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Biomedical subjects

D A Edelman

Publications and source records attributed to D A Edelman.

At least 19 recordsLinked to original sources

Does asbestos exposure increase the risk of urogenital cancer?

The risk of urogenital cancer to workers exposed to asbestos was evaluated using the results of published studies. The pooled standardized mortality ratios (SMRs), based on the results of cohort studies, were significantly increased (P less than or equal to 0.05) for ovarian and kidney cancer in North American studies but not in other studies. Part of these increases probably is due to the use of inappropriate comparison populations and the failure to take into account risk factors associated with urogenital cancer. Other types of studies generally did not indicate that exposure to asbestos increases the risk of urogenital cancer. Generally, there is insufficient information to show that urogenital cancers are caused by occupational exposure to asbestos.

Asbestos

When does exposure to agent X cause disease Y?

The concept of 'cause' between exposure to agent X and the subsequent development of disease Y is reviewed briefly in terms of how it is used in experimental and clinical medicine, statistics and epidemiology, and in law. Some of the interrelationships of the definition of cause by these disciplines are considered.

Epidemiology

Clear cell carcinoma of the endometrium.

The clinical data of 22 patients with clear cell adenocarcinoma of the endometrium treated at the University of North Carolina Memorial Hospital are reported. In addition, the data with particular reference to survival, site of recurrence, and treatment are combined with information from two previous reports of clear cell adenocarcinoma of the endometrium to better define survival. It is noted that the patients with clear cell adenocarcinoma of the endometrium were older and had an overall poorer survival than is reported for adenocarcinoma of the endometrium (nonclear cell). Patients with Stage I clear cell carcinoma of the endometrium, however, had a similar five-year survival to Stage I adenocarcinoma of the endometrium. The paper also examines treatment methods and correlates these with site of recurrence as well as survival.

Adenocarcinoma

The probability of side effects with ovral, norinyl 1/50 and norlestrin.

This report provides specific information on the prevalence rates of the most common side effects during the first 3 cycles of use of 3 combination oral contraceptives (OCs) containing 50 mcg estrogen. The probabilities of a symptom occurring for the first time, or persisting once present, during the initial cycles of OC use are given for each of the 3 combined OCs.

Acne Vulgaris

Timing of the IUD insertion.

The relationship between the time in the menstrual cycle when a TCu-200 or Cu-7-200 is inserted and subsequent IUD-related events was evaluated. For women who had either TCus or Cu-7s inserted, the pregnancy, expulsion and medical removal rates were similar for insertions performed at any time of the menstrual cycle.

Aging

Clear cell adenocarcinoma of the genital tract.

Four cases of clear cell adenocarcinoma of the genital tract in young women are presented. All patients were treated with radiation therapy. Two of the patients subsequently developed chest metastases. Three patients have died of the disease, and the other is without evidence of disease. Two patients were treated with chemotherapy, and a positive response to the chemotherapy was observed. Because this is an aggressive disease, one should consider the use of chemotherapeutic agents as a part of the primary therapy.

Adenocarcinoma

Characteristics of patients with placenta previa and results of "expectant management".

To determine the differences between pregnancies complicated by placenta previa and those without placenta previa, the characteristics of 31,070 consecutive deliveries at one institution were analyzed. The philosophy of "expectant management" of the premature fetus and frequent use of cesarean section was utilized in the 185 patients with placenta previa. A higher proportion of these patients were multiparous, were older, had had previous abortions, and were carrying a male fetus or twins. The fetal and placental weights in these patients were similar to those in other patients throughout pregnancy. Rates of prematurity, antepartum and intrapartum fetal death, neonatal death, congenital abnormality, and low Apgar scores were higher among patients with placenta previa. Data were compiled in a manner that allows the obstetrician to: (1) evaluate the fetal weight and expected fetal growth; (2) estimate the probability that his patient will deliver prematurely and will deliver within the next one-, two-, or four-week interval; (3) determine the relative risks to the fetus prior to labor, during labor, and in the neonatal period at each stage of gestation.

Apgar Score

In utero exposure to DES. Evaluation and followup of 199 women.

Among 199 women from 12 to 30 years of age who had been exposed to DES in utero, the colposcopic evaluation of the vagina and cervix was considered normal for only 13.6%. The incidence of colposcopically detected lesions was not related to the trimester of DES exposure, the patient's age, use of oral contraceptives, or presenting symptoms. Areas of punctation, mosaic patterns, white epithelium, and keratosis were not considered areas of adenosis. Cervical bands, hoods, cock's combs, etc., were considered as part of the cervix. Under this definition adenosis of the vagina was diagnosed in only 14.1% of the patients. Eight (4.0%) women were found to have cervical intraepithelial neoplasia (CIN), Grade 3 lesions, and an additional 36 (14.1%) women were found to have CIN, Grade 1 lesions based on the light microscopy evaluation of directed biopsies. There were no cases of clear cell adenocarcinoma. It appears that women with in utero DES exposure may be at a higher risk of developing squamous neoplasia compared with non-DES-exposed women.

Adolescent

Vaginal prostaglandin E2 in the management of fetal intrauterine death.

The results of a multicentre clinical trial of prostaglandin E2 (PGE2) administered by the vaginal route in the management of intrauterine fetal death and missed abortion showed an overall efficacy of 97 per cent. The mean induction-abortion interval was 10.7 hours with a mean total dose of 60.4 mg of PGE2. Side effects were tolerated well and there was no evidence of significant alterations in hepatic or renal function.

Abortion, Missed

The effects of longacting paracervical block anesthesia on the abortifacient efficacy of intra-amniotic PGF2alpha and hypertonic saline.

A comparative study was conducted to evaluate the effects of repeated, longacting paracervical blocks on the abortifacient efficacy of intraamniotic prostaglandin F2alpha (PGF2alpha)-40 mg initially and an additional 20 mg after 24 hours--and hypertonic saline augmented with intravenous oxytocin, for patients at 16 to 20 weeks' gestation. Patients were randomly assigned to the 2 abortion procedures, and one half (50) of the patients induced with each procedure received serial, longacting paracervical blocks. For those patients aborted with saline, the rates of complications, side effects, incomplete abortion, and cumulative abortion were similar for patients whether they did or did not receive paracervical blocks. Among the PGF2alpha-treated patients who were administered paracervical blocks, there was a significant reduction in the rates of gastrointestinal side effects and incomplete abortion and a significant differences in the cumulative abortion rates. Within 32 hours of the initial PGF2alpha, instillation, 98% of the patients who received paracervical blocks aborted compared to 70% of those who did not receive paracervical blocks. Although the cumulative abortion rates of PGF2alpha-treated patients with paracervical blocks and saline-treated patients were similar, the rate of incomplete abortion for the PGF2alpha-treated patients was significantly lower. Additional studies will be necessary to evaluate the safety and advantages of using paracervical block anesthesia as an adjunct to midtrimester abortion procedures.

Abortifacient Agents

Adenoid cystic carcinoma of the Cervix. Report of 9 cases and a reappraisal.

The clinical and pathologic findings of 9 patients with adenoid cystic carcinoma of the cervix are presented. A review of the literature identified an additional 29 cases. The tumor was usually associated with adenocarcinoma or squamous cell carcinoma of the cervix. Adenoid cystic carcinoma of the cervix appears to be an aggressive type of tumor; of the 38 cases reported in the literature lung metastases have occurred in 18 (47.4%), and of these, 14 patients are known to have died of the cancer.

Aged

An overview of IUD research and implications for the future.

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).

Animals

Induction of abortion with 15(S)-15-methyl PGF2alpha (Tham) vaginal suppositories.

The repeated administration of vaginal suppositories containing 1 mg 15(S)-15 methyl PGF2alpha (Tham) sucessfully induced abortions in 60 of 62 patients. Among patients who successfully aborted, the mean abortion time was 19.0 hours. The mean abortion time was not related to gestational age or parity. Sixty (96.8 precent) aborted within 48 hours, and 53 (85.5 percent) aborted within 24 hours. Gastrointestinal side effects occurred for 33.9 percent of the patients. Diarrhea was the most frequent side effect. The abortion was complete for 40.3 percent of the patients.

Abortion, Induced