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Biomedical subjects

H W Ory

Publications and source records attributed to H W Ory.

At least 55 records · Page 3Linked to original sources
PubMed1982

Deaths associated with laparoscopic sterilization in the United States, 1977-79.

In 1979, the Centers for Disease Control began epidemiologic surveillance of deaths associated with tubal sterilization as part of an effort to assess the mortality risks associated with different methods of fertility control. The surveillance system identified nine deaths following laparoscopic sterilization in the United States from 1977 through 1979. The causes of these deaths and how some of them might have been averted are discussed.

Female↗
PubMed1981

The impact of laparoscopy on tubal sterilization in United States hospitals, 1970 and 1975 to 1978.

During the 1970s, tubal sterilization became an important method of fertility control in the United States. Over the same period laparoscopy emerged as an important innovation, one that has been associated with both a shift from postpartum to interval sterilization and a dramatic decrease in length of hospital stay required for sterilization. The use of laparoscopy has also been associated with an increase in hospital-based outpatient sterilization, particularly in the West. The number of sterilizations performed in hospitals and the use of laparoscopy for interval sterilization in hospitals both appear to have peaked. The laparoscope is an example of a technologic advance that has reduced medical care costs.

Adolescent↗
PubMed1981

The declining length of hospitalization for tubal sterilization.

We analyzed factors affecting the length of hospital stay for tubal sterilization in 1970 and 1975, using data from the National Center for Health Statistic's Hospital Discharge Survey. The average hospital stay for tubal sterilization declined from 6.5 nights in 1970 to 4.0 nights in 1975. Pregnancy status, region of residence, and race were important determinants of the length of hospital stay. One technological innovation, the use of the laparoscope for tubal sterilization, accounted for 39% of the total length-of-stay reduction from 1970 to 1975. General changes in medical care from 1970 to 1975, combined with the introduction of laparoscopy, averted 1,363,000 nights of hospitalization for tubal sterilization in 1975. Conservatively, this resulted in a savings of more than $200 million. About $80 million of this savings was directly attributable to laparoscopy. Even greater savings could have been achieved if sterilization techniques requiring shorter hospital stays had been more widely used.

Black People↗
PubMed1981

Deaths associated with laparoscopic sterilization by unipolar electrocoagulating devices, 1978 and 1979.

In 1978 and 1979, two women in the United States were reported to have died from electrical complications following sterilization with unipolar coagulating devices. Both deaths followed apparent bowel injuries occurring at the time of sterilization. Numerous reports have documented the electrical accidents associated with unipolar electrocoagulation. Because unipolar electrocoagulation has greater risk for these complications than alternative sterilization techniques, without proved greater benefits, we question the need for continuing its use in female sterilization.

Adult↗
PubMed1981

Ectopic pregnancy and intrauterine contraceptive devices: new perspectives. The Women's Health Study.

In the period 1965 through 1977 the number of ectopic pregnancies in the United States tripled. A collaborative multicenter case-control study was set up to examine ectopic pregnancy as well as several other suspected complications related to use of an intrauterine contraceptive device (IUD). To determine to what extent IUD use might be related to this increase, the authors analyzed 615 women who had had an ectopic pregnancy and 3453 controls. Most important, women who had never used an IUD were equally likely to have an ectopic pregnancy as women who had used an IUD. Looking at the comparative risks for current contraceptive users, all current users, including IUD users, were less likely to have had an ectopic pregnancy than women not currently using contraceptives. Likelihood of ectopic pregnancy was the same regardless of whether a copper-containing or an inert plastic IUD was used. Among current IUD users, those who had used an IUD for a long time (25 months or more) were 2.6 times as likely to have had an ectopic pregnancy as short-term (less than 25 months) users. This difference between long- and short-term IUD users persisted for some time (not longer than 1 year) after removal of the IUD. Use of the IUD probably did not play a role in the recent tripling of ectopic pregnancies in the United States.

Adolescent↗
PubMed1980

Ethinyl estradiol and conjugated estrogens as postcoital contraceptives.

Five study centers enrolled 1,311 women seeking postcoital contraception methods. Ethinyl estradiol was administered at 5 mg/day and conjugated estrogens at 30 mg/day for five consecutive days starting within 72 hours of unprotected coitus. Eleven pregnancies occurred in the 976 women who had a single unprotected coitus at midcycle. Based on published information, 69 pregnancies would have been expected if no contraceptives were used. Although both treatments were effective in preventing pregnancy, ethinyl estradiol seemed to be more effective. At the two centers alternately prescribing both drugs, none of 137 women treated with ethinyl estradiol became pregnant, while six of the 132 given conjugated estrogens became pregnant. Women whose treatment commenced on the first postcoital day seemed to have lower pregnancy rates than those whose medication was delayed to the second or third postcoital day regardless of which drug was used. Side effects were mainly limited to nausea that occurred in 70% and vomiting that was experienced by 33% of all women treated.

Adolescent↗
PubMed1980

The association of depo-medroxyprogesterone acetate and breast cancer.

The use of depo-medroxyprogesterone acetate (DMPA) as an injectable contraceptive for women has continued to be controversial for over 10 years. The U.S. Food and Drug Administration has not approved it for contraceptive use but the World Health Organization has. We undertook a case-control study to clarify the possible association of breast cancer and DMPA use. Subjects were selected from women enrolled in the Grady Memorial Hospital Family Planning Clinic in Atlanta, Georgia, from 1967 to 1979. The risk of breast cancer in DMPA users compared to nonusers is identical. The small number of women with breast cancer, the short average exposure to DMPA, and the lack of detail about the subjects themselves caused us to interpret our results cautiously. However, it seems reasonable to conclude that short-term use of DMPA among black women is not associated with any increased risk of breast cancer.

Adult↗
PubMed1980

Demographic trends of tubal sterilization in the United States 1970-75.

An estimated 2,300,000 women in the United States underwent tubal sterilizations in 1970-1975. During this period the rate of tubal sterilizations per 1,000 women 15-44 years of age rose from 4.7 to 11.7. We studied the influence on sterilization trends of four demographic variables: age, region of residence, race, and marital status. Women 25-34 years of age were twice as likely to be sterilized as older or younger women. Rates were about 40 per cent lower in the West than in the rest of the country. In 1970 rates for non-white women were double those for Whites. Rates for Whites rose faster than those for non-Whites, however, and by 1975 the rates were similar for the 2 races. Non-Whites still tended to be sterilized about one year younger than Whites, and marked regional differences existed in the race-specific rate trends. Rates rose more sharply for previously married women than for currently married women; by 1975 rates for these two groups were similar. Never married women had rates about 1/7 of those of currently married and previously married women. Among the never married, tubal sterilization rates for non-Whites were nine times higher than those for Whites.

Adolescent↗
PubMed1980

Intrauterine device termination rates and the menstrual cycle day of insertion.

World-wide clinicians apparently prefer to insert the intrauterine device (IUD) during the bleeding phase of the menstrual cycle. To examine the benefits and risks of inserting IUDs at various times during the menstrual cycle, data on over 9000 women having copper T-200 IUD insertions were analyzed. During the first 2 months after IUD insertion: 1) rates of IUD expulsion are lower the later in the menstrual cycle ;he IUD is inserted; 2) rates of IUD removal for pain and bleeding and rates of accidental pregnancy, are higher the later in the menstrual cycle IUD is inserted, particularly after day 17. The present analysis suggests that the above are probably causal associations. It is estimated that 1000 insertions before day 11 will result in 9 more terminations of IUD use for expulsion, pain and bleeding, and accidental pregnancy than if the insertions are done after day 11. Furthermore, the copper T-200 IUD can be inserted with relative safety on the day it is requested if the woman's history indicates that she is unlikely to be pregnant. There is no justification for a blanket policy of inserting IUDs only during the menses.

Adult↗
PubMed1979

Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.

Adolescent↗
PubMed1978

Febrile spontaneous abortion and the IUD.

A case-control study was done to determine the risk and pathogenesis of febrile spontaneous abortion for intrauterine device (IUD) wearers compared to non-wearers. Four groups of women coming to a large city hospital between 1970 and 1975 were compared: 1) women presenting with febrile spontaneous abortion, 2) women presenting with afebrile spontaneous abortion, 3) women presenting with afebrile spontaneous abortion which subsequently became febrile, and 4) women delivering a live infant. Pregnant women with an IUD in situ had a 5-fold higher risk of both febrile and afebrile spontaneous abortion compared to pregnant women without an IUD in situ. Women who had a spontaneous abortion that shifted from afebrile to febrile were somewhat more likely to be IUD wearers than the other 2 spontaneous abortion groups. In our study population, the increased risk of febrile spontaneous abortion for IUD wearers appeared primarily due to the increased risk of the spontaneous abortion event itself, rather than a primary IUD-related infection causing febrile spontaneous abortion.

Abortion, Spontaneous↗
PubMed1978

World Health Organization studies of prostaglandins versus saline as abortifacients. A reappraisal.

The World Health Organization (WHO) Task Force on the Use of Prostaglandins for the Regulation of Fertility has sponsored a series of randomized clinical trials and case-series investigations to assess the effectiveness and safety of prostaglandins as abortifacients. Our reanalysis of the WHO studies found the prostaglandins to be faster and more hazardour than hypertonic saline as intraamniotic abortifacients. Moreover, studies by the Center for Disease Control imply that dilatation and evacuation (D&E) may be more effective, safe, convenient, and inexpensive than prostaglandins for abortions after 12 weeks' gestation, especially in the 13- to 16-week interval. For gestations of greater than or equal to 17 weeks, the occurrence of live births in prostaglandin-induced abortions has produced serious legal and ethical problems in the United States. Until the effectiveness and safety of other prostaglandins regimen approach that of D&E, we feel that D&E should be the index of comparison against which newer methods of inducing abortion are tested.

Abortion, Induced↗
PubMed1978

A review of the association between intrauterine devices and acute pelvic inflammatory disease.

Six controlled epidemiologic studies of the association between intrauterine device (IUD) use and development of acute pelvic inflammatory disease (PID) are reviewed. The strength and weaknesses of each study are discussed as well as the consistencies of the results. All six studies point in the same direction: IUD use is associated with approximately a three-to fivefold increased risk of PID. The consistency of the association in six different studies, in three different countries and by five different investigators is strong evidence that the association is one of cause and effect. Evidence is presented for the biologic plausability of the association. There also is evidence that copper IUDs do not appear to offer any protection from gonococcal PID. Teenagers appear as likely as older women to be similarly affected by the use of IUDs. There is the intriguing but uncomfirmed suggestion that nulliparous IUD users are more likely to suffer from acute PID than are multiparous users. A public health measure that would control this effect of IUD use is to decrease the use of IUDs in populations at high risk of PID.

Adolescent↗
PubMed1977

A case-control study of uterine perforations documented at laparoscopy.

A case-control analysis was done of 19 cases of uterine perforations which occurred during laparoscopic sterilization at Gardy Memorial Hospital in Atlanta, between February 1, 1974, and January 31, 1976. The over-all perforation rate, 30.4 per 1,000 procedures, is three to 30 times that commonly reported for dilatation and suction or sharp curettage (D&C) of the uterus. Case women were 10.4 times more likely than control women to combine two of the following three characteristics: age greater than 34, parity greater than 4, and obesity greater than 20 per cent above the ideal body weight for height. Surgeons with fewer months of formal Ob/Gyn training were no more likely than their relatively more experienced colleagues to perforate the uterus. No other risk factors were delineated. It is believed that the perforation rate, higher in this study than in earlier ones, reflects better ascertainment of perforations. The bleeding site was always visualized with the laparoscope in this series.

Adult↗
PubMed1977

Association between oral contraceptives and myocardial infarction. A review.

Analysis of the association between oral contraceptive use and the development of myocardial infarction in women less than 50 years of age shows that cigarette smoking is the most important factor in increasing the likelihood of myocardial infarction. This effect is independent of oral contraceptive use but oral contraceptive use also appears to be a risk factor; however, their use in the absence of other predisposing factors appears to have only a small effect on increasing the risk of dying from myocardial infarction. This small increase is of the same order of magnitude as the increased risk of death from thromboembolic disease. Oral contraceptive users more than 30 years of age who have other factors that increase the likelihood of myocardial infarction appear to have a substantially higher death rate.

Adult↗
PubMed1977

Oral contraceptives and hepatitis. A report from the Boston Collaborative Drug Surveillance Program, Boston University Medical Center.

History of oral-contraceptive use was compared between 68 women with a hospital-discharge diagnosis of acute hepatitis and 1142 women who had been admitted for other reasons to the same hospitals during the same period. The risk of admission to hospital for hepatitis for users of oral contraceptives was estimated to be 3-3 times that for non-users (95% confidence interval, 1-8--6-3). This overall association was almost entirely attributable to a strong association among women under 25 years of age. Among users of oral contraceptives, duration of use tended to be shorter for hepatitis patients than for controls.

Acute Disease↗