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Biomedical subjects

R M Hebertson

Publications and source records attributed to R M Hebertson.

9 recordsLinked to original sources
PubMed1991

Ectopic pregnancy.

The incidence of ectopic pregnancy has been increasing for many years and currently is two to three times higher than it was 20 or 25 years ago. The reasons for this are complex and include increased rates of pelvic and tubal infection, the use of the IUD, surgery in the pelvis for infertility, sterilization and other surgical procedures, in vitro fertilization, and improved diagnosis. Normal tubal physiology, the findings in affected tubes, and the mechanisms of how the ectopic pregnancy develops and involves the tube are considered. The cardinal points of the history and physical examination are presented in considerable detail. Further, the evolution of the tools of diagnosis--curettage, culdocentesis, laparotomy, laparoscopy, hormonal tests, and ultrasound-is considered. The different approaches to therapy are presented. Salpingectomy was once the method of accepted therapy, but currently conservative management (salpingostomy) is the most acceptable approach. More recently, selected patients are being treated with observation and a small subgroup are being managed with methotrexate and other chemical agents injected directly into the ectopic pregnancy. Ectopic pregnancy is still a leading cause of maternal death despite improved diagnosis and therapy. It should be remembered, however, that the total number of women who die from this condition is less than ever before and this is despite the rising incidence of ectopic pregnancy. There is still much to be learned about ectopic pregnancy, its etiology, diagnosis, and management.

Adolescent↗
PubMed1991

A computer method for visual presentation and programmed evaluation of labor.

Manual graphing of the progress of labor is considered useful but is not often done. The early detection of some deviations requires special graphics aids. Our objective was to develop an easy-to-use computer program for the integrated visual presentation of information characterizing the progress of labor. Through the use of inexpensive personal computers equipped with graphics monitors, the program provides a combined graphics display of timed progressive cervical dilatation, fetal station, and stimulation of uterine activity (oxytocin infusion). For the early detection of abnormalities, phase-specific normal ranges (reference areas) are displayed. In addition, protraction/arrest as well as precipitate labor disorders are highlighted and computer messages are displayed. The program was evaluated through the assessment of 405 labors entered into a local area network of computers. On average, the program identified 1.5 abnormalities per recorded labor (2.0 for labors resulting in vaginal delivery). The graphic presentation of the labor curve, produced within 3 seconds, displayed 27% more information than the tabular format on the same screen area and provided a single-screen display of the labor curve even for patients with excessive data. The computer-generated display of labor curves facilitates visual presentation and interpretation of labor progress and can also help to translate quality assurance criteria into clinical practice.

Computer Graphics↗
PubMed1990

The temporal association of the implementation of a fetal diagnostic and surveillance program and decreased fetal mortality in a private hospital.

The purpose of this study was to determine whether there was a temporal association between the introduction of a Fetal Diagnostic and Treatment Center and changes in fetal mortality. Two consecutive 15-month pre-program periods (periods I and II) were compared with one 15-month post-program period (period III). The fetal death rates for the pre-program periods I (6.16) and II (6.02) were similar, and the combined rate was 6.09. After the introduction of the Fetal Diagnostic and Treatment Center, the fetal mortality rate decreased to 2.31 (period III). When periods I and II were compared with period III, the major decrease (73.8%) in fetal mortality occurred for fetuses of greater than 34 weeks' gestation. The perinatal mortality rate decreased from 8.76 in periods I and II to 4.42 in period III, reflecting the decrease in fetal deaths.

Cesarean Section↗
PubMed1989

An anatomic evaluation of the sacrospinous ligament colpopexy.

A series of 31 sacrospinous ligament suspensions performed for correction of genital prolapse between 1980 and 1986 is reviewed. The success rate was 81 per cent. A cadaver dissection of the sacrospinous ligament was also performed with the same approach used at operation. This was done to understand better the relationships involved, to identify areas of potential complications and to improve the technique used. A dense fascia covers the coccygeus muscle, and care should be taken not to confuse this with the sacrospinous ligament. The possibility of injury to the nearby vessels and nerves can be avoided with the careful placement of suture through the sacrospinous ligament and two fingerbreadths medial to its insertion on the ischial spine. At the conclusion of the suspension, the vaginal apex should be intimately attached to the coccygeus muscle and sacrospinous ligament complex. The use of absorbable suture has been recommended by some, but the success of the procedure may be increased by using permanent suture. If anatomic relationships of the nearby structures are remembered, sacrospinous ligament suspension can be a safe, effective and relatively simple procedure for the correction of severe prolapse of the vaginal vault.

Adult↗
PubMed1986

Amniotic epithelial ultrastructure in normal, polyhydramnic, and oligohydramnic pregnancies.

The ultrastructure of the amniotic epithelial cells from normal, polyhydramnic, and oligohydramnic pregnancies were studied with the transmission electron microscope. The amniotic epithelial cell layer from normal pregnancies was 8- to 12-mu thick. In polyhydramnic pregnancies the cell layer varied widely from the normal thickness to as much as 18 to 56 mu in diabetic patients. Other ultrastructural changes observed in pregnancies complicated by polyhydramnios were abnormal microvilli, diminished intercellular canals, increased tonofilaments, and decreased rough-surfaced endoplasmic reticulum. In pregnancies complicated by oligohydramnios the thickness of the cell layer was 3 to 6 mu. The amniotic epithelial cells had increased tonofilaments, decreased desmosomes, collapsed and fused intercellular canals, and caused a marked decrease of the Golgi apparatus and the rough-surfaced endoplasmic reticulum. The sparse microvilli were short, plump, and had bizarre shapes.

Amnion↗
PubMed1977

Antimicrobial prophylaxis for catheter-associated bacteriuria.

We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospective, controlled, double-masked study. Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group. However, at the time of hospital discharge, clean-voided urine specimens were positive as frequently in the drug-treated group (8 of 82 patients cultured) as in the placebo group (8 of 75 patients cultured). No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups. The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis. However, because the protective effect is transient and is associated with the selection of resistant organisms, prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent.

Anti-Infective Agents↗
PubMedDate not supplied

Analgesic efficacy of meclofenamate sodium in episiotomy pain.

Meclofenamate sodium was compared, double-blind, with codeine and placebo for the treatment of acute episiotomy pain. One hundred sixty-eight women with moderate or severe episiotomy pain after normal delivery were assigned randomly to one of four treatment groups: one received meclofenamate sodium 200 mg at dose 1 and 100 mg at doses 2 and 3; one received meclofenamate sodium 100 mg at dose 1 and 50 mg at doses 2 and 3; one received codeine 60 mg at all three doses; and one received placebo at all three doses. Efficacy measurements were evaluated periodically for 6 hours after medication. After the first administration, both doses of meclofenamate sodium were significantly superior to placebo and to codeine from 2-6 hours in pain intensity difference and pain relief. For second and third doses, data were available for too few patients to allow valid analysis and interpretation. Adverse effects occurred in 4 patients in each meclofenamate sodium group, and in 8 in the codeine group and in 6 in the placebo group. The study indicates that single 100- and 200-mg doses of meclofenamate sodium are as safe as, and significantly more effective than, codeine 60 mg or placebo for episiotomy pain.

Adolescent↗
PubMedDate not supplied

Developing models to evaluate pregnancy outcomes.

The authors examined the proposition that the patient charge for a labor-and-delivery admission can be used as a crude index of pregnancy outcomes. They are developing models of the relationships of certain complications of pregnancy to this outcome variable. These models could be used to estimate potential cost benefits associated with specific prenatal interventions and assist in identifying the areas that should be included in the authors' expert system.

Apgar Score↗