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Biomedical subjects

D A Grimes

Publications and source records attributed to D A Grimes.

At least 19 recordsLinked to original sources
PubMed1992

Infarction of the uterus from subacute incomplete inversion.

A patient with subacute incomplete uterine inversion was transferred to our hospital when the diagnosis was made 5 days after vaginal delivery. Intravenous injection of sodium fluorescein dye identified a clear demarcation between viable and necrotic myometrium. The superior aspect of the uterus was infarcted; therefore a hysterectomy was performed.

Adult↗
PubMed1992

The safety of oral contraceptives: epidemiologic insights from the first 30 years.

Because oral contraceptives are used by tens of millions of healthy women, their safety for short-term and long-term use is an important issue that has been examined in a large number of epidemiologic studies. These studies have become more rigorous and have increased in size and analytic sophistication over the years. Although breast cancer remains the most important safety concern, the bulk of recent data suggests that oral contraceptives have no overall impact on a woman's risk of developing this disease. The results are less clear on the risk of cervical cancer and its precursors because of methodologic problems. However, the newer oral contraceptive formulations no longer appear to be associated with an increased risk of myocardial infarction or stroke.

Cardiovascular Diseases↗
PubMed1992

A randomized clinical trial of mifepristone (RU486) for induction of delayed menses: efficacy and acceptability.

Mifepristone (RU486) should be useful for inducing menstrual bleeding in women with menses delayed up to 10 days. We evaluated this potential use for "menstrual regulation" in a randomized clinical trial with 16 women, half of whom received a single 600 mg dose and half of whom received a placebo. Four of eight women in each treatment group proved to be pregnant. Seven of eight who received mifepristone were not pregnant at two-week follow-up, in contrast to four of eight who received the placebo (p = 0.15). Mifepristone may hold promise for "menstrual regulation" for women who do not have access to medical confirmation of pregnancy or who choose not to have this determination made.

Abortion, Induced↗
PubMed1992

Frontiers of operative laparoscopy: a review and critique of the evidence.

OBJECTIVE: This report reviews the evidence supporting the use of operative laparoscopy for a number of expanded indications in gynecology. STUDY DESIGN: Studies published in English were identified through a Medline search back to 1966 for literature listed under the medical subject heading of "peritoneoscopy"; this search was supplemented by reviews of reference lists and discussions with experts. RESULTS: Fair evidence exists to recommend use of laparoscopy for ectopic pregnancy, ovarian biopsy, and treatment of polycystic ovarian syndrome resistant to clomiphene citrate therapy. Evidence concerning other indications is inadequate to allow recommendations. CONCLUSIONS: Mechanisms are urgently needed to evaluate surgical innovations in gynecology with the same degree of scientific rigor currently afforded medical innovations. Without surgical technology assessment, the current double standards in gynecologic therapy will persist.

Abscess↗
PubMed1992

Luteal phase deficiency: effect of treatment on pregnancy rates.

Luteal phase deficiency is thought to be a cause of female infertility. Nevertheless, little agreement exists concerning either its diagnosis or its treatment. To address the latter question, we reviewed the English literature and examined the effect of treatment on pregnancy rates. One randomized controlled trial found a statistically insignificant benefit of treatment with progesterone suppositories or oral dehydroprogesterone versus no treatment (relative risk 1.9; 95% confidence interval 0.4 to 8.1). Three other comparative studies also showed no statistically significant benefit. Case-series reports (before-after studies) claiming benefit failed to account for the effect of regression to the mean. The benefit of treatment for luteal phase deficiency has not been established. Uniform case definitions and randomized controlled trials of adequate power are needed to resolve this problem.

Clomiphene↗
PubMed1992

Clinicians who provide abortions: the thinning ranks.

Access to abortion services in the United States has become increasingly limited because of a decrease in rural hospital providers and a growing shortage of clinicians willing to offer this service. As of 1988, 83% of United States counties had no identified provider. The deficit in numbers of clinicians stems from the current imbalance between incentives and disincentives. The single most powerful incentive appears to be altruism. On the other hand, disincentives include poor pay, frequent harassment, low prestige, suboptimal working conditions, and tedium. In 1990 a symposium on abortion provision was held, sponsored by the National Abortion Federation and ACOG. Among the remedies suggested by the attendees were increasing the integration of abortion training into the mainstream of residency education, improving the pay and work environments for clinicians, and where feasible expanding the capacity of physician providers by using midlevel practitioners working under physician supervision.

Abortion, Induced↗
PubMed1992

Randomized controlled trials of home uterine activity monitoring: a review and critique.

Home uterine activity monitoring has been proposed as an effective technique for reducing the incidence of preterm birth by early recognition of incipient labor. Five randomized controlled trials evaluating this technique have been published in peer review journals. As judged by accepted criteria for such trials, all have serious methodologic deficiencies. Four of the five trials demonstrated no significant benefit from this monitoring. Two other trials not published in peer review journals support the hypothesis that home uterine activity monitoring is no more effective than daily nursing contact. Until the efficacy of this technology has been established, home uterine activity monitoring should not be used clinically.

Evaluation Studies as Topic↗
PubMed1991

Assessing risk for pelvic inflammatory disease and its sequelae.

To assess the risk for pelvic inflammatory disease (PID), a practitioner must evaluate the likelihood that a woman has PID or will be exposed to a sexually transmitted disease causing PID. Successful risk assessment depends on accurate information about variables influencing risk of PID. To determine the current state of knowledge about PID risk variables, we examined data in published reports. Data on each risk variable were scrutinized to discern which link(s) in the PID risk chain it affects (acquisition of a sexually transmitted disease, development of PID, or development of PID sequelae) and whether it is a risk marker or a risk factor. Most PID risk variables, particularly sexual behaviors, are associated with acquisition of a sexually transmitted disease, rather than development of PID itself. With the exception of age, demographic and social indicators of risk appear to be risk markers, while contraceptive practices appear more often to be risk factors than risk markers. Additional data are needed for most PID risk variables confidently to categorize them as risk factors. Enough information is available, however, to begin assessing risk for PID, so that appropriate counseling can ensue and timely diagnosis can be made.

Age Factors↗
PubMed1991

An epidemic of antiabortion violence in the United States.

From 1977 to 1988, an epidemic of antiabortion violence took place in the United States, involving 110 cases of arson, firebombing, or bombing. The epidemic peaked in 1984, when there were 29 attacks. Nearly all sites (98%) were clinics that provided abortions. Facilities in 28 states and the District of Columbia were involved. The national rate of violence was 3.7 per 100 abortion providers and 7.2 per 100 nonhospital abortion providers. The national ratio of violence per 100,000 abortions performed was 0.6 Arson was both the most frequent (39% of all cases) and the most damaging (mean cost $141,000) type of violence. The epidemic appears partially attributable to multiple point-source outbreaks of violence caused by small numbers of individuals or groups. Thirty-three persons have been convicted to date. Vigorous prosecution of perpetrators and the reemergence of clinics after damage probably helped to curb the epidemic.

Abortion, Induced↗
PubMed1991

Ovarian neoplasms and the risk of adnexal torsion.

Previous reports examining adnexal torsion suggested that benign ovarian neoplasms are more likely to undergo torsion than malignant ovarian neoplasms. To our knowledge, this clinical observation has not been quantified. To examine this hypothesis, we reviewed our experience with ovarian neoplasms found at the time of surgery over a 10-year period. Benign ovarian neoplasms had a 12.9-fold increased risk of undergoing adnexal torsion when compared with malignant ovarian neoplasms (95% confidence interval, 10.2 to 15.9). The histologic type of ovarian neoplasm does not appear to affect the rate of adnexal torsion. Adnexal torsion rarely involves cancer.

Adnexal Diseases↗
PubMed1991

Neoplastic effects of oral contraceptives.

The potential association between the use of oral contraceptives (OCs) and certain types of cancer remains an important concern. Epidemiologic studies published over the past decade indicate that the overall risk of breast cancer is not increased among women exposed to OCs. Some studies have suggested an increased risk among younger women with long-term use, and this issue requires further study. OCs confer significant protection against endometrial and ovarian cancers, and the effect is duration-related: longer use is more protective. In the largest study to date, the protection against these two types of cancer persisted for at least 15 years after OCs were discontinued. Several studies have linked long-term OC use with an increased risk of cervical cancer or its precursors, but methodologic difficulties in studying cervical cancer are such that the potential association with OC use may never be clarified. A large international study has found no association between OC use for any duration and liver cancer. Neither malignant melanoma nor pituitary adenoma appears to be linked to OC use. In summary, OCs protect against endometrial and ovarian cancers and have no overall effect on the risk of breast cancer. Women using OCs should have regular Papanicolaou screening.

Adult↗
PubMed1991

Ascites and pleural effusions associated with endometriosis.

We report a case of ascites and bilateral pleural effusions associated with an endometrioma in a 26-year-old woman of Chinese descent. She had a right salpingo-oophorectomy and partial omentectomy performed, and she received leuprolide acetate depot injections after the operation. We believe this is the first description of use of a GnRH agonist to treat this rare condition.

Adult↗