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Biomedical subjects

P Curtis

Publications and source records attributed to P Curtis.

At least 73 records · Page 4Linked to original sources
PubMed1993

Adverse effects on sperm movement characteristics in women with minimal and mild endometriosis.

OBJECTIVE: To test the effect of peritoneal fluid from infertile women with minimal or mild endometriosis on sperm movement characteristics in comparison with fertile and infertile women with no endometriosis. DESIGN: A prospective observer-blind trial. SETTING: Academic infertility department. SUBJECTS: 57 women undergoing diagnostic laparoscopy or laparoscopic sterilisation. MAIN OUTCOME MEASURES: Changes in sperm movement characteristics in semen samples provided during routine infertility investigation or from sperm donors. Computer assisted semen analysis (CASA) performed using a Celltrack-S system. RESULTS: Significant reductions in linearity (P < 0.05), amplitude of lateral head displacement (P < 0.01), straight line velocity (P < 0.01), and curvilinear velocity (P < 0.01) (but not percentage motility) were observed. CONCLUSIONS: Peritoneal fluid from women with minimal or mild endometriosis adversely effects sperm movement characteristics in comparison to fertile women.

Adult↗
PubMed1993

The effect of prazosin on patients with symptoms of benign prostatic hypertrophy.

OBJECTIVE: To evaluate the effect of prazosin on the symptoms of benign prostatic hypertrophy for patients of general practitioners. SETTING AND PATIENTS: Eighty-two general practitioner patients from 317 who were identified as being eligible for inclusion in the trial. They were randomly allocated to receive either prazosin or placebo for the first 3 month arm then crossed-over for the second 3 months. RESULTS: Seventy-six patients completed the trial. An analogue scale of patient rating of symptoms showed a statistically significant decrease in symptoms for patients taking prazosin when compared with patients taking placebo, regardless of the order in which they had been administered. A total symptom score and an obstructive symptom score for benign prostatic hypertrophy showed a statistically significant difference between the two treatments at 4 weeks. A difference was still apparent at 8 and 12 weeks but it was not statistically significant. No difference was detected for irritative symptoms. CONCLUSION: Prazosin may have a limited place in the management of benign prostatic hypertrophy.

Aged↗
PubMed1993

Papanicolaou smear quality assurance: providing feedback to physicians.

BACKGROUND: The effective management of Papanicolaou (Pap) smears depends on the reliability and accuracy of obtaining and interpreting the specimen. Provider sampling error is one of the important factors contributing to inadequate specimens. Feedback on provider performance may be an effective way to improve the quality of Pap smears. METHODS: A pilot study in a university-based residency program involving resident and faculty physicians was initiated to assess the impact of feedback on performance of Pap smears. After establishing adequacy and inadequacy criteria and recording adequacy rates for 3 months, individual and group feedback was implemented. No formal educational intervention on Pap smear technique was undertaken. RESULTS: The quality of 836 Pap smears performed by 9 faculty and 13 resident physicians showed continued improvement in both sampling and slide preparation to 90% adequacy over a 9-month period. This improvement, though clinically useful, was not statistically significant owing to the relatively small numbers of smears performed by each physician. This form of feedback may be useful in both practice and educational settings. CONCLUSIONS: Feedback without any formal educational intervention led to a clinically useful trend of improvement in the quality of Pap smears, which has been sustained since the study began. This type of simple feedback may be useful in practice settings and particularly valuable in pinpointing areas for improvement for learners in residency programs.

Academic Medical Centers↗
PubMed1993

Development of a Pap smear quality-assurance system in family practice.

BACKGROUND AND OBJECTIVES: To improve the effectiveness of cervical cancer screening, quality assurance programs can be designed to ensure that normal Pap smear results are dealt with appropriately and that Pap smears yielding inadequate specimen material are brought to a physician's attention. The objective of this study was to use a new Pap Smear Quality Assurance (PAPQA) system to determine and monitor the performance of physicians in a family practice over a two-year period. METHODS: We developed a PAPQA system designed to gather data and report on: 1) Pap smear adequacy, 2) reporting of abnormal results to physicians, and 3) follow-up of patients who had abnormal Pap smear results. We followed these parameters for two years. RESULTS: Over a two-year period, 2,771 cervical Pap smears were performed, of which 64% were normal. The percentage of Pap smears that yielded adequate specimen material improved from 82% to 91%, an improvement we attributed to feedback the system provided to physicians. Overall, Pap smear results and follow-up appeared in the medical record of 94% of patients who had abnormal findings. However, during the second year, the quality assurance system detected a deterioration in documentation of results and follow-up plans that coincided with moving the practice to a new facility. The operating cost for this program was approximately $950 per year. CONCLUSIONS: Quality assurance programs can effectively monitor physicians' performance in dealing with abnormal Pap smears, can detect deteriorations in performance, and can improve some aspects of performance through feedback reporting to physicians.

Family Practice↗
PubMed1993

In search of the 'back mouse'.

The "back mouse" is a tender, fibrous, fatty subcutaneous nodule found in the lumbosacral area in up to 16% of people. It can be a treatable cause of low back pain that may be unrecognized by both specialists and generalists.

Adult↗
PubMed1992

Fertilization and embryonic development of human oocytes after cooling.

Injury to living cells resulting from rapid cooling to temperatures at or near 0 degrees C has long been recognized, and the phenomenon, which is termed 'cold shock', has been known to occur in some mammalian gametes. Although human embryos have been successfully stored at low temperatures, cryopreservation of the human oocyte is proving to be more difficult. Whether or not this lack of success is a direct result of cellular injury brought about by 'cold shock' is the purpose of the current investigation. Human oocytes were cooled, in the absence of cryoprotectants, at two different cooling rates (-3 degrees C/min and -1000+ degrees C/min) to a temperature of 0 degrees C and rewarmed prior to insemination. In both cases fertilization after cooling was similar to the rates achieved in a routine in-vitro fertilization and embryo transfer procedure. After cooling at -3 degrees C/min, the rate of fertilization was 19/22 (86%) and after cooling at -1000+ degrees C/min, 9/9 (100%), with non-cooled control rates of 62/87 (71%) and 35/50 (70%) respectively. Fertilized oocytes from both groups were successfully cultured for a further 24 h before termination of the experiment.

Cryopreservation↗
PubMed1992

Exposure to LHRH agonists in early pregnancy following the commencement of mid-luteal buserelin for IVF stimulation.

Exposure to buserelin in early pregnancy has been reported following its use in in-vitro fertilization treatment cycles. The number of reported cases is small. There are still no answers regarding embryotoxicity, and the need for luteal support is still unclear. A further six cases are reported here, five receiving luteal support and resulting in the delivery of healthy children, and one, without luteal support ending in a first trimester miscarriage. We propose that further data should be collected to allow adequate monitoring and follow-up of these pregnancies.

Abortion, Spontaneous↗
PubMed1992

The role of partial colpectomy in the management of persistent vaginal neoplasia after primary treatment.

OBJECTIVE: To describe and assess the technique of partial colpectomy for the treatment of persistent vaginal neoplasia. SETTING: Gynaecological oncology unit of a London teaching hospital. SUBJECTS: 12 women with persistent vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia (CIN) or for benign disease. TECHNIQUE: Partial colpectomy using a vaginal approach assisted by a Schuhardt incision to improve access. RESULTS: Assessment of patients between 9 and 99 (mean 55) months after partial colpectomy for VAIN showed no recurrence of disease in ten patients (83%). CONCLUSION: This technique of partial colpectomy is an effective procedure, associated with minimal morbidity which should be considered as primary treatment for patients suffering from persistent vaginal disease after hysterectomy or other procedures.

Adult↗
PubMed1992

Family physicians, chiropractors, and back pain.

In this article, major aspects of back care provided to patients by family physicians and chiropractors are reviewed, and the recent guidelines on spinal manipulation therapy are discussed. These guidelines should be useful for family physicians wishing to refer patients to chiropractors.

Attitude of Health Personnel↗
PubMed1991

Assessment of the relevance of zona pellucida antibodies in serum and cervical mucus in patients who have fertilization failure during in vitro fertilization.

OBJECTIVE: To assess whether antibodies to the zona pellucida can cause fertilization failure during in vitro fertilization (IVF). DESIGN: Two methods for detecting zona pellucida antibodies were used to assess 20 women undergoing IVF. Nine patients had failed fertilization during the treatment cycle. SETTING: Academic IVF department of a teaching hospital. PATIENTS: Infertile patients previously assessed as requiring IVF. INTERVENTIONS: Gonadotropin-releasing hormone analogue to achieve pituitary down regulation and human menopausal gonadotropin for superovulation. Transvaginal ultrasound directed oocyte recovery. Cervical mucus and serum samples were obtained. MAIN OUTCOME MEASURES: The presence of antizona pellucida antibodies in serum or cervical mucus in relation to fertilization. RESULTS: Seven of 20 patients had antizona antibodies in serum and 7 of 20 patients had antibodies in mucus. Only 1 patient had antibodies in both samples. No correlation between the presence of antibodies in either sample and failure of fertilization was found. CONCLUSION: Detection of antizona pellucida antibodies by the methods described have no role in the prediction of IVF.

Antibodies↗
PubMed1991

Evaluation of the risk of pelvic infection following transvaginal oocyte recovery.

The risk of introducing infection into the peritoneal cavity at the time of transvaginal ultrasound-guided recovery of oocytes in assisted reproduction techniques was assessed by culturing peritoneal fluid samples from 25 women with unexplained infertility. The samples were collected laparoscopically at the time of zygote intra-Fallopian transfer (ZIFT), 24-48 h after oocyte collection. High vaginal and endocervical specimens from 25 women treated by in-vitro fertilization (IVF) and transcervical embryo transfer were cultured for comparison. The peritoneal cultures were negative in all but one patient. High vaginal swabs grew Candida albicans in three cases and endocervical specimens were all negative. Seven and three pregnancies occurred in the ZIFT and IVF groups respectively. No pelvic damage was noted at laparoscopy in those women who had had previous treatment cycles with transvaginal oocyte recovery. This method of oocyte recovery, using prophylactic metronidazole and chlorhexidine for preoperative vaginal preparation, appears to be safe for treatment of women with no previous pelvic damage.

Adult↗