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Biomedical subjects

F D Loffer

Publications and source records attributed to F D Loffer.

At least 19 recordsLinked to original sources
PubMed1990

Removal of large symptomatic intrauterine growths by the hysteroscopic resectoscope.

Fifty-three patients underwent 55 procedures with a resectoscope for the removal of large symptomatic intrauterine growths. The presenting complaint was menorrhagia, menometrorrhagia, or heavy postmenopausal bleeding in 38 patients; excessive menses plus infertility in 13 patients; and infertility alone in two patients. Forty-three patients had pedunculated or sessile submucous myomas and ten patients had large endometrial polyps. The long-term results are based on 45 patients followed for longer than 1 year. Excessive bleeding was controlled in 40 of the 43 women (93%). Failure to control abnormal bleeding was apparent within the first year. Seven of the 12 infertility patients (58%) delivered live-born infants. Five patients have undergone subsequent hysterectomies (9%). Two patients had repeat resectoscopic removal of myomas and two had subsequent non-resectoscope myomectomies. No major complications were encountered.

Ambulatory Surgical Procedures↗
PubMed1989

Resectoscopic removal of symptomatic intrauterine lesions.

In order to avoid major surgical intervention in women who refused or were poor risks for hysterectomy or myomectomy, a hysteroscopic resectoscope was used for 90 women with uncontrollable uterine bleeding due to submucous fibroids or large polyps or with menorrhagia with normal endometria. Of those patients followed for more than three months, 90% of endometrial ablation patients had an improvement in menstrual flow, with 79% having scant or no periods. For patients with submucous fibroids or polyps, 91% had resumption of normal menses. For the 15 patients who were infertile and underwent submucous fibroid or polyp resection the term pregnancy rate is 33% to date. With only two complications in the series (perforation and endometritis), the conclusion is that resection of submucous lesions and endometrial ablation using the resectoscope is a safe and highly effective alternative to hysterectomy for those conditions.

Adult↗
PubMed1989

Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of a negative hysteroscopic view.

Hysteroscopic evaluation of 187 patients with abnormal uterine bleeding is reviewed. One hundred fifty-one patients had recent tissue sampling by a blind method. The hysteroscope with selected endometrial sampling was more accurate in 9.1% and less accurate in only 0.5% of patients. The specificity of both techniques with selected biopsies was 100%, but the sensitivity of hysteroscopy was greater (98%) than that of D&C (65%). Endometritis was the only condition missed by hysteroscopic viewing and selected biopsy. Those lesions missed by blind tissue sampling were uterine fibroids and endometrial polyps. Among 91 patients whose hysteroscopic view was negative, an abnormality was identified by tissue sampling in only one patient with endometritis.

Adult↗
PubMed1988

Laser ablation of the endometrium.

In summary, the Nd:YAG laser can be used safely and successfully to help women with menorrhagia avoid a hysterectomy. This is important not only for those women who medically are poor candidates but also for those women who for personal reasons do not want to lose their uterus or whose lifestyle will not allow them the time for a hysterectomy. Two basic applications of the laser to the endometrium are the touch and nontouch techniques. Although the nontouch technique appears to carry less risk of fluid overload and postoperative bleeding, it apparently does not decrease menstrual flow as much. Nevertheless, all techniques will allow most patients to avoid hysterectomy.

Adult↗
PubMed1987

Outpatient management of ectopic pregnancies.

The number of ectopic pregnancies has dramatically increased over the past several years. Newer diagnostic methods have resulted in earlier detection and an increase in the percentage of cases without rupture. Early diagnosis allows not only the option of conservative operation but also management of many cases on an outpatient basis. This article reviews the last 23 ectopic pregnancies that I personally managed and discusses the management that allowed outpatient care in 15 of these patients. In retrospect, all but two patients could probably have been discharged directly home.

Ambulatory Surgical Procedures↗
PubMed1987

Major ambulatory surgery of the gynecologic and obstetric patient.

Many gynecologic and obstetric procedures can be done on an ambulatory basis. There is little difference in care between ambulatory and inpatient surgery during the preoperative and intraoperative periods. Thus, the primary deciding factor as to the appropriateness of ambulatory care rather than hospitalization lies in the postoperative requirements. These include the type and amount of analgesia that will be required, the intensiveness of nursing care needed, the need for unusual postoperative monitoring, the potential for complications, and the necessity for frequent postoperative evaluation by the surgeons.

Ambulatory Surgical Procedures↗
PubMed1987

Hysteroscopic endometrial ablation with the Nd:Yag laser using a nontouch technique.

Thirty-six patients with menorrhagia were treated with a technique for laser destruction of the endometrium in which the end of the fiberoptic guide of the Nd:Yag laser is not allowed to come in contact with the endometrium. The results were excellent in 93.9% of the 33 patients followed over three months. Amenorrhea was achieved in 11 patients, a significantly decreased menstrual flow in 13 patients, and a decrease to a normal flow in seven patients. Failure to satisfactorily control menorrhagia occurred in two patients. The technique of not touching the endometrium caused no complications in this series and may prevent the problems of fluid overload and postoperative bleeding found when contact is made with the endometrium.

Endometrium↗
PubMed1986

The increasing problem of ectopic pregnancies and its impact on patients and physicians.

The incidence of ectopic pregnancies tripled between 1970 and 1980. Nonwhite patients are at considerably greater risk in all categories surveyed than are white ones. Numerous reasons for the increase have been postulated, including a possible increase in pelvic inflammatory disease, microsurgical procedures on diseased tubes, the increased number of sterilizations and an increase in the number of recognized cases. Ultrasound and beta-human chorionic gonadotropin pregnancy tests coupled with laparoscopy allow earlier and more accurate diagnosis of this problem. Deaths related to ectopic pregnancies have decreased because of the better diagnostic methods available and increased clinician awareness.

Adolescent↗
PubMed1986

Surgical settings and incisions for the management of ectopic pregnancies.

Ectopic pregnancies do not have to be managed through a laparotomy incision in a hospital. Alternative settings and surgical incisions are available. Most patients can be managed in either free-standing or hospital outpatient facilities using either a minilaparotomy, laparoscopic or possibly a colpotomy incision. Conservative surgical management, which is so important in women desiring future children, can also be done through a minilaparotomy or laparoscopic incision in an outpatient setting.

Female↗
PubMed1977

Laparoscopic tubal sterilization by the "burn only" technic.

A 5-year combined experience of 2857 cases of the "burn only" technic for laparoscopic tubal sterilization is reviewed. One method failure resulted in an ectopic gestation. There were no operator errors. One laparotomy 36 hours after the sterilization procedure was done. No hemorrhagic complications and no bowel burns were encountered. From a review of the literature and the results presented here, it seems that adequate coagulation of a generous segment of the tube is the critical factor in preventing subsequent pregnancies. Tubal division or resection appears to offer no improvement in efficacy, and when tissue is obtained for pathologic confirmation, it is often of no value. When coagulation plus division or resection is performed, the incidence of hemorrhagic complications and bowel burns increases markedly.

Female↗
PubMed1977

Documents and documentation in laparoscopy.

Some form of documentation of laparoscopic findings is essential in the proper management of the patient. We have found a simple outline form with a schematic drawing of the pelvis to be invaluable in emphasizing the need for a systematic and thorough endoscopic examination and in providing an excellent method of recall. Photographic documentation is primarily of value to those physicians involved in research or educational programs. In addition, we have found it helpful to give the patients a printed description of the procedure beforehand, as well as written instructions concerning preoperative arrangements and postoperative care.

Humans↗
PubMed1977

Risks of laparoscopic fulguration and transection of the fallopian tube.

The more common methods of laparoscopic sterilization involve transection of the fallopian tubes. There are, however, a number of cases accumulating in which coagulation without transection has been employed. The risks of bleeding requiring the use of laparotomy are considerably reduced with this technic. There is no increased risk of electrical injury. The pregnancy rate is essentially the same in both methods. It is suggested that failures with tubal transection may be secondary to fistula formation and an inherent problem, whereas the failures with coagulation without transection are secondary to inadequate coagulation and are therefore more easily prevented.

Electric Injuries↗
PubMed1977

Hospitalization for laparoscopy. The exception rather than the rule.

After studying a series of patients who underwent laparoscopy, the authors found that they are currently hospitalizing only 6.6% of them. They found that more patients are hospitalized for diagnostic laparoscopy than for surgical laparoscopy because of the potential need for laparotomy.

Female↗