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Biomedical subjects

R S Neuwirth

Publications and source records attributed to R S Neuwirth.

At least 19 recordsLinked to original sources
PubMed1991

The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas.

One hundred fifty-six of 177 patients admitted to the St. Luke's/Roosevelt Hospital Center between November 1973 and November 1988 for hysteroscopic treatment of menorrhagia and/or uterine leiomyomas were followed for long-term complications and necessity for repeat surgery. Ninety-four patients underwent submucous resection alone and 62 patients underwent endometrial ablation with or without submucous resection. Among the submucous-resection group, 24.5% reported late postoperative problems and 15.9% underwent further surgery. After 9 years of followup, 83.9% of the patients had not required further surgery. Among the ablation group, 22.5% experienced recurrence of increased bleeding and 8.1% had another surgical procedure. After 6 years of follow-up, 91.3% of the patients had not required further surgery. Twenty-one patients became pregnant after submucous resection, with 18 infants delivered. No patients who underwent endometrial ablation became pregnant. This modality of treatment appears to be effective over the long term, although effectiveness appears to diminish with time.

Adult↗
PubMed1988

Evaluation and management of the pelvic mass: a review of 540 cases.

The management of 540 patients with the diagnoses of "pelvic mass/uterine leiomyomata" was reviewed with respect to preoperative evaluation, surgical procedures, and final pathologic diagnosis. Approximately 6170 patients were admitted to the Gynecology Service at St. Luke's-Roosevelt Hospital Center from July 1984 to June 1985. During this period, 36 of 432 diagnostic laparoscopies (8.3%) and 503 of 1666 laparotomies (30.2%) were performed to evaluate or treat these women. The final diagnoses in the 249 patients admitted with the impression of leiomyomata were: leiomyomata, 235 (94.4%); benign adnexal masses, seven (2.8%); cancers, four (1.6%); and miscellaneous, three (1.2%). Of the 291 patients evaluated for pelvic mass, the findings were: benign ovarian or tubal cysts, 98 (33.7%); leiomyomata, 42 (14.4%); cancers, 40 (13.7%); benign cystic teratomas, 38 (13.1%); endometriosis, 28 (9.6%); miscellaneous, 23 (7.9%); and pelvic inflammatory disease, 22 (7.6%). Correlation between the patient's age, preoperative impression, and final diagnosis is presented with particular attention to the 44 patients (8.1%) in whom malignancy was found. All the possibilities that such masses may represent must be considered preoperatively, and the patient be informed of her risk of malignancy.

Adolescent↗
PubMed1988

The incidence of asymptomatic uterine anomalies in women undergoing transcervical tubal sterilization.

The incidence of congenital anomalies of the uterus has generally been obtained from studies of women undergoing evaluation for infertility, and has been reported as 1-10%. However, the true incidence of uterine malformations is not known. This study reviews hysterosalpingograms obtained for evaluation of tubal closure after transcervical sterilization in normal multiparous women using methylcyanoacrylate and the FEMCEPT device. Of the 840 hysterosalpingograms studied, 16 congenital uterine anomalies were identified, for an incidence of 1.9%. The presence of anomalies in this population of women may more closely represent the incidence of congenital uterine anomalies in the general population.

Female↗
PubMed1987

Intrauterine administration of methyl cyanoacrylate as an outpatient method of permanent female sterilization.

Results are presented of multicenter studies on the intrauterine delivery of 0.6 ml methyl cyanoacrylate with the FEMCEPT device (BioNexus Inc., Raleigh, North Carolina) for the purpose of causing permanent obstruction of the fallopian tubes. The studies included 1279 women and were conducted under several different protocols that required either one or two methyl cyanoacrylate application procedures. Based on hysterosalpingograms obtained about 16 weeks after the last methyl cyanoacrylate application, one procedure resulted in a tubal closure rate of 71.4% and two procedures resulted in a tubal closure rate of 89.4%. Complications of the procedure were infrequent and none required surgical treatment. Cumulative pregnancy rates among women with hysterosalpingogram-demonstrated bilateral tubal closure were similar for the one- and two-application procedures that used nonradiopaque methyl cyanoacrylate and were significantly lower (p less than 0.05) compared with a single application of radiopaque methyl cyanoacrylate. The 3-year pregnancy rate for two applications of nonradiopaque methyl cyanoacrylate was 1.7 +/- 1.2 per 100 women.

Ambulatory Care↗
PubMed1983

Trials with the FEMCEPT method of female sterilization and experience with radiopaque methylcyanoacrylate.

A previous report described the development of a blind method to deliver methylcyanoacrylate (MCA) transcervically. Using 0.6 ml of a stable MCA whose polymerization time was closely controlled, we reported a 78% bilateral tubal closure rate in 23 cases with hysterosalpingographic control. Subsequent to the previous report, we initiated a study in which patients were randomly assigned to one of three treatment groups: a single MCA injection, a single MCA injection after uterine lavage, or two MCA injections 1 month apart. In addition, a radiopaque MCA has been developed with which it is possible to determine tubal entry after its application by means of the FEMCEPT device. Patients treated with radiopaque MCA have been studied to determine whether it is possible to predict tubal closure on the basis of tubal entry and distribution patterns. The results of these studies and their implications for contraceptive effectiveness of the FEMCEPT/MCA system will be reported.

Clinical Trials as Topic↗
PubMed1983

Hysteroscopic management of symptomatic submucous fibroids.

Twenty-eight patients who underwent resection of a submucous fibroid under hysteroscopic control are reported with a follow-up for one to seven years. Seven patients underwent subsequent hysterectomy for various reasons. Two required repeat hysteroscopic resection and 17 returned to normal menses without difficulty. Five of these patients subsequently had a total of eight pregnancies, with five living children. The implications of this option of therapy are discussed.

Adult↗
PubMed1982

Symptomatic intrauterine retention of fetal bones.

Four patients with symptomatic intrauterine retention of fetal bones are discussed. Presenting complaints included infertility, irregular vaginal bleeding, vaginitis, and spontaneous passage of fetal bones. Two patients had uterine anomalies; 1 patient had a retained twin pregnancy. Pelvic ultrasound and x-ray films of the pelvic cavity are helpful in making a diagnosis. Hysteroscopy is invaluable both in confirming the diagnosis and in achieving successful removal of fetal bone.

Abortion, Incomplete↗
PubMed1982

Hysteroscopic resection of intrauterine scars using a new technique.

The authors describe a 5-year experience with 27 patients who had confirmed intrauterine scars at hysteroscopy, all of whom underwent resection of the scar. Of the 27, 14 became pregnant at least once, and 13 did not conceive. Hysteroscopic and hysterographic evidence of intrauterine scar was in general more severe in those who did not become pregnant. There were no cases of abdominal placentation in the 18 pregnancies after surgical repair, although there was 1 case of postpartum hemorrhage. Details of technique, including postoperative use of estrogen and the intrauterine device, are discussed.

Cicatrix↗
PubMed1980

An outpatient approach to female sterilization with methylcyanoacrylate.

MCA is a tissue adhesive which can be delivered transcervically to the Fallopian tubes by means of the FEMCEPT device. In the patients treated with this system, both prior to hysterectomy and on an ambulatory basis, there have been no significant complications or side effects. In the most recent series of ambulatory patients treated with the REMCEPT-MCA system, the bilateral tubal closure rate was 78%.

Ambulatory Care↗
PubMed1978

Evaluation of polymer flock and metal alloy intra-tubal device in pigtail monkeys.

Two intratubal devices, one covered with a flock made from ethylene vinyl acetate and the other constructed of titanium-aluminum-vanadium alloy with an etched surface were evaluated after being placed in the Fallopian tubes of pigtail monkeys. In some instances, the devices were medicated with 10% silver nitrate or 50% quinacrine hydrochloride. The microflock device anchored in the tube mechanically, but there is no evidence that either the polymeric or metal alloy device formed an actual attachment with Fallopian tube epithelium. It is suggested that a mechanical design approach to ITDs might be more productive than one which assumes a tissue-device bond.

Alloys↗
PubMed1977

Single-application fertility-regulating device: description of a new instrument.

An instrument is described with which it is possible to deliver low-viscosity material consistently to the interstitial and isthmic portions of the Fallopian tube in a blind fashion on an outpatient basis. Considerable care with instrument design has been taken in order to reduce potential complications and to ensure precision. The efficiency of this system in delivering a variety of dyes has been demonstrated in hysterectomy specimens with the use of laparoscopic control. We believe this system is simple to use and may be found acceptable for application by relatively unskilled personnel. If it produces a high degree of tubal closure without significant complications or pregnancies, it should be an important addition to the techniques for limiting family size and population growth.

Cyanoacrylates↗