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Biomedical subjects

N J Naftalin

Publications and source records attributed to N J Naftalin.

At least 19 recordsLinked to original sources
PubMed2001

Quantitative and qualitative assessment of women's experience of a one-stop menstrual clinic in comparison with traditional gynaecology clinics.

OBJECTIVE: A quantitative and qualitative evaluation of the views of patients attending two types of clinics for menstrual disorders. METHODS: Semi-structured qualitative interview and quantitative questionnaire. SETTING: Five traditional general gynaecology clinics and a one-stop menstrual clinic, where investigations are performed and results given to patients on the same day. PARTICIPANTS: Two hundred and thirty-nine women (126 from the gynaecology clinic and 113 from the menstrual clinic) were recruited into the quantitative study; 18 and 26 patients from the gynaecology and the menstrual clinic, respectively, were interviewed for the qualitative study. MAIN OUTCOME MEASURES: Women's views about their care and progress towards resolution of their problem. RESULTS: Following the initial consultation, 106 (84%) of the gynaecology clinic, and 98 (87%) of the menstrual clinic patients completed the first part of the questionnaire. Of those, 75 (71%) and 79 (81%) patients from the two types of clinic, respectively, completed a follow up questionnaire one year later. There were statistically significant differences in all the components of the first part of the questionnaire (information, continuity, waiting, organisation, and limbo) in favour of the one-stop menstrual clinic. After one year, there was a statistically significant difference in one of the components, patient centeredness, but not in overall process co-ordination. The interviews showed that patients attending the menstrual clinic appreciated getting the results of their investigations on the same day. They also found the organisation of the one-stop menstrual clinic more closely suited to their needs and as a result were more likely to feel they were making progress. CONCLUSION: Women were consistently more positive about their experience in the one-stop clinic. One-stop clinics organised to meet the needs of patients might be appropriate for other clinical conditions. The combination of quantitative and qualitative methods is an effective method of assessing patients' views of health services.

Adult↗
PubMed1999

Has pelvimetry a role in current obstetric practice?

Radiological pelvimetry is still requested in some centres before planned vaginal delivery for breech presentation or following a previous caesarean section. In a retrospective review of the utilisation of pelvimetry in 167 cases in our department, 103 (62%) and 64 (38%) had pelvimetry in the postnatal and antenatal periods respectively. Antero-posterior inlet and outlet diameters were inadequate in 19.2% and 16.2% respectively. Of those who had postnatal pelvimetry, only 36 (35%) returned to our unit for further confinement and the caesarean section rate in this group was 75%. The main indications for antenatal pelvimetry were breech presentation (28), previous caesarean section (23) and anticipated cephalopelvic disproportion (13). The caesarean section rates in these groups were 82%, 70% and 45% respectively. However, the emergency caesarean section rate in the breech presentation group was 28%. Nine patients (32%) of those who had breech presentation and delivered by elective caesarean section had normal pelvic measurements. Pelvimetry should only be performed if its results will influence the mode of delivery. Pelvimetry may be useful in selecting fetuses with breech presentation for vaginal delivery or elective caesarean section. However it would increase the likelihood of caesarean section in cephalic presentation.

Journal Article↗
PubMed1999

The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy.

BACKGROUND: Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the learning curve on the duration of surgery and also the peri-operative complications. METHODS: A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997. RESULTS: Over a four year period 86 cases of laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy were performed; the main indication being menstrual disorders. The mean duration of surgery was 116 minutes. There was a significant difference in the mean duration of surgery between the first two years (123 minutes) and the last two years (110 minutes) (p<0.02). The difference in the mean duration of surgery performed either by consultants or senior registrars under supervision (115 versus 116 minutes) was not significant (p>0.05). The overall complication rate was 16% with a majority (85%) occurring in the first two years of the study period. Three cases (5%) were converted to conventional abdominal hysterectomy. After the initial learning phase there was a significant reduction in the complication rates. CONCLUSIONS: The impact of the learning curve on the duration of surgery is gradual. The perceived duration of surgery should not be a disincentive for senior trainees provided they are already proficient in minor laparoscopic surgery, cases are suitably selected and adequate supervision is provided.

Elective Surgical Procedures↗
PubMed1997

Laparoscopic laser treatment for endometriosis.

The advent of the use of laparoscopy and lasers in gynaecology has added a further option for the treatment of endometriosis. This study is a retrospective review of the notes of 28 women who had endometriosis treated laparoscopically with an Nd:YAG laser. Results were assessed by subjective reporting of symptoms. Seventy-three percent of patients reported significant or complete resolution of symptoms at three to 26 months follow-up. No major complications were encountered. The results suggest this offers a further treatment option for endometriosis which merits further evaluation.

Adult↗
PubMed1990

Long-term survival after chemotherapy with cisplatinum, adriamycin and cyclophosphamide for carcinoma of the ovary.

Forty six patients with FIGO Stage II, III, and IV ovarian cancer received treatment with cisplatinum, adriamycin and cyclophosphamide. After a minimum follow-up time of 60 months 13 patients remain free of recurrence. The overall 5-year survival is 39% and the median survival is 39 months. The 5-year survival for Stages II, III, and IV is 64%, 40% and 0% respectively. The 5-year actuarial survival for those who had less than 2 cm residual disease (including those with complete debulking) is 72%, while for those who had greater than 2 cm residual disease (including those who had biopsy only) is 15%. None of the patients have developed any second neoplasm.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Treatment of stages II, III and IV primary surface epithelial ovarian cancers by maximum bulk tumour reduction and combined chemotherapy with cyclophosphamide, doxorubicin and cisplatin.

Forty-six patients with Stages II, III and IV ovarian cancer received treatment with cyclophosphamide, doxorubicin and cisplatin. Patient response to therapy was assessed 6 weeks after the cessation of therapy. Thirty-three patients (72%) were in complete response and six (13%) had a partial response to treatment. No relationship was found between the age of the patient, histologic type or grade of tumour and survival, although stage and initial debulking were important. Treatment had to be discontinued in 11 patients because of progression of the disease or serious side-effects. The probability of survival beyond 24 months for all patients was 71% and the mean survival overall was 32 months.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

The role of second-look laparotomy in the management of patients with stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide.

Twenty-eight patients underwent a second-look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulking procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumour had no effect on survival rates. Eighteen patients were surgically free of disease at the second-look procedure and of these, all are alive and disease free with a mean survival time of 39 months. Of the 10 patients with positive second-look procedures, four are dead. The mean survival for patients with positive second look laparotomies was 30.7 months. Second-look laparotomy may contribute to increased survival if pelvic clearance was not attempted at initial staging laparotomy but should primarily be used to assess new agents and new combinations of chemotherapeutic agents and to define the optimum number of courses of chemotherapy.

Adult↗
PubMed1985

A study of cryosurgery and the CO2 laser in treatment of carcinoma in situ (CIN III) of the uterine cervix.

The results of laser and cryosurgical treatment in 106 patients with histologically proven carcinoma in situ of the uterine cervix (CIN III) are presented. Seventy-one patients were treated with the laser and in 63 of these further follow-up with colposcopy and cytology failed to show any abnormality. This represents an initial success rate of 89%. In 8 patients (11%) initial treatment was considered to have failed because of persistent dyskaryotic smears and histological evidence of cervical intraepithelial neoplasia (CIN II-III). Six of these patients were treated successfully with a further laser application and two patients had conization. The overall success rate for the laser was 97%. Thirty-five patients were treated with cryosurgery and subsequent follow-up was negative in 29 of these patients (83%). The 6 treatment failures (17%) were subsequently successfully treated with local destructive therapy (4 with cryosurgery, 1 with laser, and 1 with needle diathermy). The overall success rate for cryofreezing was 94.2%. In cases of CIN III the laser is more likely to achieve eradication of the lesion with a single application than cryofreezing.

Adolescent↗
PubMed1985

Topical 5-fluorouracil in the treatment of vaginal intraepithelial neoplasia.

The effectiveness of 5-fluorouracil (Efudix) in the treatment of vaginal intraepithelial neoplasia was assessed in 14 patients diagnosed with the condition between January 1980 and December 1982. All patients received a standard dose of 2.5 g 5-fluorouracil cream once weekly for at least 10 consecutive weeks; mean duration of treatment was 12 weeks (range 10-20 weeks). The vaginal lesion was associated with a major dysplastic lesion of the cervix in all patients. The duration of follow-up ranged from 4 to 42 months (mean 15 months). Thirteen patients had complete resolution both colposcopically and cytologically. One patient still had colposcopic evidence of intraepithelial neoplasia (aceto-white epithelium) but a vaginal smear has been negative. This patient has since been lost to follow-up. We conclude that in the regimen described 5-fluorouracil is an effective treatment for vaginal intraepithelial neoplasia.

Administration, Topical↗
PubMed1977

The effects of halothane on pregnant and nonpregnant human myometrium.

Strips of myometrium were obtained at operation from eight nonpregnant and ten pregnant patients. The tissues were immediately suspended in a muscle bath and induced to contract isometrically with K2SO4 in the presence and absence of halothane (0.5 to 2.0 vol per cent). The anesthetic produced significant dose-related depression of developed tension and rates of increase and decrease of tension in both pregnant and nonpregnant muscles. Time to peak tension was increased in the nonpregnant but not in the pregnant muscles. The depressant effect of the lower halothane concentrations (less than 1.1 vol per cent) was significantly greater in the pregnant muscles.

Adolescent↗
PubMed1976

Halothane and calcium interaction in isolated pregnant and postpartum rat myometrium.

Isolated strips of mid-pregnant and postpartum rat myometrium were rendered functionally Ca2+-free by exposure to a Ca2+-free modified Krebs-bicarbonate solution containing 1 mM EGTA. The muscle strips were then exposed to 2.25 mM Ca2+ for periods of 15 to 600 seconds for the mid-pregnant tissues and one 120-second period for the postpartum tissues. At the end of each exposure, Ca2+ was removed and simultaneously each muscle was depolarized with 125 mM K2SO4. Isometric tension changes in the muscles were measured with and without 0.5 per cent halothane. In the mid-pregnant muscles, halothane diminished the initial tension development in response to Ca2+ by approximately 50 per cent, regardless of the duration of Ca2+ exposure. The contractile response of these muscles to depolarization with K2SO4 was reduced 10 per cent by 0.5 per cent halothane; this was probably due to reduction in transmembrane influx of Ca2+. In the postpartum muscles, the initial tension development in response to Ca2+ was threefold greater than in mid-pregnant muscles and was reduced 25 per cent by halothane. These tissues failed to develop by any tension in response to K2SO4. The most likely explanation for the effect of halothane is that it reduces the transmembrane influx of Ca2+ in both types of tissues, but that the postpartum sarcoplasmic reticulum present less competition for intracellular Ca2+ than pregnant sarcoplasmic reticulum.

Animals↗