International Journal of Fertility and Womens Medicine最新文献

Chlamydia psittaci is associated with significant morbidity and mortality during pregnancy, and its rarity can delay early diagnosis and treatment. A farmer's wife presented at 31 weeks with febrile illness and developed signs of septic shock, indicating immediate delivery. The child developed uneventfully. The mother survived after symptomatic mechanical ventilation, including extracorporeal lung assistance, for 11 days due to multi-organ failure. Only two weeks after admission antibody titres against Chlamydia were rising. The placenta demonstrated acute intervillositis and destruction of throphoblastic cells. Retrospectively, the infection was presumed to derive from infected pregnant sheep. Pregnant women should be advised to avoid contact with sheep and their gestational products. Proper history, early recognition and appropriate management is mandatory for survival of both mother and child.

Objective: To determine the frequency of past psychological problems associated with the reproductive cycle in women seeking routine gynecological care.

Methods: Three hundred and sixty-eight women of menopausal age seen at a university medical center gynecology clinic were mailed a questionnaire requesting information about past mood or anxiety problems associated with specific reproductive cycle or hormone use times, such as the premenstruum, pregnancy, postpartum, perimenopause, following total hysterectomy with bilateral salpingo-oophorectomy, and during oral contraceptive or hormone replacement treatment. Chi-square analysis was done between groups categorized as with and without reproductively associated psychological problems (RAPP) and with or without non-reproductively related psychological problems (non-RAPP). Relative risk of women with RAPP having non-RAPP also was calculated. Results-One hundred thirteen women returned the questionnaire. Fifty percent of these women reported a past history of reproductive cycle-associated psychological problems (RAPP). Of these, 37% also reported psychological problems at times in their lives not associated with particular reproductive cycle (non-RAPP) times. However, of the 50% of women who reported no history of RAPP, only 14% reported non-RAPP. This was a significant difference between the groups (p = .0064). There was also a 2.7 times greater risk of women with RAPP also having non-RAPP (RR 2.7).

Conclusions: Women with reproductively associated psychological problems have a greater risk of also having psychological problems at non-reproductively associated times.

Introduction: Breast cancer is a classic model of a hormone-dependent malignancy. Since the drugs used for ovulation induction as part of in vitro fertilization (IVF) treatment increase the levels of endogenous gonadal hormones, concerns have arisen regarding a possible association between IVF and the risk of developing breast cancer. The aim of this paper was to review the literature and examine the potential effects of IVF treatment on breast cancer risk.

Methods: Medline search was conducted using the key words below in English-language articles. Further papers were obtained using the bibliographies of relevant articles. Furthermore, a combined analysis of retrieved data was performed.

Results: Fifteen studies were identified; of these, 11 were cohort studies and 4 were case-control studies. None of the individual studies showed an overall significant association between IVF and breast cancer and, in fact, one study showed that treatment with hCG significantly reduced the risk of breast cancer in women whose maximum nonpregnant body mass index was less than 27.5. A combined analysis of the cohort studies including a total of 60,050 women treated with ovulation induction/IVF showed no significant association between these treatments and increased risk of breast cancer (observed vs. expected: 601 vs. 568, pooled relative risk [RR] = 1.06, P = 0.337). The case-control studies included a total of 11,303 women in the breast cancer groups and 10,930 controls. Women in the breast cancer groups were slightly less likely to have received IVF (2.2% vs. 2.5%, pooled RR = 0.88, P = 0.231). However, one study showed that infertility treatment was associated with an increased risk of breast cancer of borderline significance among women with a family history of the disease. Another study showed that the incidence of breast cancer within the first year of exposure to fertility drugs was higher than expected, possibly due to the promotion of preexisting cancer lesions caused by superovulation or due to the early diagnosis made in the course of IVF treatment. Conflicting results were reported regarding the type of fertility treatment and breast cancer risk.

Conclusion: Overall, there is no clear evidence that ovulation induction or IVF increases the risk of breast cancer. However, there may be a transient increase in the incidence of breast cancer in the first year due to earlier diagnosis. Furthermore, the risk may be increased in women with a positive family history. Future research should focus on the type of fertility treatment used and breast cancer risk. Aromatase inhibitors should be evaluated further as an alternative to standard ovulation-inducing drugs.

Background: Dietary elements and, in particular, dairy products have been implicated in the etiology of breast cancer. High saturated fat contents, contaminants such as pesticides, and insulin-like growth factor I (IGF-1) have been hypothesized as possible carcinogenic factors. In contrast, calcium, vitamin D, and conjugated linoleic acid (CLA) all are considered to reduce breast cancer risk. We aim to review the current epidemiological literature on the relationship between the intake of dairy products and breast cancer risk.

Methods: A Medline search was conducted using the key words breast neoplasms and dairy products. Further articles were obtained by cross-matching references of relevant articles. Thirty-nine case-control and 11 cohort studies were identified since 1981. Two meta-analyses and several review articles were also noted.

Results: Results from previous studies were analyzed and comparisons were made between each type of study. Controversy exists regarding this subject and we found conflicting evidence in recent literature regarding this hypothesis.

Conclusion: There is no substantial epidemiological evidence to support a significant link between the intake of dairy products and breast cancer risk.

The hormonal changes that take place in pregnancy cause breast tissue to proliferate and differentiate. Abortion interrupts this process and may leave the proliferated, undifferentiated breast tissue at higher risk of carcinogenesis. This review explains the supposed difference in effects of induced and spontaneous abortion upon the breast tissue and examines the literature for a link with breast cancer. Additional subcategories examined include parity, number of abortions, gestation, and maternal age at abortion. A comparison of retrospective and prospective studies is made and possible sources of bias are identified. There is no evidence to support a link between spontaneous abortion and breast cancer. Absence of a link with induced abortion is less clear, and further research should concentrate on investigating any relationship. We suggest that prospective research is used, with point of entry at first termination.

Background: Over the last decade, interest in the physiological role of bioactive compounds in plants has increased dramatically. Of particular interest in relation to human health are the class of compounds known as the phytoestrogens, which embody several groups of nonsteroidal estrogens that are widely distributed within the plant kingdom, including isoflavones and lignans. Epidemiological studies suggest that diets rich in phytoestrogens, particularly soy and unrefined grain products, may be associated with low risk of breast cancer. This review presents the studies published so far exploring a link between dietary phytoestrogens and breast cancer risk.

Methods: A Medline search was conducted using the key words below. Further articles were obtained by cross-matching references of relevant articles. Twenty-one case-control and 15 prospective studies were identified since 1978. One meta-analysis and several review articles also were noted.

Results: Results from previous studies were analyzed and comparisons were made between each type of study. Controversy exists regarding this subject, and we found conflicting evidence in recent literature regarding this hypothesis.

Conclusion: There is no clear evidence that phytoestrogen intake influences the risk of developing breast cancer.

Recently, there has been considerable interest in the application of magnetic resonance imaging (MRI) in the management of breast cancer. In women with a genetic predisposition for breast cancer, MRI screening is more sensitive than mammography screening. However, it is not known if the greater sensitivity of MRI screening has any impact on breast cancer mortality. Some investigators also have suggested that in women with primary breast cancer, MRI might be useful in determining suitability for breast-conserving surgery. However, the application of MRI in this manner may increase mastectomy rates without necessarily improving outcomes. Clearly, additional studies are needed to determine the optimal role of MRI in the management of breast cancer. In the meantime, patients should be informed of its potential for benefit and harm.

Breast cancer risk assessment and prevention requires careful and regularly planned follow-up by appropriate protocols such as those suggested by the Breast Cancer Risk Assessment Working Group. In this article we comment on the strengths and limitations of breast cancer risk assessment.

The objective of this article was to evaluate the sensitivity, specificity, positive predictive value, and negative predictive value of both screening and diagnostic mammograms. We looked at twenty seven studies found online with keywords: mammography, positive predictive value, negative predictive value, sensitivity, and specificity using the search engines google.com and botbot.com and placed them into three tables, sorting them first by purpose: either screening or diagnostic studies, and then by study size. We found a wide range of values in the studies reported and a high rate of false positives in many of them as well. Although many clinicians use the mammogram so often and rely on those results, many would benefit by being able to see the wide range of data that is reported worldwide in a format as shown in this article.