Biomedical subjects
Publications and source records attributed to Donald L Fylstra.
The implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. If it is diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity.
Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. Only 19 cases have been reported in the English medical literature since 1966. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. Although expectant and medical managements have been reported, termination of a cesarean scar pregnancy by laparotomy and hysterotomy, with repair of the accompanying uterine scar dehiscence, may be the best treatment option.
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There still remains no consensus on the role of HRT in the initiation of breast cancer. Stimulation of an otherwise occult breast cancer leading to more frequently diagnosed breast cancers may seem more feasible and supported by the survival data. Although HERS and WHI both fail to offer support for a cardiovascular protective effect of HRT, other studies differ in their conclusions. There is still no true primary prevention randomized trial, and we may never have one. To take or not to take HRT may be one of the most important decisions a woman makes in her lifetime. For millions of women, now expected to live into their ninth decade, this is more than a theoretical question; it is a potentially life-altering one. For the majority of women, the cancer-phobia that leads to an avoidance of HRT is neither rational nor based on scientific evidence. However, there may be a relatively small subset of women for whom HRT does pose a potential health risk. Every health decision a woman makes includes such an assessment of risk balanced against benefit. It is the health provider's obligation to participate in risk assessment and assist each woman in designing a plan for life-long good health. The well-informed and consenting woman (and this is more important now than ever before) will make the correct decision for her circumstances. From a public health perspective, it is clear that more woman-years are saved as a result of the beneficial effects of HRT than are lost from its negative effects.
STUDY OBJECTIVE: To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians. DESIGN: Multisite hospital operating rooms and physician offices. PATIENTS: Women desiring permanent hysteroscopic sterilization. INTERVENTION: Hysteroscopic female sterilization with the Essure system. MEASUREMENTS AND MAIN RESULTS: Procedure time (scope in/scope out time), device placement rates, and incidence of complications and adverse events were compared. There was no significant difference in scope time between the 2 settings. There was no significant difference in placement rates, although the placement rate was somewhat higher in-office (91% vs 88%). There were no complications among any of the procedures, and the incidence of minor adverse events was extremely low in both settings (OR=2%, in-office=1%). CONCLUSION: There is no clear advantage to performing hysteroscopic sterilization in a hospital OR. Hysteroscopic sterilization can be performed safely and efficiently in an office setting.