Biomedical subjects

A N Poindexter

Publications and source records attributed to A N Poindexter.

At least 37 records · Page 2Linked to original sources

PubMed1994

The attitudes of clinic staff as factors in women's selection of Norplant implants for their contraception.

Medical and counseling staff at 13 family planning clinics in Texas, U.S.A., were surveyed regarding their opinions and level of information about the contraceptive Norplant. These responses were used to assess the relationships between clinicians' information and attitudes about the contraceptive and the use of that method by their patients. No differences were associated with respondents' clinical responsibilities or with their type of professional training. However, significant variations in the numbers of patients receiving Norplant from individual providers, and in the proportion receiving the method from certain clinics, were associated with responses to some attitudinal questions. These findings suggest that the opinions about Norplant held by personnel staffing family planning clinics influence the method selection of their patients.

Adolescent↗

PubMed1994

Emergency contraception alters progesterone-associated endometrial protein in serum and uterine luminal fluid.

OBJECTIVE: To evaluate the effect of high-dose oral contraceptives on serum and uterine luminal fluid progesterone-associated endometrial protein in the luteal phase. METHODS: Five ovulatory women participated in the study. In a control cycle, serum and uterine lavage samples were collected on luteal day 11. In the next cycle, on luteal day 9, the participants were given two 50-micrograms ethinyl estradiol-norgestrel tablets, repeated 12 hours later. Serum and uterine lavage samples were collected 48 hours (luteal day 11) after the last dose and analyzed by two-dimensional polyacrylamide gel electrophoresis and radioimmunoassays of the serum. RESULTS: Progesterone-associated endometrial protein levels were lower in sera from treated compared with control cycles. Analysis of serum levels of this protein by two-dimensional polyacrylamide gel electrophoresis did not reveal bands corresponding to the known size and charge characteristics (27 kd and pI of 4.9) in either control or treatment samples. On the other hand, in uterine lavage samples, a complete suppression of the 27-kd, pI-4.9 species was evident after treatment. CONCLUSION: High-dose ethinyl estradiol-norgestrel emergency contraception effectively suppresses progesterone-associated endometrial protein in the midluteal uterus, potentially altering the endometrial environment unfavorably and affecting the survival of the early embryo.

Contraceptives, Oral, Hormonal↗

PubMed1994

HIV exposure in the city of Houston.

Demographic characteristics and risk factor data for 76,672 clients were studied to characterize the distribution of infection with human immunodeficiency virus (HIV) and the use of counseling and testing facilities in Houston, Tex. The number of clients who received free, voluntary HIV counseling and testing services between January 1990 and December 1992 doubled, while the seroprevalence rate declined from 6.1% to 2.9%. Rates were highest for white males, clients attending freestanding HIV testing sites, and those reporting male-to-male sexual contact. The number of females testing positive had increased by 67% over time and consisted almost entirely of blacks. Only 57% of clients who were tested returned for test results and received posttest counseling. Among those who were HIV negative, high-risk behaviors were frequently reported. Behavioral change must be reinforced, and priority must be given to contacting both seropositive and high-risk clients who seek testing.

AIDS Serodiagnosis↗

PubMed1993

Planned condom use by women with Norplant implants.

This research examines the use of condoms to protect from disease women who selected hormonal implants for contraception. After receiving contraceptive implants, subjects were surveyed regarding their past use of condoms and their plans for using them to inhibit the transmission of HIV and other sexually transmitted diseases in the future. Twenty-one percent of women in the sample had used condoms in the past, but did not plan to use them once they have the implants. While decreasing their risk for unplanned pregnancy, they and/or their partners can be expected to experience an increased risk of exposure to sexually transmitted disease. Contraceptive providers must emphasize to their patients the need for protection from disease, in addition to pregnancy, when prescribing contraceptive methods.

Adolescent↗

PubMed1993

Factors associated with the choice of Norplant by women attending subsidized clinics in the US.

US women attending family planning clinics in Texas, were surveyed to determine which characteristics, experiences, behavior and specific needs were associated with the selection of the contraceptive Norplant. Race, ethnic origin, age and education were unrelated to choice of method. Increased numbers of previous pregnancies, familiarity with the method, dissatisfaction with previous methods, and sources of information about Norplant were associated with its selection. There was significant variation among the clinics in the proportion of patients to which they dispensed the method. Therefore, clinic selection may have influenced the outcomes of contraceptive decisions.

Adolescent↗

PubMed1993

The effects of a long-acting progestin on the hypothalamic-pituitary-ovarian axis in women with normal menstrual cycles.

This study was performed to determine how a long-acting, slow-release preparation of norethindrone (NET) affects the hypothalamic-pituitary-ovarian axis of normal ovulatory women. Ten women were studied during the luteal phase of their menstrual cycle, and again at six and twelve weeks following intramuscular administration of 100 mg NET microencapsulated in poly-D,L-lactide-co-glycolide. Serial LH samples, serum E, P, and NET were followed by a GnRH stimulation test. Compared to luteal phase values, six and twelve weeks of treatment with NET inhibited serum E2 and P while mean serum LH remained unchanged and mean serum FSH increased significantly (p < 0.05). LH pulse frequency after NET treatment was twice the rate (p < 0.01) as that of the luteal phase, whereas LH pulse amplitude was decreased significantly (p < 0.05). Finally, although there was no significant change in pituitary LH secretion in response to GnRH, NET treatment augmented FSH responsiveness to GnRH at the times studied. Preserved pituitary responsiveness to GnRH in NET-treated patients suggests that inhibited ovarian function results in an increase in GnRH pulse frequency but not GnRH pulse amplitude. Since the progestational milieu is maintained in these patients by NET treatment, the decrease in serum E2 may be responsible for the increase in GnRH pulse frequency. The presence of a critical level of E2 may be necessary for progestins to affect the hypothalamic GnRH pulse generator.

Adult↗

PubMed1993

One-year experience with subdermal contraceptive implants in the United States.

Women who received Norplant contraceptive implants from any of fifteen clinical settings in southeast Texas, U.S.A., were followed for one year to determine their reactions to the method. Of 1,385 who enrolled to receive Norplant implants, 1,253 had implants inserted. Side effects were reported by 78% of those receiving implants and 70% described changes in bleeding patterns. Spotting or irregular bleeding, weight gain and headaches were the conditions reported most frequently. Nine pregnancies were reported during the study period. Six of these, however, existed before the implants were inserted. At the one year anniversary, 143 of women receiving implants had had them removed. Those who discontinued method use were less satisfied, reported more side effects and were more likely to have planned to have another child, thus using the method for spacing, or to have had a change in their marital status while they were using the contraceptive. Providers should counsel patients to focus attention on plans for the future in selecting their contraceptive method. In addition, we recommend, as does the product's distributor, that providers confirm that patients are not pregnant prior to inserting implants.

Adolescent↗

PubMed1993

GnRH agonist exposure during the first trimester of pregnancy.

OBJECTIVE: To evaluate pregnancy outcome in infertility patients with unrecognized exposure to a GnRH agonist in the first trimester. METHODS: Five women were given GnRH agonist before controlled ovarian hyperstimulation for in vitro fertilization cycles. The medication was administered in a dose of 0.5 mg/day, with drug exposure beginning on cycle day 21. The duration of exposure in all patients was 14-21 days. Thus, all five women received the medication at 3-6 weeks' estimated gestational age by menstrual dating. Pregnancy tests were not performed before the first injection of the GnRH agonist. RESULTS: Three of the five pregnancies progressed to term without complication, and normal healthy infants were delivered. Missed abortion occurred in one pregnancy, and another ended in induced abortion at 13 weeks because of trisomy 18. CONCLUSIONS: This experience suggests that despite manipulation of the hypothalamic-pituitary-ovarian axis by administration of GnRH agonist in the first trimester of pregnancy, normal pregnancies can result. Pregnancies in these patients should not be terminated because of drug exposure alone.

Abortion, Missed↗

PubMed1992

Risk factors for infection with human immunodeficiency virus among low-income women undergoing voluntary sterilization.

Data regarding risk for infection with human immunodeficiency virus (HIV) were collected from 486 women who presented in 1989 for tubal sterilization through a clinic operated by a medical school. This clinic was participating in a blind surveillance project administered by the local health department. The project was designed to estimate the prevalence of seropositivity for HIV among women seeking family planning services within the department's catchment area. The expectation was that the population of women choosing voluntary sterilization would be of relatively low risk for HIV infection. Surprisingly, however, when they were examined, nearly 25% of these women reported at least one identified risk factor for HIV infection. The rates for certain specific risk factors are no lower among these women than among the general population.

Family Planning Services↗

PubMed1992

Hysterosalpingographic diagnosis of Crohn's disease. A case report.

A woman presented with abdominal pain, weight loss and a pelvic mass. At the time of laparotomy she had a lower abdominal abscess from perforation of the ileum. Two years later she returned with a tender uterus and purulent cervical discharge. A hysterosalpingogram demonstrated an uteroileal fistula secondary to Crohn's disease, and the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Adult↗

PubMed1991

Laparoscopic tubal sterilization under local anesthesia in women with cyanotic heart disease.

Laparoscopic tubal sterilization under local anesthesia with intravenous sedation has been shown to be a safe procedure. However, the use of laparoscopy in patients with cyanotic cardiovascular disease is controversial and is generally contraindicated. Five women were referred with uncorrectable cyanotic heart disease and pulmonary hypertension. The mean preoperative arterial oxygen pressure was 56.2 +/- 5 mmHg (N = 5). After cardiology and cardiovascular anesthesia consultation and clearance, the patients underwent laparoscopic sterilization with Silastic rings under local anesthesia using direct trocar entry. Continuous hemodynamic monitoring and pulse oximetry were employed. The patients were kept in the intensive care unit or the hospital for 24 hours for monitoring, and all did well. This hospital for 24 hours for monitoring, and all did well. This small retrospective series demonstrates that laparoscopic sterilization under local anesthesia is a sterilization technique that may be suitable and safe for such patients when appropriate monitoring is performed. Tubal sterilization may be the contraceptive method of choice in women with heart disease when pregnancy is contraindicated.

Adult↗

PubMed1990

Laparoscopic tubal sterilization under local anesthesia.

Laparoscopic tubal sterilization has been performed under local anesthesia in the United States since 1971. Pilot studies suggested that local anesthesia was as adequate and as safe as general anesthesia. Since 1980, the senior author has performed more than 3000 outpatient laparoscopic tubal sterilizations with the silastic ring under local anesthesia. A retrospective descriptive study was conducted on 2827 cases. The technical failure rate was 0.14%. There were no unintended laparotomies due to complications. The mean operative time was 10.0 +/- 5.1 minutes. The mean anesthesia time was 23.3 +/- 6.9 minutes. The hospital cost for the patient was reduced by 68-85%. This study demonstrates that laparoscopic tubal sterilization can be performed adequately, safely, and quickly under local anesthesia.

Adult↗

PubMed1989

Endometriosis in multiparous women.

The incidence of endometriosis in the general population has been reported to range from 4% to 32%. A more realistic figure is probably 7.5%. An incidence of 7.4% was found in 42 of 566 multiparous women undergoing tubal sterilization at Baylor College of Medicine, Houston. Twelve of the 42 (29%) were less than five months postpartum. Hispanics had an incidence of endometriosis similar to that of whites and blacks. Indigent status had no bearing on the presence of endometriosis. A higher incidence of spontaneous abortion was found in patients with endometriosis, but the difference was not statistically significant.

Abortion, Spontaneous↗

PubMed1988

Multicenter clinical trials comparing cefotetan with moxalactam or cefoxitin as therapy for obstetric and gynecologic infections.

The clinical efficacy and safety of cefotetan was assessed in two multicenter clinical trials involving 335 evaluable patients hospitalized with obstetric and gynecologic infections. In Study I, cefotetan was compared with moxalactam and in Study II, cefotetan was compared with cefoxitin. The clinical response rate in Study I was 67 of 70 patients for cefotetan (96 percent) and 33 of 34 patients (97 percent) for moxalactam. In Study II, the clinical response rate was 138 of 147 patients in the cefotetan group (94 percent) and 76 of 84 patients in the cefoxitin group (91 percent). For the patients with bacteriologic response data, 196 of 205 cefotetan patients (96 percent), 23 of 24 moxalactam patients (96 percent), and 70 of 75 cefoxitin patients (93 percent) had a satisfactory bacteriologic response. Cefotetan was well tolerated and produced no major adverse reactions. The mean amount of cefotetan given was lower than that of moxalactam or cefoxitin.

Adult↗

PubMed1988

Results of a randomized, multicenter, comparative trial of a single dose of cefotetan versus multiple doses of cefoxitin as prophylaxis in cesarean section.

In a multicenter, open, randomized, comparative trial, 308 women undergoing cesarean section were given a single 1 gm dose of cefotetan or three 2 gm doses of cefoxitin after cord clamping to reduce the incidence of postoperative infectious morbidity. Of the 286 evaluable patients, 195 received cefotetan and 91 received cefoxitin. Most patients were in active labor and one third had ruptured membranes. Microorganisms cultured from the endocervix or intraoperatively from the endometrium or abdominal wall operative sites were comparable for the two groups. In this multicenter study, the difference between the percentage of patients receiving cefotetan who did not develop clinical signs and symptoms of infection (93%) and the percentage of patients receiving cefoxitin (85%) considered clinical successes was statistically significant (p = 0.02, chi 2). The bacteriologic response rate for patients taking cefotetan was also significantly higher than that for patients taking cefoxitin (93% versus 85%, p = 0.03). Isolates recovered from the endocervix, endometrium, or operative site were comparable for the two groups. Both drugs were well tolerated. In this evaluation, cefotetan administered in a single dose of 1 gm was more effective as a prophylactic agent than multiple 2 gm doses of cefoxitin in the reduction of infectious morbidity in this large series of patients undergoing cesarean section.

Adolescent↗

PubMed1988

Results of noncomparative studies of cefotetan in the treatment of obstetric and gynecologic infections.

In a multicenter trial involving 11 centers, 160 women were enrolled to evaluate the safety and effectiveness of 1 or 2 gm of cefotetan administered every 12 hours in the treatment of obstetric and gynecologic infections. The 133 evaluable patients generally were under 25 years of age, were nonwhite, and had hospital-acquired endometritis or pelvic inflammatory disease caused by both aerobic and anaerobic bacteria. Escherichia coli, Neisseria gonorrhoeae, group D streptococci, Bacteroides sp., and Peptococcus sp. were among the most frequently isolated pathogens. The patients were treated for a mean of 5.6 +/- 1.6 days and received a total dose of 19.27 gm. The signs and symptoms of infection were cleared or improved in 93% of the 133 patients evaluable for clinical response. Of the 116 evaluated bacteriologically, 95% had a satisfactory or presumed satisfactory response; only six patients (5%) were considered to be bacteriologic failures. Differences in the results of several clinical laboratory tests performed before and after treatment were statistically, but not clinically, significant (p less than 0.05). Safety was evaluated in the 158 patients who received cefotetan, and only four (3%) had adverse reactions considered related to the drug. Cefotetan was clearly effective and produced no untoward reactions in these women with obstetric and gynecologic infections caused by both aerobic and anaerobic organisms when administered at 1 or 2 gm every 12 hours.

Adult↗

PubMed1988

Pelvic adhesions in intrauterine device users.

A thorough inspection of the pelvis for adhesions was made at the time of laparoscopic tubal sterilization in 2131 patients. Contraceptive use was then compared in women with adhesions (cases) and those without adhesions (controls). Current or previous intrauterine device (IUD) use was not associated with a statistically significant increased incidence of adhesions (odds ratio = 0.98, 95% confidence limits 0.58-1.64). This risk was reduced to 0.62 for current IUD users. The IUDs removed at the time of laparoscopy included the Lippes Loop, Copper 7, and the Saf-T-Coil. These findings support the use of the IUD in the appropriate patient by demonstrating no increased risk for the development of adhesions in multiparous IUD users.

Adult↗

PubMed1988

Contraception: a risk factor for endometriosis.

Endometriosis was detected in 42 cases out of 566 patients undergoing laparoscopic tubal sterilization. The presence of endometriosis was then correlated with previous contraception. Those patients using no contraception, or barrier contraception alone, were regarded as controls. Previous oral contraceptive use was associated with a lower incidence of endometriosis, although the difference was not significant. A significantly higher incidence (P less than .05) of endometriosis was present in former intrauterine device users, possibly because of retrograde flow of increased menses.

Adult↗