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Biomedical subjects

J M Wheeler

Publications and source records attributed to J M Wheeler.

At least 55 records · Page 3Linked to original sources
PubMed1989

The surgical management of endometriosis.

Surgical treatment is an important option in treatment of all stages of endometriosis. Surgical options of operative laparoscopy, lasers, laparotomy technique, and perioperative medical treatment are discussed in the contexts of both published literature and the authors' clinical experience.

Endometriosis↗
PubMed1989

Epidemiology of endometriosis-associated infertility.

To explain the great discrepancy between the prevalence estimates for endometriosis in the literature, a series of operations was studied from a combined patient population derived from a 21-physician collaborative. The reported discrepancy appears to have to do more with operative indications and technique than with an actual increase in the prevalence of endometriosis over time. The least-biased estimate for the overall prevalence of endometriosis in reproductive-age women is about 10% on the basis of a study of women operated on for symptoms other than those associated with endometriosis. Accepted criteria for causality applied to the endometriosis literature failed to demonstrate an association between endometriosis and infertility.

Endometriosis↗
PubMed1988

Office hysteroscopy.

Several forces are acting on hysteroscopic surgeons to promote the 100-year-old practice of office hysteroscopy. It remains the surgeon's responsibility to triage patients properly to the office or hospital, and it is hoped that the principles discussed herein are helpful in that thinking. Office hysteroscopy implies more adaptability in the surgeon than in the surgeon's instruments. The indications, contraindications, and technique of office hysteroscopy do not differ significantly from those of hysteroscopy in the hospital on an awake patient. With current economic forces, instrumentation, and surgeon interest and training, office hysteroscopy will probably grow in popularity over the next several years.

Ambulatory Surgical Procedures↗
PubMed1985

Transperitoneal migration of the ovum. A case report.

Transperitoneal migration of ova resulting in intrauterine pregnancy is probably a common event yet rarely observed. Occasionally a woman lacks an ovary and contralateral fallopian tube; one such patient successfully carried an intrauterine pregnancy to term.

Adult↗
PubMed1983

Recurrent endometriosis: incidence, management, and prognosis.

The rate of recurrence of endometriosis after treatment has varied from 2% to 47% in published reports. In order to determine whether a meaningful prognosis for recurrence can be rendered, 423 patients treated with conservative surgical procedures from 1967 to 1982 were followed as outpatients. From among these, 62 patients underwent reoperation. Annual rates of recurrence based on findings at reoperation ranged from 0.9% in the first postoperative year to 13.6% in the eighth postoperative year. The cumulative 3- and 5-year recurrence rates were 13.5% and 40.3%, respectively. Severity of disease was not predictive of recurrence. Pregnancy did not preclude, but did delay, recurrence. Forty-seven percent of infertile patients with recurrent endometriosis conceived after a second conservative operation. Of 20 patients who had a second conservative operation for endometriosis, 20% required a third laparotomy. This is the first study of postoperative recurrent endometriosis to utilize a control group and the first to report annual rates of recurrence and reoperation.

Adolescent↗
PubMed1983

The relationship of endometriosis to spontaneous abortion.

Seventy-seven of 226 pregnancies (34%) conceived prior to conservative surgical treatment of endometriosis ended in first-trimester spontaneous abortion. Mild endometriosis was associated with a significantly greater proportion of abortions (49% in 87 pregnancies) than moderate (25% in 32 pregnancies) or severe disease (24% in 107 pregnancies). Following operation, only 7 of 76 pregnancies (9%) conceived by the same group of patients ended in spontaneous abortion. In primary infertility patients, 17 of 128 pregnancies (13%) ended in abortion following operation. The postoperative abortion rates were not significantly different between degree of severity of endometriosis. Speculation is presented on the mechanism of the increased preoperative abortion rate in patients with mild endometriosis.

Abortion, Spontaneous↗
PubMed1981

Regional blood flows in newborn lambs during endotracheal continuous airway pressure and continuous negative pressure breathing.

Cardiovascular changes resulting from continuous distending alveolar pressure during endotracheal intubation (CPAP) and continuous negative pressure (CNP) were studied in two groups of healthy newborn lambs at 6 and 11 mm Hg and -6 and -11 mm Hg, respectively. Heart rate, left ventricular pressure, and arterial blood gases were unchanged in each group. Cardiac output decreased 16 and 15% at 6 and 11 mm Hg CPAP (P less than 0.05), respectively, whereas a fall of 9% occurred at both -6 and -11 mm Hg CNP (P greater than 0.05). Central venous pressure (mm Hg) rose from a control value of 7.0 +/- 1.4 (mean +/- S.E.) to 11 +/- 3.1 and 12 +/- 2.7 at 6 and 11 mm Hg CPAP (P less than 0.025), respectively, and decreased from a control of 7.7 +/- 0.7 to 5.8 +/- 0.5 at -6 mm Hg CNP and 4.8 +/- 1.3 at -11 mm Hg CNP (P less than 0.05). Jugular venous pressure also rose progressively with increasing CPAP (P less than 0.05), but was unchanged during CNP. Regional blood flow to the liver fell at both 6 and 11 mm Hg CPAP, whereas renal and gastrointestinal blood flows showed a tendency to decrease at 11 mm Hg CPAP. The removal of CPAP resulted in a prompt return of venous pressure, cardiac output, and regional blood flows to control values. Reductions in blood flows to the gastrointestinal tract at -6 mm Hg CNP and spleen at -11 mm Hg CNP were observed; blood flows returned toward control values when CNP was removed.

Animals↗
PubMed1981

Postoperative danazol therapy in infertility patients with severe endometriosis.

The value of perioperative medical therapy in the management of infertility patients with severe endometriosis is uncertain. Previous reports of pre- or postlaparatomy danazol provide no clear direction regarding efficacy. Of 200 consecutive cases of severe endometriosis, 138 infertility patients were selected for study. One hundred nineteen patients, the control group, had laparotomy alone; 19 had laparotomy followed immediately by danazol therapy. The pregnancy rate in the control group was 30% (36/119) versus 79% (15/19) in the study group, (P less than 0.001). The results of this preliminary report indicate that danazol treatment in the immediate postlaparotomy period of patients with severe endometriosis significantly improves the pregnancy rate over comparable patients treated with surgery alone. It is hoped that these results will encourage other surgeons to implement a prospective surgical-medical approach, so that the most efficacious treatment for infertile patients with severe endometriosis can be determined.

Adult↗
PubMed1977

Hemodynamic alterations during septal or right ventricular ischemia in dogs.

This study indicates that in dogs, ischemic injury to just the ventricular septum has little effect on left ventricular function. The data demonstrate that ischemic injury to either the right ventricular free wall or the ventricular septum alters right ventricular function and/or compliance, suggesting that both regions play a role in maintaining right ventricular performance. That septal contraction supports right ventricular function may explain why in earlier studies, right ventricular pressure development and output were little affected by severe injury to the free wall.

Animals↗
PubMed1977

Influence of mannitol on maintaining coronary flows and salvaging myocardium during ventriculotomy and during prolonged coronary artery ligation.

We investigated whether prolonged infusion of hypertonic mannitol results in a sustained increase in coronary flow and reduces myocardial necrosis after ventriculotomy or two hours of circumflex coronary artery occlusion. Cardiac outputs, intracardiac pressures, and heart rates did not differ between mannitol and control animals. Those receiving mannitol after ventriculotomy had coronary flows to myocardium near the incision which did not differ from controls. During coronary occlusion, mannitol did increase flow to ischemic and peri-ischemic regions by one hour, but this increase was not sustained at two hours. On histologic examination, myocardial necrosis involving the right ventricular free wall in the ventriculotomy animals and the posterior papillary muscle and subadjacent free wall in the coronary occlusion animals, did not differ between the mannitol treated and control groups. The data obtained in the present study, combined with those from earlier evaluations of the influence of mannitol during ventriculotomy and myocardial ischemia, suggest that mannitol's ability to increase coronary flow to injured areas of myocardium is relatively short-lived.

Animals↗
PubMed1977

Continuous airway pressure breathing with the head-box in the newborn lamb: effects of regional blood flows.

Continuous airway pressure delivered by a head-box is an accepted means of treating clinical hyaline membrane disease. To investigate hemodynamic alterations resulting from its use, eight newborn lambs, 1 to 6 days of age, were studied at 6 and 11 mm Hg of positive pressure, while spontaneoulsy breathing room air. Organ blood flows and cardiac output were measured with 25 micron-diameter radioactive microspheres. Heart rate, left ventricular pressure, and arterial blood gases did not change during the study. Jugular venous pressures increased from 6.4 mm Hg to 18.6 and 24.2 mm Hg at 6 and 11 mm Hg, respectively (P less than .005). Cardiac output decreased approximately 20% at either intrachamber pressure setting. Renal blood flow fell 21% at 11 mm Hg. No significant changes in blood flow were found in the brain, gastrointestinal tract, spleen, heart, or liver when compared to control flows. Of particular interest was the finding of a 28% reduction in ocular blood flow at 6 mm Hg and 52% at 11 mm Hg. From these results, we conclude that substantial cardiovascular alterations may occur during the application of head-box continuous airway pressure breathing, including a significant reduction in ocular blood flow.

Animals↗
PubMed1976

Effect of hypertonic mannitol and isoproterenol on regional coronary flow following right ventriculotomy.

We studied the changes which occurred in regional coronary blood flow after right ventriculotomy and the subsequent effects of hypertonic mannitol or isoproterenol infusion. Regional coronary flows were measured with radioactive microspheres (9 micron) in open-chest anesthetized dogs. Either hypertonic mannitol (25%) was infused at 3.2 ml/min or 7.6 ml/min for 30 minutes, or normal saline at 7.6 ml/min for 30 minutes followed by isoproterenol at 0.05-0.10 mug/kg/min. In the mannitol treated animals right ventricular, left artrial and aortic pressures, heart rate, and cardiac output did not change significantly following vertical ventriculotomy, whereas in the saline-isoproterenol treated animals aortic pressures fell significantly. Coronary flow to the peri-incisional area fell from 41 to 24 ml/min-100 g (P less than 0.05) following ventriculotomy, increased by 34% (P less than 0.05) when osmolality rose after mannitol by 37 mOsm, but was unchanged with isoproterenol. The data indicate that a vertical ventriculotomy reduces flow to adjacent myocardium and that subsequent infusion of hypertonic mannitol at moderate rates significantly increases coronary flow to this region.

Animals↗