Biomedical subjects
Publications and source records attributed to F D Loffer.
A series of 49 patients weighing over 200 pounds is described, and a technique essential to successful care of obese patients is given. The ability to determine the intra-abdominal location of the Verres needle in order to create a physoperitoneum is the most important consideration.
A patient who had experienced an actopic pregnancy and subsequent salpingectomy was found to have an ectopic pregnancy, presenting as an hematosalpinx, in the remaining fallopian tube. The diagnosis was made at the time of laparoscopy, and the patient refused definitive surgery. Fourteen months later she achieved an intrauterine pregnancy, and repeat laparoscopic examination revealed an essentially normal pelvis and fallopian tube. This is evidently the first case report of a pregnancy occurring through a fallopian tube that had had a previous ectopic gestation and in which no surgical procedure was performed on the affected tube.
Carbohydrate tolerance was studied in pregnant patients with no personal or family history suggestive of diabetes, but with a menarche before 12 years of age. The mean disappearance rate constant for glucose (k) in the intravenous glucose tolerance test was 1.68 in the group of patients with an early menarche. This value is essentially the same as that found in patients with the usual criteria for screening for gestational diabetes, where k equaled 1.61. Both values are significantly different from the remaining patients studied, where k was 1.94. The mean fasting blood sugars and the mean 2 hours past-100 Gm. glucose meal blood sugars in patients with a menarche before 12 years of age and the patients with the usual criteria for screening for gestational diabetes were also the same when compared to each other, and significantly different from those of remaining patients studied. There were no apparent reasons for the early menarche group to have a decreased tolerance to glucose except their early menarche.
The primary use of laparoscopy is as a surgical tool, with sterilizations being the overwhelming indication. The laparoscope is used less frequently as a non-surgical tool, with the major indication being for diagnosing infertility and/or amenorrhea, and for evaluation of obscure pelvic pain. There would seem to be several indications for laparoscopy that have been neglected, these being in confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain. Lapar-The majority of these contraindications are relative, and depend soley on the laparoscopist's ability and his clinical judgment. The problems of hernias seem to have been over-emphasized. The laparoscopist should be aware of potential problems with umbilical hernia, and he probably can ignore hiatal hernias except when they are large and quite symptomatic. However, generalized abdominal peritonitis, significant hemoperitoneum with intestinal obstruction are felt by most authors to be absolute contraindications. The most frequent complications of laparoscopy involve the physoperitoneum. Except for cardiac arrest the most serious complications involve electrical burns to small bowel.
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A review of the first 100 and the last 100 patients in a series of 268 patients sterilized by hysteroscopic injection of liquid silicone into the fallopian was made to evaluate the success rate as it relates to experience with the procedure. The two groups were similar in composition. While the percentage of patients sterilized increased only from 91% in the first 100 patients to 94% in the last 100 patients the numbers that were sterilized at the time of the first procedure increased by 9%. The two major reasons for repeated procedures were tip separation and tubal spasm. The former may become less of a problem with new manufacturing changes. Tubal spasm was reduced as a problem by controlling the temperature of Hyskon but it remains a difficult problem in a smaller number of patients even in the last group. Other causes for repeated procedures were primarily related to operator inexperience and investigational problems. They appear not to be a significant problem for physicians who will learn this procedure in future. This procedure is well received by patients. Hysteroscopists will find it a valuable outpatient female sterilization technique.
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