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Biomedical subjects

D M Fedorkow

Publications and source records attributed to D M Fedorkow.

17 recordsLinked to original sources
PubMed1995

The cotton swab test. Receiver-operating characteristic curves.

The purpose of this prospective, cohort study was to perform a receiver-operating characteristic (ROC) analysis of the cotton swab test and its ability to predict stress incontinence. The study was performed in a tertiary care gynecologic urology clinic over a period of 3.5 years. Two hundred sixty-three women presenting with the complaint of urinary incontinence formed the basis of the cohort. Subjects were classified as having genuine stress urinary incontinence or incontinence secondary to another factor following urodynamic testing. The cotton swab test was performed as part of the standard urogynecologic assessment. Measurement was made of the resting, straining and calculated resultant change in angle. ROC curves were calculated for each of the angles measured. The resultant ROC curves demonstrated that straining angle has the best discriminatory power in the diagnosis of genuine stress urinary incontinence. The optimum cut-off point for this discrimination is a deflection of 40 degrees from the horizontal, with a resultant sensitivity of 83%. Despite the diagnostic trend, the sensitivity of the straining angle does not allow one to confidently make a diagnosis of genuine stress urinary incontinence without a confirmatory evaluation. The test, however, can be beneficial in the counseling and triage of women with lower urinary tract complaints.

Female↗
PubMed1993

Total abdominal hysterectomy at abdominal sacrovaginopexy: a comparative study.

OBJECTIVE: This study was designed to address whether women undergoing total abdominal hysterectomy at the time of abdominal sacrovaginopexy have a higher incidence of early postoperative febrile morbidity defined as an oral temperature > 35 degrees C (101 degrees F) on at least two occasions in the first 5 postoperative days when compared with women undergoing abdominal sacrovaginopexy alone. STUDY DESIGN: A prospective cohort study was performed in a tertiary care gynecologic urology clinic. Two hundred thirty-five patients were included in this study. Eighty-six (36.6%) underwent total abdominal hysterectomy in addition to abdominal sacrovaginopexy, whereas 149 (63.4%) had abdominal sacrovaginopexy alone, according to a standard protocol. Data were collected by chart review and analyzed with odds ratio and Student t statistics. RESULTS: The incidence of febrile morbidity was 4.7% in the group undergoing hysterectomy and 5.4% in the group having only abdominal sacrovaginopexy. The generated odds ratio (95% confidence interval) is 0.86 (0.21 to 3.28), which suggests no significant increase in febrile morbidity in the hysterectomy group. Similarly, no obvious difference was found in the duration of hospitalization or the change in hemoglobin between groups. There was, however, a significantly increased operating time in those patients undergoing hysterectomy. CONCLUSIONS: Total abdominal hysterectomy performed at the time of abdominal sacrovaginopexy does not result in a clinically significant increased risk of febrile morbidity.

Cohort Studies↗
PubMed1993

Age is prognostic variable in cervical squamous cell carcinoma.

A clinico-pathologic review was performed on all younger (under 35 years) and older (55 years or over) women with a diagnosis of cervical squamous cell carcinoma assessed at the Tom Baker Cancer Centre from 1980 to 1985 to determine the effect of age at diagnosis on survival. 45 younger women were identified: 32 were Stage IB; 10, Stage II; and 3, Stage III. 64 older women were identified: 16 were Stage IB; 30, Stage II; 14, Stage III; and 4, Stage IV. For Stage IB women, 40.6% of younger patients developed persistent or recurrent disease and all except one are dead; only one (6.2%) older woman's tumour recurred and she is alive with disease. Younger women had a poorer disease-free survival not only for Stage IB disease (p = 0.014) but also in Stages II and III (p = 0.020). In this study age at diagnosis was an independent prognostic variable with younger women having a poorer disease-free and overall survival.

Adult↗
PubMed1993

A quantitative overview of controlled trials in endometriosis-associated infertility.

OBJECTIVE: To undertake quantitative overviews of the following commonly used treatments for endometriosis-associated infertility: ovulation suppression, laparoscopic ablation, and conservative laparotomy. DESIGN: A protocol was prospectively defined detailing the research question, mode of study identification, inclusion and exclusion, data extraction, and pooling methods. Studies were assessed for relevance and validity by independent reviewers and their findings compared. Data were extracted in a similar fashion. PATIENTS: Women with visually diagnosed endometriosis, complaining of infertility. MAIN OUTCOME MEASURE: Pregnancy as defined by positive pregnancy test. RESULTS: Twenty-five relevant randomized controlled trials and cohort studies were identified with a total of 37 treatment comparisons. The common odds ratio (OR) from seven studies comparing ovulation suppression (danazol, medroxyprogesterone acetate [MPA], or gestrinone) versus placebo or no treatment was 0.85, suggesting no treatment benefit. The common OR for pregnancy after ovulation suppression (MPA, gestrinone, or GnRH agonist) versus danazol was also nonsignificant: 1.07. Although pooled data from trials of laparoscopic surgery suggested a treatment benefit, significant heterogeneity between studies undermines this conclusion. Laparoscopic data were similar to those from conservative laparotomy studies. Studies assessing conservative surgery plus danazol versus danazol alone showed no significant benefit from this adjunct. CONCLUSION: Ovulation suppression is an ineffective treatment for endometriosis-associated infertility. Well-designed trials of laparoscopic ablation deserve a high priority.

Combined Modality Therapy↗
PubMed1992

The routine use of gonadotropin-releasing hormone agonists prior to in vitro fertilization and gamete intrafallopian transfer: a meta-analysis of randomized controlled trials.

OBJECTIVE: To assess the efficacy of gonadotropin-releasing hormone agonists (GnRH-a) used in ovulation induction for in vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT). DESIGN: Meta-analysis of 10 trials comparing treatment cycle outcomes after GnRH-a (n = 914) with other ovulation induction protocols (n = 722) and 7 trials comparing outcomes after short flare-up (n = 368) with longer suppression (n = 476) GnRH-a protocols. MAIN OUTCOME MEASURES: The outcome of primary interest was clinical pregnancy rate (PR) per treatment cycle commenced. Data describing the amount of gonadotropin used, cycle cancellation rate, clinical pregnancy per ET, and multiple pregnancy and abortion rates were also analyzed. RESULTS: Clinical PR per cycle commenced was significantly improved after GnRH-a use for IVF (common odds ratio [OR] 1.80, 95% confidence interval [CI] 1.33 to 2.44) and GIFT (common OR 2.37, 95% CI 1.24 to 4.51). Clinical PR per embryo transfer was also significantly improved with GnRH-a use (common OR 1.40, 95% CI 1.01 to 1.95). Cycle cancellation was decreased (common OR 0.33, 95% CI 0.25 to 0.44), whereas spontaneous abortion rate was similar with and without GnRH-a use. Cycle cancellation and PRs after short flare-up and longer suppression protocols were similar between groups. CONCLUSIONS: This meta-analysis supports the routine use of GnRH-a for IVF and GIFT. Further research is needed, however, to assess the potential for increased rates of multiple pregnancy and ovarian hyperstimulation syndrome, which may be associated with this treatment.

Abortion, Spontaneous↗
PubMed1989

Inflammatory bowel disease: a controlled study of late pregnancy outcome.

A retrospective controlled study of 98 pregnancies complicated by inflammatory bowel disease was conducted with control pregnancies matched for parity, sex of offspring, year of delivery, and maternal age. Two control pregnancies were paired with each study case. There was no significant difference in weight gain or hemoglobin levels between the two groups. However, patients with inflammatory bowel disease had a statistically significantly higher preterm delivery rate (p less than 0.01) than the rate of the control group. The risk of these two disorders was further increased when exacerbation of the bowel disease occurred during pregnancy.

Adult↗
PubMed1989

Fetal heart rate changes associated with general anesthesia.

Decreased fetal heart rate variability was noted 90 seconds after the induction of general anesthesia with sodium thiopentone and fentanyl in a patient undergoing basket extraction of a renal calculus at 30 weeks' gestation. The fetal sleep pattern lasted for 105 minutes after the anesthetic was discontinued, 45 minutes after the mother was fully awake.

Adult↗
PubMed1988

Invasive squamous cell carcinoma of the cervix in women less than 35 years old: recurrent versus nonrecurrent disease.

Invasive cervical squamous cell carcinoma was diagnosed in 45 patients less than 35 years old from 1980 to 1985. Thirty-two cases were Stage IB; 10, Stage IIB; and three, Stage IIIB. Twenty-two patients developed persistent or recurrent disease. Only one of these is now alive with no evidence of tumor. The mean interval from diagnosis to recurrence was 8.7 months (median of 7.0) and from diagnosis to death was 14.7 months (median of 12.0). Eleven of 32 patients with Stage IB disease developed a recurrence; the intervals to recurrence in Stage IB disease were similar to those for more advanced stages. Factors predicting recurrence included advanced stage of the disease and tumor bulk (maximum size, depth of invasion, and number of involved quadrants) as well as an exophytic or ulcerative tumor and a symptomatic presentation. These factors may identify the patient at high risk for recurrence who would benefit from adjuvant therapy.

Adult↗
PubMed1988

Recurrent and persistent squamous cell cervical carcinoma in women under age 35.

Forty-five patients with invasive cervical squamous cell carcinoma were registered in the Tom Baker Cancer Centre from 1980 to 1985. The natural history of 22 patients (48.9%) who developed persistent or recurrent disease including 11 Stage IB, 8 Stage IIB, and 3 Stage IIIB is reported. Only one patient who had the uncommon papillary variant is alive without evidence of residual disease. The remainder are either dead (16) or alive with residual disease (5). Four patients never achieved a disease-free status and in the remainder recurrences developed on average in 8.7 months. Central or regional disease was not controlled in 20 of 22 patients. Neither radical surgery nor radiotherapy was evidently more effective in preventing persistent or recurrent disease. A reliable predictive marker for persistent or recurrent disease is required: lymph-vascular invasion in the radical hysterectomy specimens was present in 5 of 6 cases but it is subject to interpretive error. Since the disease is frequently systemic at the time of diagnosis, early adjuvant therapy and improved staging techniques are required to improve the survival.

Adult↗
PubMed1988

Septuplet gestation following the use of human menopausal gonadotropin despite intensive monitoring.

Despite this good correlation supporting only four follicles, seven gestational sacs developed. The cause is unknown, but oocyte division cannot be ruled out. This case demonstrates that there are no absolute criteria for preventing high multiple pregnancies. While sophisticated cycle tracking using ultrasound and E2 values may alert the clinician to the development of multiple follicles, thus permitting discontinuation of the treatment, this report emphasizes that multiple gestations exceeding the anticipated number of follicles remains a possibility.

Adult↗
PubMed1987

Ruptured uterus in pregnancy: a Canadian hospital's experience.

Between 1966 and 1985, 15 cases of complete rupture of the uterus in pregnancy were identified among 52,854 deliveries at Foothills Provincial General Hospital, Calgary, for an incidence rate of 0.3 per 1000 deliveries. Previous cesarean section (in seven patients) was not the only predisposing factor: a history of dilatation and curettage (in two patients) or laparoscopy (in one) were also implicated. Long, obstructed labour did not appear to be a factor. Rupture also occurred in patients at low risk. The most frequent immediate complication was hypotension, in five patients. The rupture site was repaired in 11 of the patients; the other 4 underwent hysterectomy. Close surveillance and prompt intervention are the keys to good fetal and maternal outcome.

Adult↗
PubMed1982

The patella in total knee arthroplasty.

Uncertainty still exists as to the necessity to resurface the patella in total knee arthroplasty. In a series of 77 ICLH knee arthroplasties there were 12 bilateral cases which had a prior patellar resurfacing on one side and a patelloplasty on the other. The results of those who had a patellar resurfacing were slightly better, but only three patients could tell the difference in their knees. Incidence of patellar fracture following resurfacing was much higher than that following patelloplasty.

Fractures, Bone↗
PubMed1980

Review of a failed knee replacement and some observations on the design of a knee resurfacing prosthesis.

In a review of failed knee replacements, one design was found to have a seventy-three percent failure rate at three years. In this design the tibial component resembled the MacIntosh prosthesis and the femoral component was polyester. Failure in most cases resulted from generation of wear debris resulting in a severe synovitis and loosening of the femoral component. These findings suggest that the femoral component should be metal and the tibial component plastic, and that if the tibial component is backed with metal, in most cases it need not be cemented in place.

Humans↗
PubMedDate not supplied

Revision rates in forefoot surgery.

In an attempt to determine failure or reoperation rates for common forefoot procedures, the records of 706 patients who had 1003 forefoot operations were studied. The revision rate for the Keller procedure was 2.26% when no interposition implant was used. The revision rate for metatarsal osteotomies, mainly due to nonunion, was 2.7%. The revision rate for proximal phalangectomies was 3.3%, being 1.9% when the distal end of the phalanx was removed and 4.4% when the proximal end was removed. The failure rate for proximal interphalangeal joint fusion was 17.8%. These results demonstrate that the antiquity of a procedure is not necessarily a recommendation.

Arthroplasty↗