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Biomedical subjects

A A Murphy

Publications and source records attributed to A A Murphy.

At least 19 recordsLinked to original sources
PubMed1992

Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial.

STUDY OBJECTIVE: To compare prospectively operative laparoscopy to laparotomy in the management of hemodynamically stable patients with ectopic pregnancy (EP). DESIGN, PATIENTS, Intervention: Patients with suspected EP presenting to a university-based residency teaching program were prospectively allocated to laparoscopy (n = 26) or laparotomy (n = 37) on alternating months for operative management. RESULTS: Operative times between laparoscopy and laparotomy did not differ significantly. Laparoscopy-treated patients had a significant reduction in estimated intraoperative blood loss, postoperative hospital stay, narcotic requirement, time to normal activity, and total hospital cost. There was no statistical difference in intrauterine pregnancy rates or in EP rates. CONCLUSIONS: In a university-based residency program, operative laparoscopy is a safe alternative for the management of appropriately selected patients with suspected EP.

Female↗
PubMed1992

Pediatric and adolescent gynecologic endocrinology.

Best described as a transformation from the infantile state to an accentuated dimorphic adult state, puberty is a sequence of events characterized by the secretion of gonadal hormones leading to the development of secondary sexual characteristics, gametogenesis, and reproductive function. In girls, the first signs of puberty may be evident at age 8, with the process largely completed by age 16; in boys, puberty commonly begins between ages 10 and 12 and is largely completed by age 18. Adrenarche, the secretion of adrenal androgens, starts between ages 6 and 8 and is clinically accompanied by pubarche. Premature pubarche should be diagnosed as either typical or atypical. In atypical premature pubarche, corticotropin testing is recommended to determine nonclassical adrenal enzyme deficiency of steroidogenesis. Children with either type of premature pubarche should be under continued follow-up throughout puberty. The trigger of the onset of puberty is still unknown. The presence of gonadotropin activity and possible circadian rhythm in the prepubertal years allows for new understanding in possible triggering mechanisms of puberty. Precocious puberty, which is associated with significant psychologic implications and possible pathology, must be categorized as complete precocious puberty with activation of the hypothalamic-pituitary axis or incomplete precocious puberty without activation of the central axis as effective therapies are so different. The categorization does not yield diagnoses, as there are multiple etiologies within each category. The treatment of central precocious puberty with gonadotropin-releasing hormone agonists will postpone pubertal progression to a more appropriate age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The effect of tetracycline on levels of oral contraceptives.

Despite the widespread use of tetracycline for treatment of dermatologic disorders and sexually transmitted diseases, the pharmacodynamics of oral contraceptive use in the presence of tetracycline has not been studied. Seven normal women ingested an oral contraceptive containing ethinyl estradiol 35 micrograms and norethindrone 1 mg in the follicular phase of the menstrual cycle. On day 0 baseline ethinyl estradiol and norethindrone levels were obtained at 0, 1/2, 3/4, 1, 2, 4, 12, and 24 hours after oral contraceptive administration. On day 1 tetracycline 500 mg was given orally every 6 hours while the oral contraceptive was continued. Tetracycline, ethinyl estradiol, and norethindrone levels were determined at the same time intervals as on day 0. Oral contraceptive and tetracycline were continued for up to 10 days, and additional concentrations of ethinyl estradiol, norethindrone, and tetracycline were determined between days 5 and 10. Four additional normal women ingested tetracycline for 5 to 10 days. Tetracycline levels were determined at the time intervals noted above on day 1 and days 5 to 10. No significant decrease in plasma ethinyl estradiol or norethindrone concentration was seen with either short-term (24 hours) or long-term (5 to 10 days) ingestion of tetracycline. Similarly, levels of tetracycline do not significantly decrease with ingestion of a low-dose oral contraceptive.

Adolescent↗
PubMed1991

Laparoscopic cautery in the treatment of endometriosis-related infertility.

Life table analysis and the two-parameter exponential method have been applied to pregnancy rates in 72 patients undergoing laparoscopic cautery exclusively. Patients with male factor infertility were excluded. Estimated cure rates for patients with stage I and II disease were 98.2% and 76.6%, respectively (not significantly different). No significant difference was seen when anovulation complicated the endometriosis (68.6%). When greater than one infertility factor was present, a significant difference was observed (50.6%). Patients with stage I disease had an average fecundity of 10.30% with decreasing values observed in stage II (7.59%), anovulation (6.67%), and more than one infertility factor (3.33%). We conclude that laparoscopic cauterization is an effective mode of therapy for the treatment of stage I and II endometriosis associated with infertility.

Adult↗
PubMed1991

Endocrine responses to long-term administration of the antiprogesterone RU486 in patients with pelvic endometriosis.

OBJECTIVE: To examine endocrine and clinical responses to long-term administration of RU486 in patients with endometriosis. DESIGN: Prospective open trial. SETTING: Faculty practice of the authors. PATIENTS, PARTICIPANTS: Six normally cycling women with endometriosis were recruited. INTERVENTIONS: Subjects received RU486 100 mg/d for 3 months. MAIN OUTCOME MEASURE(S): Hormonal changes during RU486 were compared with control data obtained in the preceding cycle during the early follicular phase. Clinical responses were determined by patient assessment and second-look laparoscopy. RESULTS: All women became amenorrheic, and daily urinary levels of ovarian steroid metabolites remained acyclic. Mean luteinizing hormone (LH) (P less than 0.02) and LH pulse amplitude (P less than 0.05) were increased without changes in LH pulse frequency. An antiglucocorticoid effect was demonstrated by an increase in serum cortisol (P less than 0.01) and adrenocorticotropic hormone (P less than 0.05) levels. Treatment resulted in an improvement in pelvic pain in all subjects without significant change in the extent of disease as evaluated by follow-up laparoscopy. CONCLUSIONS: Daily administration of RU486 results in acyclic ovarian function and improvement in the subjective painful symptoms of endometriosis.

Adolescent↗
PubMed1991

Ectopic pregnancy.

The diagnosis and management of ectopic pregnancy is changing rapidly. More sensitive pregnancy tests and high-resolution transvaginal sonography are making the diagnosis of ectopic pregnancy easier and earlier. In the future, we may become more confident with the ultrasound diagnosis of some ectopic pregnancies such that laparoscopic confirmation will not be required. These patients may be treated with systemic methotrexate. However, at the present time laparoscopy is essential for diagnostic confirmation of most ectopic pregnancies. It is senseless for a skilled laparoscopist to perform a diagnostic laparoscopy, remove the laparoscope, and then proceed with laparotomy or some nonsurgical treatment. There is sufficient evidence in the literature to demonstrate that laparoscopic management of ectopic pregnancies is equally safe, equally effective, and less traumatic than laparotomy. It should replace laparotomy as treatment for most ectopic pregnancies. Unfortunately, there are not enough trained laparoscopists to manage the 88,000 ectopic pregnancies per year in the United States. Operative laparoscopy deserves more emphasis in postgraduate and residency training programs.

Algorithms↗
PubMed1991

Use of an oxidized, regenerated cellulose absorbable adhesion barrier at laparoscopy.

The use of an oxidized, regenerated cellulose absorbable adhesion barrier has been shown to significantly reduce the incidence, extent and severity of postoperative gynecologic adhesions in a multicenter, randomized, prospective trial. Since an increasing proportion of gynecologic surgery is being performed laparoscopically, a prospective, multicenter, open-label study was initiated to evaluate the feasibility of using the adhesion barrier laparoscopically and to establish techniques for applying the barrier during those procedures. Eighty patients were studied: 42 underwent lysis of adhesions; 35, removal of endometriosis implants; and 14, tuboplasty/fimbrioplasty. An average of two pieces were placed per patient, with an average piece size of 3 x 3 cm and an average time required per piece of 2 minutes, 40 seconds. Seventy-five percent of the cases required less than three pieces each for application. Eighteen percent of the pieces were difficult to place, generally because of problems unfolding the material, excessive size or nonadherence. For similar reasons, replacement was necessary for 27 of 157 pieces placed (17.2%). The barrier can be applied with relative ease during operative laparoscopy. The fabric can be placed through either the suprapubic or umbilical sleeve, depending on the size of the piece of barrier required.

Cellulose, Oxidized↗
PubMed1989

Combination medical and surgical therapy for infertile patients with endometriosis.

Endometriosis is a difficult problem for practicing gynecologists and is commonly associated with infertility. The diagnosis of endometriosis should only be made at the time of laparoscopy or laparotomy and should be confirmed with biopsy if possible. Once the diagnosis is made, it should be classified according to the revised AFS system. The treatment of infertility associated with endometriosis is controversial and usually consists of either medical therapy with hormonal manipulation designed to suppress the disease, surgical therapy designed to debulk the disease and repair anatomic distortion, or a combination of both. Despite an abundance of research on the treatment of endometriosis, the pregnancy rate for patients with endometriosis remains lower than that of the normal population. The reasons for this are obscure. Endometriosis does not respond to hormonal changes the same way that normal endometrium does and has been shown to persist despite extensive medical therapy. The recurrence rate of the disease is impressively high after either medical or surgical therapy. Interestingly, expectant management of minimal or mild disease is associated with pregnancy rates equal to those of any other type of therapy. Only when the disease is more extensive does aggressive treatment appear to show improvement in pregnancy rates. Whether combination therapy of endometriosis is better than single agent therapy remains open to debate. Some of the best-designed studies using combination therapy have shown no difference in pregnancy rates. Yet, when taken as a whole, it would appear that if combination medical and surgical therapy is chosen, the medical therapy should be given preoperatively. The literature abounds with a wide variety of classification systems, methods of calculating pregnancy rates, and inclusion of control groups. Because of this disparity between studies, reliable conclusions cannot be drawn.

Combined Modality Therapy↗
PubMed1988

Comparison of human menopausal gonadotropin administered once and twice daily in an in vitro fertilization and embryo transfer program.

This is a retrospective study which evaluates the use of twice-daily (BID) human menopausal gonadotropin (hMG) for follicular stimulation in an in vitro fertilization and embryo transfer (IVF-ET) program from February to June 1985 and compares it to daily (QD) hMG from August to December 1984. All QD patients were begun on 2 ampoules of hMG, and BID patients on 2 ampoules twice daily. Individual patient responses to hMG determined subsequent doses so as to achieve continuously rising estradiol levels. The BID stimulation scheme appears to increase statistically characteristics that would be present in the ideal stimulated cycle such as elevated follicular-phase estradiol (E2) (2125 pg/ml for the BID vs 1581 pg/ml for the QD group) with an increase in the number of patients achieving the "desired" Jones pattern, increased oocyte retrieval (4.01 vs 2.45), and an increase in the number of transferred concepti (2.69 vs 1.87). No statistical differences were noted in the number of endogenous luteinizing hormone (LH) surges or mean LH. The luteal phase does not appear to have been altered by the frequency of administration. Although the increase in the total (20.0 vs 14.5%) and live-born/ongoing (16.9 vs 11.8%) pregnancy rate per laparoscopy with the BID regimen is not statistically significant, it may be that it is clinically relevant.

Drug Administration Schedule↗