ABSTRACT
OBJECTIVE: To test the efficacy of late-luteal phase dosing of sertraline hydrochloride in women with moderate-to-severe premenstrual dysphoric disorder. This highly prevalent disorder often causes significant psychosocial impairment. DESIGN: Double-blind, crossover trial of each 2-menstrual cycle of baseline, sertraline treatment, and placebo. Randomization to sertraline treatment vs placebo occurred after a 2-cycle, drug-free period. SETTING: A large outpatient multispecialty clinic in central Texas. PATIENTS: Fifty-seven women aged 19 to 49 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of premenstrual dysphoric disorder. INTERVENTIONS: Late-luteal phase treatment with sertraline hydrochloride in daily doses of 50 mg (cycle 1) followed by 100 mg (cycle 2) vs placebo. MAIN OUTCOME MEASURES: The 22-item calendar of premenstrual experiences was completed daily and constituted the primary outcome measure, consisting of a total score and behavioral and physical factor scores. RESULTS: A repeated-measures analysis of variance for crossover designs found a significant beneficial effect from sertraline treatment in improving the calendar of premenstrual experiences total (P < .01), behavioral factor (P < .01), and physical factor (P < .04) scores. Most women improved when taking sertraline, 50 mg, although a dose increase to 100 mg yielded further improvement in approximately 25% of women. Use of sertraline was extremely well tolerated; the only adverse event reported by 10% or more of women was insomnia in 8 (14%) of them. CONCLUSIONS: Luteal phase treatment with sertraline was a safe and effective treatment for moderate-to-severe premenstrual dysphoric disorder. Further controlled studies are needed to confirm the results of this preliminary study.
Subject(s)
Antidepressive Agents/therapeutic use , Luteal Phase , Premenstrual Syndrome/drug therapy , Premenstrual Syndrome/psychology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Adult , Cross-Over Studies , Double-Blind Method , Female , Humans , Middle Aged , Severity of Illness Index , Treatment OutcomeABSTRACT
A randomized, prospective study was conducted to compare the individual effectiveness of three types of conservative therapy in the treatment of plantar fasciitis. One hundred three subjects were randomly assigned to one of three treatment categories: anti-inflammatory, accommodative, or mechanical. Subjects were treated for 3 months, with follow-up visits at 2, 4, 6, and 12 weeks. For the 85 patients who completed the study, a statistically significant difference was noted between groups, with mechanical treatment with taping and orthoses proving to be more effective than either anti-inflammatory or accommodative modalities.
Subject(s)
Fasciitis/therapy , Foot Diseases/therapy , Orthotic Devices , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , Fasciitis/etiology , Fasciitis/physiopathology , Foot Diseases/etiology , Foot Diseases/physiopathology , Heel , Humans , Middle Aged , Pain/etiology , Pain Management , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To describe women's perceived sense of well-being before and after hysterectomy by examining a broad array of outcomes experienced by women undergoing hysterectomies for benign conditions. DESIGN: Prospective, descriptive. SETTING: A regional tertiary care facility in central Texas. PARTICIPANTS: One hundred seventy-eight women presenting for hysterectomies for nononcologic reasons who completed all three periods of data collection. MAIN OUTCOME MEASURES: Subjects completed a questionnaire assessing information pertinent to their current gynecologic health and the SF-36 Health Survey before surgery and of 4 and 11 months after surgery. The women also completed the Zung Self-Rating Depression Scale preoperatively and at 4 months postoperatively. Additional demographic and medical information was extracted from the medical record. RESULTS: In the initial period after surgery, the patients experienced an improved health status. In addition, the women reported on improvement in their psychologic well-being, including less depression and improved sexual functioning. Relationships with others also improved after the surgery. CONCLUSIONS: Outcomes for these women undergoing hysterectomy for nononcologic reasons were generally positive. This information is vital for preoperative counseling by nurses of women contemplating or about to undergo this surgery.
Subject(s)
Health Status , Hysterectomy , Patient Satisfaction , Uterine Diseases/surgery , Adult , Attitude to Health , Depression , Female , Humans , Hysterectomy/psychology , Middle Aged , Prospective Studies , Sexuality , Treatment OutcomeABSTRACT
OBJECTIVE: The purpose of this study was to survey the Society of Laparoendoscopic Surgeons (SLS) for their experience with laparoscopy during pregnancy and to develop a database on the safety and complications of laparoscopy in pregnancy. STUDY DESIGN: A survey questionnaire was mailed to 16,329 laparoscopic surgeons from the SLS mailing database. Seven questions were asked: number of laparoscopic procedures in pregnancy, type of operation, gestational age, intraoperative and postoperative complications, insufflation agent and insufflation pressure. Only surgeons who had performed laparoscopic procedures in pregnancy were asked to return surveys. RESULTS: One hundred ninety-two (1.2%) surveys were returned. Complete information was available on 413 laparoscopic cases. There were five intraoperative complications, including inadvertent placement of a Veress needle into a pregnant uterus. There were 10 postoperative complications. CONCLUSION: This is the first report to specifically address the safety and complications of laparoscopy in pregnancy. This study suggests that laparoscopy may be safe during pregnancy; however, it was limited by the biases of surveys and retrospective studies.
