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Biomedical subjects

G H Lipscomb

Publications and source records attributed to G H Lipscomb.

At least 19 recordsLinked to original sources
PubMed1998

Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate.

OBJECTIVES: The objective of this study was to review the largest single series of ectopic pregnancies treated with single-dose methotrexate reported to date. STUDY DESIGN: A review of 315 patients with unruptured ectopic pregnancies treated with single-dose methotrexate 50 mg/m2 from March 21, 1990, to March 1, 1997, was performed. RESULTS: Overall 287 patients were successfully treated with methotrexate for a success rate of 90.1%. Six patients electively withdrew and requested surgery within 1 week of starting therapy. Excluding withdrawals the overall success rate was 92.9%. Ten patients with an ectopic pregnancy > 3.5 cm but < or = 4 cm in size were treated for a 90% success rate. Forty-four patients with positive ectopic cardiac activity were treated with an 87.5% success rate. CONCLUSIONS: This large series indicates that single-dose intramuscular methotrexate for treatment of ectopic pregnancy is associated with an excellent overall success rate.

Drug Administration Schedule↗
PubMed1998

A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.

OBJECTIVE: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy. METHODS: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed. RESULTS: Sixty-five women at three institutions underwent laparoscopically assisted vaginal hysterectomy (n = 34) or abdominal hysterectomy (n = 31). Three patients in the laparoscopic group required conversion to abdominal hysterectomy. Mean operating time was significantly longer for laparoscopically assisted vaginal hysterectomy (179.8 versus 146.0 minutes). There were no differences in blood loss or incidence of intraoperative complications. There was a higher incidence of wound complications in the abdominal hysterectomy group, but no significant difference in the frequency of postoperative complications. Laparoscopically assisted vaginal hysterectomy required a significantly shorter mean hospital stay (2.1 days) and convalescence (28.0 days) than abdominal hysterectomy (4.1 days and 38.0 days, respectively). There were no significant differences in mean hospital charges between the study groups (laparoscopic $8161, abdominal $6974). CONCLUSION: Except for operating time, there are no differences between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy regarding intraoperative characteristics among abdominal hysterectomy candidates. Postoperatively, laparoscopically assisted vaginal hysterectomy requires a shorter hospital stay and convalescence. Hospital charges are similar between the procedures. A larger number of cases will help determine the indications for laparoscopically assisted vaginal hysterectomy.

Adult↗
PubMed1996

Peritoneal closure at vaginal hysterectomy: a reassessment.

OBJECTIVE: To evaluate the clinical outcome of patients who underwent vaginal hysterectomy with or without peritoneal closure. METHODS: This study was a randomized trial. Using computer-generated numbers, all patients undergoing vaginal hysterectomy without oophorectomy were randomized to either no peritoneal closure (n = 57) or routine peritoneal closure (n = 49). Patients were followed-up for a minimum of 1 year for development of complications and postoperative dyspareunia. At 4-6 postoperative weeks, the distance between the ovaries and the vaginal cuff was measured by ultrasound. RESULTS: Postoperative complications were similar in both groups. The incidence of deep-thrust dyspareunia at 6 and 12 months was also similar. No statistical differences between the two groups were noted in the ovary to vaginal cuff distances either overall or when patients with dyspareunia were considered separately. CONCLUSION: The data in this study do not support the use of reperitonealization on a routine basis. However, because of a lack of statistical power, larger studies will be required to confirm this theory.

Adult↗
PubMed1996

A comparison of the cost of local versus general anesthesia for laparoscopic sterilization in an operating room setting.

OBJECTIVE: To compare the charges between laparoscopic sterilization performed under either local or general anesthesia in a traditional operating room setting with anesthesia personnel in attendance. DESIGN: A retrospective review of charges. SETTING: The Regional Medical Center, Memphis, Tennessee. PATIENTS: Sixty-five women undergoing laparoscopic sterilization, 33 under local and 32 under general anesthesia. Interventions. Laparoscopic sterilization. MEASUREMENTS AND MAIN RESULTS: Patient demographics, history of pelvic inflammatory disease, and history of previous surgery were similar for both groups. Operating room and recovery room times were shorter for patients whose procedures were performed under local anesthesia. Flat-rate fee schedules reduced the cost savings for cases performed under local anesthesia to $529 dollars per case, with 76% ($402) of the savings related to anesthetic drugs or equipment. CONCLUSION: Although these savings appear minimal on a per case basis, if 50% of the approximately 210,000 laparoscopic sterilizations performed in the United States each year were performed under local anesthesia, a savings of over $55 million could be achieved (105,000 cases X $529 = $55,545,000). This would result in substantial overall monetary savings to the health care system.

Anesthesia, General↗
PubMed1996

Methotrexate therapy for ectopic pregnancy in adolescents.

STUDY OBJECTIVE: To determine the suitability and efficacy of methotrexate (MTX) therapy for adolescent patients with ectopic pregnancy. MATERIALS: Patients with ectopic pregnancy were treated with methotrexate, 50 mg/m2 intramuscularly. Follow-up determinations of quantitative beta hCG levels were done on days 1, 4, and 7. They were then seen weekly until beta hCG levels were less than 15 mIU/ml. PARTICIPANTS: Adolescents with ectopic pregnancy (55 patients) received MTX therapy and comprised the study group. They were compared with 186 adults similarly treated. The groups were compared for treatment outcome and for compliance with the rigid protocol requirements. MAIN OUTCOME MEASURES: Treatment success was defined as a patient who required no surgical intervention and whose beta hCG levels declined to < 15 mIU/ml. RESULTS: 85% of patients required no surgical intervention following MTX injection. Surgical intervention rates were slightly higher and success rates slightly lower for adolescent patients, but these differences were not statistically significant (p = .71). Although adult patients were more likely to have a perfect compliance rating, comparison of all compliance categories showed no significant differences (p = .17). CONCLUSIONS: MTX therapy is satisfactory for adolescent patients. It is effective, and adolescent patients are able to comply with the requirements of a rigid protocol.

Adolescent↗
PubMed1995

The effect of topical 20% benzocaine on pain during loop electrosurgical excision of the cervix.

OBJECTIVE: Our purpose was to evaluate the effect of cervical application of 20% benzocaine on the pain associated with subsequent cervical injection of local anesthetic and tissue excision during the loop electrosurgical excision procedure of the cervix. STUDY DESIGN: Fifty consecutive women scheduled for loop electrosurgical excision were randomized by use of computer-generated numbers to receive cervical application of either 20% benzocaine or placebo gel in a double-blinded fashion. A visual analog scale was used to measure the pain associated with both cervical injection of local anesthetic and tissue excision. RESULTS: Lower mean pain scores were associated with the use of benzocaine gel for both anesthetic injection and tissue excision, but these scores did not reach statistical significance in either group. CONCLUSION: Preoperative cervical application of 20% benzocaine does not appear to reduce the pain associated with either subsequent local anesthetic injection or tissue excision during the loop electrosurgical excision procedure of the cervix.

Analgesia↗
PubMed1995

Synthetic hygroscopic cervical dilator use in patients with unsatisfactory colposcopy.

OBJECTIVE: To assess the ability of a synthetic hygroscopic cervical dilator to make an unsatisfactory colposcopic examination satisfactory, thereby avoiding cervical conization. MATERIALS: From April 1991 to March 1993, 30 women with unsatisfactory colposcopic examinations underwent repeat colposcopy after a synthetic hygroscopic cervical dilator had been placed in the endocervical canal for approximately 2 hours. RESULTS: The reasons for initial unsatisfactory colposcopy in the 30 patients were squamocolumnar junction not seen in its entirety (18 patients, 60%), lesion not seen in its entirety (ten, 33%), and neither transformation zone nor lesion seen in their entirety (two, 7%). Complications were encountered in one patient from whom the dilator could not be removed completely. Of 29 patients undergoing repeat colposcopy, 23 (79%) had satisfactory examinations. In 15 of 30 patients, conization was avoided; it was required in six of 30 (20%) women for persistent unsatisfactory colposcopy (including the patient in whom the dilator broke) and in nine of 30 (30%) for other indications. CONCLUSIONS: This experience suggests that a synthetic hygroscopic cervical dilator can be used in patients with an unsatisfactory colposcopy to achieve a satisfactory examination, thus avoiding cervical conization.

Abortifacient Agents↗
PubMed1995

Computer-assisted video evaluation of surgical skills.

Compact video cameras have allowed the review of operations in self-directed learning sessions. Controlling the video viewing process by computer allows the selection of specific videotape segments containing the desired psychomotor skills to be evaluated--in this study, the steps involving laparoscopic tubal banding. Six faculty members were able to evaluate 23 videotapes efficiently without knowledge of the resident operator's identity. Because the computer allowed selection of only those frames of the videotape containing the skills to be evaluated, the duration of videotape seen was reduced by an average of 34% from the actual surgical time, with an increase in time saved as experience with the system was gained. Faculty members evaluated these events using a self-made checklist. It was possible to calculate the performance scores of each resident for the individual psychomotor skill components of the reviewed procedure. Computer-assisted video evaluation of surgical skills is technically feasible, allowing time-efficient review by multiple evaluators. With the development of psychometrically valid checklists for use with this technology, computer-assisted video evaluation of surgical skills may provide a new, innovative means of assessing surgical skills and training.

Clinical Competence↗
PubMed1995

Chronic pelvic pain.

The basic approach to the patient with chronic pelvic pain as practiced at the University of Tennessee, Memphis, has been described here. Using this approach allows the practicing physician to evaluate and manage realistically or refer appropriately most patients with chronic pelvic pain. The key to management of patients who have chronic pelvic pain is to use any and all available diagnostic and therapeutic modalities to identify the source(s) and direct therapy. By having at least a working knowledge of the various diagnostic and therapeutic modalities available to the patient, the individual clinician can better aid the patient in her understanding of chronic pelvic pain, generally, and her own pelvic pain, specifically.

Chronic Disease↗
PubMed1995

Development of a program teaching laparoscopic sterilization using local anesthesia.

A program teaching laparoscopic sterilization using local anesthesia was developed and implemented in a large residency program in which sterilization using general anesthesia was already being taught in a traditional fashion. Important steps for the development of such a program included the designation of an individual with overall responsibility for the program, identification of potential obstacles along with feasible solutions, and training of residents and staff in the new techniques. The major obstacles to implementation included opposition from anesthesia personnel, the need for additional training in the new techniques for both residents and faculty, nursing staff resistance, and the uncertainty of patient acceptance. Solutions included involving anesthesia personnel in program planning as well as in the ultimate performance of the procedures, practicing local techniques during cases under general anesthesia, limiting initial cases to candidates anticipated to be uncomplicated, and using nondirective counseling of patients. Similar strategies can be useful both to other residency programs and individuals wishing to offer local anesthesia as an option for laparoscopic sterilization at their hospitals.

Anesthesia, Local↗
PubMed1994

Basic laparoscopic knowledge among gynecologic laparoscopists.

OBJECTIVE: Our purpose was to assess the basic knowledge of laparoscopy and laparoscopic sterilization among gynecologic laparoscopists. STUDY DESIGN: A four-part multiple-choice test designed for use in residency training, covering basic aspects of laparoscopy and laparoscopic sterilization, was distributed to 155 registrants at a gynecologic surgery postgraduate course. Test results were compared among subgroups, as well as with results for 23 residents who had taken the test before their rotation in laparoscopic sterilization. RESULTS: Residents scored higher than practitioners on all test segments. No practitioner achieved the 85% correct passing score required of residents. Practitioner scores did not increase as the number of laparoscopic sterilizations performed per year increased, but higher test scores were associated with more recent completion of residency. CONCLUSION: Basic knowledge of laparoscopic sterilization among practicing gynecologists, as measured by a test designed for residents, is less than that of the residents.

Education, Medical, Continuing↗
PubMed1994

Outpatient hysterectomy: determinants of discharge and rehospitalization in 133 patients.

OBJECTIVE: This study examines our continuing experience in performing vaginal hysterectomies and laparoscopy-assisted vaginal hysterectomies with an outpatient protocol. The purpose was to review factors associated with discharge and hospitalization. STUDY DESIGN: Surgical records from all women entering our previously reported outpatient hysterectomy protocol were reviewed. Demographics, surgical indications, intraoperative data, and postoperative data were studied, and their associations with patient discharge and hospitalization were determined. Specific attention was directed to complications. RESULTS: The study group consisted of 133 women. Twelve women (9.0%) were not discharged from the hospital and 5 (3.8%) required readmission. Surgical indications, the type of hysterectomy, and the requirement for pain medication revealed no association with hospitalization. The occurrence of an intraoperative complication (p < 0.000), the need for transfusion (p = 0.043), and postoperative antiemetics (p = 0.013) were statistically associated with hospitalization. In addition, low hematocrit values and elevated temperatures on the first and second postoperative days were associated with hospitalization. CONCLUSION: Long-term experience with outpatient hysterectomy reveals a hospitalization rate of 12.8%. Complications, blood loss, elevated temperatures, and postoperative nausea are the major determinants of patient discharge and hospitalization. Readmission rates continue to remain low.

Adolescent↗
PubMed1994

A randomized comparison of the Pipelle, Accurette, and Explora endometrial sampling devices.

OBJECTIVES: Our aim was to compare the Pipelle, Accurette, and Explora endometrial sampling devices. STUDY DESIGN: Patients (n = 248) undergoing endometrial biopsy were randomized to one of the three sampling instruments. Diagnostic accuracy, ability to obtain sufficient tissue for histologic diagnosis, and patient discomfort during sampling of the three devices were compared. When available, endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy. Statistical analysis was performed with one-way variance of the means, chi 2, and Kruskal-Wallis statistic. RESULTS: In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings. However, 42% of Accurette biopsies either were failed attempts or obtained insufficient tissue (p < 0.01). Pain scores were similar among the groups. CONCLUSION: The results with the Pipelle and Explora endometrial samplers appear to be comparable. However, given a 42% unusable specimen rate, the Accurette cannot be recommended for routine endometrial sampling.

Adult↗
PubMed1994

Instruction in surgical anatomy for gynecology residents using prosected human cadavers.

Prosected human cadavers were used by a team of anatomists and gynecologic surgeons to teach surgical anatomy to gynecology residents. The course was offered at the start of each 8-week gynecologic surgery rotation. Hemisections and other similar prosections were used to demonstrate anatomic relationships and surgical procedures from vantage points unobtainable at the operating table. The initial response from the faculty and residents was encouraging. The residents believed the program to be beneficial and were satisfied with it. Both the anatomy faculty and the gynecology faculty found new insights into teaching issues during the interdisciplinary process of course preparation and teaching.

Anatomy↗
PubMed1994

Serum bupivacaine levels during laparoscopic sterilization using local anesthesia.

STUDY OBJECTIVE: To determine the serum levels of bupivacaine during laparoscopic sterilization when bupivacaine 0.5% without epinephrine is used as the sole local anesthetic agent. DESIGN: Case series. SETTING: Regional medical center and primary teaching hospital of Ob/Gyn Department of the University of Tennessee, Memphis. PATIENTS; Thirty women undergoing laparoscopic sterilization with bupivacaine for local anesthesia. INTERVENTIONS: Venous serum bupivacaine levels were measured, with samples drawn at 45, 60, 90, and 120 minutes after injection in 25 patients. Five additional patients had sampling at 15 and 30 minutes as well as at the above times. MEASUREMENTS AND MAIN RESULTS: The highest concentration of bupivacaine was detected at 15 minutes. The mean concentrations at 15, 30, 45, 60, and 120 minutes were 0.86, 0.74, 0.31, 0.27, 0.23, and 0.22 microg/ml, respectively. This is well below the level of serious toxicity. Only four patients received 2.5 mg/kg or greater of bupivacaine. In these patients, mean serum levels were 1.1, 1.0, 0.28, 0.43, 0.9, and 0.29 microg/ml, respectively. CONCLUSION: Serum bupivacaine levels during sterilization using bupivacaine 0.5% without epinephrine for local anesthesia are well below the threshold for serious toxicity.

Anesthesia, Local↗
PubMed1994

The effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia.

STUDY OBJECTIVE: To compare carbon dioxide and nitrous oxide pneumoperitoneum with respect to intraoperative and postoperative pain during laparoscopic sterilization under local anesthesia. DESIGN: Randomized, double-blind study of pain during surgery and at 15 minutes, 1 hour, and 24 hours postoperatively. SETTING: Regional Medical Center, Memphis, Tennessee. PATIENTS: Women scheduled for laparoscopic sterilization under local anesthesia. Interventions. Forty-nine patients were randomized to carbon dioxide and 56 to nitrous oxide pneumoperitoneum. MEASUREMENTS AND MAIN RESULTS: Pain was assessed using a modified McGill pain questionnaire. Intraoperative pain was measured by the amount of supplemental narcotic required. Analgesic use in the recovery room and during the first 24 hours postoperatively was compared. Demographics for both groups were similar. The groups had no statistical differences in pain during surgery or at any of the postoperative time periods. Recovery room analgesia requirement was similar, but the nitrous oxide group used fewer pain tables (0.98 vs 0.42 tablets) in the first 24 hours. CONCLUSIONS: There is no difference in intraoperative and postoperative pain between nitrous oxide and carbon dioxide pneumoperitoneum for laparoscopic sterilization when used in conjunction with a protocol such as ours.

Administration, Oral↗