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Biomedical subjects

D E DeWitt

Publications and source records attributed to D E DeWitt.

14 recordsLinked to original sources
PubMed1995

Electrosurgical loop excision of the cervical transformation zone: the experience of family physicians.

BACKGROUND: Electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure for treatment of premalignant cervical disease and the abnormal transformation zone by wire loop electrodes. The purpose of this study was to describe and assess the clinical experiences and complications of family-physician-performed ELECTZ and ELECTZ conization. METHODS: Women who were scheduled for the ELECTZ or ELECTZ conization procedures were enrolled in the study between March 1992 and March 1993, inclusive. Subjects were recruited from the practices of six family physician colposcopists located at five sites. The ELECTZ and ELECTZ conization procedures were performed on patients with abnormal Papanicolaou (Pap) smears or abnormal histologic results and abnormal colposcopic findings. Procedural complications were documented. Subjects were serially assessed during the first postoperative year by Pap smears, colposcopy, and, when necessary, by biopsy to determine therapeutic cure. RESULTS: Of 198 subjects enrolled in the study, 148 women were assessed at least once in follow-up by Pap smear and colposcopy. Only 7.6% of women were defined as treatment failures by subsequent histologic assessment. Women treated by ELECTZ conization were older (32.2 vs 25.1 years, P = .02), were more likely to develop posttreatment cervical stenosis (25.9% vs 3.8%, P = .001), and were more likely to have the postoperative squamocolumnar junction positioned in the endocervical canal (32.4% vs 8.7%, P = .002) than were women treated by ELECTZ: Loop excision specimen margins demonstrated dysplasia for 27 (13.6%) subjects. Significant operative bleeding (> 25 mL) was noted in 6.8% of subjects. Histologic thermal artifact was reported for 9.6% of specimens. One case of microinvasive cancer and one case of invasive cancer were identified unexpectedly by ELECTZ conization. CONCLUSIONS: Electrosurgical loop excision of the cervical transformation zone and ELECTZ conization may be safely and effectively performed in office settings by family physicians. Complications and treatment failure rates for the ELECTZ and ELECTZ conization procedures were similar to those experienced by other clinicians.

Adolescent↗
PubMed1994

Earlobe keloids.

Earlobe keloids are a challenging management problem. These benign, fibrous proliferations develop in predisposed persons at sites of cutaneous injury or as the result of ear piercing, burns or surgical procedures. Earlobe keloids usually appear as shiny, smooth, globular growths on one or both sides of the earlobe. Patients frequently complain of cosmetic embarrassment, but also may report pruritus, pain or paresthesias. No single therapeutic modality is best. The location, size, depth and duration of the earlobe keloid influence the choice of therapy. Surgical treatment for earlobe keloids generally includes core excision with low-tension wound closure, and shave excision. Surgical repair with corticosteroid injections and postoperative pressure on the incision site usually provide good cosmetic results. Patients must be counseled about recurrence, palpable postoperative nodules and the need for close monitoring.

Adrenal Cortex Hormones↗
PubMed1992

Skin damage associated with the Norplant contraceptive.

Three cases of localized skin reaction in the first month after implantation of the Norplant contraceptive resulted in a partial implant expulsion and removal in one patient, and implant removal in another. Clinical evidence of infection was absent in all patients. While lidocaine with epinephrine was used in all three patients, the cause for these skin reactions remains unclear. Physicians should be alerted to the possibility of significant skin reactions associated with this procedure.

Adult↗
PubMed1991

Dyspareunia. Tracing the cause.

Difficult or painful sexual intercourse is a sensitive topic for most women. The causes range from inflammation of the vulva and interstitial cystitis to marital discord. To exclude an organic disorder, a detailed pelvic examination with good lighting and magnification is in order. Dr DeWitt describes the technique for meticulous examination and discusses the diagnoses that need to be considered.

Dyspareunia↗
PubMed1985

Negative inotropic effect of etomidate in rabbit papillary muscle.

The effect of etomidate on the developed force of isometrically contracting rabbit papillary muscles in modified Krebs-Henseleit bicarbonate medium was evaluated under various stimulation conditions to gain insight into the mechanism underlying the negative inotropic effect of this anesthetic. Myocardial depressant effects of etomidate (2 and 4 mg/L) on steady-state contractions at low stimulation frequencies (0.1-0.5 Hz) were more pronounced than the effects on either steady-state contraction at high stimulation frequencies (1.0-2.0 Hz) or the effects on post-rest potentiated state contractions. Increases in the concentration of extracellular Ca2+ from an initial level of 2.5 mM to 3.4-4.0 mM reversed the effect of 2 mg/L of etomidate, whereas an increase to 4.6-5.0 mM was required to reverse the effect of 4 mg/L of etomidate. The dependence of post-rest potentiation on the duration of the preceding rest period was virtually unaffected by etomidate. These results suggest that etomidate inhibits the influx of extracellular Ca2+ but has little effect on the availability of intracellular Ca2+ required for the activation of myocardial contractile activity. Because the concentrations of etomidate required to produce negative inotropic responses in the present study are substantially greater than those likely to be achieved under clinical conditions, the present results also suggest that negative inotropism is unlikely in patients with normal hearts.

Animals↗