RESUMO
The National Cooperative Diethylstilbestrol Adenosis (DESAD) Project has completed the major portion of its enrollment phase with the examination of more than 3000 daughters of women taking synthetic nonsteroidal estrogens (denoted DES) during pregnancies occurring from the early 1940s to the mid-1960s. The aims of the Project are to fill urgent needs for information on the prevalence and incidence of structural and epithelial abnormalities or neoplastic changes and their complications in these young women. Participants are grouped by mode of entry as identified by prenatal record review (40.1%), documented as DES-exposed but walking in (25.1%), or referred (22.8%) to the DESAD Project for examination, and not documented as exposed but having gynecologic abnormalities typical of those associated with DES exposure (12.0%). This study cohort, in part having paired controls, will be examined annually for at least 5 years. Details of the design and selected preliminary findings are reported.
Assuntos
Dietilestilbestrol/efeitos adversos , Doenças Vaginais/induzido quimicamente , Adolescente , Adulto , Criança , Epitélio/efeitos dos fármacos , Feminino , Feto/efeitos dos fármacos , Seguimentos , Humanos , National Institutes of Health (U.S.) , Gravidez , Projetos de Pesquisa , Estados Unidos , Vagina/efeitos dos fármacos , Neoplasias Vaginais/induzido quimicamenteAssuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Pelve , Adulto , Aneurisma/cirurgia , Angiografia , Aorta Abdominal/diagnóstico por imagem , Aortografia , Fístula Arteriovenosa/congênito , Fístula Arteriovenosa/cirurgia , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Gravidez , Útero/irrigação sanguíneaAssuntos
Carcinoma , Neoplasias do Colo do Útero , Carcinoma/diagnóstico , Carcinoma/prevenção & controle , Carcinoma/cirurgia , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Colo do Útero/anatomia & histologia , Colposcopia , Criocirurgia , Feminino , Seguimentos , Humanos , Métodos , Gravidez , Complicações na Gravidez , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/cirurgia , Cervicite Uterina/diagnóstico , Esfregaço Vaginal , Vaginite/diagnósticoAssuntos
Dietilestilbestrol/história , Acne Vulgar/tratamento farmacológico , Adenocarcinoma/induzido quimicamente , Ductos Biliares/metabolismo , Anticoncepcionais Pós-Coito , Dietilestilbestrol/efeitos adversos , Dietilestilbestrol/síntese química , Dietilestilbestrol/metabolismo , Dietilestilbestrol/farmacologia , Dietilestilbestrol/toxicidade , Feminino , História do Século XX , Humanos , Lactação/efeitos dos fármacos , Fígado/efeitos dos fármacos , Masculino , Troca Materno-Fetal , Menopausa/efeitos dos fármacos , Distrofias Musculares/tratamento farmacológico , Fagocitose/efeitos dos fármacos , Gravidez , Neoplasias do Colo do Útero/induzido quimicamenteAssuntos
Gravidez em Diabéticas/terapia , Cuidado Pré-Natal , Adulto , Feminino , Humanos , GravidezAssuntos
Doenças Fetais , Feminino , Doenças Fetais/diagnóstico , Humanos , Métodos , Gravidez , Diagnóstico Pré-NatalRESUMO
In an effort to determine if routine prenatal chest roentgenograms were of practical value, the records of 12,109 consecutive deliveries at the Mayo Clinic were reviewed retrospectively. The roentgenograms were obtained during the first or second prenatal visit and additionally when warranted by notable symptoms or physical findings in subsequent prenatal visits. Forty-eight patients had appreciable roentgenographic abnormalities. The findings of the general medical examination (which was routinely done at the first prenatal visit) were reviewed to determine if the chest abnormalities would have been suspected from the results of physical examination alone. In every case, a positive history or abnormal physical finding would have suggested the presence of the major abnormality or of the need for roentgenography to be performed.
Assuntos
Gravidez , Radiografia Torácica , Adolescente , Adulto , Custos e Análise de Custo , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Cuidado Pré-Natal , Radiografia Torácica/economia , Risco , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
Approximately 100 cases of pregnancy in women with cardiac valve prostheses have been reported in the world's medical literature. In most instances, the need for continuous anticoagulation therapy constituted a major concern in the obstetric management of these high-risk pregnancies, particularly since coumarin has been implicated as causing an increased frequency of fetal wastage or birth defects (or both). Of all women who received cardiac valve prostheses at the Mayo Clinic between 1965 and 1975, 23 conceived 40 times after the procedure. Fetal wastage was more than doubled in women receiving coumarin therapy at conception and during the first trimester, as compared with that in women not receiving coumarin therapy. Fetal wastage exceeded 80% in women with multiple-valve prostheses who received coumarin therapy throughout early pregnancy. There were no serious maternal sequelae in any of the women. One infant of a mother receiving anticoagulation therapy had mild nasal hypoplasia, but there were no other congenital anomalies in which coumarin had been previously implicated.
Assuntos
Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/etiologia , Complicações Cardiovasculares na Gravidez/etiologia , Anormalidades Induzidas por Medicamentos/etiologia , Aborto Espontâneo/induzido quimicamente , Adolescente , Adulto , Criança , Pré-Escolar , Cumarínicos/efeitos adversos , Cumarínicos/uso terapêutico , Aconselhamento , Feminino , Morte Fetal/induzido quimicamente , Doenças Fetais/etiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , Tromboembolia/prevenção & controle , Fatores de TempoRESUMO
A total of 452 women with documented exposure in utero to diethylstilbestrol (DES) with epithelial findings present at the time of their initial examination have been evaluated prospectively to determine whether these findings changed over a period of 3 years. The examinations were all performed according to a strict protocol. Findings present at the time of the third annual examination were verified at a fourth examination. A verified decrease in the extent of epithelial findings occurred in 29.2% of these women and a verified increase in 6.6%; 53.1% had no change in the extent of epithelial findings, and 11.1% had a change that could not be verified at the time of the fourth visit. Analysis of many variables failed to identify a strong association between any variable and a decrease in the extent of the findings. It appears that the most important factor in the occurrence of changes in DES-associated findings is the passage of time.