Biomedical subjects
A A Yuzpe
Publications and source records attributed to A A Yuzpe.
Subarachnoid hemorrhage secondary to ruptured cerebral aneurysm in pregnancy.
Eight patients suffering ruptured cerebral aneurysms during pregnancy were managed at the University of Western Ontario hospitals between 1967 and 1977. Seven aneurysms were managed surgically. All of these patients survived, 1 with permanent neurologic deficit. Seven living infants were delivered, 6 by vaginal delivery and 1 by cesarean section. One pregnancy was terminated surgically. One maternal death occurred in a patient whose aneurysm was inoperable. Fetal heart rates (FHR) were monitored by Doptone monitor during the aneurysm surgery. Clipping of the aneurysms was performed under induced hypotension. The prognosis for ruptured cerebral aneurysms during pregnancy is good for both mother and fetus. A short course of conservative therapy followed by surgical management of the aneurysm is advocated. Delivery may be managed according to obstetrical indications following surgical correction of the aneurysm.
Postcoital hormonal contraception: uses, risks, and abuses.
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Laparoscopic tubal sterilization by the "burn only" technic.
A 5-year combined experience of 2857 cases of the "burn only" technic for laparoscopic tubal sterilization is reviewed. One method failure resulted in an ectopic gestation. There were no operator errors. One laparotomy 36 hours after the sterilization procedure was done. No hemorrhagic complications and no bowel burns were encountered. From a review of the literature and the results presented here, it seems that adequate coagulation of a generous segment of the tube is the critical factor in preventing subsequent pregnancies. Tubal division or resection appears to offer no improvement in efficacy, and when tissue is obtained for pathologic confirmation, it is often of no value. When coagulation plus division or resection is performed, the incidence of hemorrhagic complications and bowel burns increases markedly.
Ethinylestradiol and dl-norgestrel as a postcoital contraceptive.
Six hundred and eight women were treated with 200 microgram of ethinylestradiol and 2 mg of dl-norgestrel, administered in two divided doses, as a postcoital contraceptive. Criteria for entry into the study included definite unprotected coital exposure within the previous 72 hours and the absence of any contraindications to the use of estrogen/progestin-containing compounds. Women with coital exposures outside of the 72-hours-to-treatment time frame were excluded. Four hundred and sixty-four of the patients were cycling regularly and, of these, 152 were exposed at midcycle. Only one patient became pregnant as a result of probable method failure as compared with the minimal estimated number of 12 to 30 pregnancies.
Adenoid cystic carcinoma of uterine cervix.
A 68-year-old postmenopausal patient with adenoid cystic carcinoma of the cervic is described. Thirty-two other cases were collected from the literature, and a clinicopathologic analysis for the whole group is presented. The study indicates that a) adenoid cystic carcinoma usually occurs in postmenopausal patients in the commonest presenting problems; c) vaginal cytology was abnormal in most cases in which it was reported; d) the lesion usually forms a mass and infiltrates parametrial and paracervical tissues; e) the tumor is frequently associated with squamous cell carcinoma (in situ or invasive) or other types of cancer; f) local recurrence after radical surgery and /or irradiation, as well as pelvic and widespread metastases, can occur; and g) the histogenesis of this type of tumor is unclear. The various possibilities are discussed.
The value of laparoscopic ovarian biopsy.
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Choosing a sterilization procedure: laparoscopic tubal sterilization.
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Postcoital contraception.
The evolution of postcoital contraception has led to the development of emergency measures to be used following a single unprotected act of intercourse and to ongoing methods, such as the administration of a contraceptive steroid agent following every coital exposure. In emergency situations, the most commonly employed hormonal steroids are the synthetic, conjugated and natural estrogens, administered in large doses for five days. Recently, a combination of an estrogen and a progestin has been employed for the same purpose. A copper-bearing intrauterine device (IUD), inserted within seven days of coitus, has also been utilized with success. Progestins alone have been utilized as an ongoing method of postcoital contraception. Failure rates have been found to vary with the dosage, the specific progestin employed and the frequency of intercourse. The major role of postcoital contraception in the developed world appears to be as an emergency measure. Ease of availability, a high degree of efficacy and a low incidence of side effects are essential for patient and physician acceptance.