Biomedical subjects

B D Akright

Publications and source records attributed to B D Akright.

5 recordsLinked to original sources

PubMed1997

Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding.

We compared transvaginal sonography, sonohysterography, and diagnostic hysteroscopy in the evaluation of abnormal uterine bleeding, Sixty-eight women 40 or older with abnormal uterine bleeding were assigned to undergo either transvaginal sonography or sonohysterography. All subjects then had diagnostic hysteroscopy and endometrial biopsy. Patients with abnormal findings underwent operative hysteroscopy or definitive therapy. Transvaginal sonography, sonohysterography, and diagnostic hysteroscopy revealed a sensitivity of 95%, 90%, and 78%, and a specificity of 65%, 83%, and 54%, respectively. The average cost for transvaginal sonography of sonohysterography was $195 and the cost for diagnostic hysteroscopy was $675. Transvaginal sonography and sonohysterography are cost-effective alternatives and more sensitive diagnostic tests than office diagnostic hysteroscopy.

Adult↗

PubMed1996

Diagnosis and management of serious urinary complications after major operative laparoscopy.

OBJECTIVE: To evaluate the incidence, diagnosis, and management of serious urinary complications after major operative laparoscopy. METHODS: For this retrospective study of 953 consecutive cases of major operative laparoscopy from January 1, 1990, to December 31, 1994, we reviewed incidence, method of diagnosis, and management of complications. Urinary complications included bladder injuries, urinary fistulas, and ureteral injuries. Major operative laparoscopic procedures included hysterectomy, adnexectomy, treatment of tubal pregnancy, ovarian cystectomy, and ablation-fulguration of severe endometriosis (stage IV). RESULTS: Serious urinary complications were found during or after operative laparoscopy in 15 of 953 patients (1.6%, 95% confidence interval [CI] 0.8-2.4). Four ureteral injuries, three bladder fistulas, and eight bladder perforations were documented in this series. Eight cases of urinary complications were recognized during the original surgery (one ureteral injury and seven bladder injuries) and repaired at that time. Laparotomy or additional major surgery was performed in seven patients (three ureteral injuries, two bladder fistulas, and two bladder perforations). CONCLUSIONS: Serious urinary complications after major operative laparoscopy were discovered in 1.6% of patients. This incidence compares favorably to serious urinary complications after standard gynecologic surgery. Intraoperative recognition of these complications will likely avoid additional surgery.

Adolescent↗

PubMed1996

Complications of major operative laparoscopy. A review of 452 cases.

OBJECTIVE: To evaluate complications of operative laparoscopy. STUDY DESIGN: Operative and postoperative complications in 452 consecutive cases from January 1, 1991, to August 31, 1993, were evaluated. The series was divided into three time segments--8, 12 and 12 months. Common and serious complications were classified and reviewed. RESULTS: Complications developed during and after major operative laparoscopy in 47 (10.4%) patients in the series; 24 (5.3% of cases, or 51% of total complications) were serious, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required unplanned surgery for management of complications. During the initial learning period of eight months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods in the series. There were no cases of death, postoperative ileus, thrombophlebitis or pulmonary complications. CONCLUSION: The overall incidence of complications in major operative laparoscopy was 10.4%. Serious complications accounted for half the complications. Surgical experience reduced the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy had the highest rate of serious complications.

Dysmenorrhea↗

PubMed1994

Comparison of office loop electrosurgical conization and cold knife conization.

A group of 98 patients with abnormal Papanicolaou smears underwent cold knife conization or loop electrosurgical conization after colposcopic examination and biopsy. Average duration of surgery, intraoperative bleeding, rate of complications, and cost of the procedure were significantly less for the electrosurgical conization group. We conclude that this procedure may be performed in the office in place of hospital cold knife conization for the diagnosis and treatment of cervical intraepithelial neoplasia.

Ambulatory Surgical Procedures↗

PubMed1993

Diagnostic and therapeutic conization using loop radiothermal cautery.

A group of 173 patients with abnormal cervical cytology underwent diagnostic or therapeutic conization following colposcopic examination. The series includes 23 patients with cold knife conization in the hospital under general anesthesia, 12 patients with an outpatient KTP laser procedure under local anesthesia, 53 patients with an outpatient CO2 laser procedure under local anesthesia, 10 patients with hospital-based loop radiothermal cautery conization and 75 patients with loop radiothermal cautery conization in the office under local anesthesia. Loop radiothermal cautery conization was advantageous, with a shorter duration of surgery, lower cost, reduced operative bleeding, less of a need for pain-relieving medication and shorter duration of postoperative disability. Cold knife conization patients had the most intraoperative bleeding and the longest hospitalization. KTP laser conization produced specimens of inferior quality, resulting in the least satisfactory histologic diagnosis. Office-based loop radiothermal cautery conization may be preferable to other methods of conization in the diagnosis and management of squamous intraepithelial lesions.

Colposcopy↗