-
[show abstract]
[hide abstract]
ABSTRACT: We hypothesized that maternal birth weight was associated with the risk of cesarean delivery for nulliparous women. Study Design: In a population-based cohort study, maternal birth data were linked to a Washington State database, including the birth certificates of 18,905 first-born singleton infants (1987-1995).
Among non-Hispanic white subjects, maternal birth weight of 2500 to 3999 g was associated with a 20.9% risk of cesarean delivery, which was the lowest risk, compared with 24.5% for a maternal birth weight <2500 g (P <.05) and 24.0% for a maternal birth weight > or =4000 g (P <.05). Similar patterns of risk were noted among Hispanic and Native American subjects, although the associations did not reach statistical significance. Risk of cesarean delivery was not associated with maternal birth weight among African American subjects. Among non-Hispanic white subjects, the risk of cesarean delivery was 3.23 times greater with a maternal birth weight <2500 g and an infant birth weight > or =4000 g compared with pregnancies with both maternal and infant birth weights between 2500 and 3999 g (P <. 001). Adjustment for socioeconomic factors did not alter these results.
Low and high maternal birth weights exert an intergenerational risk of cesarean delivery in nulliparous non-Hispanic white women.
American Journal of Obstetrics and Gynecology 06/2000; 182(6):1363-70. · 3.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In summary, the emergence of CDUS presented an interesting new technical approach to the study of neovascularization in ovarian cancers. Techniques for CDUS are technically difficult and plagued with artifacts making correct interpretation difficult. Measures of blood flow (such as the resistive index) overlap significantly between ovarian cancers and benign ovarian tumors. Wide differences in estimates of the sensitivity and specificity of CDUS have been published, and fundamental norms such as resistive index also vary greatly among studies. Explanations for these differences are lacking. Most studies were performed in academic centers with referrals of high risk patients. This limits the ability to generalize results to the community. Data are insufficient to include CDUS in diagnostic protocols for ovarian cancer.
Clinical Obstetrics and Gynecology 01/2000; 42(4):902-15. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the frequency and possible relationships of overexpression of oncogenes, cytokines, and cellular proliferation proteins in ovarian cancer.
Sixty-four epithelial ovarian cancer specimens were obtained from the GOG tumor bank. Using immunocytochemistry, tumors were stained for overexpression of HER-2/neu, epidermal growth factor receptor (EGFR), p53, tumor necrosis factor alpha (TNF alpha), and Ki-67 (a marker of cellular proliferation).
Twenty-one tumors were Stage I/II and 43 were Stage III/IV. HER-2/neu was overexpressed in 7 cases (11%), EGFR in 12 cases (19%), and p53 in 32 cases (50%). Ki-67 was expressed in all but one case, and high indices (expression in over 50% of cells) were seen in 18 cases (28%). TNF alpha was expressed in all but one case. Comparison between Stage I/II and Stage III/IV cases revealed no difference in the expression of these oncoproteins. Comparison by histologic grade also revealed no difference in the expression of the oncoproteins, except for EGFR, which was overexpressed only in Grade 3 tumors (p = 0.01). Comparison between tumors that did or did not overexpress p53 revealed insignificant differences in the expression of HER-2/neu, EGFR and TNF alpha. In addition there were no differences with respect to stage, grade, or histology when tumors where analyzed with respect to p53 overexpression. There was a trend towards an association between p53 overexpression and high levels of Ki-67 (p = 0.10). Comparison of tumors with high Ki-67 indices to those with lower indices also revealed no association with the expression of HER-2/neu, or EGFR, and there were no differences in stage or grade distribution.
Ki-67 and p53 were frequently overexpressed in this representative sample of ovarian cancers from the GOG tumor bank; however, their expression was not associated with stage, grade, histology, or overexpression of other oncoproteins. Lack of a recognizable pattern of oncogene overexpression emphasizes the underlying biologic complexity of ovarian cancer.
European journal of gynaecological oncology 02/1996; 17(6):487-92. · 0.47 Impact Factor
-
American Journal of Roentgenology 01/1996; 165(6):1452. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Foundation for Health Care Quality (Washington) used three administrative public databases and indicators recommended by the Joint Commission and the American College of Obstetrics and Gynecology to build algorithms to measure quality of obstetric care in the state of Washington. Analyses demonstrated a high degree of variability across hospitals for major processes of care such as cesarean section, vaginal birth after cesarean section, and forceps deliveries. Eighty-five percent of the participating hospitals concluded that important aspects of care were being measured. Ninety-four percent found the information useful in describing their performance compared with other hospitals. Sixty-two percent believed the information was useful for initiating quality improvement projects. Of the 25 indicators tested in the project, indicators rated as most useful were the same 10 obstetric indicators chosen by the Joint Commission after alpha testing.
QRB. Quality review bulletin 05/1993; 19(4):110-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Amyl nitrite is a smooth muscle relaxant that has been used clinically to facilitate uterine relaxation in difficult deliveries. In this retrospective study, we evaluate the safety of amyl nitrite use during preterm cesarean deliveries, and we assess possible advantageous effects on surgical incision choice. Women who received amyl nitrite cesarean section were compared to a control group matched for gestational age, fetal presentation, and mode of delivery who did not receive amyl nitrite. There were no statistical differences between the groups in the independent variables (maternal age, parity, medical or obstetric history, type of anesthesia, anesthesia or obstetric attending physician, antepartum hematocrit, or neonatal weight). Outcome (dependent) variables (estimated blood loss, Apgar scores, postpartum hematocrit, cord gases, or postpartum complications) were assessed, and there were no significant differences between the groups. Low transverse cesarean section was performed more frequently in the amyl nitrite group (58 of 64) than in the comparison group (48 of 64) (p less than 0.03). Considering the 128 women with and without amyl nitrite together, the decrease in hematocrit observed postpartum was greater after classic section (7%) than after low transverse section (4%) (p less than 0.002). We conclude that the use of amyl nitrite during preterm cesarean section poses no threat to mother or fetus and may facilitate delivery by allowing the performance of a low transverse rather than a classic cesarean section without maternal or neonatal complications.
American Journal of Perinatology 08/1992; 9(4):289-92. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The efficacy of Papanicolaou smear screening intervals of longer than 1 year is uncertain. Ninety-two symptomatic cases of invasive cervical cancer diagnosed between 1978-1983 in western Washington were identified with a population-based tumor registry. Using a random-digit-dialing technique, 178 controls from the same geographic area were selected. A structured telephone interview was used to ascertain screening history and risk factors for cervical cancer. The mean interval between papanicolaou smears in the 10 years preceding diagnosis (cases) or the reference date (controls) was calculated. The risk of squamous cell cervical cancer was increased 3.9 times (95% confidence interval 1.2-12.3) for women with Papanicolaou smears at 3-year intervals compared with women with annual screening. For women who had not had a Papanicolaou smear in the preceding 10 years, this risk increased 12.3 times (95% confidence interval 2.5-60.6). For screening intervals of 2 years, the risk of cervical cancer (all cell types) was not increased (relative risk 1.01; 95% confidence interval 0.43-2.37). The presence of well-known risk factors for cervical cancer did not modify these results. These data suggest an increasing risk of cervical cancer if Papanicolaou smear screening intervals exceed 2 years.
Obstetrics and Gynecology 01/1990; 74(6):838-43. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A population-based case-control study was conducted to assess the relation of diet, especially intake of vitamins A, C and E and of folic acid, to the risk of invasive cervical cancer. Cases were 189 women diagnosed with cervical carcinoma between 1979 and 1983 in 3 counties of the Seattle area. Controls (N = 227) were selected through random digit dialling. Diet during the year preceding diagnosis was assessed by interview, using a food frequency questionnaire covering the intake of 66 food items. After adjustment for known risk factors, frequent consumption of dark green or yellow vegetables and of fruit juices was related to a reduced risk of cervical cancer. Similarly, high dietary intake of carotene was associated with a lower risk of the disease, especially of the squamous-cell type. There was an inverse relationship between vitamin C intake and the risk of cervical carcinoma. The adjusted relative risk (RR) was 0.5 (95% confidence interval: 0.2-1.0) for the highest quartile of intake compared to a RR of 1.0 for the first quartile. High vitamin E intake was also related to a reduced risk, the risk for women in the highest quartile being only one-third of the risk for those in the first quartile. Intake of pre-formed vitamin A and of folic acid was not related to the risk of cervix cancer. Thus, our study suggests that the risk of invasive cervical carcinoma might be influenced by some aspects of diet.
International Journal of Cancer 07/1989; 43(6):1050-4. · 5.44 Impact Factor
