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Biomedical subjects

R H Messer

Publications and source records attributed to R H Messer.

At least 19 recordsLinked to original sources
PubMed1992

Resident attrition in obstetrics and gynecology.

OBJECTIVE: Our goal was to determine the rate of attrition from obstetrics and gynecology residency programs. STUDY DESIGN: The Council on Resident Education in Obstetrics and Gynecology sent questionnaires to all 295 obstetrics and gynecology residency program directors in the United States and Canada. These programs represent 4306 postgraduate-year 1 through 4 (or 5) resident positions each year. The program directors were asked the number of residents who left voluntarily or were dismissed in a 2-year period and the reasons they left. RESULTS: In a 2-year period 299 residents left or were dismissed (6.94% over 2 years, or 3.47% per year). Only 88 (1% per year) left specifically because they decided they preferred a different discipline. CONCLUSION: The rate of attrition from obstetrics and gynecology residency programs is not excessively high.

Gynecology↗
PubMed1992

Chronic pelvic pain.

Chronic pelvic pain is a common and important gynecologic problem. The causes are diverse but can usually be categorized by the astute clinician. Gynecologic causes can often, although not always, be pinpointed for specific management protocols. Highlights of helpful areas are described in terms of history, physical examination, and laboratory and endoscopic diagnosis. Therapy may be medical, surgical, psychologic, or supportive. If specific, treatment is likely to be effective in some patients whereby a cause cannot be found, yet the patient may be helped. Some patients improve without treatment.

Chronic Disease↗
PubMed1990

Seminal concentssrations of total and ionized calcium from men with normal and decreased motility.

In this study, sperm motility, velocity, and progression were compared with the total and Ca++ concentrations in the SF from men with normal and decreased motility (less than 60%). No significant difference in SF total calcium content was observed in men with normal and hypomotility. However, a statistically significant decrease in seminal Ca++ was observed in those men with decreased motility, when compared with that of men with normal motility.

Calcium↗
PubMed1987

Antepartum testing for vasa previa: current standard of care.

Vasa previa is a rare accident in obstetrics with high fetal mortality. There are simple tests available to distinguish fetal from maternal blood. Recently it has been called into medicolegal question whether patients with third-trimester bleeding need to be tested for fetal bleeding. We surveyed 100 community hospitals and all the medical schools in the United States in an attempt to answer the question. It appears that the standard of care in the United States does not require such testing.

Female↗
PubMed1984

A survey of pregnancies complicated by decreased amniotic fluid.

Four hundred seventy-one patients undergoing diagnostic ultrasonography were identified as having moderately decreased amniotic fluid or oligohydramnios, and 339 of these cases were reviewed. Ninety-two of the patients were excluded from further statistical analysis because their decreased fluid was attributed to rupture of the membranes only. Of the remaining patients there was a 7% neonatal malformation rate. Decreased amniotic fluid before 27 weeks of gestation was associated with a significantly poor outcome. Of all the live births, infants of patients with oligohydramnios had lower Apgar scores at 1 minute and 5 minutes than did infants of patients with moderately decreased amniotic fluid. Of cases of patients with decreased fluid, 10% involved fetal distress during labor and in 17% meconium was present. Decreased levels of fluid were associated with an increased rate of abdominal deliveries. Preeclampsia was present in 24.7% of patients with decreased fluid. There was no correlation between the quantitative fluid amounts and the severity of the disease. In view of normative data and clinical experience, these observations suggest that the diagnosis of decreased amniotic fluid on routine ultrasonography requires a fetal scan to rule out anomalies, close antepartum observation to detect complications that may arise in the pregnancy, and delivery under conditions that allow appropriate support and intervention on behalf of the fetus.

Amniotic Fluid↗
PubMed1984

Embryonic/fetal growth following suckling-induced delay of implantation.

In rats fertilized during the first or second day post partum (second consecutive pregnancy), suckling induces delay of implantation for 8 to 22 days. However, pregnancy is prolonged for only 3 to 17 days because accelerated embryonic and early fetal growth makes up 4 to 5 days of the implantation delay. After implantation, embryonic/fetal growth is accomplished within 11 to 12 days for a second consecutive pregnancy, whereas 16 days are required for first or second-spaced pregnancies. After weaning, increased function of the intestinal tract and liver is not needed anymore for mammary milk synthesis, and abundant nutrients can be shifted to the uteroplacental unit for rapid embryonic/fetal growth. Because the exponential curves for fetal growth are similar for first, second consecutive, and second-spaced pregnancies, it seems that, besides an increased supply of nutrients, an as yet unidentified maternal or a placentofetal factor(s) may play a role for embryonic/fetal growth.

Animals↗
PubMed1984

Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria.

The antimicrobial potency of 4 per cent chlorhexidine gluconate was compared with that of 10 per cent povidone-iodine (1 per cent free iodine) on the vaginal bacteria of 150 premenopausal, non-pregnant women. From 30 of the women blood samples were taken before and at either 15, 30 or 60 minutes after vaginal cleansing with chlorhexidine for chlorhexidine analysis. Five minutes after applying either chlorhexidine or povidone-iodine almost 99 per cent of bacteria present on the lateral wall of the vagina were killed. Chlorhexidine was significantly more effective than povidone-iodine. Serosanguineous , mucoid or white-yellowish vaginal discharge did not alter the effectiveness of either antimicrobial agent. In contrast to povidone-iodine, vaginally applied chlorhexidine was not absorbed in measurable amounts (sensitivity of detection method: 0 X 1 mg/l) into the bloodstream. Chlorhexidine may therefore prove of value for treating vaginitis especially during pregnancy and also for combating microbes such as Group B streptococci which are potentially harmful to the newly-born child.

Absorption↗
PubMed1984

Thymoma in pregnancy.

The natural history of slow, localized progression usually seen with thymomas seems to be transformed by pregnancy into one of rapid growth and distant metastatic spread. Five of the six previously reported cases had died of the malignancy within 6 months postpartum. The one previous long-term survivor died of treatment-induced complications. Two important questions remain unresolved: What is the risk of recurrence in the patient who has no residual disease at the time of conception? Approximately 50 per cent of female patients can anticipate having complete resection of their thymoma, and their recurrence risk is about 2 per cent. Potentially, there are many patients who have conceived and delivered after surgical therapy. Documentation of these case histories is needed for an accurate prediction of the true risk. Two of the cases within the present review fall within this category. The clinical course in these two patients is consistent with the natural history of the disease. One exhibited local recurrence and progression. The other patient died from sepsis, probably related to immunosuppression. Whether there is a cause and effect relationship between pregnancy and their recurrences is unknown. What is the risk to the patient who is first diagnosed while pregnant? The only survivor in this category was presented by Goldman. This patient underwent immediate therapeutic abortion following diagnosis. She had radiation therapy for invasive unresectable disease and subsequently delivered two term pregnancies, but died of postcesarean cardiac arrest. She had no evidence of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Academic manpower for obstetrics and gynecology in the United States.

All 119 medical schools in the United States provided information for a study of academic manpower conducted by the Association of Professors of Gynecology and Obstetrics (APGO). The average number of full-time faculty members per medical school is 13.2, with 2 positions vacant per school. Subspecialists are concentrated in university medical school departments, which also have large residency programs. A perceived need for 46% more faculty over the next 5 years will probably aggravate the shortage.

Canada↗
PubMed1978

Breast cancer: potentially predisposing and protecting factors. Role of pregnancy, lactation, and endocrine status.

Risk factors of breast cancer have been correlated with the availability of estradiol and estrone. Mechanisms protecting from breast cancer are thought to be due to the mitotic rest of mammary epithelium (low deoxyribonucleic acid synthesis), as encountered during pregnancy and lactation, and to the actions of estriol and progesterone in opposing the "carcinogenic" estradiol and estrone.

Adult↗
PubMed1976

Maternal deaths in California from 1967 to 1971. A demonstration of the need for mortality review.

An evaluation of maternal mortality statistics in California from 1967-1971 has been performed. There has been a fall in the maternal mortality rate following the institution of a therapeutic abortion act. However, analysis of the data reveals that there was an increase in the deaths due to hemorrhage and sepsis. At this same time the maternal mortality study committee was discontinued. It is strongly felt that the data demonstrate the need for a continuing review of maternal deaths. A proposal is made to redesign the maternal mortality study committee so that it can fully meet the needs of the medical profession and the patient.

Abortion, Legal↗