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Biomedical subjects

P J Sulak

Publications and source records attributed to P J Sulak.

At least 19 recordsLinked to original sources
PubMed2000

Hormone withdrawal symptoms in oral contraceptive users.

OBJECTIVE: To measure the timing, frequency, and severity of hormone-related symptoms in oral contraceptive (OC) users, specifically to compare active-pill with hormone-free intervals. METHODS: Using daily diaries, women recorded pelvic pain, bleeding, headaches, analgesic use, nausea or vomiting, bloating or swelling, and breast tenderness during active-pill intervals and hormone-free intervals. Participants either had no prior OC use, had taken OCs and were restarting, or had been taking OCs continuously for 12 months or longer. RESULTS: Two hundred sixty-two women, 26 with no previous OC use, 43 prior users, and 193 current users, provided daily records of hormone-related symptoms. Subjects with no prior OC use and prior users restarting were similar in no recent OC use, and because of the small sample, they were pooled for analysis as new-start OC users. Current users had patterns of symptoms that were more frequent during hormone-free intervals than during the three active-pill weeks. These included pelvic pain (70% versus 21%, P < .001), headaches (70% versus 53%, P < .001), use of pain medication (69% versus 43%, P < .001), bloating or swelling (58% versus 19%, P < .001), and breast tenderness (38% versus 16%, P < .001). Similar patterns were seen in new-start OC users after the first cycle. Among new-start OC users, menstrual flow patterns, headache, bloating or swelling, and breast-tenderness symptoms decreased during the three cycles to approach those levels of current users. CONCLUSION: Almost all symptoms assessed were significantly worse during the 7-day hormone-free interval than during the 21 days of hormone-containing pills.

Adult↗
PubMed2000

Gestational diabetes screening in subsequent pregnancies of previously healthy patients.

OBJECTIVE: Our purpose was to evaluate women without gestational diabetes mellitus in an index pregnancy for the likelihood that gestational diabetes would develop and for risk factors for carbohydrate intolerance in a subsequent pregnancy. STUDY DESIGN: A retrospective review of medical records at a teaching hospital universally screening for gestational diabetes identified multiparous women who had been delivered twice between 1994 and 1997 and who, in the first (index) pregnancy, had had a normal result on a screening test with 50 g of glucose used in a "glucola" beverage (< or =140 mg/dL). RESULTS: In this population with normal glucose screening values in the index pregnancy, 352 (92.4%) of 381 women had at least one risk factor for gestational diabetes. However, none of the 381 women had gestational diabetes in the subsequent pregnancy (0/381, 95% confidence interval < or =1%), including 45 (12. 4%) who had an abnormal result on the 50-g glucose screening test. Regression analysis showed this test result in the index pregnancy (P =.001) to be the only studied variable significantly associated with the 50-g glucose value in the subsequent pregnancy. CONCLUSION: Despite a high rate of risk factors for gestational diabetes, women in our population with a normal glucose value in an index pregnancy have a minimal risk (<1%) that gestational diabetes will develop in a subsequent singleton pregnancy within 4 years. This factor may be included in determining whether women should undergo screening for gestational diabetes.

Adolescent↗
PubMed1999

Oral contraceptives: therapeutic uses and quality-of-life benefits--case presentations.

Numerous studies have shown that oral contraceptives (OC) provide protection against a wide variety of illnesses and conditions, including loss of bone density, ovarian cysts, menstrual cycle irregularities, dysmenorrhea and menorrhagia, ectopic pregnancy, pelvic inflammatory disease, benign breast disease, endometrial cancer, and ovarian cancer. How OC can be used not only for contraception but also to improve health among women throughout their reproductive years is illustrated by four case presentations: an adolescent with menstrual problems; a 25-year-old mulligravida who wishes to delay childbearing; a 35-year-old who has completed her family and requests tubal ligation; and a 45-year-old with perimenopausal symptoms. In view of their numerous health benefits, OC are to reproductive-age women as hormone replacement therapy is to menopausal women.

Acne Vulgaris↗
PubMed1998

Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation.

PURPOSE: We test the hypothesis that women without chronic pelvic pain or irritative voiding symptoms do not demonstrate petechial hemorrhages known as glomerulations that are characteristic of patients with interstitial cystitis. MATERIALS AND METHODS: A prospective cohort design was used for examination with cystoscopy and bladder distention of 20 asymptomatic women undergoing tubal ligation. Cystoscopy with the patient under general anesthesia was performed to inspect the bladder mucosa before and after distention at 70 cm. of water pressure for 2 or 6 minutes. Photographs of the right, posterior and left of the bladder surfaces taken before and after the distention were scored on a scale of 1 to 5 using a panel of standards. Five urologists blinded to the source of individual photographs independently evaluated 120 research images interspersed with 46 other pictures from a library containing images from 19 symptomatic patients with and without interstitial cystitis. RESULTS: A total of 20 normal women with a mean age plus or minus standard deviation of 29+/-6 years consented to participate in this trial during laparoscopic tubal ligation. Photographs of bladder sites before and after distention with 890+/-140 ml. were scored as 1.4+/-0.3 (before distention) and 3.1+/-1.1 (after distention) on the scale of 1 to 5. The increase in scores following distention in normal subjects was seen to the same degree and in the same proportion as in patients with symptoms of interstitial cystitis (8 of 19 symptomatic patients in this series met current diagnostic criteria for interstitial cystitis). Slight but significant differences were seen among sites in the bladder but not between 2 and 6-minute distention durations. CONCLUSIONS: Bladder mucosal lesions characteristically associated with irritative voiding symptoms and pelvic pain in patients diagnosed with interstitial cystitis were observed in asymptomatic women.

Adult↗
PubMed1997

Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms.

OBJECTIVE: To test the hypothesis that extending the number of consecutive active oral contraceptives (OC)s given will decrease the frequency of menstrual-related problems including dysmenorrhea, menorrhagia, premenstrual-type symptoms, and menstrual migraines. METHODS: A prospective analysis was designed to track the experiences of 50 women taking OCs and experiencing menstrual-related problems. Fifty consecutive patients, who were taking OCs and had symptoms during the pill-free interval, were followed in a multispecialty clinic by an individual physician and nurse practitioner team. The patients were permitted to extend the number of consecutive active OCs to delay menstrual-related symptoms. RESULTS: Immediate outcome of the 50 patients revealed 74% (37 patients) stabilized on an extended regimen of 6 to 12 weeks of consecutive days with active OCs. Twenty-six percent (13 patients) either discontinued OCs or returned to the standard regimen with 3 weeks of active pills. Of the 37 patients who were stabilized on an extended regimen, 27 have completed thus far between five and 13 extended cycles with 6-23 months of follow-up (mean 16 months). CONCLUSIONS: Experience in a series of 50 OC users with menstrual-related symptoms demonstrated that delaying menses by extending the number of consecutive days of active pills is well tolerated and efficacious. We believe that a large prospective study is warranted to further our knowledge in this area.

Adult↗
PubMed1997

Endometrial cancer and hormone replacement therapy. Appropriate use of progestins to oppose endogenous and exogenous estrogen.

Most instances of endometrial cancer are potentially preventable. Unopposed endogenous estrogen stimulation of the endometrium has been shown to be the predisposing risk factor in most cases. Risk factors have been well-delineated, and it is important to recognize and treat the progesterone-deficient patient. Low-dose oral contraceptive pills in healthy, nonsmoking, older reproductive-aged women are an underutilized treatment modality. The many noncontraceptive benefits of longterm oral contraceptive use until the menopause should be explained to the patient, including the prevention of ovarian and endometrial cancer, the maintenance of bone density, and a reduction in the many surgical procedures performed for menstrual disorders. Progestin therapy in older reproductive-aged women and postmenopausal women with unopposed estrogen production is mandatory to prevent endometrial cancer. Knowledge and skill in simple endometrial sampling techniques performed in patients with known risk factors for endometrial cancer will often detect premalignant lesions that are treatable with progestin therapy or surgery.

Biopsy↗
PubMed1993

Unwanted pregnancies: understanding contraceptive use and benefits in adolescents and older women.

The highest percentages of unintended pregnancies and the largest increases in births reported in the United States in recent years were in adolescents and in women more than 35 years of age. Increasing numbers of these women will require contraception to avoid unintended pregnancy. In adolescents the combined oral contraceptive agents protect fertility indirectly and exert favorable actions on menstrual dysfunction and certain hormone-related disorders such as acne and hirsutism. To avoid sexually transmitted disease, barrier protection should be used along with oral contraceptives until mutually monogamous, stable relationships are established. Healthy older women who are nonsmokers may also safely use currently available contraceptives. These agents have little impact on metabolic parameters linked to the development of cardiovascular disease. In addition to providing reliable contraception, oral contraceptives offer noncontraceptive benefits to older reproductive-age women, including control of abnormal bleeding and a reduction in the incidence of ovarian and endometrial cancers and other gynecologic pathology. Intrauterine devices and progestin implants are safe, effective, and underused in the United States. Progestin implants may have an additional role in patients for whom estrogen preparations are contraindicated. Counseling is very important before insertion because of the high rate of nuisance side effects. The contraception selection process must consider the efficacy and acceptability of the specific method to avoid the probability of unintended pregnancy and the risk of sexually transmitted diseases.

Adolescent↗
PubMed1993

Vaginal pessaries and their use in pelvic relaxation.

To evaluate the therapeutic usefulness of pessaries in patients with pelvic relaxation, a retrospective study was performed identifying 107 patients who had been fitted with a pessary for symptomatic pelvic relaxation. Of this group, 101 returned or were available for follow-up. Ninety-one had at least one pelvic organ protruding to or beyond the hymen. Specific reasons for using the pessary are cited. Group 1 included 19 patients who were thought to be medically unfit for surgery. Twenty-one percent of this group died within one year of their evaluation for pelvic relaxation. Group 2 was composed of 24 patients who chose to use the pessary only temporarily while awaiting a suitable time for surgery. Group 3 consisted of 58 patients who were offered the option of definitive surgical repair but initially declined. Fifty of the 101 patients have continued to use the pessary. Twenty-six had repairs, and four have died. Only 21 patients have discontinued the pessary, had no surgical repair and thus continue without treatment of their pelvic relaxation. No major complications were associated with use of the pessary.

Adult↗
PubMed1992

Resident research in obstetrics and gynecology: development of a program with comparison to a national survey of residency programs.

OBJECTIVE: The objective of this report is to describe our recently established resident research program and to compare this program with those of other obstetrics and gynecology residency training programs in the United States. STUDY DESIGN: The components of our program are described. Data for comparison from other programs were obtained from questionnaires, phone follow-up and the Directory of Obstetrics and Gynecology Residency Programs of the Council on Resident Education in Obstetrics and Gynecology. RESULTS: We initiated a residency research program in 1987 with acceptable projects defined, a time for completion of manuscripts established, and a Resident Research Day organized with presentation of articles, critique by a guest speaker, and an awards banquet. Nationally, less than 60% of residency programs have research requirements. Of the 208 programs responding to the written questionnaire 86% of programs associated with a university required research compared with 10% of community-based residency programs. CONCLUSION: While more than a third of residency programs in obstetrics and gynecology do not have resident research programs, the trend is for programs to establish research as a required portion of training. An outline of a recently established program is provided.

Data Collection↗
PubMed1992

Inadvertent administration of prostaglandin E1 instead of prostaglandin F2 alpha in a patient with uterine atony and hemorrhage.

A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. Placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia.

Adult↗
PubMed1991

Pregnancy complicated by antiphospholipid antibodies.

The manifestations of antiphospholipid antibodies in pregnancy are multiple and include maternal arterial and venous thrombosis, spontaneous abortion, intrauterine fetal death, intrauterine growth retardation, and preeclampsia. Maternal complications may also arise in the puerperium with the development of an autoimmune pleuropulmonary postpartum syndrome. Currently, there is confusion in the literature regarding appropriate treatment of patients known to possess these antibodies. We have reported the case of a patient at 29 weeks' gestation who had elevated blood pressure, proteinuria, and early intrauterine growth retardation. Studies were positive for the presence of both lupus anticoagulant and anticardiolipin antibodies. After delivery, chest pain and a pleural effusion developed as further manifestations of the patient's autoimmune disease.

Adult↗