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Biomedical subjects

E A Schaff

Publications and source records attributed to E A Schaff.

11 recordsLinked to original sources
PubMed1997

Methotrexate. A single agent for early abortion.

OBJECTIVE: To determine whether methotrexate as a single agent for induced abortion in pregnancies up to 5 weeks is as effective, has fewer side effects and is as acceptable to subjects as the combination of methotrexate and misoprostol. STUDY DESIGN: Women with no greater than a 5-week gestation were compared with a historical control group of consecutive women presenting for a medical abortion matched for gestational age. Subjects received intramuscular methotrexate on day 1. The study group received no misoprostol until day 21, when it was offered if the abortion had not yet occurred. The control group self-administered one or more doses of misoprostol within the first week after methotrexate. A complete abortion was defined by either negative transvaginal ultrasound or negative urine pregnancy test. All subjects completed a daily symptom log and satisfaction questionnaire. The analysis consisted of a comparison of the study group and control group for completion and timing of the abortion, symptoms and subject satisfaction. RESULTS: There were 40 study subjects and 53 controls. All subjects had a medical abortion without surgery. Ten (25%) of the 40 study subjects reached study day 21 without bleeding: 4 used misoprostol and 6 chose to wait for the abortion to occur spontaneously. One of the 10 subjects had persistent embryonic cardiac activity at 21 days and aborted after misoprostol. The mean number of days to bleeding was 15.5 days (SD 7.8 days) for the study group as compared with 8.1 days (SD 11.3) (P = .0003) for the control group. There was no significant difference in the number of days of bleeding, gastrointestinal side effects or reported subject satisfaction. CONCLUSION: While methotrexate as a single agent was effective in inducing abortion in early pregnancy, 15% of the study subjects finally used misoprostol, the abortion took significantly longer, and side effects were not less common as compared with those in subjects who received the combination of methotrexate and misoprostol.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Vaginal misoprostol administered at home after mifepristone (RU486) for abortion.

BACKGROUND: There have been no US studies published on the effectiveness, safety, time to bleeding, and acceptability of misoprostol administered by vagina at home and repeated, if needed, after mifepristone was administered for abortion in women up to 8 weeks pregnant. METHODS: A prospective trial was conducted with women up to 8 weeks pregnant wanting an abortion. After receiving mifepristone 600 mg orally, subjects self-administered vaginal misoprostol 800 micrograms at home 2 days later. Subjects returned within 7 days, and if the gestational sac was still present on ultrasound, a repeat dose of misoprostol was administered in the office. Subjects completed a daily symptom log and a questionnaire on the acceptability of the procedures. RESULTS: Of the 166 subjects, 163 (98%) had a complete medical abortion. Three subjects presented with persistent bleeding and an incomplete abortion from 27 to 35 days after taking mifepristone and required surgical intervention. Vaginal spotting or bleeding occurred in 104 (62%) subjects before taking misoprostol, and 18 (11%) did not use misoprostol. Bleeding occurred on average 3.5 hours (SD, 3.2) after taking misoprostol. Six (4%) subjects required a second dose of misoprostol. Gastrointestinal side effects were common, mild, and brief. One hundred fifty-nine (96%) subjects agreed that the procedure went well, and 146 (90%) agreed that home administration of misoprostol was acceptable. CONCLUSIONS: Two days after taking mifepristone, misoprostol administered by vagina was found to be safe, highly effective, and acceptable to women. Since only 6 subjects needed a second dose of misoprostol, conclusions about repeat doses are not possible. This procedure is a promising alternative to surgical abortion.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Methotrexate and misoprostol when surgical abortion fails.

OBJECTIVE: To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible. METHODS: Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square meter intramuscularly followed by a misoprostol 800-microgram suppository 72 hours later. A repeat dose of a misoprostol 800-microgram vaginal suppository was administered on day 4 if there was no bleeding, and an additional dose was given if the repeat beta-hCG titer had not decreased by at least 50%. Subjects were followed-up with serum or urine hCG assays. Complete abortion was defined by vaginal bleeding and a negative urine pregnancy test. Subjects completed a daily symptom log and a satisfaction questionnaire when the abortion was complete. RESULTS: The four women referred after failed suction curettage had the following anatomic problems: a uterus bicornis bicollis, a bicornuate uterus, uterine leiomyomas, and cervical stenosis resulting from previous laser surgery. All subjects had a complete abortion from methotrexate and misoprostol. Mild gastrointestinal side effects were reported by all four subjects: nausea (two subjects), vomiting (two), and diarrhea (two). The satisfaction questionnaire revealed that all subjects agreed with the statements that "Overall, the procedure went well" and "I would recommend this procedure over a surgical abortion." CONCLUSION: Methotrexate and misoprostol can induce an abortion when uterine or cervical anomalies make suction curettage difficult or impossible.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Methotrexate and misoprostol for early abortion.

OBJECTIVES: This study examined the effectiveness of an abortion by methotrexate and misoprostol, including side effects, subjects' satisfaction, and optimal treatment strategies. METHODS: The study evaluated a prospective ongoing trial of women with an 8-week gestation or less wanting an abortion. Subjects received intramuscular methotrexate (50 mg per m2 of body surface area) on day 1. Subjects self-administered misoprostol 800 micrograms orally or as a vaginal suppository or vaginal tablets either on day 3 to 4 or day 5 to 7. Repeat misoprostol 800 micrograms doses were used vaginally if there was no significant bleeding and the gestation was less than 12 weeks. Subjects with continuing pregnancies had a surgical abortion. Subjects completed a daily symptom log and a satisfaction questionnaire. A successful medical abortion was defined by vaginal bleeding without surgical intervention and either a negative urine pregnancy test or a negative transvaginal ultrasound. RESULTS: Of the 282 subjects, 274 (97%) had a medical abortion. Eight (3%) subjects required surgical intervention--four for continued pregnancies and four for excessive bleeding. One hundred and sixty-two (57%) subjects required only one dose of misoprostol and started bleeding, on average, 6.2 hours later. One hundred and twelve subjects (40%) required an average of 2.5 misoprostol doses and started bleeding, on average, 12.4 days after initial methotrexate injection. Misoprostol was more effective vaginally than orally. Gastrointestinal side effects were common, mild, and brief. Eighty-eight percent of the subjects agreed that the procedure went well. Subjects monitored with ultrasound completed the study sooner than those followed by beta-hCG levels. CONCLUSION: Methotrexate and misoprostol were effective in inducing an abortion up to 8 weeks' gestation. The procedure is a promising alternative to surgical abortion.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

Combined methotrexate and misoprostol for early induced abortion.

OBJECTIVE: To determine the effectiveness and side effects of and subject satisfaction with an induced abortion by administration of methotrexate and intravaginal misoprostol. SUBJECTS AND DESIGN: Prospective trial of 100 consecutive pregnant women aged 18 years or older at 8 weeks' gestation or less and wanting an abortion. INTERVENTIONS: Intramuscular administration of 50 mg of methotrexate per square meter of body surface area on day 1 and a misoprostol 800-micrograms vaginal suppository on day 3. Administration of misoprostol was repeated the following day if no bleeding occurred after the first dose. PROTOCOL: After pregnancy dating by clinical criteria, subjects were followed up with serum beta-human chorionic gonadotropin (beta-hCG) determinations on days 1, 7, and 14 and a high-sensitivity urine hCG test every 2 weeks until the value was less than 10 IU/L. Subjects completed a daily symptom log and satisfaction questionnaire on day 14. MAIN OUTCOME MEASURES: Complete abortion as defined by vaginal bleeding and a beta-hCG value of less than 10 IU/L without surgical intervention, complications and side effects, and patient satisfaction. RESULTS: Ninety-seven subjects had a complete abortion and one subject had vaginal bleeding and a 94% decrease of her beta-hCG value on day 7 but was subsequently unavailable for follow-up. Two subjects required surgical procedures: one with a continued pregnancy and one for excessive bleeding. No failures or complications occurred in early gestations prior to 45 days from the last menstrual period. Seventy-three percent responded to misoprostol treatment with bleeding within 12 hours and had a mean decrease of 90% in their beta-hCG value on day 7. Twenty-seven percent had no immediate bleeding response to misoprostol administration, began bleeding on day 10 (SD, 8 days), and had a mean decrease of 10% in their beta-hCG value on day 7. Seventy percent reported nausea; 46%, diarrhea; and 23%, vomiting. Ninety-three percent agreed that the procedure was acceptable and 95% would recommend the procedure. CONCLUSIONS: Methotrexate and misoprostol were effective in inducing an abortion up to 8 weeks. Home administration of a compounded misoprostol vaginal suppository was successful. Although gastrointestinal tract side effects were common, women found the procedure and its side effects acceptable.

Abortion, Induced↗
PubMed1995

Is the clinical spectrum of gonorrhea changing?

PURPOSE: The study's objective was to determine whether the high rates of gonorrhea in one inner city teen health care program were due to an increase in detection of asymptomatic cases and consequently a decrease in symptomatic gonococcal infections over a 4 1/2 year study period. METHODS: A chart review was conducted of all females ages 11-19 years with gonorrhea during the last six months of 1988 and all of 1990 and 1992. The presenting symptoms, physical signs, diagnosis, co-infections, and history of STD contacts were analyzed. RESULTS: Four hundred and twenty-five charts were reviewed: 104 (24%) cases in the 11-15 year old age group, 169 (40%) in the 16-17 year old age group and 152 (36%) in the 18-19 year old age group. Approximately two-thirds had physical signs consistent with a sexually transmitted disease. About 25% presented as a contact of someone with a known STD or with symptoms suggestive of a STD. Fewer than 2% had pelvic inflammatory disease. The majority of all groups had symptoms, though older teenagers provided complaints significantly more often (p < 0.01). Teenagers under 15 years that were significantly more likely to have no symptoms or signs (p < .05). CONCLUSIONS: There were no significant changes detected in the percent of symptomatic subjects over the 4 1/2 year period, i.e., the clinical spectrum of gonorrhea remained unchanged.

Adolescent↗
PubMed1995

Preventive health care for teenagers and young adults.

Risk-taking behaviors are the major source of morbidity among adolescents. The authors discuss risk reduction through preventive activities. An approach is offered to structure preventive visits for this age group given the time and financial constraints of providers.

Adolescent↗
PubMed1984

Reduced-schedule pediatric residency training.

Reduced-schedule residency training is an option deemed desirable by many residents and medical students applying for residencies. The number of such positions offered through the National Resident Matching Program and through independent arrangements made between residents and program directors is, however, quite small compared with the total number of residency positions available. In this paper, the authors review the national experience with reduced-schedule residency training during the past decade and present data concerning 15 pediatric residents at the University of Rochester Strong Memorial Hospital who chose a reduced-schedule training option between 1977 and 1984. The advantages and disadvantages of the implementation of this option from the perspectives of the residents choosing it, the residents who did not, and the faculty members are presented. Reduced-schedule training for selected residents and programs is an attractive and viable option.

Academic Medical Centers↗
PubMed1983

Adolescent and adult females with pelvic inflammatory disease in an ambulatory setting.

A retrospective chart review was conducted of all patients with pelvic inflammatory disease (PID) during 1980 at an inner-city neighborhood health center. The presenting clinical features, laboratory results, management, and recurrences within a 6-18 month follow-up were analyzed. PID was diagnosed in 264 patients, 60 (23%) of whom were less than 21 years old. Pelvic organ tenderness was present in all patients. Three percent had an elevated white blood cell count and/or erythrocyte sedimentation rate. Four percent were hospitalized. Ten percent had positive endocervical cultures for N. gonorrhoeae. Six percent of the records included treatment plans for the male contact. Twenty-seven percent had a recurrence of PID. The lack of criteria for diagnosing PID and the inconsistencies in its management are discussed. Recommendations for the management of cervicitis and male contacts are presented.

Adolescent↗