PubMed Health⌕ Search

Biomedical subjects

M Zerbe

Publications and source records attributed to M Zerbe.

6 recordsLinked to original sources
PubMed2001

High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: Laparoscopically assisted vaginal hysterectomy (LAVH) has evolved into an alternative form of surgical management in the treatment of low-risk endometrial cancer. The purpose of this study was to determine whether low-risk endometrial cancer patients are subject to a higher incidence of positive peritoneal cytology when treated with LAVH compared to total abdominal hysterectomy (TAH). METHODS: We retrospectively reviewed the medical records of patients with low-risk endometrial cancer (grade 1--2 endometrioid type with no evidence of extrauterine spread or grade 3 with <50% myometrial invasion (MI), no cervical or adnexal involvement, and negative lymph nodes when sampled) treated at Memorial Sloan-Kettering Cancer Center from January 1993 to September 1999. We compared 131 patients treated with LAVH to 246 controls who underwent TAH. The two groups were compared for known prognostic factors including grade, MI, vascular space involvement, and lower uterine segment extension. RESULTS: The mean age of patients who underwent LAVH (61 years) was similar to that of the controls (62 years). Fourteen (10.3%) of the patients treated with LAVH had positive peritoneal cytology compared to only 7 (2.8%) of the control population. Factors including FIGO grade, myometrial invasion, and preoperative hysteroscopy did not influence the final results. When stratifying for these factors, the odds ratios of having positive peritoneal washings in those patients treated by LAVH were 5.2, 5.2, and 3.7, respectively. CONCLUSION: Treatment of low-risk endometrial cancer by LAVH is associated with a significantly higher incidence of positive peritoneal cytology. This may be due to the retrograde dissemination of cancer cells into the peritoneal cavity during uterine manipulation. The clinical significance of these findings is yet to be determined.

Adult↗
PubMed1996

Exposure risks related to the management of three wound drainage systems.

BACKGROUND: In response to the Occupational Safety and Health Administration regulations and Centers for Disease Control and Prevention guidelines, health care employers must explore and incorporate new methods to protect staff and patients from blood-borne pathogens. An area directly affected by the new OSHA standards is the postoperative management of surgical drainage systems. This study compared three surgical wound drainage systems: a "closed" system (Tru-Close) and two currently used drainage systems (Hemovac, and Mini-Snyder) for nursing practices and risk of exposure to blood or body fluids in a simulated setting. METHODS: Fifty-eight volunteer registered nurses were asked to choose appropriate personal protection equipment and use recommended universal precautions while measuring and emptying fluid and reactivating each of the drainage systems and to complete a satisfaction questionnaire. Each postoperative wound drainage system was filled with simulated wound drainage and connected to a manikin in an empty patient room. Exposure/contamination was defined as spilling, dripping, or splashing of simulated drainage fluid anywhere in the patient's room or bathroom. RESULTS: Forty-five percent of nurses who emptied bulb evacuator systems and 40% of nurses who emptied Hemovac systems had resulting contamination to the environment or exposure to self. There were no contaminations with the Tru-Close system. Most contaminations were droplets of fluid on environmental surfaces rather than on the nurses themselves. Most nurses chose gloves for personal protection regardless of the system used. Gowns and face shields were rarely used. Most contaminations were due to emptying simulated fluid (27%) or emptying rinse water (29%) into the patient's toilet. Twenty-three percent (23%) of contaminations occurred while simulated fluid was poured into a container at the bedside. The most common object contaminated was the toilet seat (67%). The bed linen was contaminated 16% of the time. Nurse's gloves were exposed in 6% of the trials. CONCLUSIONS: As administrators and researchers explore new methods to protect patients, health care providers, and the environment from blood-borne pathogens, changes should be balanced with the impact on patient care and user satisfaction.

Adult↗
PubMed1992

Critical hemorrhage during pregnancy.

The major causes of obstetric hemorrhage are described, and guidelines for nursing assessment and interventions presented. Complications associated with life-threatening blood loss during pregnancy are identified as well as physiologic changes unique to pregnancy that impact on nursing care.

Critical Care↗
PubMed1990

Clinical management of the pregnant trauma victim.

The pregnant trauma victim presents unique challenges to medical care providers because two lives must be treated concurrently. Physiologic changes inherent in the normal pregnancy, modify the assessment and treatment routines. Care directed to the mother impacts the fetus. Management of the pregnant trauma victim requires a high index of suspicion. Accurate assessment and timely interventions will enhance the probability of healthy outcomes for both mother and infant.

Adult↗