Biomedical subjects
Publications and source records attributed to B S Apgar.
Endometriosis results in significant pelvic pain, dysmenorrhea, and infertility. Recognition of the signs and symptoms of endometriosis can result in early diagnosis and treatment. Management includes surgical intervention to debulk large lesions and pharmacologic therapy to produce a medical oophorectomy. Primary care physicians should suspect endometriosis in infertile patients with pelvic pain.
The hysteroscope is a valuable tool for selective viewing of the uterine cavity and the endocervical canal. With smaller-diameter scopes, hysteroscopy can be performed in the office setting, often without the need for cervical dilatation or local anesthesia. Controlled-rate CO2 insufflators allow safe distention of the uterine cavity with minimal side effects. Indications for office hysteroscopy include the evaluation of abnormal uterine bleeding, genital carcinoma and infertility and the investigation of a "lost" intrauterine device. Hysteroscopy is an adjunct to endometrial sampling, dilatation and curettage, hysterosalpingography and cervical cytology.
The loop electrosurgical excision procedure, also referred to as large loop excision of the transformation zone, is gaining acceptance in the United States as a method for treating cervical intraepithelial neoplasia. Loop excision of cervical tissue is accomplished using a high-frequency alternating current (radiofrequency) and thin wire loop electrodes. Loop excision may be in the form of simple excision of the transformation zone or electrosurgical loop conization. The specimens obtained using this technique are suitable for histologic evaluation. Loop excision, which is usually performed under local anesthesia, is associated with minimal short-term and long-term morbidity. Patient acceptance is high. Family physicians who perform colposcopy should consider using loop electrosurgical excision to treat cervical intraepithelial neoplasia in the outpatient setting.