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Biomedical subjects

J F Hulka

Publications and source records attributed to J F Hulka.

At least 19 recordsLinked to original sources
PubMed1992

Intrauterine pressure and fluid absorption during continuous flow hysteroscopy.

OBJECTIVES: Our objectives were to document the causes of fluid absorption during continuous flow hysteroscopy and to determine under which operative conditions fluid overload may occur. STUDY DESIGN: Fifteen patients underwent operative hysteroscopy with 2% ethanol solution for uterine distention. Absorption of fluid was measured by blood alcohol, sodium, osmolarity, and hematocrit. Intrauterine pressures were measured with an obstetric pressure catheter. RESULTS: Alcohol absorption was noted in one patient during a myoma resection. Two additional patients, not in the study, had fluid absorption after partial perforations of the uterus. Under normal operative conditions there were no changes in sodium, osmolarity, or hematocrit. Intrauterine pressures ranged from 45 to 75 mm Hg. Experimental pressures of greater than 200 mm Hg were not associated with fluid absorption. CONCLUSIONS: Intravasation of fluid may occur through open uterine venous channels with extensive resections and under low pressures in the presence of unrecognized perforations.

Absorption↗
PubMed1992

Management of ovarian masses. AAGL 1990 survey.

The American Association of Gynecologic Laparoscopists (AAGL) membership was surveyed on the use of laparoscopy in the management of persistent ovarian masses in 1990. A total of 13,739 laparoscopies were performed for this indication. Ninety-six percent of the respondents performed laparoscopy for this indication on premenopausal women only. Among respondents performing laparoscopy for suspected cancer, there was a 14% conversion rate to laparotomy, compared to 9% among those who performed direct laparotomies when cancer was suspected. An overall incidence of 4 per 1,000 cases of stage I ovarian cancer was found, and about 70% of women with persistent adnexal masses were managed by laparoscopy alone. The risks to women with cancer, as well as the benefits to those without, are discussed.

Female↗
PubMed1979

Laparoscopic sterilization with the spring clip: instrumentation development and current clinical experience.

Since the original spring clip sterilization studies were reported, a number of clinically important modifications to the spring clip and applicator have been developed. The spring-loaded clip, manufactured by Richard Wolf Medical Instruments Corporation of Chicago, Illinois, and Rocket of London, Inc., London, England, and New York, New York can be applied with either a one- or two-incision applicator and the clips and applicators currently available incorporate improvements to the original prototypes in design, manufacture, and quality control. The two-incision applicator is associated with significantly fewer misapplications and the high pregnancy rates reported with the original clip and applicator have not occurred with the current designs. Comparative studies between the clip and band have revealed less operative bleeding and pain associated with the clip. The method is appropriate to all women requesting sterilization but especially to those in the younger age group who may subsequently request reversal because of divorce and remarriage.

Female↗
PubMed1979

Female sterilization.

Sterilization of the female is emerging as a popular method for the permanent regulation of family size in developed countries, and as one of the more effective methods of population management in developing countries. As women move from poor rural cultures to more affluent urban ones, cultural and religious objections to permanent family planning disappear under the pressures of greater child survival and more hope for self- (and child) improvement. Postpartum sterilization remains the most appropriate and attractive method in terms of timing and technique, but interval sterilization (done in the absence of pregnancy) has stimulated interest in minilaparotomy, laparoscopy, and particular concern as to reversibility of sterilization. The techniques of sterilization will be reviewed as to their relative appropriateness in different cultures and different practices, as well as the problems of reversibility.

Clinical Competence↗
PubMed1978

Laparoscopy.

Explore the source record for details and available documents.

Humans↗
PubMed1978

Classification of adnexal adhesions: a proposal and evaluation of its prognostic value.

A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.

Adnexal Diseases↗
PubMed1977

Regional training program of laparoscopy: impact on regional care.

In response to large numbers of requests for laparoscopic sterilization, the University of North Carolina began a training program to provide this service on a regional basis throughout the state. This report reviews the final distribution of centers providing these services: one within 50 miles of every person in the state. The clinical experience of 30 private physicians (excluding experience of residency training programs) was reviewed and found to parallel the national experience in provision of services, in complications, and in pregnancies. The brief but intense training program (2 days at the University of North Carolina and one morning at the physician's hospital) was found to result in rates of complications and failures similar to national levels of performance. Should the demand for laparoscopic sterilization increase in the coming years, the region has sufficient numbers of safely trained physicians to respond.

Female↗
PubMed1976

Spring clip sterilization: one-year follow-up of 1,079 cases.

This is a report of 1,079 patients who underwent laparoscopic clip sterlization as of March, 1974. A one-year follow-up was obtained on 977 patients, or 90.5 per cent. Complications due to the clip technique appear limited to postoperative cramps for 24 to 48 hours in 26 per cent of patients. No ectopic pregnancies were detected. Pregnancies, when corrected for unsuspected existing pregnancies and surgical and manufacturing errors, occurred in 2 to 6 cases, for a method failure rate of 2 to 6/1,000. This report documents that experienced laparoscopists can perform this practice with local anesthesia, in combination with first-trimester abortion, and in hospital facilities other than an operating room.

Anxiety↗
PubMed1976

Ventilatory and blood gas changes during laparoscopy with local anesthesia.

A study was performed on a series of healthy patients undergoing laparoscopy for tubal ligation with local anesthesia in a non-operating room setting. Ventilatory parameters, blood gas, pH, blood pressure, and pulse were monitored. The results revealed that no adverse effect on hemoglobin saturation or carbon dioxide exchange were found when fentanyl alone was used as a supplementary analgesic. An occasional vagal reflex was observed, and it is recommended that an intravenous line be established in the event that pharmacologic intervention should become necessary. Nitrous oxide produced les with this minimal analgesia.

Adult↗
PubMed1975

Sudies in simpler tubocclusion methods.

This report reviews animal and human studies undertaken to develop simpler, safer, and more acceptable methods of female sterilization. Animal studies revealed inadequate prevention of pregnancy by tubocclusive methods from within the uterus, and the laparoscopic route was chosen. A series of clips were evaluated, and a clip was designed which would have a spring load, be wide enough to cause true tissue necrosis, have a firm grip on the tube to prevent dislodgement, and have a smooth external surface. Extensive human trials of the clip and applicator have resulted in over 1,000 patients with clips applied by 27 physicians in 10 centers throughout the world. Six pregnancies appear to have been due so far to application onto structures other than the isthmic portion of the tube. Complications due to the clip itself appear to be minimal, and the feasibility of performing this operation under local anesthesia in a hospital facility other than the operating room is currently under evaluation.

Ambulatory Care↗
PubMed1975

Spring clip tubal occlusion: a report of the first 400 cases.

Between September 1972 and March 1974, laparoscopic tubal sterilization was performed on 394 patients with the use of a spring-loaded plastic clip under local analgesia and on an outpatient basis. Intravenous fentanyl and infra-umbilical infiltration and tubal spray with 1% lidocaine were found to be very acceptable and effective forms of analgesia. The average time spent by a patient in the hospital was 4 hours, 26 minutes. There was no major immediate complications apart from vasovagal reactions in 34 patients. Up to June 30, 1974, six patients in the series had become pregnant, not as a failure of the clip per se, but as a result of improper application of the clips. This seems to be a safe, simple, and effective method of female sterilization with great potentials of reversibility.

Adult↗
PubMed1975

Sterilization by spring clip: a report of 1000 cases with a 6-month follow-up.

In September 1972, clinical trials of a spring-loaded clip for laparoscopic sterilization were begun and extended to a number of centers in the United States and overseas. As of March 1974, more than 1000 patients had undergone the procedure, usually performed under local anesthesia in an outpatient setting, with no fixed contraindications. Complications and pregnancy rates based on a preliminary 6-month follow-up are presented. Complications due to application of the clip appeared to be limited to postoperative cramps lasting 24 to 48 hours (26% of the patients). No ectopic pregnancies were reported. Pregnancies, when corrected for unsuspected pregnancies and misapplication of the clip, occurred in 2 of these first 1000 patients. The difficulties and relative contraindications learned from this unselected series and the advantages over electrocagulation techniques are discussed.

Abortion, Spontaneous↗
PubMed1975

Reversibility of clip sterilization.

A spring clip designed to be applied to the fallopian tube for sterilization without electrocoagulation was applied to 10 pigs. After documenting the prevention of pregnancy for 3 months, the clips were removed and successful reanastomosis was performed on eight pigs. Six of these pigs became pregnant within 2 months of the reanastomosis. This paper describes the technique of the reanastomosis and documents the potential reversibility of spring clip sterilization.

Animals↗
PubMed1975

Outpatient laparoscopic sterilization with therapeutic abortion versus abortion alone.

Records of 108 patients undergoing combined vacuum aspiration and laparoscopic sterilization in an outpatient surgical program were reviewed and compared with those of 195 patients who underwent abortion only in the same outpatient program. Mean operating time for the combined procedure was 30 minutes; total mean hospitalization time was 5 hours and 7 minutes. Complication rates for the combined procedure and for abortion alone were 9.2 and 7.2 per cent, respectively. Subsequent hospitalization was necessary for 4.7 per cent of patients undergoing the combined procedure and 3.1 per cent of those having abortion only. Laparoscopic sterilization has been found to add no significant morbidity but has markedly reduced cost and hospitalization for the patient desiring permanent contraception following first trimester abortion.

Abortion, Therapeutic↗
PubMedDate not supplied

Preclinical and clinical testing of laparoscopic sterilization techniques.

Testing laparoscopic instruments for sterility should be conducted according to a three-phased program: Phase I: A basic judgment needs to be made by a panel of clinicians familiar with sterilization as to whether or not a new technique is truely different from standard and documented techniques so as to warrant preclinical animal studies. If this is warranted, these studies should include at least 10 test animals with no pregnancies, compared to 10 control animals where a normal pregnancy rate of 70 to 80 percent is documented. Phase II: After theoretical efficacy of a new technique is documented or accepted, the developer of the technique should test it on at least 50 patients for unexpected clinical difficulties or difficulties in maintenance of equipment. Phase III: At least five prototypes of the sterilization device should then be distributed to experienced clinicians for their evaluation on atleast 100 patients each, with a prospective collection of complications and pregnancy rates in a follow-up of at least 90 percent by the end of a 1-year period. Ideally, the number of such patients should be 1000. A judgment can then be made by an appropriate panel as to the relative hazards and benefits of the technique in comparison with standard rates of safety and efficacy.

Animals↗