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Biomedical subjects

W Cates

Publications and source records attributed to W Cates.

At least 163 records · Page 9Linked to original sources
PubMed1978

World Health Organization studies of prostaglandins versus saline as abortifacients. A reappraisal.

The World Health Organization (WHO) Task Force on the Use of Prostaglandins for the Regulation of Fertility has sponsored a series of randomized clinical trials and case-series investigations to assess the effectiveness and safety of prostaglandins as abortifacients. Our reanalysis of the WHO studies found the prostaglandins to be faster and more hazardour than hypertonic saline as intraamniotic abortifacients. Moreover, studies by the Center for Disease Control imply that dilatation and evacuation (D&E) may be more effective, safe, convenient, and inexpensive than prostaglandins for abortions after 12 weeks' gestation, especially in the 13- to 16-week interval. For gestations of greater than or equal to 17 weeks, the occurrence of live births in prostaglandin-induced abortions has produced serious legal and ethical problems in the United States. Until the effectiveness and safety of other prostaglandins regimen approach that of D&E, we feel that D&E should be the index of comparison against which newer methods of inducing abortion are tested.

Abortion, Induced↗
PubMed1978

Abortion failure.

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Abortion, Induced↗
PubMed1977

Mid-trimester abortion by dilatation and evacuation: a safe and practical alternative.

Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.

Abortion, Induced↗
PubMed1977

Abortion deaths associated with the use of prostaglandin F2alpha.

Six abortion-related deaths associated with the use of prostaglandin F2alpha were reported through the Center for Disease Control's surveillance of abortion deaths between 1972 and 1975. Prostaglandin may have had only indirect association with these deaths. The patients' ages ranged from 16 to 38 years, their length of gestation ranged from 15 to 24 menstrual weeks, four were white, and three were nulliparous. Four patients had pre-existing conditions that increased their risks and contributed to their death. The estimated death-to-case rate for prostaglandin F2alpha was 10.5 per 100,000 abortions. Although lower than the rate for intra-amniotic saline instillation, this death-to-case rate is only an approximation. The relative safety of intra-amniotic prostaglandin F2alpha as a second-trimester abortifacient, compared to saline, remains to be established.

Abortifacient Agents↗
PubMed1977

Legal abortion mortality in the United States. Epidemiologic surveillance, 1972-1974.

As determined by the Center for Disease Control's epidemiologic surveillance of abortion mortality, the death-to-case rate for legal abortion in the United States for the three years 1972 to 1974 was 3.9/100,000 procedures. This mortality compares favorably with that from other commonly performed surgical procedures. Women who were older, were of nonwhite races, had the procedure in their state of residence, were at later gestational age, and who underwent intrauterine instillation or major abdominal surgery had the highest mortality. Duration of pregnancy proved to be the most important determinant of risk. Compared to mortality from pregnancy and childbirth, legal abortion in the first trimester was almost nine times safer.

Abortion, Legal↗
PubMed1977

The risk of dying from legal abortion in the United States, 1972-1975.

Data gathered by the Center for Disease Control (CDC) through epidemiologic surveillance of deaths associated with legal abortions performed from 1972 through 1975 are analyzed by the type of procedure and the gestational age of the patients. Analysis shows that deaths increase at higher gestational ages and that the risk of death from abortion is highest with hysterotomy and hysterectomy and lowest with suction curettage. Second trimester instillation procedures are associated with higher rates of mortality than first trimester curettage procedures, even when dilatation and evacuation at 13-15 weeks' gestation is included as a curettage procedure. A case history of a patient who died as a result of legal abortion demonstrates that while legal abortion is a safe surgical procedure, some of the deaths that still occur can be prevented.

Abortion, Legal↗
PubMed1977

Methods of midtrimester abortion: which is safest?

In the United States, the three principal methods of abortion for patients at 13 or more menstrual weeks' gestation are intraamniotic instillation of saline or prostaglandin F2alpha (PGF2alpha) and dilatation and evacuation (D&E). The relative safety of these methods, however, has not been established. This report compares the three methods using data on 17467 abortions collected by the Joint Program for the Study of Abortion under the auspices of the Center for Disease Control (JPSA/CDC). Abortion by D&E was found to be significantly safer than abortion by saline instillatin (p less than 0.001), and abortion by saline instillation was significantly safer than by PGF2alpha (p less than 0.01). Moreover, midtrimester D&E is both safe and practical; it is a direct and rapid procedure which can be performed on an outpatient basis. Although PGF2alpha accelerated the time required for abortion, it also significantly increased serious morbidity.

Abortifacient Agents↗
PubMed1977

Gynecomastia and cannabis smoking. A nonassociation among US Army soldiers.

Eleven patients diagnosed with idiopathic gynecomastia requiring mammoplasty were compared with matched controls to determine if there was an association between cannabis use and gynecomastia. Patients with gynecomastia were not significantly different from controls regarding their history of cannabis use. For those who admitted using cannabis, patients had a higher frequency but a shorter median duration of use than controls; differences were not statistically significant. Our epidemiologic evidence does not support the previously reported relationship between chronic cannabis use and gynecomastia.

Adolescent↗
PubMed1977

Fatal amniotic fluid embolism during induced abortion, 1972-1975.

From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hystereotomy (one case). Performance of abortion in the first trimester and use of curettage technics could minimize the risks of this catastrophe.

Abortion, Induced↗
PubMed1977

The impact of state maternal mortality study committees on maternal deaths in the United States.

State maternal mortality study committees have been widely credited with playing a prominent role in reducing maternal death rates in the United States. To evaluate this hypothesis, we compared the rates of decline in maternal mortality ratios by decades from 1938-40 to 1968-70 for states with such committees to those without. Ratios were calculated from published vital statistics of the United States, and committee initiation dates were obtained from a previous survey. States with committees and those without had nearly equal declines during the first decade; however, states with committees had smaller declines during the latter two decades. Although these committees may have been an important factor in the decline in maternal mortality in the United States, vital statistics data do not document larger declines for states with committees.

Female↗
PubMed1977

Midtrimester abortion by intraamniotic prostaglandin F2alpha. Safer than saline?

Published reports disagree on the risks of intraamniotic prostaglandin F2alpha (PGF2alpha) for midtrimester abortion. To evaluate the safety and efficacy of intraamniotic PGF2alpha, we compared 1241 PGF2alpha and 10,013 saline abortions performed during the 13th to the 24th menstrual week. The results were reported in the Joint Program for the Study of Abortion/CDC, a multicenter prospective study. PGF2alpha abortions required less time (P less than .001) but had higher rates of major complications (P less than .01), antibiotic and operative treatment of complications (P less than .001), and readmission to a hospital (P less than .001). These findings challenge the current contention that PGF2alpha is safer than saline as an abortifacient.

Abortifacient Agents↗
PubMed1976

Deaths from paracervical anesthesia used for first-trimester abortion, 1972-1975.

Since January 1, 1972, five women in the United States are reported to have died from paracervical anesthesia used for first-trimester abortions. This report describes the three most recent deaths. Toxic doses of lidocaine, substantiated by post-mortem blood levels of 5 and 9 mug per milliliter, probably led to two deaths; an intolerance to or inadvertent intravenous administration of mepivacaine probably caused the third. Administration of an appropriate dose of local anesthetic appears to be the single most important factor in preventing catastrophic reactions.

Abortion, Induced↗
PubMed1976

The intrauterine device and deaths from spontaneous abortion.

To evaluate the intrauterine device as a risk factor for mortality associated with spontaneous abortion, we analyzed all deaths from spontaneous abortions reported in the period 1972-1974. Women dying from spontaneous abortions with a device in place were more likely to be young, white and married than those not wearing a device. Risk of death from spontaneous abortion was over 50 times greater for women who continued their pregnancy with a device in place than for those who did not. The Dalkon shield carried an increased risk of death, as compared to other devices, even after rates were adjusted for duration of use. However, pregnant women with either a loop or a coil in place also had a higher risk of dying from spontaneous abortion than those without any device. The results support the clinical recommendation that any device should be removed when pregnancy is first diagnosed.

Abortion, Spontaneous↗
PubMed1975

Hepatitis B in Nuremberg, Germany. Epidemiology of a drug-associated epidemic. Among US Army soldiers.

Beginning in 1971, acute viral hepatitis was epidemic among US soldiers stationed in Europe, with a total of over 8,700 cases reported between 1971 and 1974. Hepatitis B surface antigen (HBsAg) determinations suggest a predominance of hepatitis B. In the Nuremberg area, primary association was with the illicit use of drugs. This association was demonstrated by a chronologic relationship between measurable community drug use and the number of hepatitis admissions three to six months later and by a case-control study. Parenteral drug use and, to a lesser degree, cannabis smoking appeared to be factors in disease transmission. Sharing of illicit drugs with a hepatitis contact, whether parenterally or orally, was associated with increased risk of contracting the disease.

Acute Disease↗