Gynecologic surgery
A case series of 6000 Essure® hysteroscopic sterilizations reported 10 pregnancies . Risk factors for post-procedure pregnancy included lack of confirmation of tubal occlusion and micro-inserts that were placed unilaterally, or expelled, or perforated the uterus or tube.
Tuesday, July 21, 2009
Reproductive endocrinology
Reproductive endocrinology
Whether assisted reproductive technology is an independent risk factor for development of cerebral palsy remains unclear. A meta-analysis found the risk of cerebral palsy was doubled in children who were conceived with IVF technology . However, the increased risk of cerebral palsy appeared to be mediated by the high frequency of low birth weight/preterm birth and multiple gestation in the IVF groupObesity-related hormonal changes in overweight men appear to adversely affect sperm parameters and may cause erectile dysfunction . The effect of weight loss on sperm parameters and pregnancy rate has not been studied.
Whether assisted reproductive technology is an independent risk factor for development of cerebral palsy remains unclear. A meta-analysis found the risk of cerebral palsy was doubled in children who were conceived with IVF technology . However, the increased risk of cerebral palsy appeared to be mediated by the high frequency of low birth weight/preterm birth and multiple gestation in the IVF groupObesity-related hormonal changes in overweight men appear to adversely affect sperm parameters and may cause erectile dysfunction . The effect of weight loss on sperm parameters and pregnancy rate has not been studied.
Office Gynecology
Office gynecology
The location, and not size, of a fibroid, is the principal factor impacting fertility. A meta-analysis found that women with fibroids that distort the uterine cavity were at increased risk for infertility and spontaneous abortion . Myomectomy increased the conception rate but did not decrease the risk of miscarriage.The World Health Organization revised several tables regarding criteria for contraceptive use. There are no longer restrictions on placement of the levonorgestrel-releasing intrauterine device in the first 48 hours after delivery in nonbreastfeeding women.
The location, and not size, of a fibroid, is the principal factor impacting fertility. A meta-analysis found that women with fibroids that distort the uterine cavity were at increased risk for infertility and spontaneous abortion . Myomectomy increased the conception rate but did not decrease the risk of miscarriage.The World Health Organization revised several tables regarding criteria for contraceptive use. There are no longer restrictions on placement of the levonorgestrel-releasing intrauterine device in the first 48 hours after delivery in nonbreastfeeding women.
Obstetrics
Obstetrics
A randomized trial found that women at risk for preterm birth who received a single course of antenatal glucocorticoids had better birth outcomes than women who received repeated glucorticoid courses every two weeks .A large prospective cohort study found that repeat cesarean delivery scheduled during the 39th or 40th week of gestation was associated with the lowest rates of adverse neonatal outcome, compared to earlier or later scheduled delivery .
A randomized trial found that women at risk for preterm birth who received a single course of antenatal glucocorticoids had better birth outcomes than women who received repeated glucorticoid courses every two weeks .A large prospective cohort study found that repeat cesarean delivery scheduled during the 39th or 40th week of gestation was associated with the lowest rates of adverse neonatal outcome, compared to earlier or later scheduled delivery .
Rheumatology Primary Care
Primary care rheumatology
A systematic review found that arthrographic distension (intraarticular dilation or hydroplasty) of the glenohumeral joint reduced pain and improved short-term function in patients with adhesive capsulitis .A meta-analysis in patients with fibromyalgia found that antidepressant therapy improved pain, fatigue, mood, sleep, and health-related quality of life . The effect size was greatest with tricyclic antidepressants but there were no trials directly comparing antidepressants.
A systematic review found that arthrographic distension (intraarticular dilation or hydroplasty) of the glenohumeral joint reduced pain and improved short-term function in patients with adhesive capsulitis .A meta-analysis in patients with fibromyalgia found that antidepressant therapy improved pain, fatigue, mood, sleep, and health-related quality of life . The effect size was greatest with tricyclic antidepressants but there were no trials directly comparing antidepressants.
Pulmonology Primary Care
Primary care pulmonology
A meta-analysis found that inhaled glucocorticoids in patients with COPD increased the risk of pneumonia by about 30 percent .Smoking prevalence fell among men and women from 1975 to 2006 . This was accompanied by a decline in the death rate for lung cancer among men and a leveling off of the death rate for lung cancer among women
A meta-analysis found that inhaled glucocorticoids in patients with COPD increased the risk of pneumonia by about 30 percent .Smoking prevalence fell among men and women from 1975 to 2006 . This was accompanied by a decline in the death rate for lung cancer among men and a leveling off of the death rate for lung cancer among women
Oncology Primary Care
Primary care oncology
The age at which breast cancer screening should commence in known BRCA mutation carriers is unclear. Women at high genetic risk for breast cancer may also be more susceptible to radiation-induced carcinogenesis. A pooled analysis that estimated the lifetime risk of radiation-induced breast cancer from annual mammography in young BRCA mutation carriers concluded that the harms of annual screening would outweigh benefits in women ages of 25 to 29, and probably between ages 30 and 34 as well .
The age at which breast cancer screening should commence in known BRCA mutation carriers is unclear. Women at high genetic risk for breast cancer may also be more susceptible to radiation-induced carcinogenesis. A pooled analysis that estimated the lifetime risk of radiation-induced breast cancer from annual mammography in young BRCA mutation carriers concluded that the harms of annual screening would outweigh benefits in women ages of 25 to 29, and probably between ages 30 and 34 as well .
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