Biomedical subjects
C S Field
Publications and source records attributed to C S Field.
Dysfunctional uterine bleeding.
Dysfunctional uterine bleeding is classified by the character of the menstrual cycle: ovulatory or anovulatory. Anovulation can occur at any age and is physiologic in the first year or two after menarche and for several years before menopause. Anovulatory cycles are characteristically irregular and marked by prolonged episodes of bleeding unassociated with signs or symptoms of ovulation. Specific causes of anovulation such as hyperprolactinemia, thyroid disease, androgen excess, anorexia, obesity, and excess exercise can be treated specifically; otherwise, therapy depends upon patient goals. Cycle regulation can be affected by monthly courses of progestin, such as medroxyprogesterone acetate (Provera), 10 mg daily for 10 days each month. Contraception and cycle regulation can both be accomplished with oral contraceptives. Fertility, on the other hand, will require ovulation induction. Ovulatory dysfunctional uterine bleeding most prevalent in parous women between the ages of 20 and 40 is associated with regular cycle intervals and premenstrual molimina. Midcycle and perimenstrual spotting can often be treated with observation only, but depending upon patient and/or physician concerns, periodic hormonal suppression is effective. The management of menorrhagia should include the following: (1) exclusion of pathology in the genital tract; (2) reduction in activity during days of heavy flow; (3) the avoidance of aspirin in the week before and on days of flow; (4) nonsteroidal anti-inflammatory drugs; (5) cycle suppression--oral contraceptives, danazol (Danocrine), depo-progestin; (6) luteal phase progestin; and (7) surgical intervention.
Surgical techniques for cesarean section.
Cesarean section is probably one of the oldest and certainly one of the most commonly performed surgical procedures in obstetrics and gynecology. There is always a risk in attempting to elaborate excessively on such a common operation. Each of us will develop our own personal biases based on individual experience and expertise. These differences are superficially distinct but usually have underlying similarities that allow us to achieve similar outcomes and expectations. At the same time, however, it is important to recognize that there is a difference between repetition and habit as opposed to altering a technique in order to meet a specific end. Obviously, with cesarean section, there can be several ways to accomplish the same result, and certain situations will dictate the individualization (patient, not physician) of technique. Certainly, one has to be aware of his or her own expertise and at the same time know his or her options. It seems best not to limit oneself to the same technique under all circumstances but to be able to anticipate problems and know how to rectify them in a manner that will avoid undue injury or compromise to the infant and mother.
An expert's perspective on managed health care and dentistry.
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CA-125 levels in endometriosis.
CA-125 is a cellular antigen detected in many patients with ovarian cancer, but it has also been detected in patients with endometriosis. Preoperative CA-125 levels were drawn from 113 patients before they underwent laparoscopy. Patients were categorized into diagnostic groups on the basis of pathologic findings. CA-125 levels in patients with evidence of intraabdominal adhesions were not statistically different from those in patients with normal pelvic anatomy. However, patients with advanced endometriosis had significantly elevated levels of CA-125 when compared with patients with normal pelvic anatomy (P less than 0.05). The clinical and immunologic implications of elevated CA-125 levels in patients with advanced endometriosis are discussed.
Effect of serum source on human fertilization and embryonic growth parameters in vitro.
A total of 100 mature oocytes from 13 consecutive patients were randomly assigned from each patient to one of two treatment groups (n = 53 for group 1, n = 47 for group 2). Group 1 oocytes were incubated throughout the culture periods in medium supplemented with 7.5% homologous patient serum. Group 2 oocytes were treated similarly, except the serum supplement was of fetal cord origin. End points for examination included fertilization frequency, normality of fertilization, stage of embryonic development at two time periods, and quality of embryonic development at two time periods. None of the end points examined revealed significant differences between patient serum and fetal cord serum.
Adolescent pregnancy: critical review for the clinician.
Adolescent pregnancy is a major health and socioeconomic problem with unique medical and psychosocial consequences for the patient and society. Consequently, it demands our attention and understanding of the problem and its causative factors. Survey data have documented that a majority of adolescents are sexually active, and that currently, almost 1 in 10 adolescents become pregnant each year. Over the last 2 decades, comprehensive adolescent pregnancy programs have shown that the high frequency of adverse obstetric and neonatal outcomes are closely associated with low socioeconomic status, poor prenatal nutrition and general health, and chemical use, but not maternal age. These adverse medical consequences and the psychosocial problem of the parents and infant are treatable with programs that adapt to the patient population and provide extensive support, education, and counseling in addition to continuity obstetric care initiated early in the pregnancy. One of the greatest needs of the adolescent is a competent and caring adult to serve as an advocate to guarantee access to medical and support services. To this end, responsible and qualified professionals who can relate to adolescents should resume this role in the coordination of a comprehensive care approach. This approach will not only reduce the medical risks associated with adolescent pregnancy, but it will decrease the number of repeat teenage pregnancies, promote school retention, increase compliance with health care regimens for the parent and child, and stimulate personal growth and development. All communities should develop programs to promote optimal medical care, psychosocial support, necessary financial support, and accessible education, since adolescent pregnancy occurs in all social, racial, ethnic, and economic groups in all parts of our country. Finally, the role of the adolescent father should be continually emphasized as a potential source of support to the adolescent mother and their infant and a stabilizer in the teenage family unit. In accord with such emphasis, recognition should be afforded to the psychologic and interpersonal needs of the adolescent father.
Educational program for premature labor.
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Treatment of endometriosis with the GnRH agonist nafarelin acetate.
Additional details of a multicenter study of nafarelin acetate with particular attention to a unique endometriosis scoring system utilized are reviewed. Additional information regarding the relapse of symptoms of 10 patients treated with nafarelin and danazol during a 6- to 12-month follow-up interval is described. Transient decreases in leukocytes previously reported by other investigators were observed in 3 of 8 patients, but appear to represent a laboratory artifact.