PubMed Health⌕ Search

Biomedical subjects

F F Broekhuizen

Publications and source records attributed to F F Broekhuizen.

At least 19 recordsLinked to original sources
PubMed2005

Experience using cryotherapy for treatment of cervical precancerous lesions in low-resource settings.

Cervical cancer can be successfully prevented if timely identification of precancerous lesions is followed by effective treatment. In many developing countries, treatment of precancer is neglected because therapeutic services are unavailable, inaccessible, inappropriate, or inadequately linked to screening services. One of the main focuses of the Alliance for Cervical Cancer Prevention (ACCP) has been to ensure that safe and effective methods of treatment for precancer are both available and accessible to women who need them. Cryotherapy, in use for the past 40 years, is a relatively simple, safe, effective, acceptable, and appropriate outpatient procedure for the treatment of precancer. ACCP studies conducted in more than a dozen developing countries show that cryotherapy for precancer can be performed safely and effectively as an outpatient procedure at all levels of health facilities by trained and competent midlevel providers, thus increasing availability and accessibility to precancer treatment services.

Ambulatory Care↗
PubMed1997

Nucleated red blood cells in cord blood of singleton term neonates.

OBJECTIVE: This study aims to establish normal values for nucleated red blood cells in term singletons and factors associated with their elevation. STUDY DESIGN: Cord blood was prospectively collected from term singleton gestations from Feb. 1 to July 31, 1995. Umbilical vein white blood cells and nucleated red blood cells were counted and umbilical arterial pH was determined. Medical records provided maternal and neonatal information. RESULTS: Cord blood from 1112 cases was obtained and evaluated for nucleated red blood cells per 100 white blood cells. Nine outliers were censored (nucleated red blood cells per 100 white blood cells = 126 to 830); five cases were excluded because of missing data. The mean value of nucleated red blood cells per 100 white blood cells was 8.55, the SD was 10.27, and the range was 0 to 89. The value did not very by maternal tobacco or drug use, anemia, fetal presentation, or mode of delivery. Both maternal diabetes and meconium were associated with elevated values, p < 0.01. Apgar scores and cord pHs showed trends toward inverse proportionality to the number of nucleated red blood cells per 100 white blood cells. CONCLUSION: The mean number of nucleated red blood cells per 100 white blood cells was 8.55, with a wide range and SD. Elevated values may be associated with markers of intrauterine hypoxia such as meconium, lower Apgar scores, and lower pH values.

Adolescent↗
PubMed1997

Interpreting fetal heart rate tracings. Is there a difference between labor and delivery nurses and obstetricians?

OBJECTIVE: To analyze the influence of increasing education and clinical experience on fetal heart rate interpretation by health care providers in labor and delivery areas. STUDY DESIGN: Eleven tracings representing a variety of fetal heart rate patterns and neonatal outcomes were selected. Respondents were asked to interpret the tracing strips on a 1-5 scale and predict Apgar scores and cord blood gases. RESULTS: Seventy nurses and physicians participated. Experience with labor and delivery and provider classification correlated significantly with correct interpretation. Certified nurse midwives differed significantly in number of correct interpretations from both first-year residents and low-risk nurses. Providers did not differ on ability to predict Apgar scores or cord gases. CONCLUSION: Length of clinical experience correlated positively with the interpretation of fetal heart rate tracings but not with the prediction of Apgar scores or cord blood gas measurements. These data will be useful in designing educational and orientation programs for physicians and nurses in the labor and delivery setting.

Apgar Score↗
PubMed1996

Randomized, double-blind trial of prostaglandin E2 intravaginal gel versus low-dose oxytocin for cervical ripening before induction of labor.

OBJECTIVE: Our purpose was to compare two methods of preinduction cervical ripening in a randomized, double-blind clinical trial. STUDY DESIGN: Two intravaginal, 4 mg prostaglandin E2 gel applications administered 4 hours apart were compared with 10 hours of low-dose oxytocin (2 mU/min) in 200 patients undergoing preinduction cervical ripening. RESULTS: There were no differences in parity, initial Bishop scores, estimated gestational ages, indications for induction, or birth weights. Prostaglandin E2 gel was significantly better (p < 0.0001) at achieving a change in the Bishop score of 3 or more. The number of successful inductions was significantly greater (p < 0.0003) and the mean time to active labor was significantly shorter (p < 0.0002) in the prostaglandin E2 group than in the oxytocin group. More multiple-day inductions (p < 0.01) occurred in the oxytocin group, and fewer discharged patients who did not deliver infants (p < 0.03) were seen in the prostaglandin E2 gel group. There were no differences between patient groups in the cesarean section rate, meconium staining, hyperstimulation, and Apgar scores. CONCLUSION: Two 4 mg doses of prostaglandin E2 intravaginal gel applied 4 hours apart are superior to low-dose oxytocin in producing cervical ripening and preparing for successful induction.

Administration, Intravaginal↗
PubMed1995

Correlates of multigravida women's binge drinking during pregnancy. A longitudinal study.

OBJECTIVE: To refine our understanding of prenatal psychosocial factors associated with binge drinking during pregnancy and the contribution of binge drinking during pregnancy to the duration of newborn hospitalization. DESIGN: Prospective cohort. SETTING: A large urban medical center in Wisconsin. PARTICIPANTS: One hundred thirty-nine women (106 multigravida) who were invited to participate during a prenatal clinic visit early in their third trimester. MEASURES: Prenatal measures included social support (Maternal Social Support Index), depression (Center for Epidemiologic Studies Depression Scale), stress (Difficult Life Circumstances), substance use (Monitoring the Future Substance Use Questionnaire and T-ACE Scale [a screen with questions about tolerance, annoyance, cutting down, and using alcohol as an eye-opener), and maternal-fetal attachment (Maternal-Fetal Attachment Scale). After delivery, a mothers' and infants' medical record review form was used. RESULTS: Multigravida pregnant women (n = 106) were older than primigravida pregnant women (n = 33) (25.8 +/- 0.6 vs. 20.5 +/- 0.5 years; P = .001), with more children at home (2.3 +/- 0.2 vs 1.3 +/- 0.3; P = .01) and less social support (Maternal Social Support Index, 20.1 +/- 0.6 vs 22.9 +/- 1.0; P = .03). All of the binge-drinking women in this sample were in the unmarried multigravida subgroup (17/101 [17%]). Compared with multigravida pregnant women who did not binge drink during pregnancy, binge-drinking pregnant women were older (28.1 +/- 1.3 vs 25.1 +/- 0.6 years; P = .03) and more socially isolated (Maternal Social Support Index, 17.2 +/- 1.3 vs 20.7 +/- 0.7; P = .04) and were more likely to smoke during the pregnancy (82% vs 39%; P = .001). Even after controlling for a number of other important biologic and psychosocial factors (duration of pregnancy, maternal gravidity, racial heritage, education, social support at second trimester, and birth weight), by hierarchical multiple linear regression, binge drinking within the last 2 weeks before the late second-trimester interview continued to explain a significant amount of variance in duration of newborn hospitalization (total R2 = .48, partial R2 = .04; P = .01). CONCLUSIONS: This study suggests that binge drinking during pregnancy is related to longer newborn hospitalizations. Effective prenatal interventions to improve the outcome of pregnancies for women who abuse alcohol during pregnancy should use early screening and provide augmentation of mothers' social support.

Adult↗
PubMed1995

Value of wet mount and cervical cultures at the time of cervical cytology in asymptomatic women.

OBJECTIVE: To correlate Papanicolaou smear findings with the wet mount and cervical culture results in asymptomatic patients, and to review the value of doing wet mount and/or cervical cultures in these patients at the time of Papanicolaou smear. METHODS: Asymptomatic women presenting for routine Papanicolaou smears at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1991 and January 1994 were studied by preparing wet mount (saline and potassium hydroxide preparations) and cervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae at the same visit. Fisher exact test and Pearson chi 2 statistics were applied. RESULTS: Nine hundred sixty-three patients were studied. Nearly 50% of our asymptomatic young urban women had a vaginal and/or cervical infection. Papanicolaou smears with inflammation were associated with bacterial vaginosis (P < .0001), excess white blood cells (P < .0001), trichomoniasis (P < .0001), abnormal wet mounts in general (P < .0001), and positive cervical cultures for C trachomatis and/or N gonorrhoeae (P < .001). Papanicolaou smears showing atypical cells of undetermined significance were associated with bacterial vaginosis (P < .001) and abnormal wet mounts in general (P < .03). Seventy-five percent of patients with positive cervical cultures had abnormal wet mounts. Eighty-three percent of the patients whose initial Papanicolaou smear showed inflammation and whose initial wet mount was abnormal had a normal Papanicolaou smear when the wet mount became normal. CONCLUSION: Preparing wet mounts at the time of Papanicolaou smear in asymptomatic young urban women will help in the interpretation of minimally abnormal smears and will probably decrease the need for repeat smears and colposcopy. Simultaneous cervical cultures would not add much information for such interpretation.

Adolescent↗
PubMed1994

Primary syphilis and nonimmune fetal hydrops in a penicillin-allergic woman. A case report.

The incidence of congenital syphilis is on the rise. Penicillin continues to be the drug of choice for it during pregnancy. A penicillin-allergic woman with primary stage syphilis who was treated initially with erythromycin presented with fever and nonimmune fetal hydrops secondary to an intrauterine syphilitic infection. Following desensitization and penicillin therapy the fetal hydrops disappeared, the pregnancy continued to term, and the patient delivered a small-for-gestational-age but other-wise normal infant who continued to do well up to 1 year of age.

Adult↗
PubMed1994

Spontaneous quadruplet pregnancy in a woman with a personal and family history of spontaneous twin and triplet pregnancy. A case report.

Spontaneous quadruplet pregnancies are exceptional. As compared with singleton pregnancies, quadruplets are associated with a higher incidence of preterm labor, first-trimester bleeding, toxemia, anemia, stillbirths and perinatal deaths. We report a 25-year-old, black woman with a spontaneous quadruplet pregnancy. The patient had had a previous twin pregnancy and was herself a twin. The patient's mother had a history of twin and triplet pregnancies. Following the diagnosis, the patient was hospitalized and given betamethasone weekly. At 33 weeks' gestation she had spontaneous rupture of the membranes and delivered by cesarean section. The quadruplets had good Apgar scores and were discharged 5-10 weeks later in good health.

Adult↗
PubMed1993

The effect of urban socioeconomic problems on perinatal statistics in Milwaukee, 1983-1991.

Perinatal statistics in an urban environment are analyzed over a 9-year period. Perinatal outcome parameters in 27,986 deliveries are analyzed. The number of prenatal visits, low birth weight, illicit drug use, perinatal mortality, race, and age are studied. Perinatal outcome worsened after 1986 for patients with less than five prenatal visits, but not for patients with adequate prenatal care. Adequacy of prenatal care, preventable perinatal mortality, and low birth weight rates worsened for all patients, but disproportionately for black patients. Pregnancies of women of aged 18 to 35 had the highest risk for adverse outcomes. These deteriorating perinatal statistics represent a serious social and public health challenge.

Cause of Death↗
PubMed1993

Acetic acid visualization of the cervix to detect cervical dysplasia.

OBJECTIVE: To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening. METHODS: During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively. RESULTS: Eighty-five women were referred for colposcopy because of abnormal acetowhite areas on the cervix. Thirteen patients (15%) had cervical intraepithelial neoplasia (CIN) (nine CIN I, four CIN II), 22 (26%) had koilocytosis, and 16 (19%) had benign histologic findings. In total, 51 patients had suspicious lesions at colposcopy for which biopsies were performed, and 34 (40%) had normal colposcopic examinations. CONCLUSIONS: Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy.

Acetates↗
PubMed1992

Drug use or inadequate prenatal care? Adverse pregnancy outcome in an urban setting.

OBJECTIVE: This study analyzed the relationships between illicit drug use, low birth weight, adequacy of prenatal care, and perinatal mortality. STUDY DESIGN: Perinatal outcome parameters in 23,926 deliveries between 1983 and 1990 were analyzed. Statistical analysis (chi 2 analysis) was applied for each year of study to separate the effects of inadequate prenatal care from illicit drug use. RESULTS: Patients with drug use had a two to three times higher incidence of low birth weight and perinatal death. Drug use with more than five prenatal visits had a minimal effect on outcome; drug use with inadequate care was associated with a three times higher incidence of perinatal death and low birth weight. CONCLUSION: Adequacy of prenatal care is a marker of "social chaos" and affects outcome more than drug use itself.

Adolescent↗
PubMed1990

Statistical evaluation of diagnostic criteria for bacterial vaginosis.

Bacterial vaginosis is the most common cause of vaginitis in women of reproductive age. In an attempt to clarify diagnosis of this condition, various parameters of signs and symptoms and groups of parameters were compared with classical diagnostic criteria in 310 patients. There was no significant difference in positive diagnosis rates between the Amsel et al. criteria and those of Thomason et al. (p = 0.25). The single most reliable indicator of bacterial vaginosis was the presence of clue cells on wet mount examination of vaginal secretions (sensitivity 98.2%, specificity 94.3%, positive predictive value 89.9%, negative predictive value 99.0%). The best two combinations of parameters for rapid accurate clinical diagnosis were clue cells and odor on alkalinization (sensitivity 99.5%) positive predictive value 98.8%, negative predictive value 92.1%). Gram stain criteria (bacterial morphologic types) were less accurate predictors of the disease (sensitivity 97.0%, specificity 66.2%, positive value 57.2%, negative predictive value 97.9%). Even when the bacterial morphologic type criteria were combined with presence of clue cells, predictive accuracy did not exceed that of clue cells on wet mount examination alone (sensitivity 93.9%, specificity 84.7%, positive predictive value 74.2%, negative predictive value 96.8%). Homogeneous discharge was found to be of little diagnostic value.

Bacterial Infections↗
PubMed1990

Growth of Trichomonas vaginalis in commercial culture media.

There are only two commercially available, ready-to-use culture media which are approved by the Food and Drug Administration for clinical diagnosis of vaginal trichomoniasis: Kupferberg's STS and Diamond's medium (modified). Diamond's medium (Klaas modification), recommended by the Centers for Disease Control for the isolation of Trichomonas vaginalis, was compared in vitro to Kupferberg's (STS) medium. Growth studies using six fresh clinical isolates, all from different patients, showed that while generation time was about 6 h in both STS and Diamond's, the period of exponential growth was longer in Diamond's. More important, in STS there was a 4-h lag period during which the population significantly decreased prior to exponential growth. This did not occur in Diamond's medium. Three hundred organisms inoculated into Diamond's reached a population of over 10(5) organisms in 72 h. In STS, the same inoculum could multiply to only 6 x 10(3) organisms. The fact that there is a lag phase in STS which is not seen in Diamond's could explain why low numbers of T. vaginalis do not multiply in STS but do multiply and can be detected in Diamond's. We conclude that because Diamond's medium (modified) allows more prolific growth over a shorter period of time, it is more suitable than Kupferberg's (STS) for detecting T. vaginalis in patients with vaginitis.

Animals↗
PubMed1990

Terconazole for the treatment of vulvovaginal candidiasis.

A double-blind, randomized trial was conducted to evaluate the efficacy and safety of terconazole for vulvovaginal candidiasis. Treatment consisted of daily intravaginal application of one of the following regimens: 80-mg terconazole suppositories for 3 days, miconazole nitrate suppositories for 7 days or placebo suppositories for 7 days. The terconazole and miconazole nitrate groups had significantly higher therapeutic cure rates than did the placebo group. Evaluation of vaginal secretions with microscopic examination showed no evidence of leukocyte proliferation. Proline aminopeptidase activity, present in patients who have bacterial vaginosis, could not be detected in the vaginal secretions from patients with yeast vulvovaginitis.

Administration, Intravaginal↗
PubMed1989

Advances in the understanding of bacterial vaginosis.

Bacterial vaginosis is a disease that results from massive overgrowth of vaginal bacterial flora. The exact etiology is unknown. The major components of the normal bacterial flora, peroxide-producing lactobacilli, are replaced by non-peroxide-producing lactobacilli, allowing overgrowth of anaerobic and gram-negative aerobic flora. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue" cells. Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge within six months if untreated. Serious infectious sequelae are associated with bacterial vaginosis, including salpingitis, abscesses, endometritis and pelvic inflammatory disease. There is also a danger to pregnant women because of premature rupture of the membranes and premature labor. Clindamycin and metronidazole are considered effective therapy for the disease. Treatment of sexual partners remains controversial since sexual transmission has not been proven unequivocally.

Female↗