International Journal of Fertility and Womens Medicine最新文献

Objective: Endocrine agents have been widely used in the treatment of mastalgia. Toremifene is an agent that predominantly has antiestrogenic properties with minimal estrogenic activities. This study was aimed at investigating this drug in the treatment of mastalgia and to evaluate its tolerability and efficacy.

Methods: Seventeen premenopuasal women with a mean age of 37.7 years complaining of moderate to severe mastalgia received toremifene 60 mg daily. The treatment period was 12 weeks. 70% of patients had cyclical and 30% had noncyclical mastalgia.

Results: All women with cyclical mastalgia responded to toremifene compared with only 75% of those with non-cyclical mastalgia. Four patients withdrew from the study after 4 weeks because of side effects, accounting for 23.5% of patients in the study.

Conclusion: This small study has shown that toremifene is an effective agent in the treatment of mastalgia, but a high incidence of side effects makes it ineligible as an agent of choice for treatment of mastalgia.

Background: Approximately 700,000 women in the reproductive age group are victims of sexual assault in the United States per year. Between 1% and 5% of sexual assaults result in pregnancy, for a total of 32,000 pregnancies per year. Of these, 14,000 are aborted because of incest or rape.

Objective: To determine the percent of emergency departments in the state of Pennsylvania offering routine counseling and provision of emergency contraception to victims of sexual assault. Secondary objectives were to compare provision practices for Catholic versus non-Catholic hospitals, and to compare these practices with other services, such as sexually transmitted disease prophylaxis and sexual assault counseling.

Methods: A 15-item survey instrument was designed to determine the volume of sexual assault patients seen per year, routinely offered services, and emergency contraception protocols. Three telephone callers administered surveys, using a pre-designed script for each call.

Results: Of the 165 eligible hospitals, 125 (76%) replied. Less than half (42%) of all hospitals routinely offer emergency contraception counseling, and 16% of the hospitals did not offer any counseling regarding emergency contraception.

Conclusion: Provision of emergency contraception to victims of sexual assault is inconsistent and insufficient. It is important that sexual assault patients not be further victimized by a system that fails to meet their needs.

When the monitoring board of the Women's Health Initiative (WHI) canceled the estrogen-progestin arm of the study in July 2002, the effect was immediate and dramatic, as several million postmenopausal women with the full agreement of their physicians ceased taking combined hormone therapy. Soon thereafter the manufacturers of conjugated equine estrogens felt compelled to publicize a drastic restriction of the indications for their product. Little notice, except in the medical literature, was given to the continuation of the other treatment arms of the WHI, nor did the rather small (however significant) increases in risk of cardiovascular disease and breast cancer resulting from combined therapy receive widespread serious analysis. In this article, special attention is given to the population sampling involved in setting up the WHI, arm by arm, with full discussion of how these samplings compare with those in other studies--HERS, ERA, WEST, etc. All studies are scrutinized in terms of treatment regimens, follow-up, confounding factors, particularly statins and aspirin, and high drop-out rates in order to discover possible reasons for the results in the WHI for primary and secondary prevention of cardiovascular disease in the combined-therapy arm and slightly disappointing results for breast cancer. Each of the two main sections of the article, Cardiovascular Disease and Breast Cancer, concludes with a detailed summation of points derived from the often contrasting results of the various studies, which can be used in counseling patients.

Objective: Chemotherapy with innovative state-of-the-art medicine at university level can be very costly. Reimbursement until 2002 was at a flat rate, often not even covering the costs of the pharmaceutical substances. To avoid debt a more cost-effective chemotherapy management system had to be found.

Materials and methods: From this background, an economic model with four steps was developed: 1. Analysis of current financial situation; 2. Precalculation of chemotherapy costs; 3. Assignment to an individual cost-covering reimbursement pathway; and 4. Postcalculation for cost efficiency and elimination of potential mistakes.

Results: After successful implementation of this model we were able to reach cost effectiveness for our chemo unit within 12 months and pay back previous debts and were even able to employ new medical staff.

Conclusion: With this model we are now able to perform chemotherapy cost effectively at a university level without reducing standard of care.

Europe, despite its division into multiple nations even with a European Union, now enjoys a uniformly high level of cancer detection by virtue of the Europe Against Cancer Program, begun in 1986. The program's aim was reducing cancer mortality by 15% by the year 2000. Its operating arm, the European Breast Cancer Network, compared and reported on the pilot projects in the member states. Some early results were poor, with high recall rates (up to 28%); the main cause was poor image quality. By 1992, the Network had published the first European Guidelines for Quality Assurance in Mammography Screening. Since then, oversight provided by the Network has produced not only excellence in results across the continent but also data on the interpretation of mammograms that could be of value to mammography programs everywhere.

Although animal and laboratory studies suggest a possible link between certain chemicals used in underarm cosmetics and breast cancer development, there is no reliable evidence that underarm cosmetics use increases breast cancer risk in humans. This article reviews the evidence for and against the possible link between breast cancer and underarm cosmetics and highlights the need for further research to clarify this issue.

Sentinel lymph node biopsy (SLNB) is a simple technique which uses subdermal or peritumoral injection of vital blue dye and/or both substances together to identify the first lymph node(s) draining the primary tumor. It has been shown to accurately predict axillary node status in patients with clinically node negative breast cancer. The SLNB is emerging as a new standard of care in patients with early breast cancer. However, certain criteria should be fulfilled for its safe application.

Until 10 years ago, examination of the ductal system of the breast required excision of all the major ducts, in a block of tissue. With mammary ductoscopy, direct visualization of the ducts in vivo has been possible. In the present series of 40 cases, ductoscopy was used to guide the infusion of methylene blue dye, through the endoscope, to find the index duct, which is then removed through a small incision just inside the areola.

The terms gestational breast cancer (GBC) and pregnancy-associated breast cancer are given to breast cancer that occurs during pregnancy and up to one year post-partum. It is an uncommon event, and for even the most experienced clinician, whether oncologist, obstetrician or primary health worker, the complex issues that surround a diagnosis of breast cancer during pregnancy make management difficult. The prognosis overall for women diagnosed with GBC is poor, possibly due to delays in diagnosis. Primary physicians and obstetricians can play an important role in the early detection of GBC by promoting breast awareness in premenopausal women, including women who are pregnant or lactating; and by undertaking prompt and appropriate referral of pregnant and lactating women with breast abnormalities. Even in pregnant or lactating women, clinicians should always investigate a breast abnormality using triple assessment--clinical assessment, imaging and tissue biopsy. Breast cancer during pregnancy requires a multidisciplinary approach to ensure optimal care for both the mother and the baby. Breast cancer management can be adapted to protect the fetus, but this will be dependent on the gestation and disease status at diagnosis. Pregnancy after breast cancer does not appear to affect either cancer prognosis or pregnancy outcome. Obstetricians have a vital role to play in the care of these women by supporting them through their pregnancy, providing reassurance of fetal health and maintaining good communication with their other health providers.