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Biomedical subjects

P V Mehta

Publications and source records attributed to P V Mehta.

13 recordsLinked to original sources
PubMed1989

A total of 250,136 laparoscopic sterilizations by a single operator.

A total of 250,136 women were sterilized as outpatients by a single operator working with a team in ad hoc sterilization 'camps'. Falope rings were applied by the laparocator under local anaesthesia, with premedication but without vaginal manipulation (in all but the first 10,100). Volunteers were recruited and the operation discussed in nearby villages. The women were numbered at registration and arranged in groups, each comprised of two rows (odd or even numbers) of 15 women, leading to two improvised operating tables or benches in a steep Trendelenburg position. With good teamwork the number of women sterilized was generally 40 to 50/h. There were 12 associated deaths, not all attributable to the procedure, a mortality rate of 4.8 per 100,000; 8 major complications (3.2 per 100,000) required laparotomy or admission to hospital. In a follow-up survey of 84,940 responders to a questionnaire only 90 pregnancies (0.1%) were reported to have been conceived after the cycle of surgery. The results suggest that the rapid 'no exposure' technique as used in this series is safe and acceptable in an Indian context. If others could acquire this skill it could with appropriate adaptation make appreciable inroads into the unmet need for female sterilization in many other developing countries.

Adult↗
PubMed1982

Laparoscopic sterilizations (16,803) without vaginal manipulation.

Laparoscopic sterilization is usually done after viewing the fallopian tubes brought into the laparoscopic field by a uterine manipulator introduced through the vagina. The orthodox rural Indian women, however, resent vaginal manipulation exposing their genitalia. Therefore, the author developed a single-puncture technique for performing laparoscopic sterilization with a Falope-Ring, which dispenses with a uterine manipulator. Experience with 16,803 cases is presented. This technique is recommended for mass sterilizations because it eliminates the risks involved in vaginal manipulation and enhances acceptability and popularity of the procedure. Nonetheless, the risks of bowel injury are augmented, and the method is not for the inexperienced or occasional operator.

Female↗
PubMed1982

Vaginal flora. A dynamic ecosystem.

The understanding of the dynamics of the genital flora in humans is not yet complete. Of the many extrinsic factors that influence the susceptibility of the female genital tract to colonization by bacteria, sex-hormone secretion is considered of prime importance. Hence the knowledge of any cyclic change in the microbial flora could help in reducing postoperative infections by enabling the surgeon to synchronize the surgery with the phase of minimal growth. The aim of this study was to determine the relationship, if any, of bacterial growth in the vagina and hormonal status. To study the bacterial flora and hormonal status, vaginal swab and serial colpocytology were done on five occasions at intervals of four days. Of 89 women studied, 54 were regularly menstruating, 22 had irregular cycles, and 13 were postmenopausal. An endometrial biopsy was done in all cases on the last day of the smears. The swabs were cultured for the presence of aerobic and anaerobic flora. The smears were stained by the Papanicolaou method to evaluate the hormonal status. The results indicated that there was no correlation between the hormonal status and the growth of bacteria.

Adult↗
PubMed1981

Laparoscopic sterilization with the Falope ring: experience with 10,100 women in rural camps.

Laparoscopy as an outpatient technique has brought sterilization within the reach of millions of women in the developing countries. A review of the literature indicates that it can be performed easily and safely with the patient under local anesthesia. This report presents the personal experience of the author in the performance of 10,100 laparoscopic sterilizations using the double-puncture technique and a Falope ring applicator on patients gathered in rural sterilization camps in India. Modifications of the standard procedures to suit the camp surroundings and to reduce the operating time are described. Results are described and discussed. There was 1 death (not related to the operation), 1 major complication, and a few minor complications. The method is urged as a valuable one for mass sterilization in Third World countries.

Adult↗
PubMed1979

Mechanism of single-stitch failure of tubal ligation: a morphologic appraisal.

The widespread demand for a simple, safe, and reversible sterilization procedure has attracted the attention of clinicians and researchers. A simple ligation with a single suture of nonabsorbable linen, involving a very small segment of tube (1 mm) in the isthmic portion about 1 cm from the isthmic ampullary junction, was used in 463 multiparous women. Of the 363 cases followed for a period of 1--3 years, there have been 52 failures. In 10 unsuccessful cases total abdominal bilateral salpingectomy was performed, and a detailed histologic study of these 20 tubes was instituted in an attempt to understand the mechanics of failure of the single-stitch technique. This is the first such study to be reported.

Fallopian Tubes↗
PubMed1978

Evaluation of single-stitch tubal ligation in postpartum women.

Permanent contraception by tubal surgery on completion of the family unit is increasingly becoming acceptable to younger women. Contraception by spacing methods during the long span of the reproductive period is impractical because of the cost involved, the fear of failure, and the possibility of side effects. Reversal of tubal surgery may be necessary in some young women as a result of unforseen infant deaths. Old and new techniques of tubal surgery,with or without endoscopy, still require the interruption of a long segment of the tubes (more than 1 cm) except in the spring-clip method, in which only 4 mm of tube is involved. These clips are expensive and not easily available. In a study of 463 women, the clip method was replaced by a single-stitch method to interrupt a small segment (1 mm) of the tubes. However, 24 failures occurred in the 230 women followed for a period of 6-36 months. In view of the high failure rate, use of this method was discontinued. This experience demonstrates that methods causing minimal tubal damage and providing maximum potential reversibility have greater risk of failure.

Evaluation Studies as Topic↗
PubMed1978

Study by vaginal cytology of ovarian function in pre-menopausal women.

In the pre-menopausal years, the ovarian secretion waxes and wanes until its cessation. In this study of women in the pre-menopausal period neither did the menstrual pattern prove to be a reliable criterion by which to judge the extent of oestrogen effect or deficiency nor was there correlation between serial colpocytology and endometrial histology, Hyperplasia of the endometrium was seen with different degrees of oestrogen status and in the menopause. Maximum cases of hyperplasia were seen in the irregularly menstruating group of women. It is therefore emphasized that before beginning oestrogen therapy, both colpocytology and endometrial histology should concur to establish oestrogen deficiency. A close watch should be kept on cases showing an endometrial hyperplasia.

Adult↗