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Biomedical subjects

D M Harper

Publications and source records attributed to D M Harper.

32 records · Page 2Linked to original sources
PubMed1997

Paracervical block diminishes cramping associated with cryosurgery.

BACKGROUND: The choice of treatment method for cervical intraepithelial neoplasia can be dictated by the lesion size, by comfort of the operator with the technique, by the cost of the procedure, and by patient comfort with the procedure. The purpose of this research was to compare the usual method of cryosurgery (no anesthetic block) with a method using a paracervical block to reduce the pain and cramping associated with cryosurgery. METHODS: A prospective trial was designed and conducted in a colposcopy clinic. Of the 85 women enrolled in the study, all were immediately given 550 mg of naproxen sodium orally; 40 received no block and 45 received a paracervical block before the cryosurgery procedure. After the procedure, a trained interviewer elicited pain and cramping scores using a visual analog scale. Chi-square, Fisher's exact test, Mann-Whitney U, Wilcoxon signed-ranks test, Friedman's two-way analysis of variance, and multivariate analysis of variance with covariates were used to analyze the data. RESULTS: Each part of the double-freeze cryosurgical procedure was ranked according to the participants' perceptions of pain and cramping. The cramping after the first freeze was significantly less for women receiving the paracervical block than for the women undergoing the usual procedure (z = -2.44, P = .014). Including the discomfort from the injection itself, the women who received a paracervical block perceived less cramping overall during cryosurgery than the women with no block (z = -2.35, P = .019). The paracervical block did not decrease the pain from cryosurgery according to the participants' rankings of perceived pain. CONCLUSIONS: A paracervical block is effective in reducing the cramping from cryosurgery.

Cervix Uteri↗
PubMed1997

Does comprehensive preventive medicine training enhance clinical prevention?

BACKGROUND AND OBJECTIVES: Clinical prevention is an important component of primary care, but its delivery remains deficient. This study determined the effect of a comprehensive preventive medicine curriculum, in combination with use of a prevention flow sheet, on community and family medicine residents' performance of 16 recommended clinical preventive services. METHODS: A retrospective study was done to document preventive services based on chart reviews of 240 clinic patients for the year prior to intervention initiation and the first year following the intervention. RESULTS: Chi-square analysis revealed a significant increase in the delivery of 12 out of 15 recommended clinical preventive services after the intervention. CONCLUSIONS: Implementation of comprehensive preventive medicine curricula, in combination with use of a clinical prevention flow sheet, is associated with an increase in preventive care offered to patients by community and family medicine residents.

Chi-Square Distribution↗
PubMed1996

Cervical intraepithelial neoplasia in pregnancy.

There is no evidence that cervical intraepithelial neoplasia (CIN) progresses more rapidly because of pregnancy. Management of CIN in pregnancy, therefore, is conservative. Screening for invasive cancer is done at the first prenatal visit. Colposcopically directed biopsy can then be used to rule out invasive cancer. Postpartum cytology and colposcopy are important follow-up procedures for these women. Cryosurgery for CIN is usually contraindicated in pregnancy. This report includes examples of two pregnant patients with high-grade lesions. A diagnostic and treatment algorithm based on the current "expert opinion"is presented.

Adult↗
PubMed1996

Principles of nonstress testing in pregnancy.

The nonstress test has been used to document second and third trimester fetal well-being for the past 40 years. It serves as a surrogate measure of the developing fetal autonomic nervous system. The nonstress test is more specific than sensitive, thus being a better indicator of fetal health than fetal illness. The test itself is read as reactive or nonreactive and may be repeated at intervals as a screen for high-risk maternal conditions.

Female↗
PubMed1995

Prenatal predictors of cesarean section due to labor arrest.

Cesarean section due to labor arrest occurs because the fetus is too large for the maternal outlet tract. If these women could be identified prior to labor, patient management could be optimized for both the clinician and the woman. A case-control study was designed to identify predictors of Cesarean section due to labor arrest. A five year retrospective review identified 32 cases and 329 controls with complete data for the prenatal maternal variables. Both cases and controls were considered for the stepwise logistic regression model. The prenatal variables predicting Cesarean section due to labor arrest are parity, history of past macrosomia, maternal age, term fundal height and maternal height. This model can be considered a pilot model that can be tested in a large international/inter-ethnic population.

Adolescent↗
PubMed1995

Elastin fibers resembling Sporothrix schenkii in the skin of a patient with acquired immunodeficiency syndrome.

We describe a patient with the acquired immunodeficiency syndrome who presented with an erythematous skin rash on his trunk and extremities. Initial histologic examination of a skin biopsy revealed silver-staining elements resembling Sporothrix schenkii. Additional histochemical and ultrastructural studies revealed that these elements were elastin fibers rather than fungi. The literature describing pseudofungal infections is reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Specific reactivity of leukemia cells to polyclonal anti-PCB antibodies.

Bivalve molluscs such as the soft shell clam (Mya arenaria) develop leukemias in the hemolymph which are fatal. The prevalence of leukemia in Mya was evaluated using a murine monoclonal antibody which recognizes a leukemia-specific protein expressed by tumor cells. The reactivity with a polyclonal antibody to polychlorinated biphenyls (PCBs) of both normal circulating cells and tumor cells was also determined. Both leukemia prevalence and PCB reactivity were ascertained by flow cytometry. Analytical chemistry was used to quantitate the amount of Aroclor per tumor cell population and compared directly to flow cytometric results. Our results show that the prevalence of leukemia consistently exceeds 60% when clams are retrieved from New Bedford Harbor, a site heavily contaminated with PCBs. Both normal circulating cells and tumor cells are extremely reactive with the PCB antibody. When clams from two other sites were compared with clams from New Bedford Harbor, both disease prevalence and cell reactivity to the PCB antibody were reduced. Our experiments are the first which use the flow cytometer to demonstrate PCBs in cell populations of marine invertebrates. Our results further demonstrate that the presence of polychlorinated biphenyls in vivo is directly correlated with environmentally linked leukemia.

Animals↗
PubMed1994

Pain and cramping associated with cryosurgery.

BACKGROUND: Many different cryosurgery methods have been described for the treatment of cervical intraepithelial neoplasia (CIN). The purpose of this study was to evaluate the pain and cramping perceived by patients undergoing four specific cryosurgical methods. METHODS: Seventy women consented to the prospective trial and were assigned to one of four cryosurgery techniques: a 2-minute double freeze, a 3-minute double freeze, a 5-minute single freeze, and a 5-minute double freeze. Immediately following the procedure, a trained interviewer recorded each woman's perceptions of pain and cramping. Age, parity, marital status, financial class, race or ethnicity, lesion severity, and pretreatment with a nonsteroidal anti-inflammatory drug (NSAID) were included in the analysis. RESULTS: The median pain scores for the 2-minute double freeze, the 3-minute double freeze, the 5-minute single freeze, and the 5-minute double freeze were 4, 3, 3, and 7, respectively, on a scale of 0 to 10. The median cramping scores for the procedures were 0, 0, 0, and 7, respectively. The median pain and cramping scores were significantly higher for the 5-minute double freeze than for any of the other procedures (P = .012 and P = < .001, respectively). CONCLUSIONS: Pain and cramping are associated with cryosurgery, but the 5-minute double freeze caused the most pain and cramping of all the cryosurgery methods tested. Pretreatment with an NSAID did not lessen the cramping or pain perceived during the 5-minute double freeze.

Adult↗
PubMed1994

Anesthetic blocks for loop electrosurgical excision procedure.

BACKGROUND: Various types of anesthetic blocks have been used to prevent pain during ambulatory gynecologic surgery. The purpose of this study was to compare the pain and cramping perceived by patients during the loop electrosurgical excision procedure when intramucosal or distal paracervical blocks were used. METHODS: Seventy-seven women consented to participate in the prospective clinical trial. All women were premedicated with a nonsteroidal anti-inflammatory drug. Immediately after the procedure, a trained interviewer, blinded to the type of anesthetic block, recorded the patient's perceptions of pain and cramping caused by the procedure. Age, parity, marital status, lesion severity, loop size used, number of specimens, amount of bleeding, method of hemostasis, and thermal artifact were included on the analysis. RESULTS: On a Likert scale in which 0 = no pain/cramping and 10 = worst pain/cramping, the median pain score was 3 for the distal paracervical block and 4 for the intramucosal block. The median cramping scores were 3 and 2, respectively. Pain and cramping scores did not differ significantly between the two block cohorts. The demographic and procedural variables did not predict the perception of pain or cramping. Most (89.6%) of the study population experienced pain, whereas fewer (64.9%) experienced cramping. Subjects reported significantly less cramping than pain, irrespective of the anesthetic block used (chi 2 = 13.35, P = .0003). CONCLUSIONS: There is no difference in the perceptions of pain and cramping resulting from the loop electrosurgical excision procedure between patients receiving an intramucosal block and those receiving a distal paracervical block. There is minimal pain and cramping associated with the procedure.

Adult↗