Biomedical subjects

L D Thoen

Publications and source records attributed to L D Thoen.

4 recordsLinked to original sources

PubMed1997

Medical treatment of ectopic pregnancy with methotrexate.

OBJECTIVE: To review our experience with low-dose IM methotrexate for the medical management of ectopic pregnancy (EP). DESIGN: Retrospective chart review. SETTING: Magee-Womens Hospital, Pittsburgh, Pennsylvania. PATIENT(S): The first 50 women treated by the resident service in whom EP was diagnosed and treated with methotrexate. INTERVENTION(S): Intramuscular methotrexate, 50 mg/m2. Serum beta-hCG was evaluated 4 and 7 days after treatment and then weekly thereafter. The dose was repeated if the beta-hCG level did not drop > or = 15% between days 4 and 7 or if a plateau or rise was noted during weekly follow-up evaluation. Surgery was performed if significant abdominal pain occurred in the presence of hemodynamic instability or signs of peritoneal irritation on physical examination. MAIN OUTCOME MEASURE(S): Resolution of the EP without surgical intervention. RESULT(S): Two patients were lost to follow-up and one was treated without a certain diagnosis of EP. Forty-three of the remaining 47 women (91.5%; 95% confidence interval, 83.5%, 99.5%) were treated successfully with methotrexate. Of these, 36 women were treated with a single dose, and 7 required a second dose. Four women were treated surgically after medical management failed. The time from initiation of treatment to cure in women who were treated successfully was 25 +/- 15 days (mean +/- SD). Thirteen patients (27.7%) made additional visits to the emergency department because of increased abdominal pain. CONCLUSION(S): As medical therapy for EP becomes common practice, familiarity with its side effects may lead to greater success rates. The decision to abandon medical treatment and proceed with surgery should be based on defined guidelines, such as the development of peritoneal signs, decreasing hemoglobin levels, or hemodynamic instability.

Abdominal Pain↗

PubMed1995

Asymptomatic endometrial carcinoma after endometrial ablation.

Endometrial ablation has been recently introduced as a surgical alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. The procedure itself is reasonably safe. However, if occult endometrial cancer is present before the procedure and is not detected, it may be more difficult to diagnose later. Endometrial cancer may also arise de novo from missed endometrial tissue. Two cases of endometrial cancer following endometrial ablation have been reported, but its overall incidence is unknown. A 58-year-old woman was treated with endometrial ablation for dysfunctional uterine bleeding. Three years later she underwent hysterectomy and Marshall-Marchetti-Krantz procedure for urinary incontinence; incidental, asymptomatic endometrial adenocarcinoma was discovered. The final pathology was grade 1 adenocarcinoma, invading more than 50% of the myometrium (FIGO stage Ic). Endometrial cancer may occur following endometrial ablation and it may be asymptomatic. Careful patient selection and close follow-up are essential.

Adenocarcinoma↗

PubMed1995

Rabbit fallopian tube reanastomosis using a microvascular stapling device.

The 3M Precise Microvascular Anastomotic System (MAS), a microvascular stapling device, was compared with microsurgery for the reanastomosis of rabbit fallopian tubes. Differences in operative time, tubal patency, adhesion formation, and fertility rate were studied in 18 rabbits. Only 17% of tubes repaired by MAS were subsequently patent by chromopertubation, compared with 72% with microsurgery. Mean nidation indices were 0.05 for MAS and 0.22 for microsurgery. Sixty-one percent of adnexae repaired by MAS were adhesion stage I, whereas 83% of microsurgically repaired adnexae were stage I. Mean operative time was 28.2 min for MAS vs 21.6 min for microsurgery. Only the differences in patency rate and operative time were statistically significant, but the trends suggest that fallopian tube reanastomosis by MAS offers no advantage over conventional microsurgical technique.

Animals↗

PubMedDate not supplied

Hemothorax after Lupron therapy of a patient with pleural endometriosis--a case report and literature review.

BACKGROUND: Pulmonary endometrial implants, although uncommon, have been well described in the literature. Symptoms occur with menses and may include recurrent pleuritic chest pain, pneumothorax, hemoptysis, or hemothorax. Exacerbation of pulmonary symptoms by Lupron therapy has not been previously described. CASE REPORT: A 38-year-old African-American female with known endometriosis but no history of pulmonary disease was evaluated for a 2-year history of severe dysmenorrhea. A trial of hormonal suppression was unsuccessful, and she was offered Lupron therapy. Three weeks after its initiation, and shortly after the onset of menses, she came to the emergency room with pleuritic chest pain and shortness of breath and was found to have a right-sided hemopneumothorax. Thoracentesis treatment was successful in eliminating this symptom. CONCLUSION: Although pulmonary endometriosis is rare, physicians should be aware that Lupron therapy can exacerbate pulmonary symptoms during the initial phase of therapy.

Adult↗