Search PubMed⌕ Search

Biomedical subjects

L J Dunn

Publications and source records attributed to L J Dunn.

At least 37 records · Page 2Linked to original sources
PubMed1984

Medical students' evaluation in obstetrics and gynecology.

A system for the evaluation of clinical clerks in obstetrics and gynecology is presented. Final grades were assigned through faculty judgment rather than by the use of a numerical formula. Judgment was based on narratives and grades on clinical performance as well as results of oral and written examinations. All elements of the evaluation correlated with the final grade. The clinical grade correlated best. The final grades assigned by judgment were compared with those that would have resulted from applying a numerical formula. They differed in the distribution of higher grades, but were identical for the lower grades. Both correlated equally with the Obstetrics and Gynecology subtest of the National Boards, Part II examination.

Clinical Clerkship↗
PubMed1984

Primary carcinoma of the Bartholin gland: a report of ten cases.

During the interval 1962 through 1982, ten patients, having a mean age of 49.5 years, were treated for primary carcinoma of the Bartholin gland at the Medical College of Virginia. In all cases, a primary surgical therapeutic approach was selected, which included radical vulvectomy with bilateral inguinal-femoral node dissection in nine cases. Of the patients followed from eight months to 9.5 years, 50% are alive and well without evidence of recurrent disease. Histologic assessment of lymph nodes demonstrated metastatic involvement in five of nine cases (55%) with four of five patients dead of their disease. The most common histologic pattern was squamous cell carcinoma. The most common presenting complaint was a painless mass. Radical surgery is appropriate as standard primary therapy, whereas the role of radiation appears less clear.

Adult↗
PubMed1983

Fluid weight uroflowmetry in women.

This study evaluates fluid weight uroflowmetry as a screening technique for urogynecologic conditions. Sixty women with no known pathologic condition volunteered for the evaluation of normal uroflowmetric parameters and curve patterns. Forty were menstruating cyclically, and 20 were postmenopausal. The parameters studied included: (1) total voided volume, (2) flow time, (3) peak flow rate, and (4) time to peak flow rate. In addition, uroflowmetric tracings were classified according to their patterns of configuration into: (1) normal, (2) multiple peak, and (3) interrupted. The parameters studied showed no difference in the two normal groups. A wide range of values was observed. Neither age, parity, weight, height, nor menstrual cycle phase affected the data. Values obtained from patients with idiopathic instability of the detrusor muscle, sensory urgency, and stress urinary incontinence did not show differences or trends. Seventeen percent of the tracings of the normal population group showed either multiple peak or interrupted patterns. Patients with sensory urgency (p less than 0.001) had a higher incidence of multiple peak and interrupted flow rate patterns.

Adult↗
PubMed1983

Intrapartum fetal heart rate monitoring. VIII. Atypical variable decelerations.

A total of 1,996 fetal heart rate (FHR) tracings were analyzed to assess the prognostic significance of variable decelerations. Nineteen percent (186 cases) of 988 tracings with variable decelerations in the last 30 minutes of monitored labor exhibited signs of atypia listed in order of frequency: (1) loss of initial acceleration, (2) slow return to the baseline FHR, (3) loss of secondary acceleration, (4) prolonged secondary acceleration, (5) biphasic deceleration, (6) loss of variability during deceleration, and (7) continuation of the baseline at a lower level. Variable decelerations with one or more of these features were called atypical variable decelerations and predicted a high incidence of fetal acidosis and low Apgar scores. By contrast, adverse fetal outcome was uncommon with pure variable decelerations (p much less than 0.001) irrespective of the duration and amplitude of the deceleration. Both pure and atypical variable decelerations were associated with other FHR abnormalities in over 60% of the cases. However, the particularly unfavorable combination with decreased FHR variability and tachycardia or bradycardia was seen more frequently with atypical than with pure variable decelerations (p much less than 0.001) and predicted the highest incidence of low Apgar scores. It is concluded that atypical features aid greatly in the identification of distress in fetuses with variable decelerations.

Apgar Score↗
PubMed1982

Intrapartum fetal heart rate monitoring. VII. The impact of mode of delivery on fetal outcome.

The condition of 1,991 fetuses just prior to delivery was assessed in a semiquantitative manner by means of a fetal heart rate (FHR) score. A comparison between types of delivery was made for groups with identical FHR scores to test the hypothesis that the differences in lower Apgar score rates were consequences of the type of delivery rather than differences in prenatal condition. For each of several FHR scoring categories, the differences in rates of low Apgar scores between spontaneous vaginal deliveries and cesarean sections were consistently different in favor of the vaginally delivered group. No such difference was observed when spontaneous vaginal deliveries were compared with low-forceps deliveries. Breech deliveries, when compared to spontaneous vaginal deliveries, resulted in a higher rate of low 1-minute Apgar scores. Five-minute Apgar scores were significantly different only if the breech delivery was preceded by abnormal FHR patterns.

Apgar Score↗
PubMed1982

Intrapartum fetal heart rate monitoring. VI. Prognostic significance of accelerations.

The fetal heart rate (FHR) tracings of 1,996 fetuses were analyzed to assess the prognostic value of accelerations in early labor and just prior to delivery. Accelerations were divided into periodic and sporadic types according to their association or lack of association with uterine contractions. It is shown that two or less sporadic accelerations per 30 minutes are unfavorable. Three accelerations indicate fetal well-being as much as any higher number of accelerations per 30 minutes. FHR abnormalities coexistent with three or more sporadic accelerations were found to have a better prognosis than FHR abnormalities associated with two or less sporadic accelerations. Fetuses exhibiting low FHR variability commonly showed lack of accelerations, whereas normal FHR variability was almost invariably accompanied by sporadic accelerations. The pathogenesis of accelerations is discussed. It is concluded that accelerations are indicators of fetal well-being, whereas the lack of accelerations with lack of reactivity to manipulation of the fetus may be indicative of severe fetal hypoxia with fetal acidemia. This conclusion is supported by fetal outcome and determination of pH from fetal scalp blood.

Apgar Score↗
PubMed1981

Detrusor instability syndrome: the use of bladder retraining drills with and without anticholinergics.

Ninety-two (24.6%) of 374 patients referred to our gynecologic urology unit were found to have instability of the detrusor muscle with no recognizable associated pathologic conditions: idiopathic detrusor instability. Thirty-nine (42.4%) of these 92 patients demonstrated the instability only after detrusor activation maneuvers such as coughing, heel bouncing, or positional changes. The cure rate among patients with both "spontaneous" and "provoked" contractions of the detrusor muscle was comparable to the cure rate among those whose bladder contractions were apparent only after detrusor activation maneuvers (p greater than 0.9). The success rate of bladder retraining drills (BRD) as the sole mode of therapy was not significantly different from that observed with BRD combined with anticholinergics (p greater than 0.6).

Adult↗
PubMed1981

Intrapartum fetal heart rate monitoring. V. Fetal heart rate patterns in the second stage of labor.

A total of 1,755 fetal heart rate (FHR) tracings of the second stage of labor was analyzed. The FHR patterns were classified according to the behavior of the baseline FHR and are listed in decreasing order of benignity: normocardia, transitory bradycardia, tachycardia, persistent bradycardia, and progressive bradycardia. Each category was further subdivided into four groups on the basis of association or nonassociation with early, variable, or late decelerations. Cord compression pattern were noted in over 50% of the FHR tracings and account for the majority of low Apgar scores and fetal acidosis. FHR abnormalities occurred in 91% of second-stage labor patterns, and were mild in most cases or of too short duration to influence fetal outcome. An effort was made to establish therapeutic guidelines based on the morphologic features, prognostic grading, and the etiology of the FHR patterns in the second stage of labor.

Bradycardia↗
PubMed1980

Intrapartum fetal heart rate monitoring. IV. Observations on elective and nonelective fetal heart rate monitoring.

Heart rate tracings and outcome in 919 electively and 1,077 nonelectively monitored fetuses were compared in order to investigate the value of elective surveillance of the fetal heart rate (FHR) in either group. A threefold higher perinatal mortality and a twofold higher number of low 5-minute Apgar scores were observed among patients with risk factors compared to electively monitored pregnancies. In the beginning of monitored labor, fetuses with risk factors exhibited a higher incidence of FHR patterns with low FHR variability than fetuses without risk factors. In the final phase of labor, FHR patterns indicative of hypoxia, i.e., late decelerations and severe and atypical variable decelerations, were found more often in the nonelective than in the elective group. Umbilical cord problems reflected by the occurrence of variable deceleration were responsible for the majority of low Apgar scores observed among electively monitored fetuses. The findings and their implications for FHR monitoring are discussed.

Female↗
PubMed1980

Intrapartum fetal heart rate monitoring. III. Association of meconium with abnormal fetal heart rate patterns.

Fetal heart rate (FHR) tracings of 284 fetuses with meconium-stained amniotic fluid (MSAF) and 1,672 fetuses without meconium staining were compared to investigate the significance of meconium associated with normal and abnormal FHR patterns. MSAF was found to be associated with significantly more low 1- and 5-minute Apgar scores and higher neonatal mortality rates than the control group without meconium. An increase in abnormal FHR patterns in the MSAF group over the control group as well as the postpartum sequelae of meconium itself was likely responsible for the unfavorable outcome. It is concluded that the presence of meconium should be viewed as a warning sign of fetal distress which warrants close intrapartum observation of the patient.

Amniotic Fluid↗
PubMed1980

Desquamative interstitial pneumonitis. Characterization of free intraalveolar cells.

There is some disagreement concerning the nature of the free intraalveolar cells in desquamative interstitial pneumonitis, although the greatest weight of evidence suggests them to be alveolar macrophages. We have obtained these cells by bronchoalveolar lavage from two patients with desquamative interstitial pneumonitis and studied their in vitro antibacterial activity and their ultrastructural morphology. Our results indicate that the free intraalveolar cells in these two patients were alveolar macrophages with normal antibacterial function.

Humans↗