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Biomedical subjects

T S Kosasa

Publications and source records attributed to T S Kosasa.

At least 19 recordsLinked to original sources
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

Incidence of Chlamydia trachomatis infection related to selected signs and symptoms of lower genital tract infections in women.

Chlamydia trachomatis infections of the female reproductive tract is associated with a spectrum of clinical syndromes from simple colonization to mucopurulent cervicitis, urethritis, proctitis, and pelvic inflammatory disease. Its natural history and tendency for progression is unclear. It is said these infections are the most common of all sexually transmitted diseases.

Chlamydia Infections↗
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

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↗
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↗
PubMed1976

A comparison between gonadotropin radioimmunoassays with the use of 48 hour and six-day incubation methods.

A double-antibody radioimmunoassay for human follicle-stimulating hormone (FSH) and human luteinizing hormone (LH) which can be carried to completion in 48 hours was compared with the conventional six-day double-antibody radioimmunoassay. The bound-over total (B/T) dose response curves for the 48 hour assay were comparable in slope and dose range with the six-day assay and the four per cent average within-assay and the nine per cent between-assay coefficients of variation for the 48 hour assay were comparable with the variation observed in the conventional six-day assay. Maximum variation among identical serum samples assayed in both systems was 15.3 per cent so that quantitative results obtained with either assay system were comparable.

Chorionic Gonadotropin↗
PubMed1976

Microscopic appearance of the human fallopian tube following a reanastomosis procedure.

Microscopic evaluation of a human fallopian tube following end-to-end anastomosis over a polyethylene stent was performed 10 days after the initial surgical procedure. The stent was removed on the 3rd postoperative day. Examination of the excised tube revealed a patent lumen without any evidence of mucosal compromise. The submucosa adjacent to the anastomotic site revealed a mild polymorphonuclear leukocytic infiltration, although a marked inflammatory response was observed around the 5-0 chromic sutures used in the reanastomosis. This case and recent animal studies suggest that early removal of the stent does not appear to jeopardize the patency of the tube and may be preferable to removal after 3 to 4 months.

Adenocarcinoma, Papillary↗
PubMed1976

Diagnosis of a supernumerary ovary with human chorionic gonadotropin.

The preoperative diagnosis of ectopic ovarian tissue has been reported only once in the literature. In the present case, differential ovarian and adrenal testing was used to diagnose and aberrant ovarian source of persistently elevated plasma estrogen in a patient who had undergone bilateral oophorectomy and adrenalectomy for metastatic breast carcinoma. The ovarian source was diagnosed by stimulation with human chorionic gonadotropin (hCG), and treatment with human menopausal gonadotropin (hMG) prior to surgery was used to facilitate its location at laparotomy.

Adrenalectomy↗
PubMed1975

Rapid hCG-specific radioimmunoassay for menstrual aspiration.

Fifty-one women with missed periods ranging from 5 to 14 days who suspected a pregnancy underwent an aspiration curettage with a flexible soft-tipped cannula attached to a Karman-type syringe. Sera from these women were measured for human chorionic gonadotropin (hCG) by a rapid 2-hour solid phase radioimmunoassay using an antibody with a specificity for the beta subunit of hCG. The sensitivity and specificity of this assay insured detection of bCG with 100% accuracy at the time of the missed period. Of the 51 women, 33 (64.7%) were found to have hCG in their serum, and 29 (56.8%) had histologic evidence diagnostic of pregnancy.

Abortion, Induced↗
PubMed1975

A rapid solid-phase radioimmunoassay specific for human chorionic gonadotropin in gestational trophoblastic disease.

A rapid solid-phase radioimmunoassay (RIA) specific for human chorionic gonadotropin (hCG) has been used for the measurement of serum hCG activity in patients with molar pregnancy and gestational trophoblastic disease (GTD). Serum hCG regression as determined by the specific RIA method after evacuation of uncomplicated molar pregnancy was noted to occur over a longer duration of time than previously reported from this Center using a nonspecific RIA system which measures human luteinizing hormone (hLH) and hCG simultaneously. Therapy for proliferative trophoblastic disease was withheld after evacuation of molar pregnancy while the serum hCG level regressed normally, but was instituted when the serum hCG level rose or plateaued for more than two consecutive weeks. Serum hCG levels in patients requiring chemotherapy for GTD were also more accurately monitored with the specific RIA method than with the nonspecific technic. Therapy was based solely on the hCG titer rather than the subsidence of toxicity, as has been our practice in the past. As a result, the duration of hospitalization, total dose of drug required for remission, and toxic side effects were substantially reduced without sacrificing the effectiveness of chemotherapy.

Adolescent↗