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Biomedical subjects

J F Hulka

Publications and source records attributed to J F Hulka.

At least 19 recordsLinked to original sources
PubMed1992

Intrauterine pressure and fluid absorption during continuous flow hysteroscopy.

OBJECTIVES: Our objectives were to document the causes of fluid absorption during continuous flow hysteroscopy and to determine under which operative conditions fluid overload may occur. STUDY DESIGN: Fifteen patients underwent operative hysteroscopy with 2% ethanol solution for uterine distention. Absorption of fluid was measured by blood alcohol, sodium, osmolarity, and hematocrit. Intrauterine pressures were measured with an obstetric pressure catheter. RESULTS: Alcohol absorption was noted in one patient during a myoma resection. Two additional patients, not in the study, had fluid absorption after partial perforations of the uterus. Under normal operative conditions there were no changes in sodium, osmolarity, or hematocrit. Intrauterine pressures ranged from 45 to 75 mm Hg. Experimental pressures of greater than 200 mm Hg were not associated with fluid absorption. CONCLUSIONS: Intravasation of fluid may occur through open uterine venous channels with extensive resections and under low pressures in the presence of unrecognized perforations.

Absorption↗
PubMed1992

Management of ovarian masses. AAGL 1990 survey.

The American Association of Gynecologic Laparoscopists (AAGL) membership was surveyed on the use of laparoscopy in the management of persistent ovarian masses in 1990. A total of 13,739 laparoscopies were performed for this indication. Ninety-six percent of the respondents performed laparoscopy for this indication on premenopausal women only. Among respondents performing laparoscopy for suspected cancer, there was a 14% conversion rate to laparotomy, compared to 9% among those who performed direct laparotomies when cancer was suspected. An overall incidence of 4 per 1,000 cases of stage I ovarian cancer was found, and about 70% of women with persistent adnexal masses were managed by laparoscopy alone. The risks to women with cancer, as well as the benefits to those without, are discussed.

Female↗
PubMed1991

Gas and steam sterilization of assembled versus disassembled laparoscopic equipment. Microbiologic studies.

Current recommendations specify disassembly of most laparoscopic equipment prior to sterilization. Surgical technicians, however, are often unfamiliar with the proper assembly of laparoscopic instruments, resulting in possible patient injury from equipment malfunction. Therefore, we tested the hypothesis that disassembled laparoscopic equipment is sterilized more thoroughly than assembled equipment. We inoculated internal sites on laparoscopic instruments prior to assembly with bacterial spores resistant to ethylene oxide and steam sterilization. We also manually cleaned the equipment after inoculation prior to steam sterilization of both the assembled and disassembled instruments. The control instruments were stored at room temperature during test sterilization runs. No vegetative bacteria survived ethylene oxide or steam sterilization in assembled equipment, but despite a significant reduction, spore-forming bacteria could be cultured from the assembled equipment. If the instruments were washed before steam sterilization, there was similar spore clearance in the assembled and disassembled instruments, with both groups attaining a high level of disinfection. Our data suggest that disassembly, cleaning and proper assembly of equipment prior to sterilization present no more risk of infection transmission than does disassembly during prevacuum steam sterilization. The method provides properly assembled and functioning equipment at the time of surgery.

Clinical Protocols↗
PubMed1991

Modified endometrial ablation: electrocoagulation with vasopressin and suction curettage preparation.

Patient preparation and a modified operative technique are described for electrocoagulation ablation of the endometrium using a roller-bar electrode. No preoperative or postoperative endometrial suppression was used. Rather, the endometrial cavity was denuded by suction curettage just before ablation, which was performed in the early proliferative phase of the menstrual cycle. Lidocaine paracervical block containing vasopressin was injected at the start of the procedure to control pain and to minimize bleeding and irrigation fluid absorption. Pulsed irrigation of the uterus was used to improve visibility through uterine debris and the bubbles generated by the electrical current. The first 20 patients who had electrocoagulation ablation of the endometrium with these modifications were compared with the first 18 patients who had laser coagulation ablation using standard technique and preoperative endometrial suppression. Compared with the laser method, the modified coagulation method resulted in a comparable rate of satisfactory bleeding decrease at 6 months (90 versus 94%), but involved a clinically significant reduction in total anesthesia time (66.8 versus 117.3 minutes) and volume of irrigation fluid used (5.7 versus 15.9 L).

Adult↗
PubMed1990

A simple irrigator-aspirator cannula for laparoscopy: the Stewart system.

An irrigator-aspirator cannula (Stewart system) that may be assembled from common operating room supplies is described for use during operative laparoscopy. The unit consists of a disposable three-way stopcock inserted into a standard 5-mm suction probe. One stopcock port is connected to an irrigation fluid source and pressurized with an inflatable cuff; the other stopcock port is attached to wall suction. Flow rates were determined comparing two types of influx tubing, two different heights of the fluid source, and a range of inflatable cuff pressures. The flow rate of this system with urologic irrigation tubing at pressures of 150 mmHg was comparable to that of a commercially available irrigator-aspirator system. The instrument has been used in 15 routine and emergency operative laparoscopy cases and provides adequate aquadissection, rapid and easy maintenance of a clean operative field, smoke evacuation during laser vaporization, and atraumatic suction traction of tissues.

Female↗
PubMed1990

American Association of Gynecologic Laparoscopists' 1988 membership survey on laparoscopic sterilization.

The 1988 membership survey of the American Association of Gynecologic Laparoscopists (AAGL) indicated that the membership continued to perform fewer sterilizations than previously reported. The respondents reported performing 30,480 sterilizations, 41,160 diagnostic laparoscopies and 13,920 hysteroscopies. The distribution of laparoscopic sterilizations by method of tubal occlusion did not change appreciably since 1985. Complications from diagnostic laparoscopy were consistently higher than those after sterilization; two deaths (4.8 per 100,000 procedures) were identified after diagnostic laparoscopy, and no deaths were reported after sterilization. The relative likelihood of ectopic pregnancy was substantially greater after coagulation procedures than after mechanical ones. The decrease in the membership's performance of laparoscopic sterilization was occurring during a relative increase in the performance of newer diagnostic and therapeutic endoscopic procedures.

Female↗
PubMed1990

American Association of Gynecologic Laparoscopists' 1988 membership survey on operative laparoscopy.

The American Association of Gynecologic Laparoscopists' (AAGL) 1988 membership survey on operative laparoscopy had a response rate of 24%. A total of 880 respondents reported performing 36,928 operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer procedures. The most frequently reported conditions managed with operative laparoscopy were endometrial implants, extensive adhesions and ovarian cysts. Most operative laparoscopies were performed because of infertility (40%) or pelvic pain (41%). The overall serious complication rate was 15.4 per 1,000 procedures. Complications that occurred in greater than 1 per 1,000 procedures included hospitalization greater than 72 hours, persistent human chorionic gonadotropin titer elevation after ectopic pregnancy, hospital readmission and unintended laparotomy to manage bowel injury, urinary tract injury or hemorrhage. Two deaths (5.4 per 100,000 procedures) were reported.

Gynecology↗
PubMed1990

American Association of Gynecologic Laparoscopists 1988 Membership Survey on Operative Laparoscopy.

The American Association of Gynecologic Laparoscopists' (AAGL) 1988 Membership Survey on Operative Laparoscopy had a response rate of 24%. A total of 880 respondents reported performing 36928 operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer procedures. The most frequently conditions managed by operative laparoscopy were endometrial implants, extensive adhesions, and ovarian cysts. Most operative laparoscopies were performed because of infertility (40%) or pelvic pain (41%). The overall serious complication rate was 15.4 per 1,000 procedures. Complications which occurred in more than 1 per 1,000 procedures included hospitalization greater than 72 hours, persistent HCG titer elevation after ectopic pregnancy, hospital readmission, and unintended laparotomy to manage bowel injury, urinary tract injury, and hemorrhage. Two deaths (5.4 per 100,000 procedures) were reported.

Female↗
PubMed1990

American Association of Gynecologic Laparoscopists 1988 Membership Survey on Laparoscopic Sterilization.

The 1988 Membership Survey of the American Association of Gynecologic Laparoscopists (AAGL) indicated that the membership continues to perform fewer sterilizations than previously reported. The respondents reported performing 30,480 sterilizations, 41,160 diagnostic laparoscopies and 13,920 hysteroscopies. The distribution of laparoscopic sterilizations by method of tubal occlusion has not changed appreciably since 1985. Complications from diagnostic laparoscopy are consistently higher than those after sterilization; two deaths (4.8 deaths per 100,000 procedures) were identified after diagnostic laparoscopy and no deaths were reported after sterilization. The relative likelihood of ectopic pregnancy is substantially greater after coagulation procedures than after mechanical ones. The decrease in membership performance of laparoscopic sterilization is occurring at the same time as a relative increase in the performance of newer diagnostic and therapeutic endoscopic procedures.

Female↗
PubMed1990

Staging of adnexal adhesions: a brief history.

Arriving at a system for staging adnexal disease is a scientific, clinical and political process which has already begun. Gynecologic oncologists started this process in 1967, and are still arriving at refinements and adjustments in the staging of cancer after 22 years. To rigorously evaluate new medical and surgical technologies in the treatment of adhesions it is important for infertility surgeons to continue the process of working towards a classification system, keeping in mind that it will take a long time.

Adnexal Diseases↗
PubMed1990

American Association of Gynecologic Laparoscopists 1988 Membership Survey on Operative Hysteroscopy [correction of hysterectomy].

The 1988 American Association of Gynecologic Laparoscopists' (AAGL) Membership Survey on Operative Hysteroscopy had a 19% response rate. A total of 377 respondents reported performing 7,293 operative hysteroscopies. The number of procedures reported per respondent ranged from 1 to 325; 75% of physicians reported performing 20 or fewer procedures. In 1988, a small number of practitioners performed a large number of procedures. Directed biopsy and polypectomy through the hysteroscope were the procedures most commonly reported. Most operative hysteroscopies were performed for a complaint of either abnormal bleeding (57%) or infertility (27%). The most frequently reported complication was uterine perforation not requiring transfusion (13 per 1,000 procedures). More serious complications which occurred in at least 1 per 1,000 procedures included water intoxication or pulmonary edema, hospital readmission, hospitalization greater than 72 hours, and transfusion for hemorrhage.

Female↗
PubMed1990

American Association of Gynecologic Laparoscopists' 1988 membership survey on operative hysteroscopy.

The 1988 American Association of Gynecologic Laparoscopists' membership survey on operative hysteroscopy had a 19% response rate. A total of 377 respondents reported performing 7,293 operative hysteroscopies. The number of procedures reported per respondent ranged from 1 to 325; 75% of physicians reported performing 20 or fewer procedures. In 1988 a small number of practitioners performed a large number of procedures. Directed biopsy and polypectomy through the hysteroscope were the procedures reported most commonly. Most operative hysteroscopies were performed for a complaint of either abnormal bleeding (57%) or infertility (27%). The complication reported most frequently was uterine perforation not requiring a transfusion (13 per 1,000 procedures). More serious complications that occurred in at least 1 per 1,000 procedures included water intoxication or pulmonary edema, hospital readmission, hospitalization greater than 72 hours and transfusion for hemorrhage.

Gynecology↗
PubMed1989

Cervical dilation: a comparison of Lamicel and Dilapan.

A randomized prospective double-blind study compares the dilatation achieved with Lamicel and Dilapan synthetic dilators in the setting of second-trimester elective abortions. A total of 51 patients with estimated gestational ages of 13 to 16 weeks had either Lamicel dilators or Dilapan dilators placed approximately 20 hours before dilation and evacuation. The placement and removal were by someone other than the operator. The operator then recorded the number of the Pratt dilator at which resistance was first met. The mean for the Lamicel group was French size 38.5 +/- 6.4. The mean for the Dilapan group was French size 50.4 +/- 9.6. In the Dilapan group there were six patients for whom cervical resistance was never reached. The results indicate a significantly greater dilatation was achieved with Dilapan dilators. This correlation was also noted within the subsets of nulliparous and parous patients.

Abortion, Induced↗
PubMed1988

Sterilization reversal: results of 101 attempts.

One hundred one patients underwent reversal of sterilization. Among the 79 patients with a known outcome, the successful pregnancy rate was 35%. In contrast, the tubal patency rate was 91%. An analysis of standard preoperative fertility factors failed to reveal their predictive value. Total motile sperm counts of greater than 60 x 10(6) resulted in more successful pregnancies than counts below this number (p less than or equal to 0.005). The operating microscope did not have any advantage over loupes. Patients with one tube greater than 7 cm in length had a delivery rate of 75%, compared with 16% for those with shorter tubes (p less than or equal to 0.001). Eighty percent of patients with a distal segment of the anastomosis that included part of the isthmic tube had deliveries (p less than or equal to 0.029). In contrast, all ectopic pregnancies were associated with a distal segment consisting only of ampulla; the risk of ectopic pregnancy after patent ampullary anastomosis was 23% (p less than or equal to 0.05).

Fallopian Tube Patency Tests↗
PubMed1988

Pratt dilators: resistance at 9 mm is an instrumentation artifact.

A previous study reported frequent resistance of the cervix at 9 mm during dilation and interpreted the resistance as the beginning of a tear of the internal os. A more recent identical study did not indicate such tears. Measurement of the dilators revealed that the set used in the previous study had uneven increments in diameter with a wide variation between size 25 and size 27 dilators. Increments of newer dilators are more even, and newer dilators reveal a more even progression of cervical resistance with increasing diameter.

Abortion, Induced↗
PubMed1987

Transuterine resection of fibroids: a new approach to the management of submucous fibroids in selected patients.

Transuterine resection of fibroids is an effective alternative to hysterectomy in patients with uterine bleeding secondary to submucous fibroids. To date we have performed this procedure in 3 patients. In 2 patients transuterine resection was performed for uterine bleeding with a successful outcome. In the third patient the procedure was performed to treat infertility and the outcome is not yet known. The procedure should be performed by the combined efforts of a urologist and gynecologist.

Adult↗