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Biomedical subjects

D A Edelman

Publications and source records attributed to D A Edelman.

At least 91 records · Page 5Linked to original sources
PubMed1978

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↗
PubMed1978

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↗
PubMed1978

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↗
PubMed1978

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↗
PubMed1977

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↗
PubMed1977

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↗
PubMed1977

Menstrual regulation: risks and "abuses".

The definitions, methods, and techniques of menstrual regulation (MR) are presented. The risks and abuses of performing MR by vacuum aspiration to terminate pregnancies of less than 7 menstrual weeks are reviewed.

Abortion, Induced↗
PubMed1977

Laparoscopic sterilization after "spontaneous" abortion.

One hundred eighty-nine patients were evaluated to assess the safety of laparoscopic sterilization after completion of a "spontaneous" abortion by curettage. Some of the "spontaneous" abortions had probably been illegally initiated outside the hospital and were septic. The laparoscopic sterilization procedures used tubal rings to achieve tubal occlusion. They were performed 4 to 48 hours after completion of the abortion. Patients were discharged from the hospital on the day the procedure was performed. Surgical difficulties and complications associated with the laparoscopy were infrequent. Undergoing a curettage prior to sterilization with tubal rings by laparoscopy did not appear to result in increased rates of complications.

Abortion, Septic↗
PubMed1977

Laparoscopic sterilization as an outpatient procedure.

Since June 1972, more than 2,000 laparoscopic sterilizations have been performed as outpatient procedures using neuroleptanalgesics. Electrocoagulation, spring-loaded clips or tubal rings were the methods used for tubal occlusion. All laparoscopies were performed in a family planning clinic. The surgical facilities were minimal and did not include general anesthesia equipment or a blood bank. The nearest hospital was about one-half mile from the clinic. The procedures were performed by a physician assisted by two paramedical personnel and a technician. Patients were scheduled to be at the clinic on the morning of the procedure and were discharged three to six hours after the procedure. Only one patient required hospitalization for treatment of a complication: her aorta was punctured during placement of the Tuohy needle. The patient was admitted to a local hospital and underwent laparotomy for repair; her subsequent recovery was uneventful. No bowel or bladder burns have occurred. Minor complications (emphysema of the abdominal wall, bleeding from the tubes, infections) have occurred in less than 4% of the patients. The results of this study indicate that laparoscopy in an outpatient clinic is safe and presents minimal additional risks to the patient if the surgeon is experienced.

Adult↗
PubMed1977

A comparative study of spring-loaded clips and electrocoagulation for female sterilization.

The surgical, immediately postoperative and delayed postoperative complications and complaints associated with spring-loaded clips and electrocoagulation as techniques of tubal sterilization at laparoscopy were evaluated in a comparative study. Each of the two techniques was randomly assigned to 150 subjects. All sterilizations were performed as outpatient procedures. Subjects were followed-up during the first six weeks and again at about six months after sterilization. Rates of complications (surgical and early postoperative) were similar for the two procedures. None of the subjects required subsequent hospitalization. Technical difficulties at surgery were more frequent with the spring-loaded clip technique, principally as a result of mechnical problems with the prototype laparoscope and clip applicator. Postoperative pelvic and abdominal pain were reported by a significantly higher proportion of the patients when the spring-loaded clip was used (spring-loaded clips, 43.6%; electrocoagulation, 31.5%). At the six-month follow-up examination, rates of abnormal pelvic findings and changes in menstrual cycle formation were similar for the two techniques of tubal occlusion. There was one procedure failure among the electrocoagulation patients and none among the spring-loaded clip patients.

Adult↗
PubMed1977

Six-year continuation rates for CU-T-200 users.

The long-term (six years) contraceptive effectiveness of the Cu-T-200 is evaluated based on 833 first insertions performed by physicians and nurse-midwives. IUD event rates (pregnancy, expulsion, pain/bleeding removal or removal for medical reasons) did not increase with increasing duration of use. The results of the study indicate that the Cu-T-200 is a safe and effective contraceptive for at least six years after insertion.

Adult↗
PubMed1977

A clinical comparison of prostaglandin F2alpha and intra-amniotic saline for induction of midtrimester abortion.

The relative safety and effectiveness of hypertonic saline and intra-amniotic prostaglandin F2alpha (PGF2alpha), when used under clinical rather than research conditions, were evaluated for 100 patients aborted with a 20% saline solution, and 100 patients aborted with PGF2alpha (40 mg initially and an additional 20 mg if abortion had not occurred in 24 hours). While the overall risk of morbidity was similar for the two procedures, rates of incomplete abortion were higher with prostaglandin (51.0%) than with hypertonic saline (35.0%). The prostaglandin procedure, however, was associated with a significantly shorter median time from instillation to abortion of the fetus (25.3 versus 34.5 hours).

Abortion, Induced↗
PubMed1977

Long-term safety and use-effectiveness of intrauterine devices.

The long-term safety and effectiveness of Lippes Loops, A, C, and D, Dalkon Shields, Saf-T-Coils, and Cu 7-200 intrauterine devices (IUDs) were evaluated on the basis of 670 insertions in 588 women. Ten-year life-table rates for the Lippes Loops C (291 first insertions) and D (213 first insertions) were evaluated. The Loop C was consistently associated with a significantly higher expulsion rate but lower pregnancy rate as compared with the Loop D. Over-all, the removal rates for these two IUDs were similar. The incidence of pelvic infection and abnormal Papanicolaou smears, the time from IUD removal to conception, pregnancy outcome, and the need for any surgery post-IUD insertion were evaluated for all IUDs and all segments of use.

Bacterial Infections↗