Biomedical subjects

Gary H Lipscomb

Publications and source records attributed to Gary H Lipscomb.

11 recordsLinked to original sources

PubMed2006

A trial that compares Monsel's paste with ball electrode for hemostasis after loop electrosurgical excision procedure.

OBJECTIVE: The purpose of this study was to compare Monsel's paste with fulguration with ball electrode for hemostasis after loop electrosurgical excision procedure. STUDY DESIGN: One hundred healthy women were assigned randomly by computer-generated random numbers to ball electrode or thickened Monsel's paste for hemostasis after loop electrosurgical excision procedure. Patients rated pain during hemostasis using a visual analog scale. At 2 weeks, postprocedural vaginal discharge was rated on a Likert scale. Pathology was reviewed for dysplasia grade and margin status. Recurrent dysplasia on repeat Papanicolaou tests was noted. RESULTS: Six patients (2 Monsel's and 4 fulguration) required an alternate method of hemostasis. Patient demographics, postprocedural discharge, and recurrent dysplasia were comparable between the 2 groups. Visual analog scale scores and hemostasis time were significantly higher in the fulguration group. Estimated blood loss, although higher in the fulguration group, was not significant between groups. CONCLUSION: Monsel's paste and fulguration with ball electrode appear be equally effective as hemostatic agents after loop electrosurgical excision procedure.

Adult↗

PubMed2006

Torsion of the appendix mimicking ovarian torsion.

BACKGROUND: Appendiceal torsion is rare and generally seen more frequently in children than adults. Untreated it can lead to necrosis, ulceration, and subsequent peritonitis. CASE: A middle-aged female presented with a 5-day history of cramping abdominal pain and nausea and vomiting. Abdominal wall guarding and rebound tenderness was noted on examination. Computerized tomography showed an 8 x 4 cm mass anterior to the uterus, suggestive of degenerating fibroid versus ovarian dermoid cyst. Laparoscopy was performed for presumed ovarian torsion. Torsion of the appendix was discovered and treated by laparoscopic appendectomy. CONCLUSION: Patients with presumed ovarian torsion should undergo urgent laparoscopy for diagnosis and attempted ovarian salvage. The possibility of conditions that may require different surgical interventions, such as appendiceal torsion, should be considered.

Appendix↗

PubMed2006

Uterine cancers.

Explore the source record for details and available documents.

Adenocarcinoma↗

PubMed2006

Ureteral avulsion during uterine dilatation and evacuation: a case report.

BACKGROUND: Ureteral injury during elective pregnancy termination is rare and has been reported only 8 times. Two of these cases involved avulsion, and 1 occurred during a second-trimester procedure. CASE: Ureteral avulsion and damage to the lower colon occurred during second-trimester pregnancy termination. Although the ureter was initially thought to be intact on direct visualization of the pelvic ureter and stent placement, pathologic evaluation of the curettage specimen revealed a segment of ureter. Subsequently, intravenous pyelography confirmed ureteral avulsion at the junction of the ureter with the kidney. CONCLUSION: Although damage to the ureter at the time of uterine evacuation is unusual, use of intraoperative intravenous pyelography may be advisable when injury is suspected but not obvious.

Abortion, Induced↗

PubMed2005

Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy.

OBJECTIVE: The purpose of this study was to compare success rates of 643 patients who had ectopic pregnancy from the same database who were treated with multidose or single-dose methotrexate protocols. STUDY DESIGN: We compared demographics, gestational age, serum human chorionic gonadotropin, progesterone levels, ectopic sac size and volume, overall ectopic mass size and volume, ectopic cardiac activity, history of ectopic pregnancy, number of treatment days, methotrexate doses, and outcome in consecutive patients with ectopic pregnancy who were treated with methotrexate. RESULTS: Success rates were comparable between patients with multidose and single-dose therapy (95% vs 90%, respectively) as were human chorionic gonadotropin and progesterone levels, history of ectopic pregnancy (21.4% vs 21.7%, respectively), number of treatment days, gestational age, ectopic size, ectopic volume, and ectopic mass volume. Patients who received single-dose therapy were significantly heavier (146 vs 159 pounds), had greater ectopic cardiac activity (3.1% vs 10.3%), and received fewer methotrexate doses. CONCLUSION: This study suggests single-dose methotrexate therapy is as effective as multidose methotrexate therapy for the treatment of ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy.

OBJECTIVE: To investigate whether a history of previous ectopic pregnancy is an independent risk factor for failure of methotrexate therapy in subsequent ectopic pregnancies and whether the previous treatment method influenced failure. SETTING: Inner-city teaching hospital. DESIGN: Retrospective case review. PATIENT(S): Five hundred four consecutive patients treated with "single-dose" methotrexate for ectopic pregnancy. Nine patients electing surgery after beginning medical therapy were excluded from analysis. INTERVENTION(S): Systemic methotrexate 50 mg/m(2). MAIN OUTCOME MEASURE(S): Failure of methotrexate therapy. RESULT(S): Twenty-one (18.6%) of 113 of previous ectopic patients and 26 (6.8%) of 382 first-time ectopic patients failed methotrexate therapy (odds ratio, 3.12). The overall success rate was 90.5% (448/495 patients). Univariant analysis showed that treatment hCG and progesterone (P) levels and ectopic cardiac activity were significantly different between successful and failed therapy. Logistic regression analysis for these four variables showed that only hCG and history of previous methotrexate remained significant risk factors for failure of methotrexate therapy. The likelihood of failure in patients with a previous ectopic was not influenced by previous treatment with salpingostomy, salpingectomy, or medical treatment. CONCLUSION(S): A history of previous ectopic pregnancy appears to be an independent risk factor for failure of systemic methotrexate treatment, but failure is not affected by previous treatment method.

Adult↗

PubMed2003

Is a resident's score on a videotaped objective structured assessment of technical skills affected by revealing the resident's identity?

OBJECTIVE: The purpose of this study was to determine whether knowledge of resident's identity affects the evaluation of surgical skills. STUDY DESIGN: During an objective structured assessment of technical skills, 33 residents in obstetrics and gynecology who performed 10 surgical skills were videotaped with two digital cameras simultaneously. One camera videotaped "hands only," concealing resident identity; the other camera videotaped from the "waist up," revealing identity. Residents wore opaque gowns and gloves. Four faculty reviewers with previous clinical experience with the residents scored the "hands only" videos first. The scoring was based on the total of a global rating scale and a task-specific checklist. RESULTS: The combined scores for all reviewers was significantly different between the two views (P=.03). When the video tapes were analyzed individually, two reviewers scored the views differently; one reviewer scored higher, whereas the other reviewer scored lower. CONCLUSION: Bias can occur in evaluation of surgical skills but is dependent on the individual reviewer. Resident identification can alter the score, depending on the evaluator.

Clinical Competence↗

PubMed2003

Cefazolin versus cefazolin plus metronidazole for antibiotic prophylaxis at cesarean section.

BACKGROUND: Although prophylactic antibiotic medications have been shown to reduce the incidence of postoperative infectious morbidity after cesarean delivery, the most effective regimens have not been established. The purpose of this investigation was to compare the efficacy and costs of prophylaxis with cefazolin alone with cefazolin plus metronidazole. METHODS: Women undergoing cesarean delivery were randomized to prophylaxis with 2 g cefazolin (n = 81) or 1 g cefazolin plus 500 mg metronidazole (n = 79). Postoperative infectious morbidity and the duration of hospitalization in the two groups were compared. RESULTS: Thirty-seven (23%) of 160 patients developed endomyometritis. There was a significant reduction in the number of postoperative infections (14 versus 32%) and hospital days (3.12 versus 4.46) with cefazolin and metronidazole prophylaxis (P = 0.0064 versus P = 0.014) compared with cefazolin alone. The estimated antibiotic prophylaxis cost per person was less with cefazolin and metronidazole than with cefazolin alone (9.12 dollars versus 26.73 dollars). CONCLUSION: Antibiotic prophylaxis with metronidazole and cefazolin results in fewer postoperative infections, decreased duration of hospitalization, and lower medication cost than cefazolin alone.

Adult↗

PubMed2002

Molar cornual ectopic pregnancy.

BACKGROUND: Few cases of ectopic molar pregnancies have been reported. We present one such case of a molar cornual pregnancy. CASE: A woman at 12 weeks' gestation by last menstrual period presented with ultrasound evidence of a molar pregnancy and a surgical abdomen. Diagnostic laparoscopy revealed a large amount of free intraperitoneal blood. Laparotomy revealed villous-appearing tissue with numerous fluid-filled cysts erupting from the posterior aspect of the right uterine cornu. A cornual resection was performed, followed by a suction dilation and curettage (D&C). The pathologic findings from the cornual resection were consistent with a partial molar pregnancy, while the material from the suction D&C demonstrated no villi or trophoblastic tissue. CONCLUSION: A molar cornual ectopic pregnancy is presented.

Female↗

PubMed2002

A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery.

OBJECTIVE: The purpose of this study was to investigate the efficacy of continuous local anesthetic infusion system for pain control after cesarean delivery. STUDY DESIGN: This was a randomized prospective double-blind study. Patients who underwent cesarean delivery had a pain system implanted subcutaneously after closure of the fascia. Patients were randomized to receive an infusion of either 0.25% bupivacaine (n = 20) or normal saline solution (n = 16) into the wound for 48 hours. Postoperative pain (determined with a visual analog scale) and postoperative morphine use were assessed at 12, 24, and 48 hours. RESULTS: There were no significant differences in patient demographics or visual analog pain scores at any time interval between the bupivacaine versus the placebo group. However, narcotic requirements to produce this amount of pain relief were significantly less in patients who received bupivacaine infusion rather than normal saline solution at all time intervals. CONCLUSION: The continuous local anesthetic infusion system appears to be effective in reducing postoperative morphine use after cesarean delivery.

Adult↗

PubMed2002

Oral methotrexate for treatment of ectopic pregnancy.

OBJECTIVE: The purpose of this study was to evaluate oral methotrexate tablets in the treatment of ectopic pregnancy. STUDY DESIGN: Patients with a diagnosis of ectopic pregnancy were offered oral methotrexate tablets rather that intramuscular injection. Oral methotrexate was given in 2 divided doses 2 hours apart at a dose of 60 mg/m(2) with standard 2.5 mg methotrexate tablets. Patients were followed up with the use of the same protocol that was used typically for intramuscular methotrexate. RESULTS: Nineteen of 22 patients (86%) were successfully treated. There was no statistical difference between patients who were treated successfully or unsuccessfully, with respect to initial human chorionic gonadotropin titers (P =.55), ectopic size (P =.77), or methotrexate dose (P =.18). Nineteen of 22 patients (86%) had increased pain during treatment. Outside of pain, gastrointestinal side effects were the most common. Thirty-two percent of patients required more than one treatment cycle. CONCLUSION: Oral methotrexate can be used to treat ectopic pregnancy successfully, but there are few advantages to recommend its use over intramuscular methotrexate.

Abortifacient Agents, Nonsteroidal↗