Search PubMed⌕ Search

Biomedical subjects

R D Gambrell

Publications and source records attributed to R D Gambrell.

At least 73 records · Page 4Linked to original sources
PubMed1978

Management of postmenopausal bleeding to prevent endometrial cancer.

The primary goal in management of postmenopausal bleeding is to insure that no malignancy is present. In this study of 3,682 climacteric women, 340 patients (9.2%) presented with postmenopausal bleeding during an 18-mth period. The pathology at curettage was reported as normal endometrium in 33.8%, atrophic endometrium in 24.7%, and hyperplasia in 39.1%. Adenocarcinoma of the endometrium was diagnosed in only 5 patients (1.5%), a reduction from 3.0% found in a previous study performed in 1972-1973. The second goal in management of postmenopausal bleeding is to identify and treat those patients with endometrial hyperplasia since this is a precancerous lesion. Cyclic progestogens were given to 105 of 133 women with hyperplasia of the endometrium for 3-6 mth and curettage repeated. The hyperplasia reverted to normal endometrium in 101 of the 105 patients (96.2%). In those 4 women with persistent hyperplasia after progestogen therapy, a hysterectomy was performed. Hysterectomy was the primary therapy for 20 women with hyperplasia because of associated findings such as leiomyomata uteri. The incidence of curettage was highest in the untreated women (23.2%), lowest in the estrogen-progestogen users (3.9%) and indicated in 14.2% of those patients receiving estrogens alone.

Adenocarcinoma↗
PubMed1978

The prevention of endometrial cancer in postmenopausal women with progestogens.

Due to adverse publicity alleging an increased risk of endometrial cancer with estrogen therapy, a prospective study was begun in 1976 to determine the incidence of this disease in postmenopausal women. During 5,025 patient-years of observation in 1976-1977, 6 adenocarcinomas of the endometrium were diagnosed for an incidence of 1.2:1,000 postmenopausal women per year. No endometrial malignancies were detected in 2,552 patient years of therapy with estrogens and progestogens. In 1,028 patient-years of observation where estrogens only was the therapy, there were 3 endometrial cancers for an incidence of 2.9:1,000. Adenocarcinoma of the endometrium was found in 2 of the untreated group, which gave an incidence of 3.0:1,000. The sixth endometrial cancer occurred in a patient using estrogen vaginal cream. During this same period, 139 perimenopausal and postmenopausal women were treated with progestogens for endometrial hyperplasia. The hyperplasia was reversed to normal endometrium in 133 patients (95.7%). Hyperplasia is a precancerous lesion and should be treated with either progestogens or hysterectomy. All postmenopausal women with a uterus should be given the Progestogen Challenge Test and the progestogen continued each month as long as bleeding follows. These methods will prevent most endometrial cancers.

Adenocarcinoma↗
PubMed1976

Regression of Polycystic Ovaries by Estrogen Therapy.

Adolescent girls and single women with progressive hirsutism due to polycystic ovaries present a therapeutic dilemma. Clomiphene citrate is useful only to induce ovulation and has no beneficial effect on hirsutism. Surgical wedge resection of these ovaries usually arrests progression of hirsutism and restores ovulatory menses. Such treatment, however, is best reserved until such time as pregnancy would be an equal objective. Treatment of 5 patients by hypothalamic-pituitary-ovarian suppression with 100-mg estradiol pellets implanted subcutaneously every 6 months reduced ovarian size in all 5 patients and halted the progression of hirsutism.

17-Ketosteroids↗
PubMed1975

Use of medroxyprogesterone acetate to prevent menopausal symptoms.

A number of patients with severe vasomotor symptoms of menopause, specifically hot flashes, are unable to take exogenous estrogens because of intolerance of contraindications. Others achieve less than satisfactory relief of symptoms with extrogen. A double-blind study was established to determine whether depomedroxyprogesterone acetate (DMPA) injectable (Depo-Provera, Upjohn) could be used as a satisfactory substitute in these patients. The basis of the study was to evaluate clinical impressions that some menopausal patients taking DMPA for other purposes achieved relief from these distressing symptoms. Fifty-seven patients were treated with DMPA, 150 mg IM monthly, and 12 controls were given 1.5 ml sterile saline IM monthly. Serum FSH and LH were measured initially and serially. Clinical response was determined by the patients' estimates of the frequency and severity of their hot flashes. Of 57 patients in the treatment group, 51 (89.5%) were relieved of symptoms compared to 3 of 12 (25%) in the control group. DMPA can be an effective alternate to estrogen therapy in selected menopausal patients.

Adult↗
PubMedDate not supplied

Leiomyoma of the bladder: case report and review of the literature.

Primary mesothelial tumors of the bladder are rare. Although less than 5% of all bladder tumors are malignant in origin, the most common bladder tumor is the benign leiomyoma. Genitourinary leiomyomata may arise in any anatomic structure containing smooth muscle. They have been reported to involve single or multiple organs. Since they may also mimic malignant lesions, they should always be considered in the differential diagnosis of any pelvic mass. Sometimes, depending upon location, such lesions can only be diagnosed after surgical removal.

Diagnosis, Differential↗