Background and Purpose:Prenatal corticosteroids have been used in fetuses with congenital diaphragmatic hernia (CDH)-. We tested the utility of steroids by 2 methods. Methods:Mothers carrying fetuses with CDH were ran...Background and Purpose:Prenatal corticosteroids have been used in fetuses with congenital diaphragmatic hernia (CDH)-. We tested the utility of steroids by 2 methods. Methods:Mothers carrying fetuses with CDH were randomized to 3 weekly doses of betamethasone or placebo starting at 34 weeks. Patients were followed until death or discharge. In a separate cohort study,the CDH Registry was used to compare infants who received prenatal steroids to those who had not. Results:Thirty-four patients were enrolled at 7 centers,with 32 completing the trial. There were 15 placebo and 17 steroid patients. There was no difference in survival,length of stay,duration of ventilation,or oxygen use at 30 days. For the cohort study,we looked at infants older than 34 weeks who were born after October 2000 when data on prenatal steroids were collected. There were 1093 patients; 390 were evaluable,with 56 receiving steroids. There was no difference in survival,length of stay,ventilator days,or oxygen use at 30 days. Conclusion:Neither the trial nor the CDH Registry suggest that late prenatal corticosteroids benefit fetuses with CDH. More than 1700 mothers and fetuses would need to be enrolled in a trial to show a 10% improvement in survival. It is unlikely that late steroids offer benefit to most fetuses with CDH.展开更多
We studied the impact of progestin dose on this risk. The pattern and number of days per month that progestin is given in postmenopausal combined hormone therapy appears to affect endometrial cancer risk. We assessed ...We studied the impact of progestin dose on this risk. The pattern and number of days per month that progestin is given in postmenopausal combined hormone therapy appears to affect endometrial cancer risk. We assessed the impact of progestin dose on this risk. A population based, case control study included 647 cases with endometrial cancer and 1209 controls. Among users of estrogen with medroxyprogesterone acetate (MPA) 10 to 24 days/month, women who took >100 mg/month had an endometrial cancer risk that was equal to that of hormone nonusers (95% CI 0.6- 1.7). The corresponding relative risk was 0.8 (95% CI 0.5- 1.5) in those who used a lower monthly MPA dose for 10 to 24 days/month. Among users of a continuous combined hormone regimen, the risk of endometrial cancer was low relative to hormone nonusers, regardless of MPA dose. Among the combined hormone regimens most commonly used by postmenopausal women today, MPA monthly dose bears little or no relation to endometrial cancer risk.展开更多
文摘Background and Purpose:Prenatal corticosteroids have been used in fetuses with congenital diaphragmatic hernia (CDH)-. We tested the utility of steroids by 2 methods. Methods:Mothers carrying fetuses with CDH were randomized to 3 weekly doses of betamethasone or placebo starting at 34 weeks. Patients were followed until death or discharge. In a separate cohort study,the CDH Registry was used to compare infants who received prenatal steroids to those who had not. Results:Thirty-four patients were enrolled at 7 centers,with 32 completing the trial. There were 15 placebo and 17 steroid patients. There was no difference in survival,length of stay,duration of ventilation,or oxygen use at 30 days. For the cohort study,we looked at infants older than 34 weeks who were born after October 2000 when data on prenatal steroids were collected. There were 1093 patients; 390 were evaluable,with 56 receiving steroids. There was no difference in survival,length of stay,ventilator days,or oxygen use at 30 days. Conclusion:Neither the trial nor the CDH Registry suggest that late prenatal corticosteroids benefit fetuses with CDH. More than 1700 mothers and fetuses would need to be enrolled in a trial to show a 10% improvement in survival. It is unlikely that late steroids offer benefit to most fetuses with CDH.
文摘We studied the impact of progestin dose on this risk. The pattern and number of days per month that progestin is given in postmenopausal combined hormone therapy appears to affect endometrial cancer risk. We assessed the impact of progestin dose on this risk. A population based, case control study included 647 cases with endometrial cancer and 1209 controls. Among users of estrogen with medroxyprogesterone acetate (MPA) 10 to 24 days/month, women who took >100 mg/month had an endometrial cancer risk that was equal to that of hormone nonusers (95% CI 0.6- 1.7). The corresponding relative risk was 0.8 (95% CI 0.5- 1.5) in those who used a lower monthly MPA dose for 10 to 24 days/month. Among users of a continuous combined hormone regimen, the risk of endometrial cancer was low relative to hormone nonusers, regardless of MPA dose. Among the combined hormone regimens most commonly used by postmenopausal women today, MPA monthly dose bears little or no relation to endometrial cancer risk.
