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Biomedical subjects

C M March

Publications and source records attributed to C M March.

At least 19 recordsLinked to original sources
PubMed1992

Estradiol gel in the treatment of menopausal symptoms: a placebo-controlled double-blind case study of efficacy and safety.

Thirty-nine postmenopausal women were randomized to treatment with either percutaneous estradiol or a placebo. Those taking the estradiol had an increase in serum estradiol to follicular phase levels and a concomitant fall in serum follicle-stimulating hormone (FSH) levels. Atrophic vaginal epithelium became well estrogenized, and the frequency and severity of hot flushes decreased significantly. No significant benefits accrued to those using the placebo. Side effects were mild and similar in both groups. Percutaneous estradiol delivered in an alcohol-water gel is effective in treating climacteric symptoms and is an attractive alternative to both oral and transdermal patch administration of estrogen.

Administration, Topical↗
PubMed1992

Hysteroscopy.

Hysteroscopy is a "new" endoscopic approach for the gynecologist. The development and refinement of the sophisticated fiberoptic light system can illuminate the darkness of the uterine cavity. Polyps can be differentiated from submucous myomas; intrauterine adhesions can be accurately "mapped" and classified, with synechiae lysed under direct vision; endometrial carcinoma can be diagnosed and possibly staged; embedded intrauterine devices can be identified and dislodged; the wastebasket diagnosis of "dysfunctional uterine bleeding" can be cleaned up; submucosal myomas and uterine septa can be resected; and successful transuterine sterilization may become a reality. If culdoscopy is menopausal and laparoscopy in its reproductive years, hysteroscopy is certainly in its infancy.

Decision Trees↗
PubMed1992

Uterine surgical approaches to reduce prematurity.

Success rates of up to 80% can be expected after surgical treatment of abnormal uteri. A careful investigation should be conducted to verify that other causes of prematurity are not present prior to surgical intervention.

Congenital Abnormalities↗
PubMed1990

A comparison of the efficacy and safety of ceftizoxime with doxycycline versus conventional CDC therapies in the treatment of upper genital tract infection with or without a mass.

It is well known that sexually transmitted infections of the upper genital tract are widespread. A variety of regimens are used to treat these conditions, many of which have not been subjected to randomized, prospective clinical trials (including the 1985 Centers for Disease Control [CDC] Guidelines for the treatment of upper genital tract infections [UGTI]). This investigation was undertaken to compare the 1985 CDC treatment guidelines with different doses of ceftizoxime, a third-generation cephalosporin with an intermediate half-life, plus doxycycline in patients with UGTI. The patients were divided into subgroups, depending on the presence or absence of a pelvic mass. Sixty-seven women participated in the study. They were older than 14 years of age and required hospitalization for the treatment of UGTI. These women had lower abdominal pain and tenderness, cervical motion or adnexal tenderness, and one of the following: temperature greater than 100.4 degrees F orally, leukocytosis greater than 10,500/mm3, or presence of a suspected inflammatory pelvic mass on pelvic examination or by ultrasound. Informed consent was obtained from all patients in a manner approved by the Institutional Review Board. Pelvic examinations and ultrasound evaluations of the pelvic soft tissues were performed on all patients at the time of admission. Those who were found not to have a pelvic mass or who had a pelvic mass less than 4 cm in transverse diameter were randomly allocated to receive either ceftizoxime 2 gm intravenously every 12 hours with doxycycline 100 mg intravenously twice daily (Rx 1, n = 13) or cefoxitin 2 gm intravenously every six hours with doxycycline 100 mg intravenously twice daily (Rx 2, n = 14). Those patients found to have a pelvic mass (greater than 4 cm in transverse diameter) were randomly allocated to receive either ceftizoxime 2 gm intravenously every eight hours with doxycycline 100 mg intravenously twice daily (Rx 3, n = 19) or clindamycin 900 mg intravenously every eight hours with a 2-mg/kg loading dose of gentamicin followed by 1.5 mg/kg intravenously every eight hours, with adjustments as necessary (Rx 4, n = 21). All UGTI patients without a mass treated with either Rx 1 or Rx 2 responded adequately. However, UGTI patients with a mass treated with Rx 4 were more likely than those treated with Rx 3 to require a change in antibiotics or need extirpative surgery in order to obtain a satisfactory clinical response (Fisher's exact test = 0.046, two-sided).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

Cefmetazole and cefonicid. Comparative efficacy and safety in preventing postoperative infections after vaginal and abdominal hysterectomy.

A single 1-g dose of cefmetazole was compared with a single 1-g dose of cefonicid for prophylaxis in vaginal and abdominal hysterectomy to determine their efficacy and safety. The antibiotics were administered intramuscularly 15-90 minutes before the incision was made. Cefmetazole and cefonicid had similar activity against most of the aerobic organisms recovered, but cefmetazole was significantly more active against anaerobic gram-negative microorganisms. The patterns of regrowth of vaginal flora were similar in the two treatment groups. Patient demographic characteristics and surgical procedures were similar in both groups. The difference in primary prophylactic failure (e.g., cuff cellulitis) with the two study drugs (1 of 53 [1.9%] with cefmetazole and 2 of 28 [7.1%] with cefonicid) did not reach statistical significance, and the results were similar for the two routes of hysterectomy. Cefmetazole, at a dose of 1 g intramuscularly preoperatively, is a safe and effective agent for prophylaxis during hysterectomy.

Adult↗
PubMed1990

Pregnancy outcome in women with müllerian duct anomalies.

The outcomes of 186 pregnancies in 150 women with müllerian duct anomalies who delivered over an eight-year period were analyzed. The average birth weight was 2,919 g. Eighty-three percent of the deliveries were by cesarean section; malpresentation was the indication for 80% of those deliveries. The incidences of breech presentation and transverse lie were 61% and 11%, respectively. Delivery of preterm infants occurred in 25% of the pregnancies, and 12% were small for their gestational age. There were two sets of twins. A history of a previous preterm infant, recurrent abortion or a second-trimester loss was given by 13%, 9% and 59% of the patients, respectively. Of patients examined for renal anomalies, 11% had a defect, usually unilateral renal agenesis.

Abnormalities, Multiple↗
PubMed1989

Experience with ultrasound.

Treatment with human menopausal gonadotropins is safe and effective. However, in order to maintain those properties, careful monitoring of the ovarian response to the exogenous gonadotropins is mandatory. Safety is afforded by the use of rapid assays of the estrogen level in serum or urine. The use of real-time ultrasonography to monitor follicular growth has improved the efficacy. The administration of human chorionic gonadotropin (hCG) can be delayed until follicular maturation has been achieved; hCG can be withheld if too many mature follicles are present. Monitoring therapy with both modalities as well as with clinical methods ensure a high rate of successful gestations.

Chorionic Gonadotropin↗
PubMed1989

Surgical management of leiomyomata during pregnancy.

This report reviews an 8-year experience with surgical management of leiomyomata during pregnancy at Los Angeles County Women's Hospital. Fourteen patients had such surgery, for a rate of 1.1 operations per 10,000 births. Five women had exploratory laparotomy only, six had myomectomy, and three had hysterectomy; one patient aborted after surgery. Thirteen other women had incidental myomectomies at cesarean delivery; one of these had an intraoperative hemorrhage. No other complications occurred. Surgical management of leiomyomata during pregnancy is safe in carefully selected patients.

Adult↗
PubMed1988

Efficacy and safety of single-dose ceftizoxime vs. multiple-dose cefoxitin in preventing infection after vaginal hysterectomy.

The efficacy, safety and effect of a single, 1-g dose of ceftizoxime on the return of vaginal flora were compared to those of the standard regimen of three 2-g doses of cefoxitin for prophylaxis in 99 randomized women undergoing vaginal hysterectomy. Thirty-four were studied in Dallas and 65 in Los Angeles. Surgical procedures were comparable for all the antibiotic groups, although proportionately more simple hysterectomies were performed in Dallas. The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents. Primary prophylactic failure (operative site infection) occurred in 1 of 52 (1.9%) and 4 of 47 (8.5%) of the ceftizoxime- and cefoxitin-treated patients, respectively, for a nonsignificant difference. All five primary prophylactic failures occurred in the Los Angeles patients. One patient in each antibiotic group developed a urinary tract infection and was classified as a secondary prophylactic failure. Febrile morbidity, length of hospital stay and incidence of adverse effects did not differ by antibiotic. The enterococcus was commonly found in the postoperative vaginal flora and was of no value in predicting operative-site infection. Enterobacter species and Pseudomonas aeruginosa were isolated more commonly in patients who received cefoxitin. Diphtheroids, Staphylococcus epidermidis and Peptostreptococcus species were isolated more commonly in patients treated with ceftizoxime.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Improved pregnancy rate with monitoring of gonadotropin therapy by three modalities.

The frequency of complications during gonadotropin therapy was reduced after the introduction of rapid estrogen assays. However, pregnancy rates remained low especially in normoestrogenic women. One hundred forty-three infertile normoestrogenic women were treated with human menopausal gonadotropin-human chorionic gonadotropin for 661 cycles. Almost all cycles were ovulatory. Whereas 53.7% of the patients conceived when drug administration was monitored by cervical score and serum estradiol levels only, 72.1% became pregnant when treatment was monitored by these modalities and real-time ultrasonography of the ovaries (p less than 0.05). Mean serum estradiol levels were significantly higher when ultrasonography was used to monitor response, but complications such as multiple births and ovarian enlargement did not occur more often. The data suggest that "true" ovulation occurs more often when ovarian imaging is used to determine drug dosage. Because of the higher pregnancy rate achieved by combined clinical (cervical score), biochemical (serum estradiol), and sonographic methods of monitoring, this approach should replace less extensive techniques.

Adult↗
PubMed1987

Hysteroscopic management of recurrent abortion caused by septate uterus.

Between April 1982 and April 1986, 91 patients underwent hysteroscopy for treatment of septate uteri. In 88 patients simultaneous laparoscopy was performed and one patient had a simultaneous laparotomy. Ninety procedures were performed on an outpatient basis with the patients under general anesthesia. The septum was incised with flexible scissors. Sequential estrogen-gestagen therapy was used immediately after operation to reepithelialize the freshly dissected surfaces. Patients were permitted to conceive in the first month after operation. The indications for hysteroscopy were multiple but included recurrent abortion in 79 patients. Among those patients in this category the pretreatment reproductive wastage was 95%. Most losses were in the first trimester. Among those patients who conceived after therapy, the gestational outcome markedly improved. Eighty-seven percent of the pregnancies have resulted in a living infant or have progressed beyond 20 weeks of gestation. Because the gestational outcome equals or exceeds that achieved by transabdominal metroplasty and because of its lower morbidity and the option for vaginal delivery, hysteroscopic incision of the symptomatic septate uterus should replace transabdominal metroplasty.

Abortion, Habitual↗
PubMed1984

Hysteroscopic incision of the septate uterus.

Fifteen women underwent hysteroscopic incision of symptomatic septate uteri between April, 1982, and July, 1983. All procedures were performed on an outpatient basis with general anesthesia, by means of dextran hysteroscopy with direct-vision scissors incision of the septa under external laparoscopic guidance. No significant intraoperative nor postoperative complications occurred. Preoperative indications included repetitive pregnancy loss (eight), repetitive pregnancy loss and infertility (four), infertility and total uterine septum (one), preinsemination by donor (one), and intractable dysmenorrhea (one). A total of 72 hysteroscopic septal incision/resection procedures unassociated with any significant morbidity have been reported in the literature. Compared to transabdominal metroplasty, hysteroscopy is an outpatient procedure that avoids abdominal and uterine incisions and requires no long-term postoperative delay in attempting pregnancy. In addition, subsequent pregnancy does not require cesarean section. With these advantages, hysteroscopic incision of the symptomatic septate uterus can replace transabdominal metroplasty and allow liberalization of operative indications.

Endoscopy↗
PubMed1984

The use of pergonal for the induction of ovulation.

With proper patient selection, appropriate pretreatment studies and careful monitoring will ensure that patients ovulate safely. Table 7 is a summary of the results that may be expected following properly monitored hMG therapy. Among estrogen-deficient patients without other causes of infertility, the cumulative pregnancy rate after six cycles will exceed 90%. However, among normoestrogenic patients with no other infertility factors the cumulative conception rate has been reported to be only 50% after 12 courses of therapy, although with the use of ultrasound monitoring it is likely that this latter figure will improve. Nevertheless, these data may be used to afford couples with a realistic prognosis.

Abnormalities, Drug-Induced↗
PubMed1983

Correlation of ultrasonic and endocrinologic measurements in human menopausal gonadotropin therapy.

Ultrasonographic measurement of follicle growth and estradiol concentrations have been shown to correlate well in spontaneous and Clomid-induced ovulatory cycles. However, little is known about these changes during human menopausal gonadotropin (hMG) therapy. Twenty-five women who did not ovulate when treated with clomiphene were treated with hMG during 70 treatment cycles. Eleven patients had withdrawal bleeding after progesterone administration (group 1) and 14 did not bleed (group 2). Follicle growth was monitored with intermittent serum estrogen determinations and daily ovarian ultrasound with an ADR Model 2140 real-time sector scanner. The mean dominant follicle size at the time of human chorionic gonadotropin (hCG) injection was 21.2 mm +/- 0.6 (SEM) and was not different between the two groups. Mean serum estrogen level at the time of hCG injection was 1,121 pg/ml and correlated with follicle volume. At the time of hCG injection in group 2, one dominant follicle was present in 65% and two were present in 35% of the patients. Among those in group 1, two or more dominant follicles were present during all cycles. Mean serum estrogen levels were significantly higher in group 1 patients than those in group 2. This "chemical hyperstimulation" was induced in order to delay ovulation until adequate follicular size had been achieved. All cycles were ovulatory. Five patients in group 1 and eight in group 2 conceived. The use of ultrasound enables the physician to evaluate follicular growth and development daily and thus to individualize treatment and to reduce the need for estrogen monitoring.

Female↗