Biomedical subjects
Publications and source records attributed to A Goldsmith.
The efficacy of transcervical insertions of quinacrine hydrochloride pellets to produce tubal occlusion has been evaluated in a study of 139 women in Santiago, Chile. At one year, the pregnancy rate was 3.1%, an acceptable rate for a nonsurgical method of female sterilization.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
From the array of sterilization procedures that are safe, simple and effective, the service provider must select procedures that fit his or her logistical criteria, which include the cost and maintenance of equipment, availability of supplies, and training of the requisite personnel. In this paper, these criteria are discussed for each of the various sterilization procedures. Information about female sterilization equipment for conventional postpartum laparotomy, minilaparotomy, colpotomy, laparoscopy, and culdoscopy is presented, together with facts about the related tubal occlusion techniques. The standard ligation techniques for male sterilization are compared with the newer electrocoagulation and thermocoagulation methods. A variety of methods for both female and male sterilization that are in the research stage are also mentioned. It is concluded that, from a programmatic point of view, vasectomy and postpartum ligation via laparotomy are the optimal sterilization procedures. For women who have not recently been pregnant, minilaparotomy with a standard tubal ligation technique is recommended, except in large teaching hospitals where laparoscopy can be performed efficiently.
Explore the source record for details and available documents.
The limitations of nonmedicated intrauterine devices (IUDs) and the potential for improving IUD performance through the addition of pharmacologic agents are discussed. The mechanisms of action of IUDs, particularly of the copper and the progesterone-releasing devices, are reviewed. The development of improved intrauterine contraceptive devices will depend on an understanding of these mechanisms of action. In order to determine the optimal design of intrauterine contraceptives, the effects of the pharmacologic agents will also have to be evaluated, both separately and in combination with the carrier (vector).
One hundred eighty-nine patients were evaluated to assess the safety of laparoscopic sterilization after completion of a "spontaneous" abortion by curettage. Some of the "spontaneous" abortions had probably been illegally initiated outside the hospital and were septic. The laparoscopic sterilization procedures used tubal rings to achieve tubal occlusion. They were performed 4 to 48 hours after completion of the abortion. Patients were discharged from the hospital on the day the procedure was performed. Surgical difficulties and complications associated with the laparoscopy were infrequent. Undergoing a curettage prior to sterilization with tubal rings by laparoscopy did not appear to result in increased rates of complications.
Since June 1972, more than 2,000 laparoscopic sterilizations have been performed as outpatient procedures using neuroleptanalgesics. Electrocoagulation, spring-loaded clips or tubal rings were the methods used for tubal occlusion. All laparoscopies were performed in a family planning clinic. The surgical facilities were minimal and did not include general anesthesia equipment or a blood bank. The nearest hospital was about one-half mile from the clinic. The procedures were performed by a physician assisted by two paramedical personnel and a technician. Patients were scheduled to be at the clinic on the morning of the procedure and were discharged three to six hours after the procedure. Only one patient required hospitalization for treatment of a complication: her aorta was punctured during placement of the Tuohy needle. The patient was admitted to a local hospital and underwent laparotomy for repair; her subsequent recovery was uneventful. No bowel or bladder burns have occurred. Minor complications (emphysema of the abdominal wall, bleeding from the tubes, infections) have occurred in less than 4% of the patients. The results of this study indicate that laparoscopy in an outpatient clinic is safe and presents minimal additional risks to the patient if the surgeon is experienced.
The surgical, immediately postoperative and delayed postoperative complications and complaints associated with spring-loaded clips and electrocoagulation as techniques of tubal sterilization at laparoscopy were evaluated in a comparative study. Each of the two techniques was randomly assigned to 150 subjects. All sterilizations were performed as outpatient procedures. Subjects were followed-up during the first six weeks and again at about six months after sterilization. Rates of complications (surgical and early postoperative) were similar for the two procedures. None of the subjects required subsequent hospitalization. Technical difficulties at surgery were more frequent with the spring-loaded clip technique, principally as a result of mechnical problems with the prototype laparoscope and clip applicator. Postoperative pelvic and abdominal pain were reported by a significantly higher proportion of the patients when the spring-loaded clip was used (spring-loaded clips, 43.6%; electrocoagulation, 31.5%). At the six-month follow-up examination, rates of abnormal pelvic findings and changes in menstrual cycle formation were similar for the two techniques of tubal occlusion. There was one procedure failure among the electrocoagulation patients and none among the spring-loaded clip patients.
The long-term (six years) contraceptive effectiveness of the Cu-T-200 is evaluated based on 833 first insertions performed by physicians and nurse-midwives. IUD event rates (pregnancy, expulsion, pain/bleeding removal or removal for medical reasons) did not increase with increasing duration of use. The results of the study indicate that the Cu-T-200 is a safe and effective contraceptive for at least six years after insertion.
Explore the source record for details and available documents.
The safety and effectiveness of laparoscopic sterilization with electrocoagulation and separation of the tubes when performed within five days of a normal delivery is evaluated. The majority of patients (53.5%) were sterilized within 36 hours of delivery and were discharged on either the same day or the first post-sterilization day (91.0%). While some form of complications were reported for 9.5 percent of the patients, potentially serious complications occurred for only 2 patients (1.%). Most of the complications were probably unrelated to the laparoscopic procedure. At six months after sterilisation, complications were reported by 2.9 percent of the patients who returned for a follow-up visit. One patient became pregnant 3.5 months after sterilization. The results of this study suggest that performing laparoscopic sterilization in the immediate puerperium does not significantly increase the complication or failure rates of the procedure.
The surgical and early postoperative complications and complaints associated with laparoscopic sterilization using electrocoagulation or tubal rings for tubal occlusion were evaluated in a comparative study. Procedures were randomly assigned to subjects (electrocoagulation to 151 subjects and tubal rings to 148 subjects). Difficulties in carrying out the sterillization procedures occurred more frequently when tubal rings were used (6.1%) than when electrocoagulation was used (2.0%). Rates of complications occurring at the time of surgery were similar for the two procedures. However, one patient in the electrocoagulation group had a bowel burn. Postoperative pelvic and abdominal pain were reported by a significantly higher proportion of the tubal ring cases (32.0%) than electrocoagulation cases (19.4%). It appears that although the incidence of surgical difficulties and pain may be somewhat more frequent with the tubal ring, the avoidance of such potentially serious complications as bowel burns may make femal sterilization by the tubal ring method preferable.
The surgical and early postoperative complications were evaluated in a study of 221 laparoscopies and 29 minilaparotomies in which tubal occlusions were performed with the application of tubal rings. For either procedure, complications were infrequent. None of the procedures had to be completed by another technique of tubal occlusion, and none of the patients required an extended hospitalization for the treatment of a complication. Among the 79 patients who have been followed up for more than 6 months, no pregnancies have been reported. The tubal ring technique appears to be safe and effective when used with either laparoscopy of minilaparotomy.
The safety and efficacy of the repeated transcervical instillation of quinacrine hydrochloride in a suspension of 5 ml of 2% Xylocaine was evaluated in 200 patients. All instillation procedures were performed during the proliferative phase of the menstrual cycle: the second instillation was made in the first menstrual cycle following the initial instillation and the third and last instillation at 6 months after the first. None of the patients used any adjunctive contraceptives. Follow-up visits were scheduled at 6-month intervals after the last instillation. The potentially serious complications following the instillation were four cases of cortical exitation, and one case of acute adnexitis. The second instillation was not performed for 16.0% and the third instillation was not performed for 16.7% of the patients, for medical and/or personal reasons. Fifty-one pregnancies were reported, 41 (80.4%) before completion of the three instillations. The results of this study show that the instillation schedule used is unsatisfactory for widespread use. Additional studies are currently being conducted to evaluate the use of an adjunctive contraceptive up to the time of the third instillation in order to reduce the high pregnancy rate.
Explore the source record for details and available documents.
Comparison of powder diffraction patterns of unheated normal bone mineral with the damaged by Paget's Osteitis Deformans showed that due to a difference in the spacing of one weak inner reflection the possibility exists that carbonate-containing alpha-calcium sodium orthophosphate may be a minor constituent of the osteitic bone mineral. The chemical and physical properties of this substance make it a likely minor constituent of bone salt. The presence of this calcium alkali phosphate in the osteitic mineral was tentatively proposed after demonstrating the similarity of the diffraction patterns of synthetic mixtures of this substance with tricalcium phosphate hydrate to those of the osteitic bone salt.
Among 2283 patients, rates of technical failure, technical difficulty, and operative and early postoperative complications were evaluated for different methods of tubal occlusion at laparoscopy: electrocoagulation (980 cases), spring-loaded clip application (991 cases), and Silastic band application (312 cases). Rates of technical failure and technical difficulty at surgery were significantly higher (P less than 0.05) for the spring-loaded clip technique than for the electrocoagulation and Silastic band techniques. Mechanical and optical difficulties with the prototype spring clip applicator were the major sources of technical difficulties. Rates of operative (1.2%) and early postoperative (1.9%) complications were not significantly different for the three techniques of tubal occlusion. It is concluded that all three study techniques appear to be practical, and large, long-term, randomized, comparative studies to determine rates of failure and subsequent gynecologic problems are necessary to determine the best method of sterilization.