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Biomedical subjects

F W Ling

Publications and source records attributed to F W Ling.

At least 55 records · Page 3Linked to original sources
PubMed1993

Dyspareunia. A special type of chronic pelvic pain.

The presence of dyspareunia as a specific complaint should be a routine part of the gynecologic history. Even if the patient does not present with this as a chief complaint, the regular inclusion of the question of whether the patient has pain during intercourse can address emotional and physical concerns the patient may leave unspoken unless given the opportunity. Once identified, the symptoms should be dealt with by the clinician potentially as both an organic and as a sexual problem. This will allow the clinician to keep in mind that secondary sexual dysfunction can arise from initially simple organic problems. Patients should be advised at the onset that the process is ongoing and that therapy may be more than just one single treatment approach. Dyspareunia that occurs after a period of good sexual adjustment may be more amenable to an office-based counseling and educational approach, assuming that the patient and her partner are comfortable and cooperative in approaching the problem. Dyspareunia of long standing or in a more complicated relationship may require skills possessed by more highly trained professionals.

Chronic Disease↗
PubMed1993

Use of trigger point injections in chronic pelvic pain.

In order to fully evaluate the woman with chronic pelvic pain, the clinician must consider the possibility of abdominal wall pain. A useful technique in both diagnosis and treatment may be trigger point injections.

Abdominal Muscles↗
PubMed1993

Ectopic pregnancy. Diagnostic and therapeutic algorithms minimizing surgical intervention.

Presented are the results of a diagnostic algorithm for ectopic pregnancy incorporating history, physical examination, quantitative human chorionic gonadotropin (hCG), serum progesterone, color-flow vaginal Doppler sonography and endometrial curettage as well as a treatment algorithm combining expectant, medical and surgical management. These algorithms resulted in: (1) earlier diagnosis of ectopic pregnancy, with fewer ruptured ectopic pregnancies; (2) virtual elimination of diagnostic laparoscopy; (3) elimination of culdocentesis; (4) greater use of methotrexate; and (5) increased use of expectant (i.e., nonsurgical and nonmedical) treatment. These algorithms are potentially applicable in other clinical settings and should be considered for use on at-risk populations or when the diagnosis of ectopic pregnancy is in question.

Algorithms↗
PubMed1993

Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.

Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double-lumen sampling device. The most frequent endometrial isolates were Peptostreptococcus and Bacteroides species, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 receiving gentamicin and clindamycin responded to therapy. There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.

Adolescent↗
PubMed1993

Senior obstetric-gynecologic residents' perceptions of their surgical training, experiences and skill.

Senior obstetric and gynecologic residents' self-perceptions of surgical skill seem to be unrelated to the kinds of didactic experiences received or to the number of basic gynecologic procedures performed during training. These data offer further support for the need for a comprehensive reevaluation of the components of gynecologic surgical curricula; the cognitive, behavioral and psychomotor educational objectives of such training; and the methods by which the outcomes for these objectives are measured.

Clinical Competence↗
PubMed1993

The effect of same-day pregnancy testing on the incidence of luteal phase pregnancy.

OBJECTIVE: To assess the impact of same-day pregnancy testing on the incidence of luteal phase pregnancy (pregnancy in which conception occurs before sterilization). METHODS: Retrospectively, all patients (N = 1006) undergoing laparoscopic tubal ligations at the Regional Medical Center, Memphis, from May 1990 through December 1991 were reviewed for sterilization failures. Negative urine pregnancy tests were documented on all scheduled patients at their preoperative examination. After the first 401 sterilizations, same-day pregnancy testing with enzyme-linked immunosorbent assay (ELISA) pregnancy tests was instituted. We reviewed the records of all presumed sterilization failures as well as all patients with a positive pregnancy test on the day of surgery. Last menstrual period, ultrasound records, and date of delivery were analyzed to determine time of conception. RESULTS: Seven luteal phase pregnancies were discovered among the first 401 sterilization cases (17 per 1000). No luteal phase pregnancies occurred in the next 605 sterilizations after institution of same-day pregnancy testing. Eight patients' sterilizations were canceled because of a positive pregnancy test on the morning of surgery. If these patients had not been eliminated, the incidence of luteal phase pregnancies in this second group would have been 13 per 1000 sterilization procedures. CONCLUSION: Same-day pregnancy testing with an ELISA-type pregnancy test is a rapid, inexpensive, and effective means of reducing the incidence of luteal phase pregnancy.

Enzyme-Linked Immunosorbent Assay↗
PubMed1992

Serum progesterone and uterine curettage in differential diagnosis of ectopic pregnancy.

The implementation of a serum P less than 5.0 ng/mL is important because it resolves the differential diagnosis of EP by enabling timely uterine curettage. Curettage with examination of curettings or documentation of falling hCG can be used to prevent unnecessary laparoscopies in patients undergoing spontaneous abortions and can make possible definitive diagnosis and medical treatment of EP completely eschewing anesthesia and surgery.

Curettage↗
PubMed1992

Improved sensitivity and specificity of a single measurement of serum progesterone over serial quantitative beta-human chorionic gonadotrophin in screening for ectopic pregnancy.

The sensitivity and specificity of a single serum progesterone measurement was compared against two beta-human chorionic gonadotrophin (HCG) measurements 48 h apart in screening for abnormal pregnancy, i.e. ectopic pregnancy, completed or incomplete abortion. Of 1120 patients in the first trimester presenting with a positive urinary pregnancy test, 116/1120 (10.4%) had an ectopic pregnancy, 755/1120 (67.4%) had ultrasonographically confirmed intra-uterine pregnancies, and 249/1120 (22.2%) had abnormal intra-uterine pregnancies documented as complete, incomplete or missed abortions. Of the ectopic pregnancies, 113/116 (97.4%) had a serum progesterone level less than 25 ng/ml while 516/755 (68.3%) viable intra-uterine pregnancies had a serum progesterone level greater than or equal to ng/ml. Of the 1120 patients screened, 402 (35.9%) had both a serum progesterone and two HCG measurements and were eligible for inclusion in this study. Setting a cut-off of 25 ng/ml, the sensitivity and specificity of a single serum progesterone measurement was then compared against two serial HCG measurements, utilizing receiver operating characteristic curves. This analysis demonstrated that a single serum progesterone measurement was significantly more sensitive (P less than 0.05) than two HCG measurements in screening for an abnormal pregnancy. In some patients, a single serum progesterone makes possible the diagnosis of ectopic pregnancy 2 days earlier than two HCG determinations because a second blood sample was not required. We conclude that a single serum progesterone measurement should be added to serial HCG determinations as a standard diagnostic screening test for ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1992

Tubo-ovarian abscess in postmenopausal patients.

We retrospectively reviewed 20 surgically confirmed tubo-ovarian abscesses in postmenopausal women for the period 1973 to 1989. Pain and bleeding were the two most common presenting symptoms. Nine of the 20 patients (45%) had recently had endometrial instrumentation. Fever and the presence of a pelvic mass and elevated white blood cell count, without evidence of peritonitis, were frequent findings on admission. At surgery, seven abscesses were already ruptured or leaking, 12 of 18 patients with both ovaries had unilateral abscesses, and dense adhesions were found in 11 patients. A common intraoperative complication was inadvertent bowel injury. Postoperative complications included fascial dehiscence, enterocutaneous fistula, deep venous thrombosis, and need for prolonged ventilatory support. Eight patients had a coexisting gynecologic malignancy. A high index of suspicion is required for early recognition of postmenopausal tubo-ovarian abscess. Prompt surgical exploration should be done to avoid occult rupture or sepsis.

Abscess↗
PubMed1992

Gynaecological teaching associates in the 1990s.

Chairmen of academic obstetrics and gynaecology departments in the USA and Canada were asked if they used gynaecological teaching associates (GTAs) and their opinions of their educational and cost effectiveness. Three-quarters of chairmen used GTAs and were satisfied with the educational aspects of GTA instruction. Departmental discretionary funds provided all or part of the GTA funding in 40% of departments and the medical school all or part of the GTA funding in 72%. As more monies came from departmental discretionary funds, chairmen were increasingly dissatisfied. Because the 1990s will be difficult financially, it was hypothesized that chairmen may eventually cancel GTA programmes as expendable 'luxuries'.

Attitude of Health Personnel↗
PubMed1992

Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia.

OBJECTIVE: To compare objectively the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia. METHODS: Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were randomized to Silastic rings (N = 50) or electrocoagulation (N = 52) as the method of tubal occlusion. Sterilization was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain questionnaire. This questionnaire was used to assess pain at 15 minutes, 1 hour, and 24 hours postoperatively. RESULTS: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 versus 21.8 minutes; P = .001), and this group also required less intraoperative anesthesia (P = .004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. No patient in either group required antiemetics or pain medication in the recovery room. CONCLUSION: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilization under local anesthesia when long-acting local agents are used for tubal anesthesia.

Adult↗
PubMed1992

Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.

OBJECTIVE: To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomy. METHODS: Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy-assisted vaginal hysterectomy with endoscopic staples (N = 29) or a standard vaginal hysterectomy (N = 27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operations. RESULTS: Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy-assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891. CONCLUSION: Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

Adult↗
PubMed1992

Methotrexate for treatment of unruptured ectopic pregnancy.

Clinical experience with and adverse effects of methotrexate for the treatment of unruptured ectopic pregnancy are described. Ectopic pregnancy is suspected in the presence of the following: positive results on pregnancy test (e.g., test for beta-human chorionic gonadotropin [beta-hCG]), lower abdominal pain, a normal or slightly enlarged uterus, and a mass on either side of the midline. When laparoscopy is required for diagnosis, surgical correction is done at the same time. However, use of serial beta-hCG titers, vaginal ultrasound examinations, serum progesterone concentrations, and dilation and curettage (when the pregnancy is confirmed to be nonviable) allows earlier detection of ectopic pregnancy without laparoscopy. If rupture has not occurred, i.v. or i.m. methotrexate is administered; usually, i.m. leucovorin is given, on alternate days, to prevent hematologic toxicity. Adverse effects of methotrexate include stomatitis, gastritis, and hepatic enzyme elevation. Use of a single-dose regimen of i.m. methotrexate without leucovorin has been associated with a lower frequency of toxicity. Selection criteria for patients are as follows: (1) an unruptured ectopic pregnancy less than or equal to 3.5 cm in greatest dimension on transvaginal ultrasound, (2) no active renal or hepatic disease, and (3) no evidence of leukopenia or thrombocytopenia. Intramuscular methotrexate therapy is a safe and effective alternative to surgery for the treatment of unruptured ectopic pregnancy.

Clinical Trials as Topic↗
PubMed1992

Outpatient vaginal hysterectomy: a pilot study.

To determine the feasibility and safety of outpatient vaginal hysterectomy, we conducted a prospective study of 35 patients. Inclusion criteria required that the patient: 1) had no medical problems requiring hospitalization, 2) had a working telephone and a support person during the first 48 postoperative hours, 3) signed an informed consent document and understood the postoperative instructions, 4) required no concomitant surgical procedure such as anterior or posterior colporrhaphy, 5) required no additional antibiotic therapy for valvular heart disease, and 6) sustained no intraoperative injury requiring hospital monitoring. A physician contacted the patient by telephone on the evening of surgery and on postoperative days 1 and 2, and a nurse saw each patient in her home on postoperative days 1 and 2. Total hospital stay from admission to discharge from the ambulatory surgery unit was 9.4 +/- 0.81 hours (range 7.8-10.6). The mean preoperative hematocrit was 37.0 +/- 3.5% (range 29.3-43.5), with a mean discharge hematocrit of 32.5 +/- 4.2% (range 27-39). Follow-up hematocrit measurements at 24 hours, 48 hours, and 1 week were unchanged (P greater than .05) from that at hospital discharge. Two patients required hospital readmission, one on postoperative day 7 for a vaginal cuff abscess and another on postoperative day 3 for a spinal headache. On a 13-item questionnaire, most subjects rated the entire outpatient experience positively. These data suggest that outpatient vaginal hysterectomy can be a safe procedure and is well-accepted by selected patients. Based on these preliminary findings, an expanded clinical trial is warranted.

Adult↗
PubMed1991

A prospective, randomized comparison of the Pipelle endometrial sampling device with the Novak curette.

This prospective, randomized study compares sample adequacy, pain associated with endometrial biopsy, and correlation of endometrial histologic sampling with hysterectomy histologic results in specimens obtained by the Pipelle (Unimar Inc., Wilton, Conn.) device (N = 149) and the Novak (Miltex, Inc., Lake Success, N.Y.) curette (N = 126). During a 2-year period, patients with abnormal uterine bleeding seen in our ambulatory care facility were enrolled in this trial, unless they did not wish to participate or had a positive pregnancy test result. Patients in both groups were similar with respect to mean gravidity, parity, and menopausal status, although patients in the Novak group were older (43.4 vs 39.1 years, p = 0.005). Patients undergoing Novak biopsy had a mean pain score of 4.36 with 22 of 126 (17%) reporting severe pain, whereas patients undergoing Pipelle biopsy had a mean pain score of 3.21 with only 10 of 149 (6.7%) reporting severe pain (p less than 0.05). These pain scores were not affected by menstrual day, gravidity, parity, or menopausal status. Insufficient tissue was reported in 12.8% of patients in the Pipelle group compared with 9.5% in the Novak group (p greater than 0.05). Fifty patients underwent subsequent hysterectomy. In 48 of 50 (96%), the pathologic results at hysterectomy were in agreement with the histologic findings at endometrial sampling. This clinical trial suggests that Pipelle biopsy appears to be as effective as the Novak curette in obtaining an adequate specimen for histologic analysis and is associated with less pain.

Biopsy↗
PubMed1991

A randomized trial evaluating leuprolide acetate before hysterectomy as treatment for leiomyomas.

Fifty premenopausal patients requiring hysterectomy as treatment for symptomatic uterine leiomyomas, which were the size of 14 to 18 weeks' gestation, were randomized into two groups to determine whether preoperative gonadotropin-releasing hormone agonist would increase the feasibility of vaginal rather than abdominal hysterectomy. The control group (group A; n = 25) did not receive preoperative gonadotropin-releasing hormone agonist, but patients in Group B (n = 25) received 2 months of gonadotropin-releasing hormone agonist before undergoing hysterectomy. Patients in the two groups were similar with respect to age, gravidity, parity, pretreatment uterine size, and hemoglobin and hematocrit levels. Patients in group B had an increase in hemoglobin levels (10.75 to 12.12 gm/dl, p less than 0.05) and a decrease in uterine volume (1086.7 to 723.4 ml, p less than 0.05) after 8 weeks of agonist therapy and were more likely to undergo vaginal hysterectomy (76.0% vs 16%). Patients in group B also had shorter hospitalizations (5.2 vs 3.8 days, p less than 0.05). We conclude that the administration of gonadotropin-releasing hormone agonist for 2 months followed by vaginal hysterectomy is preferable to abdominal hysterectomy in selected patients with uterine leiomyomas.

Female↗
PubMed1991

Prevention of osteoporosis by medroxyprogesterone acetate in postmenopausal women.

The effect of medroxyprogesterone acetate 10 mg BID alone, conjugated estrogens alone or in a combination regimen for the prevention of osteoporosis was determined in 36 postmenopausal women using single photon densitometry. No significant differences in cortical or trabecular bone mass over time were detected in women between the three treatment groups, although a slight increase in bone mass was noted in women with the combined therapy. Medroxyprogesterone acetate appears efficacious in preventing postmenopausal osteoporosis, and may be especially useful in women with contraindications to estrogen replacement therapy.

Adult↗