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Biomedical subjects

G D Adamson

Publications and source records attributed to G D Adamson.

48 records · Page 3Linked to original sources
PubMed1984

Certification of specialists: survey of candidates and review of the literature.

To evaluate the specialty certification process, the Canadian Association of Internes and Residents (CAIR) surveyed 634 candidates who had attempted the written and oral exams of the Royal College of Physicians and Surgeons of Canada. The results suggest that in-training evaluation is a more reliable and valid assessment of competence than the written and oral exams. There is a lack of well defined program objectives that are coordinated with the examinations. CAIR recommends that the present concept of an examination "hurdle" be replaced by different, integrated methods of assessment during training, and that an effective appeal mechanism be developed.

Canada↗
PubMed1982

Endometriosis: studies of a method for the design of a surgical staging system.

This study develops a method of identifying factors that predict pregnancy rates in patients with endometriosis. In 123 women, 60% had adhesions, 89% had implants, and 29% had endometriomas. The most common lesions were cul-de-sac implants (60%), ovarian implants (58%), and ovarian adhesions (55%). With no treatment, the life-table-estimated 3-year pregnancy rate was 40%; with oral contraceptives, 33%; and with surgery, 53%. Clustering techniques suggested new combinations of variables to be tested. We identified structures commonly involved simultaneously in a given patient, defined subgroups based on type of lesion, and developed a method to determine which factors were important in predicting outcome. In our patients, neither of two current methods of endometriosis staging predicted outcome. Further testing of the model systems suggested by the data may enable us to develop a staging system more predictive of pregnancy rates in endometriosis patients.

Adult↗
PubMed1982

Somatomedins in pregnancy: a cross-sectional study of insulin-like growth factors I and II and somatomedin peptide content in normal human pregnancies.

To explore the role of the somatomedins (SM) during human pregnancy, we have measured plasma levels of insulin-like growth factor I (IGF-I), IGF-II, and SM peptide content (SMPC) in 79 women in various stages of normal pregnancies. IGF-I and IGF-II were measured by specific RIAs, and SMPC was measured by a radioreceptor assay using human placental membranes. IGF-I and SMPC rose during pregnancy, showing a significant positive correlation with the length of gestation. Plasma levels of IGF-I in the third trimester averaged 324 ng/ml, a 33% increase over the first trimester average of 243 ng/ml (P less than 0.05). Although IGF-II did not correlate with the length of gestation, the third trimester average was significantly higher than the first trimester average (780 vs. 630 ng/ml; P less than 0.05). After delivery, both IGF-I and IGF-II levels rapidly dropped to levels significantly below those seen in the third trimester. The gestational rise in SMPC and plasma levels of both IGF-I and IGF-II supports the hypothesis that SM play a role in the regulation of fetal growth.

Adolescent↗
PubMed1980

Home or hospital births?

Advocates of home birth cite psychological and medical benefits in their demand for a different approach to birthing procedures. Opponents emphasize the risks of this approach and point to improved outcomes through medical progress available only in hospitals, as well as to recent, less positive European attitudes toward home births. A review of the literature shows that present data are limited and do not conclusively support either opinion. It is essential that the medical profession become actively involved in an objective analysis of the merits and deficiencies of home and hospital birth settings. This participation should ensure that new approaches to birth will maintain the highest possible standards in maternal, fetal, and neonatal welfare.

Attitude of Health Personnel↗
PubMed1980

Predicted ovulatory response to 2-brom-alpha-ergocryptine (CB-154) in amenorrhea-galactorrhea syndromes.

Adenohypophyseal function was evaluated in 20 consecutive patients with hyperprolactinemic amenorrhea-galactorrhea in an attempt to predict ovulatory response with 2-brom-alpha-ergocryptine (CB-154) therapy. Pituitary fossa tomography and response to insulin, thyrotropin-releasing hormone, and luteinizing hormone--releasing hormone were correlated with the return of ovulatory cycles. Fourteen of 15 patients demonstrating normal pretreatment sellar volume ovulated, compared with 0 of 5 showing increased volume. Thirteen of 14 with adequate adenophypophyseal reserve of growth hormone and luteinizing hormone ovulated, compared with 0 of 6 and 1 of 6, respectively, with inadequate reserve. Serum prolactin suppression to normal occurred in 19 of 20 patients but could not predict response. Only 2 of 10 patients receiving clomiphene citrate ovulated and neither conceived, while 8 of the 10 ovulated with CB-154 and 6 of 7 desiring pregnancy conceived. CB-154 is an effective "fertility drug" and response to therapy can usually be predicted.

Adult↗
PubMed1980

The effect of pregnancy on suspected pituitary adenomas after conservative management of ovulation defects associated with galactorrhea.

Thirty infertile patients with ovulation defects and galactorrhea conceived after medical therapy: four after clomiphene stimulation (with or without hCG) and 26 after receiving CB-154 (2-Br-alpha-ergocryptine or bromergocryptine). Pregnancies were followed closely; sellar tomography and perimetry were repeated at 36 weeks' and 8 weeks' post partum. One patient required transsphenoidal adenectomy because of acute pituitary enlargement. Two developed minimal asymptomatic fossa enlargement. Lactation was suppressed with Lactostat in the first eight patients delivered; hyperprolactinemia, amenorrhea, and galactorrhea recurred. Five of eight showed asymptomatic enlargement of the sella. Bromergocryptine was used to suppress lactation in the rest. Long-term bromergocryptine therapy resulted in the restoration of euprolactinemic ovulatory cycles in all patients. These data suggest that patients with ovulation defects associated with galactorrhea can conceive with medical therapy now available. However, there is a risk of significant pituitary enlargement during pregnancy and the puerperium. Lactation should be suppressed with bromergocryptine.

Adenoma↗
PubMed1980

Rhythmic fetal movements.

In recent years, studies have confirmed that rhythmic movement of the fetal torso occurs. These movements have been investigated with respect to a large number of factors, but no conclusive evidence of their significance has been documented. Much effort has been directed at developing better methods of measuring these movements. In this paper, examples of preliminary clinical results utilizing an advanced real-time B-scan phase-locked tracking scheme are presented. These traces represent a significant advancement in our ability to record rhythmic fetal torso movements and should enable us to enhance our knowledge of the physiology and clinical significance of this phenomenon.

Adult↗
PubMed1980

A practical approach to the patient with dysmenorrhea.

Pelvic pain associated with the menses may be a result of physiologic problems, premenstrual tension syndrome, primary dysmenorrhea or secondary dysmenorrhea. All of these conditions may be caused by both physiologic and psychologic factors. An accurate diagnosis requies a complete history and physical examination and astute assessment of predisposing or aggravating conditions. Diagnosis has been improved through the use of laparoscopy, hysteroscopy, hysterosalpingography and dilatation and curettage. Treatment has been revolutionized with the use of oral contraceptives and prostaglandin synthesis inhibitors. These diagnostic and therapeutic advances now enable the sympathetic physician to effectively evaluate and treat almost all patients with menstrually related pelvic pain. When all of these approaches fail, the physician should consider psychiatric consultation or referral to pain clinic or gynecologist with special interest in this field.

Contraceptives, Oral, Synthetic↗
PubMedDate not supplied

Pain of endometriosis: effects of nafarelin and danazol therapy.

OBJECTIVE: To compare the efficacy of nafarelin acetate with danazol in the treatment of dysmenorrhea, dyspareunia, and pelvic pain associated with endometriosis. DESIGN: Prospective, randomized double-blind controlled study. PATIENTS, SETTING, TREATMENTS: Two hundred thirteen patients aged 18 to 48 with laparoscopically confirmed pelvic endometriosis and dysmenorrhea, dyspareunia or pelvic pain were randomly assigned to 6 months of treatment with either nafarelin acetate 800 micrograms per day or 400 micrograms per day, or danazol 800 micrograms per day. MAIN OUTCOME MEASURES: The percentage of patients with dysmenorrhea, dyspareunia or pelvic pain before treatment who still had these symptoms after 6 months of treatment and 6 months following completion of treatment. RESULTS [table: see text] CONCLUSIONS: Nafarelin acetate and danazol both provided significant relief of dysmenorrhea, dyspareunia, and pelvic pain during treatment and for 6 months following treatment in women with endometriosis.

Administration, Intranasal↗
PubMedDate not supplied

Can staging systems for endometriosis based on anatomic location and lesion type predict pregnancy rates?

OBJECTIVE: Development of an endometriosis classification system based on empirically derived stages of the disease, to supplant the Acosta (1973), Kistner (1977), and American Fertility Society (1985) classifications, which are based on arbitrarily defined stages and often fail to predict pregnancy rates. DESIGN: Retrospective cohort analysis. SETTING: University infertility clinic. PATIENTS AND METHODS: Women with endometriosis and > or = 1 year of infertility. Diagnosis of endometriosis was made by direct visualization, with type of lesion (implant or adhesion) at multiple sites recorded; total of 202 patients. All diagnosed infertility problems were treated based on semen analysis, postcoital test, and endometrial biopsy. Pregnancy rates were analyzed by life-table and cluster analyses, and combinations of site and type were also analyzed by Cox's regression model. RESULTS: No individual anatomic site or type significantly affected prognosis, nor was any cluster useful for predicting outcome. CONCLUSION: Anatomic site and type of lesion are insufficient for predicting fertility when used as sole components of a clinical staging system for endometriosis.

Adult↗