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M F McCann

Publications and source records attributed to M F McCann.

31 records · Page 2Linked to original sources
PubMed1978

Training: an integral adjunct to the introduction of newer methods of fertility regulation.

The provision of new technologies of fertility control that are known to be safer, simpler, and more effective may at first result in higher complication rates, particularly if training in the new techniques is inadequate. This was illustrated by analysis of data on several fertility control methods collected by the International Fertility Research Program. Various studies showed significantly higher complication rates earlier in the series than later, including one study in which complication rates fell dramatically after clinical training was provided. Another study showed the highest complication rate among the physicians performing the fewer number of cases. Finally, one analysis documented greater variability in several clinical criteria among the participating physicians than between the two pieces of equipment being compared. These data document that it is essential to train physicians and other staff members in the proper use of new equipment and techniques if the potential improvements offered by new technologies in fertility regulation are to be realized.

Allied Health Personnel↗
PubMed1978

Experience with minilaparotomy in the Philippines.

This paper presents the socio-demographic characteristics, medical histories, and clinical data on 651 women sterilized by interval minilaparotomy procedures in Manila, Philippines. About two thirds of the procedures were performed with local anesthesia; the Pomeroy technique was used for tubal ligation. In 2.8% of the patients, salpingectomy or fimbriectomy was performed on one side because of surgical difficulties and complications. Surgical difficulties were encountered in 19.8% of the procedures; adhesions (4.3%) and bowel interference (4.0%) were the most frequent causes of surgical difficulty. Complications occurred during surgery in 1.7% of the procedures. Early postoperative complications were noted in 9.1% of the cases. None of the patients required readmission to the hospital. While 612 women were followed up at 6 months, 299 were followed up at 12 months. One women (0.2%) became pregnant after sterilization; at repeat minilaparotomy, ligation of the left round ligament rather than the tube was observed. Pelvic surgery, other than pregnancy-related surgery, during the year following sterilization was reported for one patient who underwent exploratory laparotomy with appendectomy and oophorocystectomy. Menstrual pattern changes were minimal. The results of this study suggest that tubal ligation via minilaparotomy is practical, safe, and effective.

Adult↗
PubMed1978

Advances in sterilization equipment.

From the array of sterilization procedures that are safe, simple and effective, the service provider must select procedures that fit his or her logistical criteria, which include the cost and maintenance of equipment, availability of supplies, and training of the requisite personnel. In this paper, these criteria are discussed for each of the various sterilization procedures. Information about female sterilization equipment for conventional postpartum laparotomy, minilaparotomy, colpotomy, laparoscopy, and culdoscopy is presented, together with facts about the related tubal occlusion techniques. The standard ligation techniques for male sterilization are compared with the newer electrocoagulation and thermocoagulation methods. A variety of methods for both female and male sterilization that are in the research stage are also mentioned. It is concluded that, from a programmatic point of view, vasectomy and postpartum ligation via laparotomy are the optimal sterilization procedures. For women who have not recently been pregnant, minilaparotomy with a standard tubal ligation technique is recommended, except in large teaching hospitals where laparoscopy can be performed efficiently.

Adult↗
PubMed1977

A new look at an old technique: sterilization by infundibulectomy.

Removal of the fimbriated portion of the fallopian tube is, theoretically, quite an effective method of sterilization that has received scant attention in the recent medical literature. In this study 310 cases of infundibulectomy via laparotomy performed at the Castle Street Hospital for Women in Colombo, Sri Lanka, were analyzed. Most of the patients (88.4%) were sterilized within 10 days of the vaginal term delivery whereas the remainder were sterilized in the immediate postabortion period. General anesthetic was used in 93.9% of the procedures. Difficulties at surgery which prevented infundibulectomy were encountered in three cases (1.1%). Infection and other incision problems were the primary complications. Incision infection was noted prior to discharge in four postpartum cases (1.5%) and in no postabortion cases. At the time of the first follow-up visit, seven to 21 days after sterilization, this complication was noted in eight postpartum women (3.1%) and in one woman (2.8%) who had had an abortion. No pregnancies have been reported among the 169 patients who have already been seen at the six-month follow-up visit. The results of this study indicate that infundibulectomy is a safe and effective method of tubal occlusion for postpartum patients.

Adult↗
PubMed1976

Female sterilization via minilaparotomy.

A simple, safe, economical and potentially reversible technique for female sterilization via minilaparotomy is evaluated in 204 patients (not recently pregnant and postpartum). Only light general anesthesia is required, and the procedure is performed with only equipment normally available in any hospital or outpatient clinic. A 2cm circumumbilical or suprapubic incision is made, and the physician manipulates the uterus to bring the fallopian tube in line with the incision. As the cornu passes the incision, the release of intraabdominal pressure at the site of the wound usually pushes the tube out of the peritoneal cavity. A majority of the procedures were performed in less than five minutes. No surgical difficulties were encountered, and no immediate complications or complaints were reported. Patients were usually hospitalized for one or two nights. Early postoperative complications or complaints were reported for 8.4% of the not-recently-pregnant patients and for 4.1% of the postpartum patients at the 7-to-21-day follow-up visit. The most frequently reported complications and complaints were fever and lower abdominal pain. Further studies to determine the effectiveness of this type of sterilization and whether the procedure can be performed safely with local anesthetics and on an outpatient basis are being planned.

Adult↗
PubMedDate not supplied

Risks and benefits of culdoscopic female sterilization.

This paper reviews the risks and benefits of the culdoscopic approach to female sterilization in an alnalysis of 2153 culdoscopic sterilization procedures performed at 11 centers in nine countries. Inability to occlude the tubes as planned was reported for approximately 6.0% of the cases including 1.4% in which one or both tubes could not be occluded by any technique. Surgical difficulties were reported for about 13.0% of the procedures, and surgical complications, of which the most frequent was torn or bleeding tubes, occurred in 2.0% of the cases. Pregnancy rates were significantly higher for patients whose tubes were occluded by tantalum clips (7.7 per 100 women at 12 months), indicating that this is not the preferred technique of tubal occlusion; the 12-month life table pregnancy rates were 0.1 per 100 women for tubal ring and 0.0 for Pomeroy and fimbriectomy. Comparison of these data with similar pooled data on laparoscopy and minilaparotomy indicates that culdoscopy is associated with greater technical difficulty and morbidity. Thus, abdominal procedures will continue to be preferred for use in most large-scale programs.

Culdoscopy↗
PubMedDate not supplied

Active and passive cigarette smoke exposure and cervical intraepithelial neoplasia.

This case-control analysis presents odds ratios for active and passive cigarette smoke exposure and cervical intraepithelial neoplasia of levels II and III (CIN II and CIN III) while controlling for confounders. From 1987 to 1988, 103 biopsy-conformed incident cases of CIN II or III and 268 controls with normal cervical cytology were enrolled. Seventy % of cases were cigarette smokers, while only 30% of controls had ever smoked. The adjusted odds ratio for current cigarette smoking was 3.4 (95% confidence interval, 1.7-7.0). The following confounders were included in logistic regression models: age, race, education, number of sex partners, contraceptive use, sexually transmitted disease history, and Pap smear history. The risk of CIN II/III increased with increasing years of cigarette smoking and with increasing pack-years of exposure. Smoking was associated more strongly with CIN III than CIN II. The effect of passive cigarette smoke exposure was explored separately for smokers and nonsmokers and was found not to be consistently associated with CIN II/III when controlling for confounders.

Adolescent↗
PubMedDate not supplied

Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers.

Although epidemiological studies suggest that cigarette smoking is a risk factor for cervical cancer, further evidence is required to document the biological plausibility of this relationship. This study obtained cervical mucus, using a cervical flush technique, from 50 patients in a neoplasia clinic. Nicotine was detected in the cervical mucus of all 25 smokers and cotinine in the mucus of 84% of the smokers; nicotine and cotinine levels were correlated (P < or = 0.10) with both the number of cigarettes usually smoked and the number smoked in the last 24 h. Nicotine and cotinine levels for passive smokers and nonexposed women were much lower than for women who currently smoked, with little difference found between the nonsmoking women who did and did not report passive smoke exposure. In the one woman who reported smokeless tobacco use, both nicotine and cotinine were detected at much higher levels than for other nonsmoking women. These results indicate that tobacco constituents do indeed reach the uterine cervix, suggesting that they could play a causal role in the development of cervical cancer.

Adolescent↗