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Biomedical subjects

F W Ling

Publications and source records attributed to F W Ling.

At least 91 records · Page 5Linked to original sources
PubMed1989

Preventing ruptured ectopic pregnancy with a single serum progesterone.

Retrospective data on patients with documented ectopic pregnancies have demonstrated the potential usefulness of serum progesterone in decreasing the time to diagnosis. We report a prospective trial utilizing serum progesterone in the emergency department of a large city-county hospital. Sixty-seven ectopic pregnancies were document in the 582 patients screened; 54 (80.6%) had a progesterone level less than 15 ng/ml. Only one (1.5%) ruptured ectopic pregnancy was associated with a progesterone level greater than 25 ng/ml. There were 387 documented or presumed normal intrauterine pregnancies, 41 (10.6%) had progesterone concentrations of less than 15 ng/ml and 236 (61%) had a progesterone level greater than 25 ng/ml. We decreased minimum time of diagnosis from 48 to 72 hours to less than 24 hours by use of a progesterone screening protocol. During this time the percentage of ruptured ectopic pregnancies decreased from 79.2% to 38.8% (p less than 0.05). Because of its simple interpretation and 24-hour maximum delay, we conclude that the determination of serum progesterone should be used for ectopic pregnancy screening in all patients at risk for ectopic pregnancy, or at any time when the diagnosis is in question.

Algorithms↗
PubMed1989

Adhesion formation associated with the use of absorbable staples in comparison to other types of peritoneal injury.

Adhesion formation was assessed after inducing peritoneal injury with absorbable staples, absorbable suture, surgical excision or thermal injury. In addition, adhesion formation was assessed in the presence of Hyskon. Absorbable staples were associated with increased adhesion formation when compared to the other methods of injury. Hyskon appears to significantly reduce the formation of peritoneal adhesions at sites of peritoneal suturing, excision, and thermal injury, but did not reduce adhesion formation in the area of stapling.

Animals↗
PubMed1989

Predictors of pelvic adhesions.

The presence of pelvic adhesions is implicated as a significant cause of pelvic pain, bowel obstruction and infertility in women. Laparoscopy has become an invaluable method for the evaluation and treatment of such adhesions. A prospective study was designed to correlate specific findings in the preoperative history and physical examination with the presence of adhesions seen at laparoscopy. Two hundred seventy-three consecutive patients undergoing laparoscopy were analyzed; pelvic adhesions were found in 99 (36.3%). At the time of laparoscopy the only historical predictor found to be associated with adhesive disease was previous pelvic surgery. Physical examination predictors associated with the presence of adhesions were uterine immobility, a right adnexal mass and right adnexal tenderness.

Female↗
PubMed1989

Student evaluation in obstetrics and gynecology clerkships in the United States and Canada, 1985.

Chairmen of departments of obstetrics and gynecology in the United States and Canada were surveyed to determine how students were evaluated in obstetric-gynecologic clerkships. Internally developed written and oral examinations and subject examinations from the National Board of Medical Examiners were used in more than one-half the departments. Written, oral and practical examinations were considered ideal evaluation methods.

Canada↗
PubMed1989

Outpatient chemotherapy of unruptured ectopic pregnancy.

This report describes an individualized, reduced dose, methotrexate (MTX) and citrovorum factor (CF) treatment regimen for outpatient management of unruptured ectopic pregnancy (EP). One hundred sixteen laparoscopically documented EPs, the majority (90%) of whom were symptomatic, were diagnosed from an Emergency Department population. Eighty of 116 (69%) were unruptured, 37 (46.3%) of whom were eligible for MTX-CF chemotherapy. One patient refused chemotherapy. Thirty-four of the 36 (94.4%) patients treated with MTX-CF had complete resolution of their ectopics, whereas 2 experienced rupture after chemotherapy, 1 of them 23 days after MTX initiation. While there were no major chemotherapy-related side effects, 3 of the 36 (8.3%) patients experienced minor side effects. The authors conclude that: (1) individualized dosing of outpatient MTX-CF chemotherapy for symptomatic EP can be safely managed, even in an indigent population; (2) rupture can occur up to 23 days after chemotherapy initiation; (3) fetal cardiac activity is an absolute contraindication to chemotherapy; (4) chemotherapy in patients with symptoms is of limited value because the disease is too far advanced; therefore, it is essential that the diagnosis of EP be established before symptom onset; and (5) chemotherapy offers no significant immediate advantages to outpatient laparoscopic surgery. However, increasingly reliable nonlaparoscopic diagnosis will soon give wider application to this approach.

Adult↗
PubMed1989

Endometrial sampling prior to hysterectomy.

Many gynecologists use routine endometrial sampling prior to hysterectomy to detect an unsuspected endometrial carcinoma. Gynecologists who formerly performed uterine curettage under anesthesia before hysterectomy now often use an outpatient endometrial sampling technique. Although safe, this procedure is complicated by discomfort, cost, and the risk of infection or uterine perforation. The purpose of this study was to determine the utility of pre-hysterectomy endometrial sampling. Between 1981-1985, 619 patients undergoing hysterectomy had preoperative endometrial sampling using Vabra aspiration, the Novak curette, or D&C. The endometrial sampling histology was compared with that in the hysterectomy specimen. There were 30 instances in which the endometrial sampling failed to identify either endometrial hyperplasia or carcinoma. In the two cases of endometrial carcinoma, D&C was the sampling method used. The findings of this study indicate that these three techniques of endometrial sampling are equal in their diagnostic capabilities. The results confirm the need for biopsy in patients with postmenopausal bleeding or with abnormal uterine bleeding at age 35 years or older. Our findings do not support routine endometrial sampling prior to hysterectomy.

Adolescent↗
PubMed1988

Short-course antibiotic therapy for the treatment of chorioamnionitis and postpartum endomyometritis.

The development of chorioamnionitis and endomyometritis has traditionally required treatment with broad-spectrum antibiotic therapy and extended hospitalization. In the past, once parenteral antibiotic therapy was instituted, it was continued for 5 to 7 days and until the patient remained afebrile for 48 hours. To shorten the length of hospital stay, the length of parenteral antibiotic administration was reduced and an oral antibiotic was added, to complete a 7- to 10-day course of therapy. We evaluated the effectiveness of an even shorter course of parenteral antibiotics without the addition of oral antibiotics. Forty-two patients with chorioamnionitis and 64 with endomyometritis were enrolled in the study. Antibiotic therapy was continued until the patient's temperature was less than 99.5 degrees F for 12 to 24 hours. Of the 106 patients, only two were readmitted, both as a result of superficial wound separation. No patient had an infectious complication. A shorter course of parenteral antibiotics without the addition of an oral antibiotic gives results comparable to the standard extended treatment regimens, but is advantageous with respect to cost, patient compliance, and hospital stay.

Adolescent↗
PubMed1988

Successful nonsurgical treatment of cervical pregnancy with methotrexate.

Although cervical pregnancy is a rare complication of gestation, previously described treatments are associated with a high morbidity. A case of cervical pregnancy successfully treated without surgery is presented. When the diagnosis is made early in gestation, the use of methotrexate should be considered for the treatment of cervical pregnancy when future fertility is desirable.

Abortion, Induced↗
PubMed1988

Splenosis: report of a case and review of the literature.

Splenosis is the autotransplantation of splenic tissue that usually follows traumatic rupture of the spleen. These splenic implants may be located anywhere within the peritoneal cavity. Although a relatively rare entity, when present these implants may mimic endometriosis or even metastatic carcinoma. As splenosis may compensate in part for the asplenic state, it is recommended that these splenic implants not be removed. It is important to correctly diagnose this condition to avoid unnecessary therapy. Diagnosis and management are discussed as well as a review of the literature.

Adult↗
PubMed1988

Adhesion formation and prevention after peritoneal injury and repair in the rabbit.

Fifteen rabbits were used to assess peritoneal healing and adhesion formation after suturing and stapling peritoneal edges or excising, cauterizing and abrading areas of peritoneum. Two weeks after peritoneal injury, the amount of adhesions formation was noted. Resection of peritoneal tissue with natural rehealing was preferable to reapproximation of free peritoneal edges with either staples or sutures.

Animals↗
PubMed1987

A histologic evaluation of peritoneal injury and repair: implications for adhesion formation.

A study of peritoneal healing after specific types of peritoneal injury was conducted in rabbits. Histologic specimens were examined at four, eight, 12, 24, and 48 hours, and at five, seven, and 14 days postperitoneal injury. Comparison of types of injury and attempts at peritoneal repair revealed differences in healing mechanisms. Histologic evidence of rapid reperitonealization was associated with those types of repair that involved minimal tissue necrosis and absence of foreign body reaction.

Animals↗
PubMed1986

A double-blind, controlled comparison of piperacillin and cefoxitin in the prevention of postoperative infection in patients undergoing cesarean section.

Data are presented from a randomized, double-blind multicenter trial (six study sites, involving 346 patients) in which piperacillin was compared with cefoxitin as a prophylactic agent for patients undergoing cesarean section. One hundred and sixty-nine patients received piperacillin and 177 received cefoxitin; in each instance, the total dosage was 6 grams. Strict criteria were used to evaluate safety and efficacy. The courses of all of the patients were evaluable for safety and 183 courses were evaluable for efficacy (136 efficacy-evaluable courses were from patients treated with piperacillin and 147, from those treated with cefoxitin). Postoperative infection was prevented in 89 per cent of the patients treated with piperacillin and in 93 per cent of the those treated with cefoxitin. The difference was not statistically significant. The data from each of the individual study sites, as well as the pooled data, indicated that the short term perioperative administration of piperacillin in patients undergoing a cesarean section was as safe and effective as cefoxitin with regard to prophylactic response, duration of hospitalization and the usage of other systemic antibiotics.

Adolescent↗