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Biomedical subjects

M E Thoma

Publications and source records attributed to M E Thoma.

6 recordsLinked to original sources
PubMed2000

Early detection of ectopic pregnancy visualizing the presence of a tubal ring with ultrasonography performed by emergency physicians.

Early diagnosis of ectopic pregnancy (EP) continues to be problematic for emergency physicians. With the increasing availability of endovaginal ultrasonography (EVS) for emergency physicians, recognizing additional EVS findings, ie, the presence of a tubal ring, in patients with risk factors or clinical presentation for EP can assist the emergency physician in diagnosing EP.

Adult↗
PubMed1998

Serum progesterone and endovaginal sonography by emergency physicians in the evaluation of ectopic pregnancy.

OBJECTIVE: To determine a discriminatory level for serum progesterone (SP) in pregnant patients with no definite intrauterine pregnancy (IUP) on endovaginal ultrasonography (US) in the differentiation of ectopic pregnancy from normal IUPs. METHODS: A prospective observational study in a convenience sample of women at risk for ectopic pregnancy was performed at an urban teaching hospital from May 1991 until May 1994. Women aged > or =18 years presenting to the ED with a positive pregnancy test in combination with pelvic or abdominal pain, vaginal bleeding, orthostasis, adnexal mass or tenderness, or any historical risk factor for ectopic pregnancy were eligible. Hypotensive or unstable patients were excluded. Endovaginal US was performed and patients with no definite IUP had a serum beta-hCG and SP measured. RESULTS: 314 patients were enrolled, with 14 excluded for lack of follow-up or incomplete SP data, yielding 300 patients. The initial endovaginal US diagnoses included 169 definite IUP, 31 abnormal IUP, 5 definite ectopic pregnancy, and 95 no definite IUP. 68/95 had SP measured, with values of 22.8 +/- 13.4 ng/mL (mean +/- SD) for IUP; 4.9 +/- 6.5 for spontaneous abortion, and 7.5 +/- 7.2 for ectopic pregnancy. The mean values were significantly different (2-tailed t-test) for ectopic pregnancy vs IUP and for spontaneous abortion vs IUP. An SP of > or =11 ng/mL (sensitivity 91%; specificity 84%) was post hoc the best cutoff value for suggesting an IUP when the endovaginal US was not definite for IUP. CONCLUSIONS: SP cannot reliably discriminate ectopic pregnancy vs spontaneous abortion in pregnant patients with no definite IUP on endovaginal US; however, a low SP (<11 ng/mL) in this sonographic category suggests an abnormal pregnancy.

Abortion, Spontaneous↗
PubMed1996

Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy.

STUDY OBJECTIVES: To determine whether bedside endovaginal sonography (EVS) performed by emergency physicians reduces complications associated with ectopic pregnancy (EP) including missed EP and EP rupture. METHODS: Our setting was an urban trauma center emergency department. We assembled a prospective convenience sample (n=314) with a historical EP control group (n=56) of women 18 years or older with a positive pregnancy test and any signs, symptoms, or risk factors for EP. Bedside EVS for all subjects and immediate quantitative serum human chorionic gonadotropin determination for patients with no definite intrauterine pregnancy by EVS. RESULTS: Retrospective chart review identified 56 EP patients in the historical control group who had had no bedside EVS. Twenty-four of these patients (43%; 95% confidence interval [CI], 30% to 56%) were discharged from the ED, 12 of whom (50%; 95% CI, 30% to 70%) were later categorized as having ruptured EP. During the prospective study period, 40 patients were diagnosed as having EP; 11 (28%; 95% CI, 14% to 42%) were discharged from the ED (P=NS), and only 1 (9%; 95% CI, 0% to 26%) of the discharged patients was later determined to have a ruptured EP (P<.05). CONCLUSION: An EP protocol incorporating bedside EVS performed by emergency physicians significantly reduced the incidence of discharged patients with subsequent EP rupture, compared with historical controls.

Adult↗
PubMed1995

Use of glucagon for removal of an orogastric lavage tube.

This report presents the first case in which glucagon administration enabled the removal of an impacted orogastric tube in a patient with distal esophageal spasm. For patients in whom the removal of a gastric tube is impeded, we suggest initially determining tube position and checking for any knotting or kinking of the tube using fluoroscopy. Provided that the gastric tube is distal to the mid-esophagus and is not kinked or knotted, we suggest that glucagon can be used as an adjunctive modality for gastric tube removal. This care provides an additional and previously unreported use for glucagon in emergency medicine.

Adult↗
PubMed1993

Life change events and coping behaviors in families of children with cancer.

This study investigated life change events and coping behaviors in families of children with cancer compared with those who have physically healthy children. The sample consisted of 21 families with a child with cancer and 17 families with physically healthy children. All the children in the study were 6 to 12 years of age. Parents from each group completed items from the Family Inventory of Life Events and Changes and the Family Crisis Oriented Evaluation Scales. These tools evaluate stressful life change events experienced by families within a 12-month period and coping behaviors used by families during difficult situations. Families with a child who has cancer experienced significantly more stressful life change events (t = 2.15, P = 0.04) than those with physically healthy children. There were no significant differences (t = 0.23, P = 0.82) in the coping behaviors that were used by the two groups. The results provided a clearer understanding of stressful life change events that impact families with a child with cancer.

Adaptation, Psychological↗