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Biomedical subjects

R W Hale

Publications and source records attributed to R W Hale.

At least 19 recordsLinked to original sources
PubMed1992

Breast evaluation and diagnosis by obstetrician-gynecologists. Survey of practice patterns.

Surveys of the obstetrician-gynecologists attending the breast disease postgraduate courses at the 1988 and 1990 American College of Obstetricians and Gynecologists annual clinical meetings report a high level of practice involvement in breast disease evaluation and cancer screening for their patients. A consistently high percentage stated they performed regular clinical breast examinations, documented the examinations with a diagram in the medical record, gave breast self-examination instruction, advised screening mammography following the American College of Obstetricians and Gynecologists guidelines, utilized a patient tracking system for follow-up and referred patients with undiagnosed dominant breast masses. Most stated that they did breast cyst aspiration; those who did not mostly referred their patients for cyst aspiration. The accurate and cost- and time-effective office technique of fine needle aspiration of palpable dominant solid breast mass continues to be underutilized even though the procedure has been proven effective and accurate in the cytologic diagnosis of benign and malignant breast neoplasms. Instruction in the technique of fine needle aspiration of palpable breast cysts and solid masses is available in many clinics, workshops and postgraduate courses.

Biopsy↗
PubMed1991

Birth of the first 100 babies in Hawaii after conception in-vitro: experience at the Pacific In-Vitro Fertilization Institute.

This paper reports on the first 100 infants delivered consecutively the result of 63 pregnancies after conception in-vitro at the Pacific In-Vitro Fertilization (IVF) Institute. These pregnancies were established prior to the introduction of embryo-cryopreservation into the program. Ninety-seven percent (97%) of singleton pregnancies delivered after 36 weeks; only 5/31 (16%) required tocolytic therapy. The overall multiple gestation rate was 51%, higher than in many other IVF centers. Maternal complications and neonatal morbidity were associated primarily with these multiple gestations. Forty-one percent (41%) delivered in less than 36 weeks, and tocolytics were administered in 22/27 (81%) of twin and 5/5 (100%) of triplet gestations. Neonatal morbidity was noted in 39 infants (33 from multiple gestations); 28 neonates were admitted to the intensive care unit (27 from multiple gestations). Nine births had or developed minor abnormalities (hernias, pyloric stenosis). One case of Trisomy 21, and one infant death at 11 months occurred in the group. The caesarean section rate for all IVF deliveries was 65%. It is concluded that IVF is clearly established in Hawaii for infertility refractory to other methods of treatment. The risk associated with IVF stem from the possibility of multiple gestations, not whether the pregnancy was initiated in-vitro. In the future, embryo cryopreservation may help to reduce the risk of multiple pregnancy.

Adult↗
PubMed1990

Evaluation of the cost-effectiveness of home monitoring of uterine contractions.

In 1988, the major health insurance carrier in the state of Hawaii initiated a prospective study to determine the cost-effectiveness of ambulatory uterine activity monitoring. At the end of the study, 79 patients had completed 3189 days on the monitor. Thirty-six patients (45.6%) did not have preterm labor; the daily monitoring resulted in an average loss to the insurance carrier of $3300 per patient, or $118,800. Forty-three patients (54.4%) experienced preterm labor and were found to have benefited from the monitoring system. Earlier detection of preterm labor and better management of oral tocolysis in this group resulted in earlier initiation of maternal tocolytic therapy, which ultimately decreased the preterm birth rate and hospitalization days in the neonatal intensive care unit. Cost analysis of this group demonstrated an average savings of $24,000 per patient, or an overall savings of $1,032,000. The total group of high-risk patients (79) resulted in a net savings to the insurance carrier of $913,200, or $11,500 per patient, suggesting that use of the ambulatory uterine activity monitoring system significantly reduced the cost associated with preterm labor and early delivery.

Adult↗
PubMed1990

Adnexal masses in pregnancy: occurrence by ethnic group.

Two hundred twenty-eight adnexal masses during pregnancy were discovered among 37,159 deliveries occurring between January 1, 1983 and October 31, 1988 at Kapiolani Medical Center for Women and Children in Honolulu. Hydatid cysts of morgagni (45.6%) occurred most frequently, followed by benign cystic teratomas (15.8%), epithelial cystadenomas (15.4%), and paraovarian cysts (13.6%). There were no malignant or borderline tumors. The patients were categorized as 22.1% part Hawaiian, 18.5% white, 17% Filipino, and 16% Japanese. We demonstrated an increased incidence of benign cystic teratomas in Filipinas (P less than .01). There was no significant predisposition for the occurrence of non-neoplastic or other neoplastic lesions among any of the other ethnic groups studied.

Adnexal Diseases↗
PubMed1989

What is the significance of the human chorionic gonadotropin value in ectopic pregnancy?

Surgical and pathology data were analyzed with the quantitative serum hCG values from 131 patients with tubal pregnancies. The hCG value correlated with both the size and contents of the eccyesis. Patients with ruptured tubal pregnancies had significantly greater serum hCG levels than did those with intact tubal gestations. Isthmic tubal pregnancies were associated with more frequent rupture and larger amounts of hemoperitoneum than were pregnancies in the ampullary segment of the tube. Tubal rupture with hCG values below 100 mIU/mL occurred in two isthmic pregnancies but in no ampullary pregnancies. With serum hCG levels below 300 mIU/mL, significant hemorrhage did not occur unless the tube was ruptured. Half of the patients had hCG levels sufficient to use a vaginal sonographic hCG discriminatory zone to assist in the diagnosis. A maximum of 15% of tubal pregnancies may be diagnosed by ultrasonographic detection of adnexal cardiac activity. A serum hCG assay sensitive to 10 mIU/mL will detect nearly all tubal pregnancies. The hCG level frequently has diagnostic value when used in conjunction with vaginal sonography. At hCG levels of 100 mIU/mL or less, tubal rupture is very unlikely for ampullary, but not for isthmic, tubal pregnancies.

Chorionic Gonadotropin↗
PubMed1989

Meconium aspiration syndrome without evidence of fetal distress in early labor before elective cesarean delivery.

Seventy-seven cases of meconium aspiration were documented among 14,527 deliveries. Four cases occurred in early labor and with normal fetal heart tracings. Three cases followed repeat cesarean sections at term, and one followed an elective cesarean section for a primigravid breech presentation. Aggressive airway management was used in every case, and included intrapartum pharyngeal suctioning with a DeLee catheter and intubation of the trachea with suctioning under direct vision. These cases suggest that meconium aspiration may occur before the onset of active labor and without evidence of fetal distress.

Adult↗
PubMed1987

Exercise and pregnancy. How each affects the other.

Organized exercise is most likely here to stay. The number of participating women has been gradually increasing and will most likely continue to do so. As a result, the physician will probably receive more and more questions about the advisability of exercise in pregnancy and the problems that might occur. Familiarity with the impact of pregnancy on exercise and of exercise on pregnancy will be of benefit to any physician serving women of child-bearing age.

Blood Volume↗
PubMed1987

Phasic approach to oral contraceptives.

Oral contraceptives were initially very high in estrogen and progestogen and had a uniform dosage schedule throughout the entire cycle. These early oral contraceptives were associated with high rates of side effects and complications. As a result, the hormone levels have been gradually reduced to attain the minimal amount necessary for contraception while most of the undesired side effects and complications have been eliminated. Recently, a new approach has been added. This mechanism consists of altering the dose of estrogen or progestogen or both during the month and is referred to as the phasic approach. The newest phasic pills now use a triphasic approach. Three basic formulations of the triphasic pill have been developed. In two of the three formulations, the progestogen level is altered, whereas the estrogen level remains stable; in the third formulation, both estrogen and progestogen are changed. Multiple clinical studies of the triphasics, such as ethinyl estradiol and levonorgestrel, prove that there is a significant reduction in the incidence of side effects and complications related to oral contraception.

Contraceptives, Oral, Combined↗
PubMed1987

Persistent ectopic pregnancy.

From 1982-1986, 625 tubal ectopic pregnancies were treated at the University of Hawaii School of Medicine Affiliated Hospitals. The percentage of cases in which the involved tube was preserved increased from 7% in 1982 to 26% in 1986. The presence of persistent trophoblastic tissue was diagnosed by elevated serum levels of the beta subunit of human chorionic gonadotropin (beta-hCG) after conservative surgery in four patients. Three of the four patients developed intra-abdominal hemorrhage and required laparotomy. One patient remained asymptomatic despite elevated beta-hCG levels, which disappeared 60 days after surgery. Evaluation of histologic slides demonstrated persistent intraluminal trophoblastic tissue without invasion in two patients, and extraluminal invasion into the tubal wall in one patient. The use of postoperative serial beta-hCG titers might facilitate recognition of this complication in time to prevent further tubal damage and hemorrhage.

Adult↗
PubMed1986

Hydrops fetalis secondary to Bart hemoglobinopathy.

Alpha-thalassemia is the most common cause of hydrops fetalis among Southeast Asians. With the recent influx of Southeast Asian refugees and the rapidly growing Filipino population this will become an increasingly important obstetric problem in the United States. Homozygous alpha-thalassemia, or Bart hemoglobinopathy, is invariably fatal to the fetus and produces significant maternal morbidity. Eighteen cases of homozygous alpha-thalassemia in one hospital are reviewed. This is the largest series reported in the United States. Recommendations are made for antenatal screening, diagnosis, and management of alpha-thalassemia.

Adult↗
PubMed1986

Presterilization counseling and women's regret about having been sterilized.

A study was designed to assess satisfaction with presterilization counseling, contentment with being sterilized and the effect of variables, such as age, number of children at the time of surgery and ethnic background, on the level of contentment with being sterilized. A total of 1,716 questionnaires were distributed at various hospitals and clinics. Questionnaires were collected from 492 women, who had ranged from 17 to 46 years of age at the time of sterilization. The majority of the women were married, and their average number of children was two. Of 487 women who replied, 30% did not receive any presterilization counseling from a physician; 15% of 480 women received their counseling from a nurse. Of 487 women, 2% fully regretted their sterilization, and the majority of them wanted more children. A positive correlation was found between the degree of satisfaction with presterilization counseling and the level of contentment with being sterilized. It was also found that 6 of the 53 women who were under 25 years of age at the time of surgery fully regretted their sterilization. The ethnic backgrounds of the women and their number of children at the time of surgery had no significant effect on their contentment with sterilization.

Adaptation, Psychological↗
PubMed1985

Monitoring of suspected infertile men with varicocele by the sperm penetration assay.

Although varicocele remains the most frequently diagnosed cause of male infertility, and improvement in semen quality is associated with repair of varicocele, improvement in spermatozoal fertilizing capacity has not been conclusively demonstrated. The sperm penetration assay was employed to monitor prospectively surgical (n = 59) and nonsurgical (n = 40) groups of men with varicocele. There were no significant increases in the average count, motility, morphologic features, or sperm penetration assay results for either group. Varicocele surgery enhanced assayable egg penetration rates in 14 of the 59 patients (23.7%), whereas the nonsurgical group had 10% spontaneous improvement. Of those in the surgery group who showed assayable fertility enhancement and were attempting conception, pregnancies were achieved in 70% (7 of 10 patients). Of patients in the nonsurgical group who improved in the assay, no pregnancies were obtained.

Adult↗
PubMed1985

Ritodrine and terbutaline compared for the treatment of preterm labor.

A prospective study comparing intravenous ritodrine and terbutaline was initiated to assess the efficacy of each drug in arresting preterm labor. Delivery was delayed for 25.8 days in patients treated with terbutaline and 13.0 days in patients treated with ritodrine. Patients treated with terbutaline gave birth to infants with a mean birthweight of 2 588 grams and 60% achieved a gestation of 36 weeks. Patients treated with ritodrine gave birth to infants with a mean birthweight of 2 392 grams and 39% achieved a gestation of 36 weeks. From this study it is evident that parturition was more effectively delayed in women treated with terbutaline than in a similar group of women treated with ritodrine.

Clinical Trials as Topic↗
PubMed1979

Office termination of pregnancy by "menstrual aspiration".

A program of office menstrual aspiration was initiated in our institution in 1972. Since that time 1,443 patients have been admitted into the study. These patients were evaluated by age, marital status, gravidity, repeat pregnancy terminations, complications, and detailed tissue analysis as well as contraception utilized at the time of conception and following counseling after the procedure. A majority of these patients were less than 25 years old and single; 28% had had a previous termination and 51% a previous pregnancy. Pathologic evaluations revealed Arias-Stella reaction in 78%. When these data were compared to those of a similar group of women whose pregnancies were terminated in the hospital by suction curettage, it was found that the office procedure is comparatively safe and should therefore be the therapy of choice.

Abortion, Induced↗
PubMed1977

Hormonal evaluation of the intrauterine progesterone contraceptive system.

Nine women were studied for one menstrual cycle prior to the insertion of an intrauterine progesterone contraceptive system (IPCS) delivering 65 microng progesterone/day into the uterus and again at 1 month after its insertion. Eight of these women were again studied between 6-8 months after the insertion of the IPCS. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol-17beta, progesterone, prolactin and relaxin were measured in each plasma sample. The data from each study were combined according to the day of the LH peak. Ovulation occurred in all the cycles studied in spite of an elevation in plasma estradiol-17beta and a depression of prolactin and relaxin immunoactivities at the 6-8 month follow up. Menstruations noted at the 6-8 month of use occurred while levels of estradiol-17beta and progesterone were elevated.

Adult↗