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Biomedical subjects

A A Murphy

Publications and source records attributed to A A Murphy.

51 records · Page 3Linked to original sources
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↗