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Biomedical subjects

K O Reeves

Publications and source records attributed to K O Reeves.

12 recordsLinked to original sources
PubMed1999

A simple, inexpensive device for teaching the loop electrosurgical excision procedure.

OBJECTIVE: To develop an inexpensive and practical inanimate model to teach the loop electrosurgical excision procedure in a resident clinic. TECHNIQUE: A vaginal speculum is inserted into one end of a cardboard tube. At the opposite end, a piece of knockwurst sausage is inserted into the cardboard tube. A grounding pad is attached to the distal end of the sausage. The teaching session proceeds using a colposcope or direct visualization. After the training session, the excised and uncut portions of sausage can be examined. EXPERIENCE: Faculty found this inanimate model an excellent way to teach residents how to use the loop electrode, and the resident staff appreciated its merits as a useful prelude to treating cervical disease in women. The house staff adapted to the confines of the vagina and transferred skills acquired from working with the cardboard tube, where instruction and constructive criticism can be given without the presence of apprehensive patients. CONCLUSION: A simple, inexpensive, inanimate model has been developed to teach the loop electrosurgical excision procedure. The materials required to construct it are available to any colposcopy clinic.

Electrosurgery↗
PubMed1997

Relevance of human papillomavirus screening in management of cervical intraepithelial neoplasia.

OBJECTIVE: To evaluate the utility of human papillomavirus detection in identifying women with abnormal Papanicolaou smears who can be safely followed up with cytologic study only, we conducted a study to determine the sensitivity, specificity, and negative and positive predictive values of a Food and Drug Administration-approved human papillomavirus test kit for detection of cervical intraepithelial neoplasia in colposcopically directed biopsy specimens. STUDY DESIGN: We enrolled women with abnormal Papanicolaou smears referred to a colposcopy clinic serving indigent patients. All 1128 women had a referral Papanicolaou smear, a clinic Papanicolaou smear, and a sample for human papillomavirus deoxyribonucleic acid test; 1075 underwent colposcopically directed biopsies and endocervical curettage. We used the HPV Profile kit for human papillomavirus testing. RESULTS: Of 486 women with low-grade squamous intraepithelial lesions on Papanicolaou smear, 35.4% had high-risk human papillomavirus deoxyribonucleic acid detected, and of 592 with high-grade lesions, 44.4% had high-risk human papillomavirus detected. Among 527 women with biopsy specimens showing cervical intraepithelial neoplasia and in 267 with cervical intraepithelial neoplasia grades 2 or 3, 38.7% and 56.2% had high-risk human papillomavirus deoxyribonucleic acid detected. However, the sensitivity of human papillomavirus deoxyribonucleic acid detection to identify biopsy-confirmed cervical intraepithelial neoplasia grades 2 or 3 was 55.7%, and the positive predictive value of the test was only 34.9%. CONCLUSION: Human papillomavirus appears to be causally associated with cervical cancer but human papillomavirus screening does not appear to be of value to identify women with abnormal Papanicolaou smears who can be safely followed up with cytologic study alone.

Adolescent↗
PubMed1996

Comparison of spermicides on vulvar, vaginal, and cervical mucosa.

The objective of this study was to compare the tolerability of Advantage 24 to two other spermicides containing non-oxynol-9 (N-9). These spermicides were Today Sponge (Sponge) and Conceptrol. In order to examine the incidence of complaints and the clinical observation of vaginal ulceration and irritation of the three spermicides, a randomized, open label, three period cross-over trial was conducted. Thirty-three women, ages 18-45, with a normal vaginal environment based on physical exam, Pap smear, vaginal wet prep, colposcopy, and serum N-9 were randomized into four treatment groups. Each treatment was for seven consecutive days with a 21-day washout. Data obtained were studied by one-way analysis of variance, chi-square, and Kruskal-Wallis test. No vulvar or vaginal abnormality was observed from either spermicide. Subjects had fewer and less severe cervical lesions by colposcopy during treatment with Advantage 24 than with Conceptrol or Sponge (p < 0.01). Comparison of the incidence of abnormal gynecological findings, serum N-9 levels, and the incidence of adverse events before and after treatment with the three study drugs indicate that most subjects had normal examinations pre- and post-treatment. Pap smear and colposcopy changes from normal to abnormal accounted for about 50% of all gynecological findings during the Conceptrol and Sponge treatments, but less than 20% during treatment with Advantage 24. All serum N-9 levels were below the level of detection (< 1.9 microgram/ml). Advantage 24 is better tolerated than Conceptrol or the Sponge. Furthermore, the cervical mucosa appears to be less resilient to spermicides than vulvo-vaginal mucosa.

Adolescent↗
PubMed1995

Preterm external cephalic version in an outpatient environment.

OBJECTIVE: Our purpose was to study the safety and efficacy of external cephalic version before term (37 weeks' gestation). STUDY DESIGN: We retrospectively reviewed 114 pregnancies in 110 women at 30 to 41 weeks' gestation who had a total of 133 attempts at external cephalic version. RESULTS: Seventy-nine percent of the versions performed before the thirty-seventh week and 53% performed during or after the thirty-seventh week were successful. After adjustment parity and body mass index, a version performed before the thirty-seventh week was 27 times more likely to be successful than if performed during or after the thirty-seventh week. Ninety-nine percent of the successful versions were delivered with a vertex presentation, and of these only 16% required cesarean delivery. CONCLUSION: External cephalic version is safe and successful if performed before 37 weeks' gestation, hence substantially reducing the rate of cesarean section among nonvertex presentations and reducing the risks associated with breech delivery.

Breech Presentation↗
PubMed1995

Colposcopically directed biopsy and loop excision of the transformation zone. Comparison of histologic findings.

We performed a retrospective comparison between the findings from colposcopically directed biopsies and those from loop excision of the transformation zone (LETZ) specimens. The correlation was satisfactory. When a low grade squamous intraepithelial lesion (SIL) was predicted on a cytologic smear and biopsy specimen, no cases of invasive carcinoma were found. In two (0.8%) cases in which a high grade SIL was predicted on the cervical smear and biopsy, microinvasive carcinoma was found in the LETZ specimen.

Adolescent↗
PubMed1988

Endocervical brush cytology. An alternative to endocervical curettage?

The usefulness of an endocervical brush for cytologic sampling was studied in 288 consecutive women attending a colposcopy clinic. One hundred sixty had initial colposcopic examinations with directed biopsies and endocervical curettage (ECC). One hundred twenty-eight had follow-up examinations that included Papanicolaou smears and ECC some time after evaluation and/or treatment for cervical dysplasia. Within an established protocol for the evaluation and management of abnormal Papanicolaou smears, the endocervical brush was compared to ECC. When the combination of colposcopy and cervical conization showed that dysplasia was confined to the endocervix, the endocervical brush was significantly more sensitive than ECC in detecting this endocervical disease (P less than .05). In follow-up evaluations and in patients with unsatisfactory colposcopic examinations, endocervical brush cytology could replace ECC without affecting clinical management. In patients with a satisfactory colposcopic examination, ECC may be required only when endocervical brush cytology is abnormal. Endocervical brush cytology is less costly and painful and could prove to be a reasonable alternative to ECC for the initial evaluation of the endocervix. Endocervical brush cytology shows promise as a safe adjunct to the colposcopic evaluation of pregnant women, whereas ECC is contraindicated in such women.

Adenocarcinoma↗
PubMed1988

Sigmoidovaginal fistula secondary to diverticular disease. A report of three cases.

Colovaginal fistula from any cause is rare. Diverticular disease is the most common cause. We treated three women for sigmoidovaginal fistulae secondary to diverticular disease. These 3 cases bring the total number reported to 49. Diagnosis of these fistulae may be difficult, and controversy exists over which form of surgical management should be employed. Since more women are living to an age at which diverticular disease is common, colovaginal fistulae probably will be encountered by the gynecologist with increasing frequency. Colovaginal fistula secondary to diverticular disease should be considered in the differential diagnosis when an elderly women complains of flatus vaginalis.

Aged↗
PubMed1976

Severe atypical endometrial changes and sequential contraceptive use.

Of eight young women, seven had a diagnosis of well-differentiated endometrial adenocarcinoma and one had atypical endometrial hyperplasia. The average age was 40.1 years, with 6.04 years of dimethisterone-ethinyl estradiol (Oracon) sequential contraceptive use. The patients were not typical of those in whom endometrial carcinoma develops. Although these cases do not prove that long-term administration of dimethisterone-ethinyl estradiol causes endometrial adenocarcinoma or atypia, they indicate that it may do so.

Adenocarcinoma↗