Objective: Studies in animals and human muscle have demonstrated differential splicing of the insulin-like growth factor-1 gene in response to mechanical strain and damage. We conducted a study on the expression of in...Objective: Studies in animals and human muscle have demonstrated differential splicing of the insulin-like growth factor-1 gene in response to mechanical strain and damage. We conducted a study on the expression of insulin-like growth factor-1 splice variants in the levator ani muscle after the first vaginal delivery. Study design: Ten women were recruited after the first vaginal delivery. Biopsy specimens were taken vaginally of the pubovisceral component of the levator ani muscle. Five nonpregnant women were recruited as control subjects. Samples were processed with real-time quantitative polymerase chain reaction, with specific primers for the insulin-like growth factor-1 splice variants. Results: Insulin-like growth factor splice variants mechano growth factor and insulin-like growth factor1Ea were significantly up-regulated (100-and 1000-fold) in the delivery population, compared with control subjects (P = .012 and .04, respectively). Statistical analysis indicated a correlation between the expression of the insulin-like growth factor-1 splice variants and the length of the second stage. Conclusion: These results show that damaged levator ani muscle results from stretch and overload after the first vaginal delivery.展开更多
Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent lapar...Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent laparoscopic excision of visually diagnosed peritoneal lesions suggestive of endometriosis returned postal questionnaires. The main outcomes measures were change in pelvic pain symptoms measured on a continuous and ordinal scale and patient satisfaction following treatment. Secondary outcomes were quality of life, time off work and use of health service resources. Results: 42/62 (68% ) women with an average follow up time of 13 months (range 6- 38 months)- returned completed outcome questionnaires. The mean amount of pelvic pain was reduced following surgery compared to immediately prior to treatment, regardless of the nature of the pain (P < 0.05). Overall, 67% (95% CI 50- 80% ) of women reported improvement in pain symptoms and 71% (95% CI 55- 84% ) were satisfied with the results of treatment. Satisfaction with treatment was comparable whether the visual diagnosis of peritoneal endometriosis was confirmed histologically or not (62% versus 64% , P = 1.0). Conclusion: Laparoscopic excision of visually diagnosed endometriosis appears to be efficacious in the treatment of women with chronic pelvic pain. The launch of a long-term randomised controlled trial to confirm these provisional results is now required.展开更多
Objective: To identify current management practices and evaluate subsequent outcomes of treatment for women diagnosed with endometrial hyperplasia. Study design: All women with a histological diagnosis of endometrial ...Objective: To identify current management practices and evaluate subsequent outcomes of treatment for women diagnosed with endometrial hyperplasia. Study design: All women with a histological diagnosis of endometrial hyperplasia at the Birmingham Women s Hospital were identified between October 1998 and September 2000. A retrospective case note review was performed for each woman using a standardised data abstraction sheet. Baseline characteristics including clinical presentation and treatment strategywere obtained. Results of subsequent endometrial tissue examinations were used to assess histological response to treatment and the need and indication for hysterectomy was used to assess clinical response. Results: There were 351 women diagnosed with endometrial hyperplasia during the study period of which 84% presented with symptoms of abnormal uterine bleeding and 54% were postmenopausal. Complex endometrial hyperplasia was the most common diagnosis accounting for 60% of all cases. Eighty percent of women with atypical endometrial hyperplasia were treated by hysterectomy compared with 30% without evidence of cytological atypia (relative hysterectomy rate of 2.6, 95% CI 2.0- 3.3). Hysterectomy was avoided in 138/172 (80% , 95% CI 74- 86% ) women managed conservatively during the study period. Overall 35/108 (36% , 95% CI 27- 46% ) of women managed conservatively had persistent or progressive disease identified (mean follow up 36 months). 20/143 (14% ) women initially diagnosed with endometrial hyperplasia who subsequently underwent hysterectomy were found to have endometrial cancer, the majority of whom had been diagnosed with atypical disease (14/20, 70% ). Conclusion( s): The majority of women with atypical endometrial hyperplasia were managed by hysterectomy and the substantial risk of diagnostic under-call supports this approach to treatment. In contrast, there is no consensus regarding the initial management of women with endometrial hyperplasia without cytological atypia.展开更多
文摘Objective: Studies in animals and human muscle have demonstrated differential splicing of the insulin-like growth factor-1 gene in response to mechanical strain and damage. We conducted a study on the expression of insulin-like growth factor-1 splice variants in the levator ani muscle after the first vaginal delivery. Study design: Ten women were recruited after the first vaginal delivery. Biopsy specimens were taken vaginally of the pubovisceral component of the levator ani muscle. Five nonpregnant women were recruited as control subjects. Samples were processed with real-time quantitative polymerase chain reaction, with specific primers for the insulin-like growth factor-1 splice variants. Results: Insulin-like growth factor splice variants mechano growth factor and insulin-like growth factor1Ea were significantly up-regulated (100-and 1000-fold) in the delivery population, compared with control subjects (P = .012 and .04, respectively). Statistical analysis indicated a correlation between the expression of the insulin-like growth factor-1 splice variants and the length of the second stage. Conclusion: These results show that damaged levator ani muscle results from stretch and overload after the first vaginal delivery.
文摘Objective: To determine the efficacy of laparoscopic excision of visually diagnosed endometriosis in the treatment of chronic pelvic pain. Study design: Sixty-two women with chronic pelvic pain and who underwent laparoscopic excision of visually diagnosed peritoneal lesions suggestive of endometriosis returned postal questionnaires. The main outcomes measures were change in pelvic pain symptoms measured on a continuous and ordinal scale and patient satisfaction following treatment. Secondary outcomes were quality of life, time off work and use of health service resources. Results: 42/62 (68% ) women with an average follow up time of 13 months (range 6- 38 months)- returned completed outcome questionnaires. The mean amount of pelvic pain was reduced following surgery compared to immediately prior to treatment, regardless of the nature of the pain (P < 0.05). Overall, 67% (95% CI 50- 80% ) of women reported improvement in pain symptoms and 71% (95% CI 55- 84% ) were satisfied with the results of treatment. Satisfaction with treatment was comparable whether the visual diagnosis of peritoneal endometriosis was confirmed histologically or not (62% versus 64% , P = 1.0). Conclusion: Laparoscopic excision of visually diagnosed endometriosis appears to be efficacious in the treatment of women with chronic pelvic pain. The launch of a long-term randomised controlled trial to confirm these provisional results is now required.
文摘Objective: To identify current management practices and evaluate subsequent outcomes of treatment for women diagnosed with endometrial hyperplasia. Study design: All women with a histological diagnosis of endometrial hyperplasia at the Birmingham Women s Hospital were identified between October 1998 and September 2000. A retrospective case note review was performed for each woman using a standardised data abstraction sheet. Baseline characteristics including clinical presentation and treatment strategywere obtained. Results of subsequent endometrial tissue examinations were used to assess histological response to treatment and the need and indication for hysterectomy was used to assess clinical response. Results: There were 351 women diagnosed with endometrial hyperplasia during the study period of which 84% presented with symptoms of abnormal uterine bleeding and 54% were postmenopausal. Complex endometrial hyperplasia was the most common diagnosis accounting for 60% of all cases. Eighty percent of women with atypical endometrial hyperplasia were treated by hysterectomy compared with 30% without evidence of cytological atypia (relative hysterectomy rate of 2.6, 95% CI 2.0- 3.3). Hysterectomy was avoided in 138/172 (80% , 95% CI 74- 86% ) women managed conservatively during the study period. Overall 35/108 (36% , 95% CI 27- 46% ) of women managed conservatively had persistent or progressive disease identified (mean follow up 36 months). 20/143 (14% ) women initially diagnosed with endometrial hyperplasia who subsequently underwent hysterectomy were found to have endometrial cancer, the majority of whom had been diagnosed with atypical disease (14/20, 70% ). Conclusion( s): The majority of women with atypical endometrial hyperplasia were managed by hysterectomy and the substantial risk of diagnostic under-call supports this approach to treatment. In contrast, there is no consensus regarding the initial management of women with endometrial hyperplasia without cytological atypia.
