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J F Hulka

Publications and source records attributed to J F Hulka.

At least 55 records · Page 3Linked to original sources
PubMed1987

Local versus general anesthesia for laparoscopic sterilization: a randomized study.

Despite the contention by some that local anesthesia is a preferred alternative to general anesthesia for laparoscopic sterilization, there have been no randomized studies comparing these techniques. To better characterize the relative safety and acceptability of these techniques for laparoscopic sterilization, we randomly assigned 100 women undergoing bipolar electrocoagulation or spring clip application to either local or general anesthesia. Of the 53 women assigned local anesthesia, four had their procedures completed using another technique because of technical problems related to obesity. Thirteen other obese women, however, underwent successful surgery with local anesthesia. Women undergoing local anesthesia had a slightly shorter anesthesia time (30 versus 36 minutes) and recovery room stay (65 versus 78 minutes). Women having general anesthesia were 2.3 and 1.5 times more likely to have maximum systolic and diastolic blood pressures above 160 and 90 mmHg, respectively. They were also 5.7 times more likely to have a maximum heart rate 110 or higher. Patient movement was reported to be a concern in five women undergoing general anesthesia, but in none having local anesthesia. An equal percentage (80%) of women in each group expressed satisfaction with their anesthetic technique.

Adolescent↗
PubMed1987

Vaginal prostaglandin E1 analogue (ONO-802) to soften the cervix in first trimester abortion.

Cervical softening by vaginal administration of a prostaglandin E1 analogue (ONO-802) was studied in a double-blind, placebo-controlled study using an objective measure of cervical resistance in 121 women undergoing first trimester induced abortion. Three hours after administration, cervical resistance in control and treated patients did not differ significantly in nulliparous women but did in parous women.

Abortion, Induced↗
PubMed1985

1983 AAGL survey. Professional profile of the membership. AAGL Research and Survey Committee.

The average AAGL physician does general obstetrics and gynecology, with 135 deliveries, 41 hysterectomies and 38 IUD insertions a year in addition to about 50 laparoscopies for sterilization and 43 for diagnosis. About 1 in 10 will experience a major complication, and 1 in 25 will undergo medicolegal actions, although their complication rates as a group are no higher than those of the total membership.

Gynecology↗
PubMed1984

Ovarian function in monkeys after bilateral salpingectomy.

Since ovarian dysfunction after sterilization may be of clinical importance in women, we studied whether microsurgical removal of both fallopian tubes would have adverse effects on ovarian function in the monkey. Macaca fascicularis monkeys were divided into two surgical groups: those that had undergone bilateral salpingectomy or a sham operation. Femoral blood samples were drawn before and after the operation for radioimmunoassays for progesterone. No significant difference was found between pre- and postoperative levels of the salpingectomized vs. the sham-operated group. At a second laparotomy during the luteal phase, all salpingectomized monkeys had at least one corpus luteum with a distinct stigma on one ovary, as did the sham-operated monkeys. The absence of any demonstrable endocrine change after salpingectomy makes it unlikely that any poststerilization symptoms, if they exist, are caused by the absence of tubal tissue.

Animals↗
PubMed1984

Retrograde menstruation in healthy women and in patients with endometriosis.

Blood was found in the peritoneal fluid in 90% of women with patent tubes at laparoscopy during perimenstrual time. If the fallopian tubes were occluded, then only 15% of patients had evidence of blood in the pelvis. Also, 90% of patients with endometriosis and eight of nine women on oral contraceptives had bloody fluid during the menstrual period. The present observations indicate that retrograde menstruation through the fallopian tubes into the peritoneal cavity is a very common physiologic event in all menstruating women with patent tubes.

Ascitic Fluid↗
PubMed1984

American Association of Gynecologic Laparoscopists' 1982 membership survey.

A survey of 1,024 U.S. members of the American Association of Gynecologic Laparoscopists (AAGL) concerning 1982 practice revealed that 125,560 laparoscopic sterilizations had been performed. The bipolar method was the most frequent one, used by 65%. The band was used by 21%, the clip by 4% and the unipolar method by 11%. Local anesthesia was used in 4% of cases and open laparoscopy in 4%. No correlation was possible between technique used and the incidence of hemorrhage (0.45 per 1,000), bowel injury (0.42 per 1,000), postoperative pelvic infection (0.42 per 1,000) or anesthetic complications (0.16 per 1,000).

Anesthesia↗
PubMed1983

Pharmacokinetics and pharmacodynamics of local analgesia for laparoscopic tubal ligations.

The pharmacokinetics and pharmacodynamics of lidocaine and bupivacaine, when used for laparoscopic sterilization under local anesthesia, are described in 21 patients. Under direct vision with the use of a laparoscope, local anesthetic solution was sprayed onto the fallopian tubes. Nine patients were administered 12 ml of lidocaine 2% (240 mg), and 12 patients received 20 ml of bupivacaine 0.5% (100 mg). Samples of venous blood were drawn at 0, 5, 10, 15, 20, 30, 60, and 120 minutes after the intraperitoneal placement of local anesthetic. Drug assays were performed by means of gas chromatography. The peak concentration of lidocaine was detected within 30 minutes. The mean concentration was 1.70 +/- 0.34 micrograms/mg (range, 1.19 to 2.07 micrograms/ml; convulsive level, 18 to 26 micrograms/ml). The peak concentration of bupivacaine was not evident until 60 minutes after injection. The mean concentration was 0.44 +/- 0.15 micrograms/ml (range, 0.20 to 0.77 micrograms/ml; convulsive level, 4.5 to 5.5 micrograms/ml). These findings may justify the use of larger volumes of these local anesthetics for more painful diagnostic laparoscopies whenever adhesions and/or extensive manipulation is anticipated.

Anesthesia, Local↗
PubMed1983

Direct trocar insertion at laparoscopy: an evaluation.

The need for pneumoperitoneum before trocar entry in laparoscopy is evaluated. In over 2000 unselected cases performed in a residency training program from January 1979 to December 1982, three complications of bowel perforation and peritonitis occurred, one despite needle induction of pneumoperitoneum. In entering the abdomen directly with a trocar, critical surgical points are emphasized: adequate relaxation, sharp trocars, adequate skin incision, elevation of the abdominal wall, and insertion of the trocar into the true pelvis. For most patients with no previous abdominal surgery, the authors suggest that this technique offers more clinical security because it does not place reliance on secondary tests but emphasizes concentration entirely upon surgical skill and anatomic knowledge during entry.

Abdominal Injuries↗
PubMed1982

Adnexal adhesions: a prognostic staging and classification system based on a five-year survey of fertility surgery results at Chapel Hill, North Carolina.

From 1976 to 1980, the endocrinology and fertility service at the North Carolina Memorial Hospital, Chapel Hill, performed 108 lyses of adnexal adhesions, including those in 61 patients who also required salpingostomies. A follow-up of 6 months to 4 years in regard to pregnancy outcome was obtained in 90% of these patients. The extent of adnexal disease is described, and a simplified staging system is presented in this report. The stages are based on four independent observations: (1) extent of ovarian involvement in adhesive disease, (2) nature of the adhesions, (3) fimbrial patency, and (4) isthmic patency. Each of the adnexa was staged separately, and patients were classified according to the operation performed on the more favorable side. In an analysis of the results as defined by live births, with use of this system, a statistically significant (p = 0.01) gradient was demonstrated from minimal adhesions (46.7% births) to extensive adhesions (0 births). A similar strong gradient (p = 0.02) was demonstrated with salpingostomies, with a 30% birth rate with no adhesions ranging to 0% with extensive adhesions. This staging and classification system is particularly useful in offering realistic prognoses to patients who are contemplating adnexal operations.

Adnexal Diseases↗
PubMed1982

Second-look laparoscopy in infertility surgery: therapeutic and prognostic value.

Sixty infertile women underwent infertility surgery followed by "second-look laparoscopy" (SLL). All these women had undergone detailed fertility workups, including a diagnostic laparoscopy prior to surgery. The tuboovarian adhesive disease was staged according to the severity of the disease and compared with findings at SLL. Sixty percent of adnexa showed improvement at SLL. During SLL, newly formed adhesions were lysed and stenotic fimbrial ostia dilated. Optimal time for SLL was 4 to 8 weeks after surgery. From these observations, we suggest that SLL provides further opportunity to lyse re-formed adhesions and may have prognostic and therapeutic benefits after laparotomy for lysis of adhesions.

Adult↗
PubMed1980

Midtrimester abortion by dilatation and evacuation versus intra-amniotic instillation of prostaglandin F2 alpha: a randomized clinical trial.

To compare the safety and feasibility of midtrimester abortion by outpatient dilatation and evacuation (D-E) versus inpatient intra-amniotic instillation of prostaglandin F2 alpha (PGF2 alpha), we performed a randomized clinical trial with 100 subjects estimated to be 13 to 18 menstrual weeks pregnant. Subjects undergoing D-E abortion had significantly better compliance with the assigned treatment (100% vs. 88%, < 0.05) and less delay prior to abortion (mean 3.7 vs. 10.1 days, p < 0.001). Subjects receiving PGF2 alpha had a relative risk of sustaining a complication 5.7 times that of subjects undergoing D-E (95% confidence interval 2.1-15.3, p < 0.001). Subjects receiving PGF 2 alpha also had significantly higher rates of vomiting and diarrhea (p < 0.01). Midtrimester abortion by outpatient D-E appears to be more acceptable to women, faster, and safer than by instillation of PGF2 alpha.

Abortion, Induced↗