Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Dec 2003
The role of metformin in the management of polycystic ovary syndrome.
The purpose of this review is to provide a critical summary of recent studies on the clinical effects of metformin in polycystic ovary syndrome. ⋯ Although most studies are nonrandomized trials, current data provide a rationale for metformin as first-line management for women with polycystic ovary syndrome, alone or in combination with conventional treatments. Controversy still exists, however, regarding the mechanisms by which metformin exerts its beneficial effects in polycystic ovary syndrome.
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Laparoscopy is the gold standard for the diagnosis of endometriosis but the need for visual evidence of the disease is a major stumbling-block for both effective clinical management of affected patients as well as for research into this common and debilitating reproductive disease. Laparoscopy is invasive and often causes a delay in diagnosis and treatment, especially in symptomatic teenagers and young women. Moreover, the visual inspection of the pelvis has major limitations, particularly for the diagnosis of retroperitoneal lesions. It is therefore not surprising that considerable efforts are being made to improve imaging techniques and to evaluate the diagnostic value of potential molecular markers of disease. ⋯ Current imaging techniques, such as transvaginal ultrasonography, are useful to screen the pelvis for the presence of retroperitoneal endometriosis but fail to diagnose peritoneal lesions, small ovarian endometriomas and adhesions. Postgenomic technologies and identification of novel serum and endometrial markers are likely to revolutionize future diagnosis of endometriosis.
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To review the recent literature on amniotic fluid embolism and how it may influence the clinical management and further study of the condition. Morbidity and mortality from amniotic fluid embolism in the international context will be described, given the recent Confidential Enquiries into Maternal Deaths in the United Kingdom and other studies. With this rare condition we need to look for clues as to how to facilitate diagnosis and improve outcomes. ⋯ With a rare condition additions to the literature are sparse. Early consideration of the diagnosis after prompt resuscitation is needed. Further data are needed to advance beyond this.
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Curr. Opin. Obstet. Gynecol. · Feb 2003
ReviewNew technologies for the identification of markers for early detection of ovarian cancer.
The ovarian cancer screening regimens in current use fail to identify disease at an early curable stage. ⋯ Further evaluation of serum proteins associated with ovarian cancer holds promise for the development of a tumor marker panel that could aid in the early diagnosis of ovarian cancer, and save lives.
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The rates of obesity are increasing rapidly in the United States and other countries. Because obesity is a major factor in the development of many chronic diseases, it is an important individual and public health issue. This review focuses on the pregnancy complications associated with maternal obesity. ⋯ Recommendations regarding the counselling of obese pregnant women and specific guidelines for the obstetrician, family physician, or midwife managing the pregnancy are presented. Cultural and political changes with the potential to decrease the epidemic of obesity in our society are discussed.