PubMed Health⌕ Search

Biomedical subjects

M Wortman

Publications and source records attributed to M Wortman.

17 recordsLinked to original sources
PubMed2004

Endometrial ablation for von Willebrand disease-related menorrhagia--experience with seven cases.

BACKGROUND: Endometrial ablation has recently gained popularity as a treatment of menorrhagia in the general population. In the von Willebrand disease (VWD) patient, intuitively, it would appear that the failure rate would be higher because of the underlying hypocoaguability increasing the likelihood for re-bleeding. In a consecutive series of seven patients, we assessed the efficacy and safety of endometrial ablation in VWD-related menorrhagia. PATIENTS AND METHODS: We performed a retrospective analysis using chart review and a 21-item questionnaire administered to seven (six type 1, one type 2A) women who underwent endometrial ablation between the years 1997 and 2001. Parameters assessed included operative complications, the development of abdominal pains, recurrence of menstrual bleeding post-ablation and the change in the pre-/post-ablation quality of life (QOL). Three patients underwent endomyometrial resection and one each underwent rollerball, thermal, electrocautery and balloon ablation. All patients were pre-treated with i.v. desmopressin (DDAVP) except the 2A patient who received Humate P. Mean age of the patient was 41 +/- 6 years and follow-up was for 45 months (range 31-73) post-ablation. RESULTS: No significant perioperative bleeding complications were observed in any of the patients. All patients initially responded (two amenorrhoea, four hypomenorrhoea, one moderate improvement). In all patients, QOL assessed by 10 parameters improved significantly following the ablation procedure, regardless of the specific technique used. However, at the end of follow-up, only one patient remained amenorrheic, one was hypomenorrheic, one had moderate improvement and four patients experienced recurrence of menorrhagia, three eventually requiring a hysterectomy at a median of 11 months post-ablation. CONCLUSION: Endometrial ablation appears to be a safe procedure that improves the QOL in patients with VWD-related menorrhagia. However, its long-term efficacy appears to be lower in VWD patients when compared with women with menorrhagia without VWD.

Adult↗
PubMed2001

Reoperative hysteroscopic surgery in the management of patients who fail endometrial ablation and resection.

STUDY OBJECTIVE: To determine the safety and efficacy of reoperative hysteroscopic surgery for women who fail endometrial ablation and resection. DESIGN: Retrospective chart review and follow-up (Canadian Task Force classification II-2). SETTING: Private office practice. PATIENTS: Twenty-six women who had undergone endometrial ablation or resection and experienced failure characterized by intolerable pain, bleeding, or asymptomatic hematometra. INTERVENTION: Sonographically guided hysteroscopic endomyometrial resection. MEASUREMENTS AND MAIN RESULTS: Mean length of time from initial treatment for abnormal uterine bleeding and reoperative hysteroscopic surgery was 41.2 +/- 47.9 months. Five (19.2%) women required simple dilatation and 21 (80.8%) required endocervical resection to achieve access to the uterine cavity. There were no operative complications. Mean operating time was 20.3 +/- 9.5 minutes. Mean specimen weight was 6.7 +/- 4.9 g. Adenomyosis was present in 15 (57.7%) specimens. Women were followed for a mean of 23.2 +/- 22.7 months. Twenty-three (88.5%) achieved satisfactory results and avoided hysterectomy. Three women (11.5%) eventually required hysterectomy because of recurrent pain or bleeding. CONCLUSION: Reoperative hysteroscopy is useful in managing women after failed endometrial ablation and resection. It produces excellent results in achieving amenorrhea and relief of cyclic pelvic pain, thereby avoiding hysterectomy in most patients.

Adult↗
PubMed1998

A case of treatment-refractory psychosis responsive to sertindole.

Sertindole is an antipsychotic with atypical in vitro and ex vivo binding profiles and little propensity to cause extrapyramidal symptoms. However, its potential usefulness in the treatment of psychosis resistant to the 'classical' neuroleptics has not been determined. In the present study we used a double blind, placebo-controlled trial of sertindole and observed dramatic, sustained resolution of formerly-chronic positive and negative psychotic symptoms in a schizophrenic patient. This patient had averaged 2.5 inpatient admissions per year for the 8 years preceding initiation of sertindole therapy, but has had no hospitalizations or psychosis in the 3.5 years since. Improved cognitive function has also been documented. This preliminary, but controlled, experience suggests that sertindole may possess a spectrum of clinical activity distinct from that of the typical antipsychotic agent.

Adult↗
PubMed1996

Methotrexate and misoprostol when surgical abortion fails.

OBJECTIVE: To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible. METHODS: Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square meter intramuscularly followed by a misoprostol 800-microgram suppository 72 hours later. A repeat dose of a misoprostol 800-microgram vaginal suppository was administered on day 4 if there was no bleeding, and an additional dose was given if the repeat beta-hCG titer had not decreased by at least 50%. Subjects were followed-up with serum or urine hCG assays. Complete abortion was defined by vaginal bleeding and a negative urine pregnancy test. Subjects completed a daily symptom log and a satisfaction questionnaire when the abortion was complete. RESULTS: The four women referred after failed suction curettage had the following anatomic problems: a uterus bicornis bicollis, a bicornuate uterus, uterine leiomyomas, and cervical stenosis resulting from previous laser surgery. All subjects had a complete abortion from methotrexate and misoprostol. Mild gastrointestinal side effects were reported by all four subjects: nausea (two subjects), vomiting (two), and diarrhea (two). The satisfaction questionnaire revealed that all subjects agreed with the statements that "Overall, the procedure went well" and "I would recommend this procedure over a surgical abortion." CONCLUSION: Methotrexate and misoprostol can induce an abortion when uterine or cervical anomalies make suction curettage difficult or impossible.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Hysteroscopic endocervical resection.

A new method was developed to access the uterine cavity in women in whom cervical stenosis precludes hysteroscopic surgery. Thirty-three women with intractable uterine bleeding were chosen to undergo either hysteroscopic myometrial resection or myomectomy. All of them had cervical stenosis that would, in the authors' opinion, not permit safe dilatation to 9 mm, the minimum diameter necessary to introduce a gynecologic resectoscope. Endocervical resection was performed in all 33 patients, with safe, easy access to the uterine cavity. No cases of fluid overload or excess bleeding occurred. We conclude that hysteroscopic endocervical resection is a safe method to create a portal of entry to the uterine cavity in women with absolute or relative cervical stenosis.

Cervix Uteri↗
PubMed1995

Hysteroscopic myomectomy.

STUDY OBJECTIVE: To review the results of hysteroscopic myomectomy in 75 women with menorrhagia. DESIGN: A retrospective analysis of 75 women who were evaluated and treated between November 1, 1988, and March 3, 1994. SETTING: Private gynecologic practice. PATIENTS: Seventy-five women with menorrhagia with confirmed hysteroscopic evidence of one or more submucous myomata. INTERVENTIONS: Sixty-five women who had completed their childbearing underwent myomectomy and a concomitant procedure to destroy the endometrium. The remaining 10, who wished to retain their childbearing ability, underwent myomectomy alone. With two new techniques, large submucous myomata were removed rapidly and efficiently. Both laparoscopy and intraoperative ultrasound were performed when surgical guidance and control were thought to be necessary. MEASUREMENTS AND MAIN RESULTS: Myomectomy was performed in 55 (73%) of women without intraoperative control, and in 10 (13.4%) with laparoscopic and ultrasound control. No serious complications occurred. Three patients had leiomyomas of uncertain malignant potential, the significance of which underscores the importance of having all the tissue that is excised evaluated histologically. The outcome of a single operation was satisfactory to 84% of women. CONCLUSIONS: Hysteroscopic myomectomy to control menorrhagia appears to be a safe and effective procedure. Two new techniques should improve its efficiency. In addition, controlling with ultrasound may help to avoid perforation injuries and obviate the need for laparoscopic guidance.

Adult↗
PubMed1994

Hysteroscopic endomyometrial resection: a new technique for the treatment of menorrhagia.

Thirty-five patients with menorrhagia and a normal uterine cavity underwent hysteroscopic endomyometrial resection. None underwent any form of medical or surgical preparation of the endometrium. A standard gynecologic resectoscope was used to excise a minimum of 3 mm of endomyometrium from the entire uterine cavity. This depth was reduced to 2 mm at the tubal ostia. All patients were followed for 3-6 months. Twenty-one of the 25 patients (84%) who were followed at 6 months reported amenorrhea. The mean dysmenorrhea scores improved from 2.84 to 0.56 postoperatively. Seven of the 35 patients were diagnosed with adenomyosis. One woman was found to have adenomatous hyperplasia of the endometrium. Hysteroscopic endomyometrial resection is a highly effective method for the treatment of menorrhagia. This technique produces a very high rate of amenorrhea, provides a histologic specimen of the endomyometrium, and obviates the need for medical or surgical preparation of the endometrium.

Adult↗
PubMed1993

Hysteroscopic management of intractable uterine bleeding. A review of 103 cases.

One hundred three patients with intractable uterine bleeding were treated using the continuous flow resectoscope. All patients underwent diagnostic hysteroscopy and endometrial sampling prior to surgery. The patients were divided into three groups. Group I (n = 69) patients had a normal hysteroscopic examination. Group II (n = 26) had intrauterine pathology visible on their diagnostic hysteroscopy. Group III (n = 8) had failed to improve satisfactorily on previous hysteroscopic ablation of the endometrium using the Nd:YAG laser. Group I and III patients underwent hysteroscopic ablation of the endometrium using a 3-mm, ball-end electrode. Group II patients underwent hysteroscopic resection of an intra-uterine lesion utilizing a 7-mm wipe loop electrode. The results in all three groups were analyzed and compared. Seventy patients underwent endometrial preparation with one of five pretreatment regimens: danazol, depoleuprolide, depomedroxyprogesterone acetate and surgery.

Adult↗
PubMed1984

In vitro alkylation of calf thymus DNA by acrylonitrile. Isolation of cyanoethyl-adducts of guanine and thymine and carboxyethyl-adducts of adenine and cytosine.

Reaction of the rodent carcinogen acrylonitrile (AN) at pH 5.0 and/or pH 7.0 for 10 and/or 40 days with 2'-deoxyadenosine (dAdo), 2'-deoxycytidine (dCyd), 2'-deoxyguanosine (dGuo), 2'-deoxyinosine (dIno), N6-methyl-2'-deoxyadenosine (N6-Me-dAdo) and thymidine (dThd) resulted in the formation of cyanoethyl and carboxyethyl adducts. Adducts were not detected after 4 h. The adducts isolated were 1-(2-carboxyethyl)-dAdo (1-CE-dAdo), N6-CE-dAdo, 3-CE-dCyd, 7-(2-cyanoethyl)-Gua (7-CNE-Gua), 7,9-bis-CNE-Gua, imidazole ring-opened 7,9-bis-CNE-Gua, 1-CNE-dIno, 1-CE-N6-Me-dAdo and 3-CNE-dThd. Structures were assigned on the basis of UV spectra and electron impact (EI), chemical ionization (CI), desorption chemical ionization (DCI) and Californium-252 fission fragment ionization mass spectra. Evidence is presented which strongly suggests that N6-CE-dAdo was formed by Dimroth rearrangement of 1-CE-dAdo during the reaction between AN and dAdo. The carboxyethyl adducts resulted from initial cyanoethylation (by Michael addition) at a ring nitrogen adjacent to an exocyclic nitrogen atom followed by rapid hydrolysis of the nitrile moiety to a carboxylic acid. It was postulated that the facile hydrolysis is an autocatalyzed reaction resulting from the formation of a cyclic intermediate between nitrile carbon and exocyclic nitrogen. AN was reacted with calf thymus DNA (pH 7.0, 37 degrees C, 40 days) and the relative amounts of adducts isolated were 1-CE-Ade (26%), N6-CE-Ade (8%), 3-CE-Cyt (1%), 7-CNE-Gua (26%), 7,9-bis-CNE-Gua (4%), imidazole ring-opened 7,9-bis-CNE-Gua (19%) and 3-CNE-Thy (16%). Thus a carcinogen once adducted to a base in DNA was shown to be subsequently modified resulting in a mixed pattern of cyanoethylated and carboxyethylated AN-DNA adducts. Three of the adducts (1-CE-Ade, N6-CE-Ade and 3-CE-Cyt) were identical to adducts previously reported by us to be formed following in vitro reaction of the carcinogen beta-propiolactone (BPL) and calf thymus DNA. The results demonstrate that AN can directly alkylate DNA in vitro at a physiological pH and temperature.

Acrylonitrile↗
PubMed1982

Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation?

The effects of stretching techniques on the flexibility of the shoulder, trunk, and hamstring muscles were compared in college men. Subjects were randomly assigned to one of 4 groups: control (n=10), ballistic (n=11), static (n=10), or proprioceptive neuromuscular facilitation (PNF) (n=12). Baseline measurements (Leighton flexometer) were obtained on 2 separate days prior to and following a 3-day per week, 6-week flexibility training program. A 4x3 (subject group x muscle group) unweighted mean factorial analysis of variance for the difference scores (post minue pre) revealed significant (p less than 0.05) main effects for the 4 subjects groups and the 3 muscle groups. Post hoc analysis showed that only the PNF group had flexibility increases (10.6 degrees) greater than the control (3.4 degrees), and that the hamstrings (9.4 degrees increase) improved more than the trunk (5.2 degree increase). Furthermore, reliability was generally higher for the post-training scores, and the variability between days was lower for the post-training scores of the shoulder and hamstrings (p less than 0.05). The significant (p less than 0.05) between-day changes in flexibility pre-training confirm the importance of establishing baseline data prior to any training study. The findings indicate that PNF may be the preferred technique for improving flexibility, and that flexibility training results in an increased consistency of flexibility scores.

Adult↗
PubMedDate not supplied

A severe transfusion reaction associated with anti-EnaTS in a patient with an abnormal alpha-like red cell sialoglycoprotein.

A 71-year-old woman (Ped) received 3 units of red cells (RBCs), compatible by the indirect antiglobulin test but strongly (4+) incompatible by direct agglutination at 37 degrees C. The next day, her plasma hemoglobin was 1252 mg percent and the direct antiglobulin test (DAT) was weakly positive (IgG and C3). Less than 5 percent of the transfused cells could be detected 48 hours posttransfusion. Her clinical condition deteriorated and renal failure developed. The patient died of pulmonary embolism. Her serum contained a strong (4+) IgM agglutinin and a weakly reactive (microscopically positive) IgG antibody, with anti-EnaTS specificity. EnaFS and EnaTS antigens were severely depressed or absent from the patient's RBCs; the ficin-resistant Ena antigen (EnaFR) appeared to be present. Pretransfusion RBC sialic acid level was 53 +/- 2 percent of normal. The patient's RBC membranes were shown to contain sialoglycoproteins beta and delta by sodium dodecyl sulphate polyacrylamide gel electrophoresis with periodic acid Schiff's base staining, with weak staining of components in the regions corresponding to alpha, alpha 2 and alpha delta. The nature of these components was not identified, but their presence suggested that the patient's RBCs expressed a previously undescribed sialoglycoprotein alpha variant.

Aged↗
PubMedDate not supplied

Hysteroscopic endomyometrial resection.

OBJECTIVE: To determine the efficacy of hysteroscopic endomyometrial resection in treating women with intractable uterine bleeding. METHODS: A retrospective analysis was carried out on 304 women with intractable uterine bleeding treated between August 1, 1991, and December 31, 1997. The average patient was 41.3 +/- 8.0 years old and was followed for a mean of 31.8 +/- 22.1 months (range 6-75 months). RESULTS: Eighty-three percent of women were amenorrheic at the time of their one-year follow-up. The overall amenorrhea rate was 85.5%. Only 0.8% of subjects reported no improvement during the study period. Histologic analysis of the endomyometrial specimens revealed that 17 (5.6%) women were found to have significant endometrial pathology not previously identified with routine preoperative screening. There was a total of 20 complications (6.6%), although only 2 (0.7%) were considered severe. Twenty-seven women (8.9%) eventually required subsequent surgery during the study period. Finally, 69 (22.7%) women with adenomyosis were identified. They did not appear to be at increased risk for subsequent surgery. CONCLUSIONS: Hysteroscopic endomyometrial resection produces superior results as measured by amenorrhea rates, the need for subsequent surgery and its low incidence of associated complications; and it produces an important histologic specimen. For patients with significant comorbidity, endomyometrial resection can be adapted to a single-stage procedure incorporating the diagnostic and treatment phases in women with abnormal uterine bleeding.

Adult↗