Biomedical subjects

FM Howard

Publications and source records attributed to FM Howard.

4 recordsLinked to original sources

PubMed1998

A randomized, placebo-controlled comparison of EMLA() and dorsal penile nerve block for pain relief during neonatal circumcision.

Objective: To evaluate the relative efficacies of eutetic mixture of local anesthetics (EMLA()) cream and dorsal penile nerve block (DPNB) for pain relief during neonatal circumcision.Methods: After parental informed consent, appropriate-for-gestational age, term, healthy newborns were randomized to receive either EMLA cream and placebo saline DPNB or placebo cream and 1% lidocaine DPNB. Placebo and EMLA cream were prepared by the pharmacy and applied by study nurses. Preloaded syringes of saline or 1% lidocaine were also prepared by the pharmacy for the DPNB injections. This ensured blinding of the surgeons and assistants at the time of circumcisions. Circumcisions were performed with the Gomco clamp technique by one of three obstetrics and gynecology residents. Pain levels were assessed by measuring pulse and respiratory rates and determining Brazelton states at each step of the circumcision. Videotapes were made of each procedure to allow later scoring by a single blinded observer for Brazelton states. Brazelton state scores increase with increased infant pain and distress, as do heart and respiratory rates. Means were compared by t test and proportions by chi(2). A P value of.05 was considered statistically significant.Results: A total of 60 infants were randomized, 29 to DPNB and 31 to EMLA. Preoperative Brazelton state scores, heart rates, and respiratory rates were similar in both groups. Brazelton state scores were lower in the DPNB group at each step of the procedure-injection, dissection of the foreskin, clamp placement, and clamp removal-and postoperatively and overall, but the differences only reached statistical significance during dissection and clamp removal. Heart and respiratory rates also were lower at all surgical steps in the DPNB group but only reached statistical significance during postoperative observation.Conclusions: Although both EMLA and DPNB have been shown in other studies to decrease pain during neonatal circumcisions, DPNB has greater effectiveness in relieving the pain of circumcision.

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PubMed1996

Lateral Ovarian Transposition before Radiation Treatment of Hodgkin Disease

Preservation of ovarian function by repositioning the ovaries out of the irradiation field is suggested in women of reproductive age before pelvic radiotherapy for cervical cancer or Hodgkin disease. In women with Hodgkin disease this is usually done at the time of staging laparotomy. A 21-year-old woman with stage IIIa Hodgkin disease underwent repositioning of the ovaries during staging laparotomy, but before planned irradiation therapy it was noted that the ovaries were back in their normal anatomic position. Outpatient laparoscopic lateral transposition of the ovaries was performed without complication. Five years after pelvic irradiation she still has normal ovarian function. In selected women with malignancy and planned irradiation therapy, laparoscopy is an alternative to laparotomy to preserve ovarian function by lateral ovarian transposition.

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PubMed1994

Laparoscopic Surgery During Pregnancy

Adnexal masses diagnosed in a gravid woman sometimes must be surgically evaluated and treated during the pregnancy. A laparoscopic surgical approach may have several advantages over laparotomy, but only one case of laparoscopic adnexal surgery during pregnancy has been previously reported. Two pregnant patients with acute pelvic pain and adnexal masses were surgically treated via operative laparoscopy. One patient had a large benign cystic teratoma and one had torsion of the fallopian tube secondary to a paratubal cyst. Cystectomies were performed in both cases and in the second case the tube was reduced and conserved. It appears that with proper surgical technique and caution to exclude malignancy, laparoscopy may be successfully used to remove adnexal masses during the second trimester of pregnancy.

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PubMed1994

Management of Selected Adnexal Masses in Postmenopausal Women by Operative Laparoscopy-A Multicentered Study

With careful preoperative assessment we have selected postmenopausal women who were believed to have benign adnexal masses and who were candidates for removal of these masses via operative laparoscopy. Criteria for inclusion were: postmenopausal status; cystic adnexal mass less than 10 cm. with distinct borders and without irregular solid parts or thick septa; CA 125<35 U/ml; and no contraindications for surgery. Sixty-one women were entered into the study. All of the masses were benign, including 27 serous cysts, 15 serous cystadenomas, 1 mucinous cystadenoma, 5 serous cystadenofibromas, 6 paratubal cysts, 3 retroperitoneal cysts, and 4 chronic hydrosalpinges. Fifty-eight patients had successful pelviscopic removal of their adnexal mass. Three patients (5%) required laparotomy. For patients managed by operative laparoscopy, mean operating time was 63 minutes, mean postoperative stay was 12 hours, and mean time to return to normal activity was 5.6 days. We conclude that the combination of CA 125 values and pelvic ultrasound can successfully predict benign masses in postmenopausal women, and removal of these masses by operative laparoscopy is acceptable in carefully selected women.

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