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Biomedical subjects

A N Poindexter

Publications and source records attributed to A N Poindexter.

At least 55 records · Page 3Linked to original sources
PubMed1988

Is vaginal birth after two or more cesarean sections safe?

Fifty-five patients with a history of two or more cesarean sections underwent a trial of labor. Forty-two had had previous uterine incisions of unknown type, 11 had had low cervical transverse incisions, and two had had low vertical incisions. Twenty-five women (45%) had successful vaginal deliveries, and 30 (55%) received oxytocin augmentation of labor. The incidence of vaginal delivery was significantly lower in patients who required oxytocin augmentation (30 versus 64%, P less than .01). Three of the 55 patients had scar separation detected at the time of delivery. Two patients underwent hysterectomy. There were no maternal or neonatal deaths. A history of multiple cesarean sections need not exclude the patient from the option of trial of labor.

Adult↗
PubMed1987

Medical aspects of contraception.

It is evident that choice of contraceptive has important medical implications, whether a mechanical or a hormonal method is elected. Each technology has unique benefits and risks, constraints, applicability, and inconvenience. Wise advice in a medical context must be based on thorough familiarity with the options available to each woman.

Adult↗
PubMed1987

Trocar introduction performed during laparoscopy of the obese patient.

Obesity, especially morbid obesity, is reported to be a relative contraindication to laparoscopy. A technique for trocar introduction and laparoscopy of the obese patient to eliminate this contraindication is described. The technique presented herein differs from the traditional method by: 1, primary trocar entry at a 90 degree angle to the horizontal plane, and 2, confirmation for intraperitoneal position of the instruments before creating the pneumoperitoneum. A retrospective study was done to compare demographic, medical and surgical data of obese and non-obese patients. No important differences were found and it was also found that obesity was not a relative contraindication to laparoscopy. Obesity was defined by a ponderal index of less than 11.7. No operative complications were found for the 344 obese patients studied and all laparoscopy procedures were completed as intended. These differences in technique can avoid the pitfalls commonly reported concerning laparoscopy of the obese patient.

Adult↗
PubMed1987

Comparison of in vitro fertilization results in women with one or two ovaries.

A study compared the in vitro fertilization results in women with one or two ovaries. Eighteen percent (23/125) of in vitro fertilization/embryo transfer cycles were in patients with one ovary. One-ovary patients averaged 4.2 follicles (greater than or equal to 10 mm) as compared to 7.9 in two-ovary patients, and significantly fewer ova were recovered from one-ovary patients (4.0 vs. 5.3). The total follicular volume was significantly less in one-ovary patients as compared to two-ovary patients, and the serum estradiol per follicle was less in one-ovary patients. However, the volume of the dominant follicle, the maximum serum estradiol levels, the number of ampules of Pergonal given and the ovum fertilization rate were not significantly different in one- and two-ovary patients. The mean number of embryos transferred was 3.9 +/- 1.9 in one-ovary patients and 4.5 +/- 1.8 in two-ovary patients (NS). Two pregnancies occurred in one-ovary patients (8.3% per laparoscopy) and 13 in two-ovary patients (12.9% per laparoscopy). The two one-ovary patients who achieved pregnancy behaved more like two-ovary patients in terms of peak serum estradiol levels and number of ova recovered.

Adult↗
PubMed1986

Cefotetan in the treatment of obstetric and gynecologic infections.

The efficacy, tolerance, and safety of cefotetan--a new 7-alpha-methoxy cephalosporin--was assessed in controlled and uncontrolled evaluations involving 131 evaluable patients hospitalized with obstetric and gynecologic infections. The 99% satisfactory clinical response rate obtained with this drug was equivalent to that obtained with either moxalactam or cefoxitin, yet the mean amount of cefotetan given was lower than that of the other two drugs. Cefotetan was well tolerated and produced no major adverse reactions. In this era of Diagnosis Related Groups and cost containment, the twice-daily dosage schedule of cefotetan is a decided cost benefit.

Adult↗
PubMed1986

In vitro fertilization in couples with male factor infertility.

The data from 83 consecutive in vitro fertilization-embryo transfer cycles were examined with emphasis on the presence of subfertile male parameters, including abnormal sperm density, motility, morphologic features, or an abnormal result in the sperm penetration assay (zona-free hamster ova penetration). There were 25 cycles (21 couples) in which there was a solitary or coexistent abnormal male factor. The presence of a male factor was associated with a lower fertilization rate and fewer embryos transferred. Statistically important reductions in the fertilization rate occurred with reduced sperm density and abnormal motility, but not with abnormal morphologic features. The parameter that was most significantly associated with human ova fertilizability was the ability to exceed two penetrations per egg in the sperm penetration assay.

Animals↗
PubMed1986

Residual embryos in failed embryo transfer.

One hundred thirteen embryo transfers (ETs) were performed in an in vitro fertilization and ET program of which residual or extruded embryos were found in 17 transfers (15%). Residual or extruded embryos are those embryos found outside the uterine cavity, either at the cervical os, on the vaginal speculum, or remaining in the catheter after an ET. Patients were divided into two groups according to the method of inspection for residual embryos. In group I, microscopic visualization of the transfer catheter alone revealed that 9 of the 67 transfers (13.4%) had 17 residual embryos either at the catheter tip or adherent to mucus on the side of the catheter. In group II inspection of the catheter and cervical wash revealed that 8 of 46 ETs (17.4%) had 15 residual embryos that failed to be transferred during the initial attempt. Six of these 15 (40%) were found in the cervical wash medium. Thus, failure of the proper placement of embryos at the time of transfer may occur frequently. Evaluation of only the transfer catheter may result in a significant underestimation of the problem.

Animals↗
PubMed1983

The recovery of normal plasma progesterone levels in the postpartum female.

The return of fertility in postpartum women is gradual. This may be related to ovarian hormonal deficiencies, in particular, inadequate stimulation of the endometrium by progesterone (P). The purpose of this study was to evaluate the recovery of normal luteal function in four postpartum women who were followed for four cycles with serum P, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and prolactin (PRL) taken three times weekly. PRL decreased immediately after delivery and was at normal levels before the first cyclic increases in serum LH and P. E2 and FSH cyclic changes were identical over the four menstrual cycles. LH peak values rose consistently from the first to the fourth cycle. P increased statistically each subsequent cycle in all parameters studied. These parameters of P were peak levels, days to the peak, duration of the luteal phase, and area under the P curve. The postpartum woman thus seems an excellent model for the study of ovarian hormonal disorders, particularly as they relate to disordered luteal P.

Corpus Luteum↗
PubMed1983

Anovulatory uterine bleeding.

The patient who seeks medical attention for abnormal vaginal bleeding represents an enormous responsibility. The physiologic systems that may be defective are numerous. If a diagnosis of dysfunctional uterine bleeding is made there must still be an investigation of the hormonal imbalance. The specific cause must be known in order to treat the patient effectively. In addition, recent scientific advances regarding possible cellular mechanisms for DUB make it imperative that the physician be aware of available tests. Certain tests may indicate the relative appropriateness of and the prognosis for a particular therapy. The treatment is via the addition of progesterone to complete the hormonal milieu. Progesterone may be administered either endogenously by ovulation induction or exogenously by oral or parenteral progestogens.

Adolescent↗
PubMed1982

Longitudinal studies of fetal growth with the use of dynamic image ultrasonography.

To characterize the growth of individual fetuses, serial measurements of the crown-rump length (CRL), biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC) were made at specified intervals of 2 to 3 weeks (between 6 to 8 weeks [conceptual age] and delivery) in 20 normal fetuses with known dates of conception. Values for the HC-AC ratio and the estimated fetal weight were also obtained from these data. Measurements of CRL were similar to those reported previously, except in those cases in which the follicular phase was prolonged or the fetal growth potential was reduced. Mathematical modeling demonstrated that the linear-cubic model was optimal for the BPD and HC growth curves, the linear model for the AC, and the linear-quadratic model for fetal weight. The HC-AC ratio could not be modeled adequately because of significant individual variability. Optimal models for average longitudinal growth curves were determined for the BPD, HC, AC, and fetal weight from individual growth curves. These average longitudinal curves were similar in shape, mean values, and variability to those obtained in previous cross-sectional studies. Statistical analysis indicated that the coefficients of the average longitudinal curves are not likely to change by more than 5% to 15% if the size of the sample is increased very significantly. These results indicate that the average longitudinal growth curves are good estimators of the true population growth curves.

Adult↗
PubMed1980

Patient cooperation: a determinant of perinatal outcome in the pregnant diabetic.

From 1974 through 1978, 59 insulin-dependent diabetic patients were treated in a university-affiliated general hospital. They were managed primarily as outpatients with hospitalization for regaining glucose control and/or in the treatment of obstetric complications. In 1976 a special clinic for pregnant diabetic patients was established. The 26 patients treated during the clinic's first two years are compared to 33 treated in the preceding 2 1/2 years. The significant difference between the two groups was the improvement in the number of patients whose cooperation was good, 67% to 85% (p less than 0.05), and the reduction of perinatal morbidity and mortality. The perinatal mortality rate was 18% and 8% in the preclinic group (group I) and the clinic group (group II), respectively. The combined perinatal morbidity and mortality was reduced from 36% to 15%, respectively, in groups I and II (p less than 0.01). A constant rate of 3.2% perinatal mortality was observed in the obstetric population during the study period.

Blood Glucose↗
PubMed1980

The clinical significance of testosterone in the female patient.

A thorough knowledge of the biochemistry and metabolism of androgens in the female patient is extremely important for the understanding of the pathophysiology and treatment of hyperandrogenic states. It is now possible to not only measure 17-ks and total plasma testosterone levels, but also to have an index of the biologically active fraction of plasma testosterone. Treatment of excess androgen disorders can be achieved by combination estrogen-progestin steroid suppression or by ovulation induction.

17-Ketosteroids↗
PubMed1979

Prolactin receptors in the ovary.

The binding of prolactin (PRL) to the plasma membranes of bovine and human ovaries was investigated using both homologous and heterologous 125I-prolactin. Saturation and Scatchard analysis demonstrated that human prolactin binds to human ovarian membranes with a Kd of 2 x 10(-10) M; to bovine ovarian membranes with a Kd of 1.9 x 10(-10) M; and to bovine corpora lutea membranes with a Kd of 1.9 x 10(-10) M. The concentrations of binding sites in bovine and human ovaries were 2.9 x 10(-15) moles/mg of protein and 2.0 x 10(-15) moles/mg of protein, respectively. The number of bindings sites in the bovine corpora lutea was 1.5 x 15(-15) moles/mg of protein. Specificity studies with bovine PRL, ovine PRL, human luteinizing hormone, human follicle-stimulating hormone, and bovine growth hormone showed this binding to be specific. Comparison of binding of PRL to membranes of other target and nontarget tissues suggests that the ovary is one of the primary target tissues. These data suggest that prolactin plays a role in the ovarian cycle.

Animals↗