Biomedical subjects

R J Gimpelson

Publications and source records attributed to R J Gimpelson.

9 recordsLinked to original sources

PubMed1992

Mechanical preparation of the endometrium prior to endometrial ablation.

Of 143 women who underwent endometrial ablation between May 1986 and August 1991, 16 also had repeat procedures. Medical preparation of the endometrial lining (danazol, leuprolide acetate, or nafarelin acetate) was used in 109 patients; mechanical preparation in the form of suction curettage, in 28 patients; and no preparation, in 6 postmenopausal patients. Evaluation of the results following endometrial ablation showed that the results in mechanically prepared patients were comparable to those in patients receiving traditional medical preparation; thus mechanical preparation can make the procedure simpler, enhance patient compliance, and reduce side effects considerably.

Cohort Studies↗

PubMed1992

Endometrial ablation repeat procedures. Case studies.

Of 143 women who underwent endometrial ablation from May 1986 through August 1991, 16 requested repeat endometrial ablation and 7 underwent hysterectomy. Only two of the hysterectomies were performed for bleeding, and no hysterectomy was needed for any woman who had a repeat endometrial ablation. For patients undergoing one ablation, the results were amenorrhea in 55 women (38%), staining in 32 (22%), light flow in 33 (23%), 7 hysterectomies (5%) and 16 patients requesting repeat endometrial ablation (11%). Repeat endometrial ablation resulted in amenorrhea in 10 women (63%), staining in 3 (19%) and light flow in 3 (19%). Repeat endometrial ablation can eliminate the need for hysterectomy in women who continue to have bleeding problems after one endometrial ablation. Gynecologists should not hesitate to offer repeat ablation since the results will usually be excellent.

Electrocoagulation↗

PubMed1992

Office hysteroscopy.

Most operative office surgery can be done easily. If, midway through a procedure in the office, the operator finds that a myoma is too large or deep to resect safely in the office, the procedure can be terminated and rescheduled for the operating room. Polyps, retained products, and the lost intrauterine device all can be treated similarly. With the proper equipment and patient selection, the well-trained hysteroscopist can do extensive operative hysteroscopy in the office. With experience, the hysteroscopist can do diagnostic and operative hysteroscopy at the same time, resulting in a substantial savings of both cost and time for the patient and the physician. The future of office hysteroscopy may include endometrial ablation and transcervical sterilization, in addition to the procedures described in this chapter. Diagnostic hysteroscopy is becoming a standard part of office gynecology. With continued training, operative hysteroscopy will move into the realm of office gynecology at the same level as diagnostic hysteroscopy.

Ambulatory Surgical Procedures↗

PubMed1991

Operative laparoscopy with the Nd:YAG laser in the treatment of endometriosis and pelvic adhesions.

A multicenter, prospective trial was initiated to test the effectiveness and safety of the Nd:YAG laser equipped with artificial sapphire contact tips for the laparoscopic treatment of pelvic pain. Ninety-three women were enrolled in the study, 37 with endometriosis alone, 47 with endometriosis complicated by pelvic adhesions, and 9 women with adhesions alone. In over 90% of adhesions and 96% of endometriotic implants the Nd:YAG laser could be delivered to the site and be used to restore normal anatomy. The exception was deep bowel involvement with endometriosis, which was not treated. The majority of women had marked reduction or resolution of their symptoms for up to 12 months postoperatively. We conclude that the use of the Nd:YAG laser is an appropriate method to laparoscopically treat pelvic pain resulting from endometriosis or pelvic adhesions.

Abdominal Neoplasms↗

PubMed1991

Comparison of tissue effects with sculptured fiberoptic cables and other Nd:YAG laser and argon laser treatments.

The use of a fiber optic cable in contact with tissue results in a complex thermal interaction between the cable and the tissue. The effect of the laser-tissue interaction was investigated using sculptured quartz fiber optic cables, sapphire contact rods, and bare fiber optic cables attached to the Nd:YAG laser. The laser-tissue effects of the Nd:YAG and argon lasers were compared. Examination of treated animals showed there to be a significant difference between immediate and 48-hour thermal effects. The sculptured fibers created significantly less tissue damage than the sapphire contact tips, the 0.6-mm bare fiber, or the argon laser with a 0.3-mm bare fiber either with or without contact. All Nd:YAG laser contact treatments were less damaging than the argon laser treatments.

Abdominal Muscles↗

PubMed1991

Suction curettage with a tissue trap compared with sharp curettage for tissue sampling.

Recent reports have shown that various endometrial sampling techniques are comparable to each other. This study showed that suction curettage utilizing tissue traps is superior to sharp curettage in terms of adequacy of sampling. The results show that adequate tissue was obtained in all 114 cases, regardless of which type of curettage was utilized first. However, when sharp curettage was the second procedure, only 43 of 57 procedures yielded adequate tissue, whereas when suction curettage was the second procedure, 56 of 57 procedures yielded adequate tissue. Suction curettage utilizing tissue traps was more thorough than sharp curettage.

Curettage↗

PubMed1989

Pulmonary edema after photocoagulation of the endometrium with the Nd:YAG laser. A case report.

A woman developed pulmonary edema as a result of fluid overload during Nd:YAG ablation of endometrial tissue. As a result of a miscalculation of fluid administration and collection, she was overhydrated with irrigation fluid. The clinical picture of pulmonary edema was noted in the immediate postoperative period and responded to positive pressure ventilation and diuretic therapy. The mechanism of pulmonary edema is postulated to have been the result of the absorption of irrigating fluid through open venous channels resulting from the laser ablation.

Adult↗

PubMed1989

An animal model for learning Nd:YAG laser ablation of the endometrium.

Gynecologists must have a good model for practice before performing Nd:YAG laser ablation on humans. The New Zealand white rabbit has been used as a teaching model in courses. Knowing the anatomy and technique enables gynecologists to acquire the skill and dexterity needed to perform this useful procedure.

Animals↗

PubMed1988

A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage. A review of 276 cases.

A total of 276 women underwent both panoramic hysteroscopy and dilatation and curettage. All of these patients underwent directed endometrial biopsies through the hysteroscope. Indications for operation included abnormal bleeding, postmenopausal bleeding, suspected leiomyoma with bleeding, follow-up for adenomatous hyperplasia, intrauterine contraceptive device with bleeding, retained products of conception, infertility with bleeding, abnormal hysterosalpingogram with bleeding, and abnormal endometrial cells on Papanicolaou smear. In 223 cases the results of hysteroscopy and curettage were in agreement. Hysteroscopy revealed more information than curettage in 44 patients, whereas curettage revealed more information than hysteroscopy in only nine patients. When the results of this study are combined with those of previous studies, there is little doubt that panoramic hysteroscopy is superior to curettage in making an accurate diagnosis of pathologic conditions in the uterine cavity.

Adult↗