologists.","authors":"N. Johnson, E. Philipson, S. Curry","doi":"10.1097/00006254-199911000-00011","DOIUrl":"https://doi.org/10.1097/00006254-199911000-00011","url":null,"abstract":"OBJECTIVE\u0000To describe current practices of chaperone use during pelvic examinations among obstetrician/gynecologists affiliated with a large tertiary care teaching hospital.\u0000\u0000\u0000STUDY DESIGN\u0000Questionnaires were distributed at department of obstetrics and gynecology grand rounds to all practicing attending physicians to obtain physician demographic data, including age, years in practice, practice type (solo or group) and whether chaperones were currently used when performing pelvic examinations at the first obstetric or gynecologic office visit. Physicians were also asked whether they were taught to use chaperones for pelvic examinations during medical school or residency.\u0000\u0000\u0000RESULTS\u0000Of the 59 attending physicians, 100% responded to the questionnaire. As compared to female physicians, male physicians used chaperones more at the first obstetric examination (76.9% vs. 27.8%, P < .002), at gynecologic office visits (70.0% vs. 22.2%, P < .002) and for breast examinations (51.2% vs. 11.1%, P < .01). Physicians greater than 40 years old, in practice longer than 10 years and taught as medical students or residents to use chaperones were statistically more likely to use chaperones. No attendings, male or female, reported losing a patient to another provider or being sued or threatened with legal action because of not using a chaperone.\u0000\u0000\u0000CONCLUSION\u0000Chaperones were used more frequently during pelvic examinations by male physicians, age greater than 40, solo practice, and physicians in practice longer than 10 years. Education affected current practices as specific medical student or residency training influenced the use of chaperones in private practice.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132885607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Ransom, J. F. McComish, R. Greenberg, D. A. Tolford
{"title":"Oral metronidazole vs. Metrogel Vaginal for treating bacterial vaginosis. Cost-effectiveness evaluation.","authors":"S. Ransom, J. F. McComish, R. Greenberg, D. A. Tolford","doi":"10.1097/00006254-199908000-00015","DOIUrl":"https://doi.org/10.1097/00006254-199908000-00015","url":null,"abstract":"OBJECTIVE\u0000To compare the cost-effectiveness of metronidazole versus Metrogel Vaginal in the treatment of bacterial vaginosis.\u0000\u0000\u0000STUDY DESIGN\u0000Sixty consecutive patients with a clinical diagnosis of bacterial vaginosis were randomly assigned prospectively into either the metronidazole, 500 mg (twice daily for seven days by mouth) or Metrogel Vaginal (one applicator twice daily for five days) treatment group. The study patients were aged 18-30 years, without other medical problems. The patients proceeded with outpatient therapy and returned 7-10 days after the completion of treatment for reevaluation. During the study, patients refrained from sexual relations, avoided alcohol and drugs, and avoided all medication. The physician evaluated the patients for bacterial vaginosis through standard wet preparation, whiff test and pH testing prior to and after treatment. The patients were randomized by a nurse and were blinded for study purposes to the evaluating physician.\u0000\u0000\u0000RESULTS\u0000Successful treatment outcomes for bacterial vaginosis occurred in 27 and 28 patients for Metrogel Vaginal and metronidazole, respectively, out of the original 30 patients in each study group. All patients introduced into the study completed the study without difficulty. No significant complications were found in either treatment group. Three patients treated with metronidazole experienced nausea during the treatment interval. The entire cost of treatment was $19.71 and $1.51 for Metrogel Vaginal and metronidazole, respectively.\u0000\u0000\u0000CONCLUSION\u0000The most cost-effective treatment for bacterial vaginosis was generic metronidazole. While the use of the more expensive Metrogel Vaginal may be reasonable for patients experiencing side effects of oral metronidazole, most patients should be treated with the less expensive generic metronidazole.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114596659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Torsion of the uterine adnexa. Pathologic correlations and current management trends.","authors":"P. Argenta, T. J. Yeagley, G. Ott, S. Sondheimer","doi":"10.1016/S0029-7844(99)90195-3","DOIUrl":"https://doi.org/10.1016/S0029-7844(99)90195-3","url":null,"abstract":"","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116850742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}