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Biomedical subjects

B S Apgar

Publications and source records attributed to B S Apgar.

18 recordsLinked to original sources
PubMed1998

Exercise during pregnancy.

Exercise has become a vital part of many women's lives. However, theoretic concerns have been raised about the safety of some forms of exercise during pregnancy. Because of the physiologic changes associated with pregnancy, as well as the hemodynamic response to exercise, some precautions should be observed. The physician should screen for any contraindications to exercise and encourage patients to avoid overly vigorous activity, especially in the third trimester, when most pregnant women have a decreased tolerance for weight-bearing exercise. Adequate hydration and appropriate ventilation are important in preventing the possible teratogenic effects of overheating. Pregnant women should avoid exercise that involves the risk of abdominal trauma, falls or excessive joint stress, as in contact sports and vigorous racquet sports. In the absence of any obstetric or medical complications, most women can maintain a regular exercise regimen during pregnancy. Some studies have found a greater sense of well-being, shorter labor and fewer obstetric interventions in physically well-conditioned women as compared with other women.

Exercise↗
PubMed1998

Triage of the abnormal Papanicolaou smear in pregnancy.

Triage of the abnormal Papanicolaou smear in pregnancy requires colposcopic evaluation and directed biopsy. If histologic cervical intraepithelial neoplasia is confirmed, the patient can be managed with observations and can be re-evaluated in the postpartum period. If evidence of microinvasion is present, conization must be performed. For patients with invasive disease, a delay in therapy until fetal maturity is achieved does not compromise survival.

Algorithms↗
PubMed1998

Assessing colposcopic skills: the instructor's handbook.

BACKGROUND AND OBJECTIVES: In the United States, 93% of family practice residency programs teach colposcopy. Training should ideally include didactic teaching of basic knowledge, followed by practice on models and then supervised teaching with patients. Although various curricula have been published that outline basic principles of colposcopy education, methods of determining clinical competency among resident physicians are lacking. Methods of assessing psychomotor are cognitive skills in colposcopy are available for instructors, including the use of preclinical cervical practice models for colposcopic biopsy and endocervical curettage, visual skills tests that use images of colposcopic findings, colposcopy CD-ROMs, written pretest and posttest knowledge assessment instruments, and procedural checklists. Specific parameters for many of these tools can be used to define clinical competency in colposcopy.

Clinical Competence↗
PubMed1997

Office procedures. Endometrial biopsy.

Endometrial biopsy is a relatively safe, efficient, and well-tolerated procedure. Indications include evaluation of abnormal uterine bleeding and infertility. Excluding the presence of endometrial cancer and precursors is of primary concern. Use of the popular narrow polyethylene sampling devices results in a sensitivity approaching 95% for the diagnosis of endometrial cancer. Inadequate samples are more common in postmenopausal than premenopausal women, primarily because of atrophy of the endometrium.

Biopsy↗
PubMed1997

Dysmenorrhea and dysfunctional uterine bleeding.

Dysfunctional uterine bleeding is a diagnosis of exclusion. Endometrial cancer and endometrial precursor lesions must be excluded before a diagnosis of anovulatory bleeding is made. Treatment consists of intravenous estrogen therapy, oral contraceptive pills, and progestational agents. Menorrhagia is excessive menstrual bleeding treated with antiprostaglandins, levonorgestrel-releasing intrauterine contraceptive devices, endometrial ablation, and danazol. Dysmenorrhea results from the release of prostaglandin 2alpha and is treated with antiprostaglandin agents such as nonsteroidal anti-inflammatory drugs.

Adult↗
PubMed1996

Differentiating normal and abnormal findings of the vulva.

Proper evaluation of the vulva required background in general dermatology and an understanding of the special nature of many vulvar conditions. A firm understanding of normal vulvar findings is necessary to guard against overdiagnosis and unnecessary treatment. In the past few years, the most common overdiagnosis has been that of micropapillae of the inner labia minora, or acetowhite changes of the vulva, secondary to human papillomavirus (HPV) infection. Differentiating normal variants and minor nonspecific findings from well-developed disease is not always easy. Vulvar biopsy should be performed if a diagnosis cannot be made confidently by visual inspection alone. Vulvar intraepithelial neoplasia is a precancerous lesion of squamous origin associated with HPV infection. It usually occurs in younger patients. Vulvar intraepithelial neoplasia in older women is associated with chronic inflammation, especially in areas of hyperplasia and atrophy. The older patient with vulvar intraepithelial neoplasia has a higher risk of developing invasive vulvar cancer.

Adult↗
PubMed1996

Evaluation of amenorrhea.

Pregnancy is the most common cause of amenorrhea and must be ruled out before proceeding with diagnostic evaluation. A careful history and physical examination may reveal evidence of androgen excess, estrogen deficiency or other endocrinopathies. Serum prolactin and thyroid-stimulating hormone (TSH) levels should be checked in all women who are not pregnant. Galactorrhea by history or on examination and/or an elevated prolactin level should be investigated with an imaging study to rule out a pituitary adenoma. If serum prolactin and TSH levels are normal, a progesterone challenge test should be performed to determine outflow tract patency and estrogen status. In women with hypoestrogenic amenorrhea, indicated by a negative challenge test and a competent outflow tract, serum gonadotropin, follicle-stimulating hormone and luteinizing hormone levels may be measured to determine whether amenorrhea represents ovarian failure or pituitary or hypothalamic dysfunction. Hypothalamic amenorrhea is common in women with a history of weight loss, stress or vigorous exercise. Amenorrheic women with adequate estrogen levels should receive cyclic progesterone. Hormonal therapy and calcium supplementation in hypoestrogenic amenorrhea.

Adult↗
PubMed1995

Preconceptual obstetric risk assessment and health promotion.

Preconceptual risk assessment is an increasingly important part of obstetric care in the era of fetal therapeutics, invasive diagnostic techniques and "premium" pregnancies. The constant rates of the two greatest contributors to infant morbidity and mortality--congenital malformations and low birth weight--suggest that our basic approach to obstetric care is not sufficiently preventive. Preconceptual obstetric risk assessment, along with health promotion, education and therapeutic intervention, can reduce risk and improve outcome. A medical and psychosocial emphasis on preconceptual and early pregnancy care, along with promotion of the health of the pregnant woman, the fetus, the infant and the family up to one year after birth, may prove to be a way of decreasing infant morbidity and mortality. The identification of important risks associated with demographics, systemic disease, infection, environment, genetics and lifestyle will assist the family physician in promoting health strategies in obstetric care.

Adolescent↗
PubMed1994

Cervical intraepithelial neoplasia: current management options.

Cervical intraepithelial neoplasia is an increasingly common finding among sexually active young women. Many of these women have not completed their families, so preservation of fertility is an important factor to consider when planning appropriate treatment. In the past, management of precancerous cervical lesions was aggressive, primarily consisting of conization of the cervix. This procedure yielded excellent cure rates but was associated with a high incidence of complications. The widely accepted use of colposcopy in the evaluation of abnormal cervical cytology and the use of ablative and conservative excisional treatment modalities have resulted in a decreased number of conization procedures. More recently, management of cervical intraepithelial neoplasia has taken a more conservative approach. This article describes the risks and benefits of the multiple modalities available for the management of cervical intraepithelial neoplasia.

Cryotherapy↗
PubMed1993

Spontaneous abortion.

Spontaneous abortion rates vary with maternal age, but the overall incidence is approximately 2% of clinically recognized pregnancies. The incidence of clinically unrecognized loss is approximately 20%. Most early fetal losses are caused by abnormal karyotypes. Other causes include heavy caffeine use, acute alcohol consumption, and smoking. Ultrasonographic examination, which includes yolk sac configuration and crown-rump length determination can help differentiate between normal and abnormal pregnancies. After 8 weeks' gestation, hormonal assays are decreased. Conservative management of spontaneous abortions can be considered if patients have low beta-hCG levels and no residual tissue detected using ultrasonography. Complications of spontaneous abortion include maternal death, bleeding, and infection. Consideration should be given to the psychological health of women and their partners who experience spontaneous abortion, particularly if they exhibit depression, guilt, and grief reactions.

Abortion, Spontaneous↗
PubMed1993

Ectopic pregnancy. An update on technologic advances in diagnosis and treatment.

From 1970 to 1986, the number of ectopic pregnancies in the United States quadrupled. Maternal mortality rates dramatically declined, yet the risk of dying from an ectopic pregnancy is still 10 times that associated with a term delivery and 50 times that associated with a legal elective abortion. Ectopic pregnancy can be a very difficult diagnosis to make, but advances in hCG assays and transvaginal ultrasound scanning allow the diagnosis to be made in 90% of cases before rupture. Conservative surgical and medical management are associated with success rates greater than 95% and resultant pregnancy rates of approximately 60%.

Female↗
PubMed1992

Endometriosis. Diagnostic clues and new treatment options.

Endometriosis results in significant pelvic pain, dysmenorrhea, and infertility. Recognition of the signs and symptoms of endometriosis can result in early diagnosis and treatment. Management includes surgical intervention to debulk large lesions and pharmacologic therapy to produce a medical oophorectomy. Primary care physicians should suspect endometriosis in infertile patients with pelvic pain.

Adolescent↗
PubMed1992

Diagnostic hysteroscopy.

The hysteroscope is a valuable tool for selective viewing of the uterine cavity and the endocervical canal. With smaller-diameter scopes, hysteroscopy can be performed in the office setting, often without the need for cervical dilatation or local anesthesia. Controlled-rate CO2 insufflators allow safe distention of the uterine cavity with minimal side effects. Indications for office hysteroscopy include the evaluation of abnormal uterine bleeding, genital carcinoma and infertility and the investigation of a "lost" intrauterine device. Hysteroscopy is an adjunct to endometrial sampling, dilatation and curettage, hysterosalpingography and cervical cytology.

Abortion, Missed↗
PubMed1992

Colposcopy.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1992

Loop electrosurgical excision procedure for CIN.

The loop electrosurgical excision procedure, also referred to as large loop excision of the transformation zone, is gaining acceptance in the United States as a method for treating cervical intraepithelial neoplasia. Loop excision of cervical tissue is accomplished using a high-frequency alternating current (radiofrequency) and thin wire loop electrodes. Loop excision may be in the form of simple excision of the transformation zone or electrosurgical loop conization. The specimens obtained using this technique are suitable for histologic evaluation. Loop excision, which is usually performed under local anesthesia, is associated with minimal short-term and long-term morbidity. Patient acceptance is high. Family physicians who perform colposcopy should consider using loop electrosurgical excision to treat cervical intraepithelial neoplasia in the outpatient setting.

Ambulatory Surgical Procedures↗