Biomedical subjects

M E Rivlin

Publications and source records attributed to M E Rivlin.

31 records · Page 2Linked to original sources

PubMed1985

Danazol in the management of ureteral obstruction secondary to endometriosis.

Ureteral obstruction caused by endometriosis is uncommon. It is, however, an important complication that imposes a 25% chance for permanent loss of renal function on the affected side. The standard management is surgical; however, three cases have been reported in which regression of obstruction followed medical therapy. This case report concerns a patient with long-standing partial ureteric obstruction due to endometriosis who was treated for 2 months with danazol. Clinical response of the endometriosis was excellent, but the obstruction persisted, a retroperitoneal ureteroneocystotomy was therefore performed. The ureter was found to be obstructed by dense fibrous tissue that contained endometrial glands. It seems therefore that a trial of danazol may be attempted in selected cases, but that the drug is unlikely to relieve endometriotic ureteric obstruction once dense fibrosis has occurred.

Adult↗

PubMed1985

Persistent ectopic pregnancy: complication of conservative surgery?

Conservative surgery with conservation of the affected tube is widely recommended as optimal therapy in the management of unruptured tubal gestation. Unfortunately it is not possible to guarantee complete removal of all trophoblastic tissue and there remains the possibility of continuing trophoblastic growth after the conservative operation, usually necessitating a second, more radical procedure. Four cases of this complication have been reported in the literature and we have recently encountered a fifth. It is our impression that the problem may be under-reported. We recommend routine serial beta-subunit human chorionic gonadotropin surveillance in the postoperative period following conservative surgery and feel that patients should be advised of the possibility of this complication whenever conservative surgery is contemplated. Furthermore, there may be a potential for management of this problem with cytotoxic agents in a manner analogous to that used for gestational trophoblastic disease.

Fallopian Tubes↗

PubMed1985

Conservative surgery for adnexal abscess.

Twenty-eight women were treated with conservative surgery for adnexal abscesses over a six-year period (1968-74). The mean age was 29.9 +/- 8.9 years (SD) and mean parity 1.2 +/- 1.1. Indications for surgery included failure to respond to medical therapy (16 cases) and exploration of a pelvic mass of uncertain etiology (12). The mean admission-operation interval was 8.7 +/- 9.9 days. The mean total hospital stay was 23.1 +/- 14.7 days. The most common procedures were unilateral adnexectomy (13 cases), simple drainage (6) and bilateral medial ligation (4). The intraoperative complications (one fatal cardiac arrest, two bladder lacerations and one bowel laceration) did not appear to be related to the conservative nature of the surgery. The postoperative complications, wound sepsis (six cases) and fecal fistula (one case), might have occurred equally with more radical operations. Menstrual function was retained in all the surviving patients and the potential for pregnancy in 18 (62%). Extrapolating these data from unselected cases in a developing nation, it seems likely that conservative procedures would afford an acceptable option in well-selected, fully informed women undergoing surgery for adnexal abscess in developed countries.

Abscess↗

PubMed1984

Continual postoperative antibiotic peritoneal lavage in diffuse peritonitis complicating cesarean section.

Nine women treated surgically for diffuse peritonitis complicating cesarean section underwent continual postoperative antibiotic peritoneal lavage as an adjunct to surgery. In all the patients the indication for surgery was failure to respond to standard medical therapy. Seven patients treated with hysterectomy recovered without evidence of continuing peritonitis or intraabdominal abscess formation. One of two patients in whom uterine conservation was attempted required an emergency hysterectomy three days later. In this series, continual postoperative antibiotic peritoneal lavage appeared to be an effective adjunctive treatment in the prevention of continuing peritonitis and abscess formation provided that hysterectomy was performed at the initial operation.

Adult↗

PubMed1983

Clinical outcome following vaginal drainage of pelvic abscess.

Fifty-nine women treated by colpotomy drainage for pelvic abscess over a 20-year period (January 1961 to July 1981) were studied. Mean age was 27.3 years (+/- 9.5 SD). Mean parity was 2.0 (+/- 2.3 SD). The abscess was secondary to pelvic inflammatory disease in 37 cases, abortion in four, cesarean section in six, other surgery in two, intrauterine device in four, appendicitis in four, and followed term vaginal delivery in two. The mean stay in the hospital was 14.4 (+/- 10.7) days. There were two deaths, both related to septic abortion with diffuse peritonitis. Further surgery during the same admission was performed in 13 instances (seven hysterectomies); additional surgery at a later admission was carried out in 11 patients (10 hysterectomies). Fourteen of these procedures were emergencies. Two patients were readmitted with pelvic inflammatory disease. Five of 40 potentially fertile patients (12.5%) had successful pregnancies at a later date.

Abscess↗

PubMed1982

Diffuse peritoneal sepsis associated with colpotomy drainage of pelvic abscess.

The incidence of and mortality from diffuse peritoneal sepsis associated with the vaginal drainage of pelvic abscesses were retrospectively studied at two hospitals. During the 16-year period from 1961 through 1977 at the University of Mississippi Medical Center, 50 patients underwent colpotomy drainage of pelvic abscesses, diffuse peritoneal sepsis occurred in 5 cases (10%), and 2 of these 5 patients died (40%). During the five-year period from 1972 through 1976 at Baragwanath Hospital, 298 patients underwent colpotomy drainage of pelvic abscess, diffuse peritoneal spesis occurred in 18 cases (6%), and 4 of these 18 patients died (22%). By combining the two series, a total of 348 cases of colpotomy drainage yielded 23 instances of diffuse peritoneal sepsis (6.5%0, with six deaths attributable to this condition (26%). The overall mortality for the 348 cases was 2% (seven deaths), and diffuse peritoneal sepsis was the cause of six of the seven fatalities. It is concluded that colpotomy drainage of pelvic abscesses is a safe and most effective procedure provided that the cases are well selected and the postoperative course is closely followed. Neglect of these basic principles may result in the development of diffuse peritoneal sepsis in a small but important group of patients.

Abscess↗

PubMed1980

The use of medroxyprogesterone acetate for relief of climacteric symptoms.

Climacteric symptoms in the menopausal woman are perplexing to the physician. Recent literature concerning the relationship of estrogen to carcinogenesis has caused many women to discontinue this medication; thus, there is a need for an alternative therapy for the relief of these symptoms. The drug medroxyprogesterone acetate (Depo-Provera) was assessed in a double-blind, randomized, placebo-controlled study involving 48 subjects. Only one of the placebo-treated patients claimed any relief from climacteric symptoms while only two of the patients who received the study drug noted little or no relief (P < 0.0001). Relief from climacteric symptoms began at 4 to 7 days after entry into the study and extended for 8 to 20 weeks. The only side effects were withdrawal bleeding and a slight, transient weight gain. Depo-Provera appears to be a reliable substitute for estrogen in the treatment of climacteric symptoms. Further investigations with this medication seem indicated.

Adult↗

PubMed1977

Ruptured tuboovarian abscess. Is hysterectomy necessary?

The use of conservative pelvic surgery combined with intra- and postoperative antibiotic peritoneal lavage has been evaluated in 113 women with generalized peritonitis due to ruptured tuboovarian abscess. Mortality was 7.1% and hysterectomy was only required in 3% of cases. Hormonal and menstrual functions were retained in 73.5% and the potential for future pregnancy in 42.5%. Further surgery was required in 17.5% of the patients. These results are contrasted with recent series of comparable size in which the mortality and morbidity were similar but the frequency of hysterectomy ranged from 70--100%. It is concluded that hysterectomy is not necessary in the management of ruptured tuboovarian abscess if the major source of sepsis is removed and adequate peritoneal drainage is provided by the use of lavage.

Abscess↗

PubMed1975

Antibiotic peritoneal lavage in severe peritonitis. A preliminary assessment.

A method of intra- and postoperative antibiotic peritoneal lavage, using 0.015% gentamicin in dialysis solution, has been assessed for the treatment of life-threatening peritonitis. It is believed to be the first time that the use of gentamicin for this purpose has been recorded, and the first time that antibiotic peritoneal lavage has been used for the treatment of a series of patients with peritonitis of gynaecological or obstetrical origin. At Baragwanath Hosital, gynaecological patients with life-threatening purulent peritonitis arising from septic abortions, tubal sepsis (ruptured pyosalpinx) or postoperative causes, were studied. Thirty-eight such patients undergoing standard operative treatment had a mortality of 47.4%, which is in accordance with world figures for serious peritonitis. In 38 patients, after the addition of antibiotic peritoneal lavage, mortality was halved to 2397%, with minimal morbidity. The procedure used has been fully described, and is recommended for wider trial in patients with life-threatening peritonitis or peritoneal soiling.

Abortion, Septic↗

PubMed1970