Patient satisfaction with results of hysterectomy.

OBJECTIVE: The objectives of this study were to measure patient satisfaction with the results of hysterectomy and to determine factors associated with dissatisfaction. STUDY DESIGN: A total of 1299 women who underwent hysterectomy at 28 hospitals in Maryland were interviewed before and at 3, 6, 12, 18, and 24 months after the operation. RESULTS: At 12 and 24 months after the hysterectomy 95.8% and 96.0%, respectively, reported that the hysterectomy had completely or mostly resolved the problems or symptoms they had before surgery; 93.3% and 93.7%, respectively, reported that the results were better than or about what they expected; 85.3% and 81. 6%, respectively, reported that their health was better than before the hysterectomy; and 87.9% and 93.1%, respectively, reported being totally recovered. The factor most strongly and consistently associated with patient reports of negative outcomes was readmission because of a postdischarge complication. CONCLUSION: Postdischarge complication necessitating readmission plays an important role in patient dissatisfaction with the results of hysterectomy.

Effectiveness of hysterectomy.

OBJECTIVE: To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief. METHODS: In a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1,299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed. RESULTS: Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy. CONCLUSION: Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

Hysterectomy and sexual functioning.

CONTEXT: Women considering hysterectomy often are concerned about its potential effects on their sexual functioning but the effects of hysterectomy on sexual functioning remain unclear. OBJECTIVE: To examine changes in sexual functioning after hysterectomy. DESIGN AND SETTING: A 2-year prospective study (Maryland Women's Health Study) of hysterectomy, which included measures of sexual functioning prior to hysterectomy and at 6, 12, 18, and 24 months after hysterectomy, performed during 1992 and 1993. PATIENTS: Of 1299 women interviewed prior to hysterectomy, 1101 (84.8%) completed the study and provided information about their sexual functioning. Most were between the ages of 35 and 49 years, white, married or living with a partner, and high school graduates. MAIN OUTCOME MEASURES: Frequency of sexual relations, dyspareunia, orgasm, vaginal dryness, and sexual desire. RESULTS: The percentage of women who engaged in sexual relations increased significantly from 70.5% before hysterectomy to 77.6% and 76.7% at 12 and 24 months after hysterectomy. The rate of frequent dyspareunia dropped significantly from 18.6% before hysterectomy to 4.3 % and 3.6% at 12 and 24 months after hysterectomy. The rates of not experiencing orgasms dropped significantly from 7.6% before hysterectomy to 5.2% and 4.9% at 12 and 24 months after hysterectomy. Low libido rates also decreased significantly from 10.4% before hysterectomy to 6.3% and 6.2% at 12 and 24 months after hysterectomy. The distribution of women not reporting vaginal dryness in the past month improved significantly from 37.3% before hysterectomy to 46.8% and 46.7% at 12 and 24 months after hysterectomy. Prehysterectomy depression was associated with experiencing dyspareunia, vaginal dryness, low libido, and not experiencing orgasms after hysterectomy. CONCLUSIONS: Sexual functioning improved overall after hysterectomy. The frequency of sexual activity increased and problems with sexual functioning decreased.

The relationship between insomnia and mortality among community-dwelling older women.

OBJECTIVES: To investigate the relationship between insomnia and 6-year survival among older, community-dwelling, white women. DESIGN: Longitudinal study. SETTING: The sample was selected randomly from a 20-census tract area of Baltimore, Maryland. PARTICIPANTS: In 1984, 778 women aged 65 years and older participated in the baseline survey; 613 were re-interviewed in 1985; 596 were reinterviewed in 1986. MEASUREMENTS: Insomnia was measured as self-report of at least one of three sleep complaints: trouble initiating sleep, waking at night and trouble falling back to sleep, and waking too early. Cox proportional hazards models were used to assess the relationship between insomnia, as reported at the most recent of three interviews, and mortality. RESULTS: Twenty-nine percent of the sample reported trouble initiating sleep, 22.4% reported waking at night and having trouble falling back to sleep, and 26.6% reported waking too early. Of the sample, 43.2% had insomnia at the baseline interview; 23.2% percent of respondents with insomnia at baseline died during the follow-up period compared with 22.0% of those without insomnia at baseline. Recent insomnia was not associated significantly with mortality in either crude analyses (Hazards Ratio (HR) = 1.11, 95% CI, 0.78-1.60) or analyses adjusted for age, prescription medication use, functional limitations, self-rated health, and number of chronic conditions (HR = 0.74, 95% CI, 0.50-1.09). CONCLUSION: Our results, combined with the results from previous studies, suggest strongly that insomnia is not an indicator of approaching mortality in older community-dwelling populations.

Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992.

OBJECTIVES: This study sought to describe prevalence rates of chronic gynecological conditions and correlates of these conditions in a representative sample of US women. METHODS: National Health Interview Survey data from 1984 through 1992 for women aged 18 to 50 were used. RESULTS: The estimated annual prevalence rate for the reported presence of one or more gynecological conditions was 97.1 per 1,000 women. Menstrual disorders were most common, with an annual prevalence rate of 53.0 per 1,000 women. Adnexal conditions and fibroids were the next most common conditions, with rates per 1,000 women of 16.6 and 9.2, respectively. Prolapse, endometriosis, and fibroids were the conditions most likely to lead to hysterectomy within the year prior to the interview. More than three quarters (77.1%) of women with gynecological conditions had talked with a doctor in the previous year concerning their condition, and 28.8% reported spending 1 or more days in bed in the previous year because of their condition. CONCLUSIONS: Nearly a tenth of American women aged 18 to 50 report having one or more chronic gynecological conditions annually, the most common being disorders of menstruation.

A comparison of alternative ways of measuring fatigue among patients having hysterectomy.

In a study of the outcomes of hysterectomy, 1,205 patients rated their fatigue levels via three single-item measures and the Profile of Mood States (POMS) Fatigue Scale. The single-item fatigue measures asked patients to indicate how often they were tired during the day, how often feeling tired had prevented them from doing what they wanted to do, and how big a problem feeling tired was for them. All four measures of fatigue were found to be correlated with pain, activity limitation, and psychological dysfunction, although the POMS Fatigue Scale was more strongly related to psychological dysfunction than the other fatigue measures. All four measures indicated substantial relief from fatigue 6 months after hysterectomy among the participants in this study. Patients who remained or became fatigued by 6 months posthysterectomy had more physician contacts than those not fatigued, and were less satisfied with the results of the surgery. Fatigue was found to be a useful outcome measure of medical treatment. Each of the fatigue measures examined provided unique and useful information, with no one fatigue measure proving to be substantially superior to the others.

Hysterectomy and race.

OBJECTIVE: To investigate black-white differences in factors related to hysterectomy. METHODS: Discharge summary data were analyzed for 53,159 hysterectomies that occurred in Maryland from 1986-1991. RESULTS: The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. Logistic regression was used to measure the effect of race on complications, length of stay, and mortality after adjustment for a variety of factors including age, comorbidities, diagnosis, route (abdominal, vaginal, or subtotal), hospital characteristics, and source of payment. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care (odds ratio 1.4, 95% confidence interval [CI] 1.3-1.5), a length of stay of more than 10 days (odds ratio 2.7, 95% CI 2.5-3.1), and in-hospital mortality (odds ratio 3.1, 95% CI 2.0-4.8). CONCLUSIONS: In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate.

Human uterine leiomyoma cells: binding and growth responses to epidermal growth factor, platelet-derived growth factor, and insulin.

The specific binding of epidermal growth factor (EGF), platelet-derived growth factor (PDGF) and insulin were measured in matching cultures of human leiomyoma and myometrial cells, along with the effects of these proteins on DNA and protein syntheses. Scatchard analyses of the binding data revealed that the EGF receptor sites/cell were significantly lower in leiomyoma than myometrial cultures. Two types of PDGF binding were observed when porcine PDGF was used, and one type was seen with human PDGF. By contrast to EGF, more PDGF receptor sites/cell were found in leiomyoma than myometrium but the receptor affinity was higher in the latter. Insulin binding was similar among the myometrial and leiomyoma cells. Protein synthesis was stimulated 3-fold by EGF, PDGF, or insulin in both cell types. DNA synthesis, was higher in myometrial than leiomyoma cells in the basal state and was stimulated by EGF, insulin, or PDGF. A synergistic stimulation (p less than 0.02) of DNA synthesis was observed in both myometrial and leiomyoma cells when EGF was added with insulin. The addition of PDGF with insulin caused only additive stimulation of DNA synthesis. However, the addition of EGF with PDGF caused a synergistic decrease (p less than 0.05) in DNA synthesis by myometrial but no leiomyoma cells. Cultures of human vascular smooth muscle cells obtained from umbilical veins gave results similar to those from myometrium. These findings single out the EGF receptor and EGF, or perhaps an EGF-like growth factor, and to a lesser degree PDGF, as potential regulators of uterine leiomyomata.

A double-blind trial of clonazepam in the treatment of parkinsonian dysarthria.

We studied the effect of clonazepam in a double-blind trial on 12 parkinsonian patients with hypokinetic dysarthria. Speech samples were judged on 14 of the dimensions used in the Mayo Clinic dysarthria study. Of the 11 patients who completed the study, 10 showed improvement. The effective dosage of clonazepam was 0.25 to 0.5 mg/d with higher dosage than that less effective. Clonazepam has a definite role in the management of parkinsonian dysarthria.

Self-tonometry to manage patients with glaucoma and apparently controlled intraocular pressure.

We tested a self-tonometer than can be used by the patient alone to monitor intraocular pressure (IOP) in a normal environment. The instrument is safely and easily used after training. Normal subjects and patients with glaucoma who had an IOP of 22 mm Hg or less at three consecutive visits were referred for diurnal monitoring. After successful training, they received a self-tonometer and instructions to obtain five measurements daily between awakening and bedtime for three to six days. More than half the patients had one or more readings above 22 mm Hg. About half of the IOP peaks occurred at times outside of normal office hours. Interestingly, more elevated IOP readings were recorded in patients with suspected or documented progression of glaucomatous damage than in patients thought to be stable or in normal subjects. In eyes that have already sustained glaucomatous damage, the progression may be explained by the presence of previously undocumented IOP peaks. Valuable additional clinical information can be gained by diurnal IOP monitoring, and the self-tonometer is a practical tool for its measurement.

Culture of squamous head and neck cancer on 3T3 fibroblasts following isokinetic velocity sedimentation.

Growth in culture of squamous head and neck cancer is hampered by microbial contamination, low plating efficiency, and cellular heterogeneity within tumors. Furthermore, clumps of cells must be removed if plating efficiency is to be accurately determined. Isokinetic velocity sedimentation was applied to 44 primary tumor specimens in an effort to minimize these problems. Seven fractions were evaluated for cell number, clump number, cell viability, clonogenic growth, plating efficiency, and microbial overgrowth. Unseparated specimens were simultaneously cultured. Microbial growth was significantly associated with the highest gradient fraction. Clumps were significantly associated with the lowest gradient fraction. Colony formation was significantly associated with middle gradient isokinetic velocity sedimentation, although seven specimens grew only when fractionated, suggesting the possibility of inhibitor cells within the tumor specimen.

Ocular fluorophotometry in the normal- and diabetic monkey.

Normal- and diabetic rhesus monkeys without retinopathy demonstrable by ophthalmoscopy or fluorescein angiography were examined with ocular fluorophotometry to detect alterations in their blood-ocular barriers. All vitreous fluorophotometry values were corrected for fluorescence attributable to background levels and then normalized to a blood fluorescein level of 10 micrograms ml-1. Reproducibility studies demonstrated an average coefficient of variation of 0.17 for all animals combined. Insulin-dependent monkeys, both pancreatectomized and streptozotocin-treated, demonstrated significantly higher posterior vitreous fluorescence levels than either control animals or monkeys treated with streptozotocin that were not insulin-dependent. These results cannot be attributed to differences in fluorescein binding or to vitreous abnormalities. However, 14 out of 24 (58%) of the insulin-dependent animals exhibited posterior vitreous fluorescence values within two standard deviations of the control mean. No correlation was apparent between the vitreous values and age or duration of treatment. No difference in anterior chamber concentrations was found between groups after correction. Our results indicate that alterations in blood-retinal barrier can occur in insulin-dependent diabetic monkeys before development of retinopathy.

Cervicovaginal peroxidases: markers of the fertile period.

The specific activity of guaiacol peroxidase was measured daily in human cervical mucus, vaginal fluids, and saliva during 45 cycles in 31 women. Also determined were basal body temperatures and serum hormones (luteinizing hormone [LH], estradiol, progesterone). The guaiacol peroxidase was extracted with 0.5 M CaCl2 and thus may be a different peroxidase from that obtained by noncalcium extraction procedures. The guaiacol peroxidase specific activity did not vary in the saliva during the cycle but fell sharply in the cervical mucus and vaginal fluid four to five days before the ovulation time, estimated by the LH peak, and rose again one to two days after ovulation. Anovulatory cycles did not show the midcycle drop in guaiacol peroxidase. Growth curve analysis gave excellent fitting of the guaiacol peroxidase data to a polynominal model. These data suggest that cervicovaginal guaiacol peroxidase may be clinically useful in detecting the fertile period for population control and for infertility treatment.

Cervicovaginal peroxidases: sex hormone control and potential clinical uses.

Thirty-one normal women were studied daily in 41 cycles. Venous blood samples were taken for measurements of luteinizing hormone (LH), estradiol (E2), and progesterone (P), and vaginal examinations were done to obtain cervical mucus and vaginal fluid. The specific activity of guaiacol peroxidase (GP), extracted from cervicovaginal secretions with 0.5 M CaCl2, was determined in the vaginal samples. In the follicular phase, from day -7 to day 0 (the LH +1 day, when ovulation presumably occurred), there was a strong negative correlation between GP and the rising E2 (r = -0.94). On days 1 to 10 after ovulation, there was a strong positive correlation between GP and P (r = 0.84). In nine ovulatory cycles in which P levels did not exceed 8 ng/ml on any day, indicating possible luteal phase inadequacy, there were significantly lower GP levels than in another 32 ovulatory cycles with higher P (P = 0.04). These results suggest that (1) at midcycle, E2 seems to "down-regulate" the GP specific activity; and (2) in the luteal phase, serum P levels parallel those of GP activity, even in the presence of high luteal E2. GP activity profiles during the menstrual cycle can be used to define the fertile period, may prove useful in diagnosing pregnancy, and may be a simple, convenient test for an inadequate corpus luteum.