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Biomedical subjects

S L Curry

Publications and source records attributed to S L Curry.

At least 19 recordsLinked to original sources
PubMed2000

Granular cell tumors: a new clinically important histologic finding.

OBJECTIVE: The objective of this study was to review clinical characteristics, histological findings, and surgical treatment of patients with granular cell tumors of the vulva at Hartford Hospital and examine histologic characteristics associated with those cases that recurred. MATERIALS AND METHODS: A retrospective case review of 13 patients diagnosed with granular cell tumors of the vulva at Hartford Hospital from April 1982 through May 1998 was undertaken to compare age, size and location of the lesion, histopathologic features, presenting symptoms, progression of disease, and treatment. RESULTS: Tumor growth patterns were divided into those with confluent expansile growth (nodular) and those that infiltrated the dermis and soft tissue in a haphazard fashion interdigitating with native connective tissue and skin appendages (infiltrative). The advancing edge of the tumors was assessed as having either a "pushing" or an infiltrative border. The advancing edge of the tumor was noted to be irregular and infiltrative in 8 of the 13 cases. The tumor edge in the remaining 5 was pushing and well demarcated. Five of the eight tumors with an infiltrative edge recurred despite the fact that 3 of the 5 cases had negative surgical margins at resection. None of the 5 cases with "pushing" borders developed recurrence. CONCLUSIONS: Although rare, vulvar tumors are the most common variety of granular cell tumors encountered in the female genital tract. Histologic evaluation seems to indicate that patients are more likely to have a recurrence if an infiltrative growth pattern is present at the advancing edge of the granular cell tumor even with negative margins at resection. An appropriate management strategy may be to recommend reexcision of "infiltrative border" lesions rather than clinical observation alone.

Adult↗
PubMed1999

A postpartum self-medication program: effect on narcotic use.

Our objective was to determine the impact of a self-medication program on postpartum narcotic use. We retrospectively studied narcotic use in patients who underwent vaginal delivery before and after implementation of a self-medication program in April 1997. Narcotic use was compared between patients who delivered in January 1997 (n = 263) and those who delivered in January 1998 (n = 254). Oral narcotic use was also analyzed with respect to type of vaginal delivery (spontaneous vs. operative), extent of episiotomy or laceration, and use of epidural analgesia during labor. Narcotic use was significantly reduced (p < 0.001) in postpartum patients who participated in the self-medication program. The reduction was consistent despite the type of vaginal delivery or use of epidural analgesia during labor. A more extensive episiotomy or laceration at delivery (fourth-degree episiotomy or vaginal sulcus tear) was associated with an increase in narcotic use, although there was still a statistically significant decrease in use in patients in the self-medication program. A significant reduction in postpartum narcotic use may be achieved through implementation of a self-medication program. As a result, substantial benefits are potentially gained by both the patients and the nursing staff.

Administration, Oral↗
PubMed1999

Chaperone use by obstetrician/gynecologists.

OBJECTIVE: To describe current practices of chaperone use during pelvic examinations among obstetrician/gynecologists affiliated with a large tertiary care teaching hospital. STUDY DESIGN: Questionnaires were distributed at department of obstetrics and gynecology grand rounds to all practicing attending physicians to obtain physician demographic data, including age, years in practice, practice type (solo or group) and whether chaperones were currently used when performing pelvic examinations at the first obstetric or gynecologic office visit. Physicians were also asked whether they were taught to use chaperones for pelvic examinations during medical school or residency. RESULTS: Of the 59 attending physicians, 100% responded to the questionnaire. As compared to female physicians, male physicians used chaperones more at the first obstetric examination (76.9% vs. 27.8%, P < .002), at gynecologic office visits (70.0% vs. 22.2%, P < .002) and for breast examinations (51.2% vs. 11.1%, P < .01). Physicians greater than 40 years old, in practice longer than 10 years and taught as medical students or residents to use chaperones were statistically more likely to use chaperones. No attendings, male or female, reported losing a patient to another provider or being sued or threatened with legal action because of not using a chaperone. CONCLUSION: Chaperones were used more frequently during pelvic examinations by male physicians, age greater than 40, solo practice, and physicians in practice longer than 10 years. Education affected current practices as specific medical student or residency training influenced the use of chaperones in private practice.

Adult↗
PubMed1998

Pyoderma gangrenosum following cesarean delivery.

BACKGROUND: Pyoderma gangrenosum is a rare, chronic inflammatory disease that can develop after minor trauma or surgery. Most reports of this condition developing after abdominal surgery have been reported following ostomy formation. A number of systemic diseases have been associated with this disorder, most commonly inflammatory bowel disease, though 40-50% of cases have no associated systemic disease. CASE: A 32-year-old woman developed spiking fever and purulent appearing wound discharge with a rolled erythematous border after cesarean delivery. Her condition worsened despite various regimens of intravenous antibiotics and local treatment. Pyoderma gangrenosum was diagnosed. Treatment with steroids resolved the lesion, and associated systemic diseases were not found. CONCLUSION: Consideration of the diagnosis of pyoderma gangrenosum in cases of apparent wound infections unresponsive to antibiotics should result in early diagnosis and treatment of this condition.

Adult↗
PubMed1997

The outcome of triplet pregnancies at Hartford Hospital--1989-1996.

The advent of artificial induction of ovulation has increased the incidence of triplet pregnancies. Although the outcome of triplet pregnancies has improved through advanced technology, several studies have suggested that triplets conceived by artificial induction of ovulation have worse prenatal and perinatal outcomes than those conceived naturally. Our study examined the outcome of 14 sets of triplets conceived at Hartford Hospital between 1989 and 1996. Five of 14 sets of triplets were conceived by artificial methods and nine of 14 were conceived naturally. The mean gestational age was 31.8 weeks for artificially conceived infants vs 29.7 weeks for naturally conceived infants. Average weight at birth was 1.625 kg in the artificially conceived study group and 1.377 kg in the naturally conceived group. Time spent in the neonatal intensive care unit was 4.67 weeks for the artificially conceived study group and 3.57 weeks for the naturally conceived group. It is concluded that there was no difference in outcome in the triplets conceived by artificial induction of ovulation vs natural conception. Maternal age and sex of triplets were important factors determining perinatal outcomes of triplets.

Adult↗
PubMed1994

The impact of systemic lupus erythematosus on women's sexual functioning.

OBJECTIVE: We investigated the impact of systemic lupus erythematosus (SLE) and the mediating effects of psychosocial factors on women's sexual adjustment. METHODS: Data were obtained through structured interviews and psychometric scales administered to 100 female subjects with SLE and 71 disease-free controls. RESULTS: Compared with controls, patients with SLE had a significantly higher rate of abstention (26 vs 4%, p < 0.01), a lower frequency of sexual activity among the sexually active (p < 0.05), diminished vaginal lubrication (p < 0.01), and poorer general sexual adjustment (p < 0.01). Greater disease severity was associated with more impairment in sexual function (p < 0.01). Variables mediating the relationship between diagnostic status and sexual outcome included age (delta R2 = 0.04, p < 0.01), relationship status (delta R2 = 0.03, p < 0.05), weight concerns (delta R2 = 0.05, p < 0.01), premorbid sexual adjustment (delta R2 = 0.04, p < 0.01), and depression (delta R2 = 0.03, p < 0.05). Seventy-two percent of patients with SLE were receptive to physician inquiry about sexual functioning and 82% desired further education about the sexual impact of the disease. CONCLUSION: Our results suggest that sexual impairment is not inevitable among women with SLE. The role that providers can play in helping to prevent sexual difficulties is discussed.

Adult↗
PubMed1994

Quality assurance: measuring its effect on a busy obstetric service.

OBJECTIVE: To evaluate the effect of establishing a new quality assurance program in obstetrics at a large teaching hospital. METHODS: Seven obstetric clinical indicators were selected. After the computerized data base identified the patients as outliers from these indicators, the medical record of each patient was reviewed. Each case was presented to the nine-member committee, which made recommendations or actions for changes or improvement in patient care. The number of patients coming to review and the number of clinical indicators from the year before the program were compared to the results of the second year of the program. RESULTS: The new program significantly reduced the number of patient records reviewed and the clinical indicators. Of the clinical indicators, prolonged hospitalization after both vaginal and cesarean births was decreased. Recommendations to the department included the need for better chart documentation, specific educational presentations as grand rounds, and a protocol for antibiotic use for postpartum endomyometritis. CONCLUSION: A quality assurance program in obstetrics may decrease the number of clinical indicators after only 1 year. This decreasing trend and better documentation may be considered as measures of improvement in obstetric care.

Connecticut↗
PubMed1993

Medical and psychosocial predictors of sexual outcome among women with systemic lupus erythematosus.

The influence of medical and psychosocial variables on sexual outcome in 100 women with systemic lupus erythematosus was examined. Subjects were administered a sexual adjustment interview and scales assessing depression, body image, and relationship quality. Medical data were obtained from patients and physicians. Key predictors of sexual outcome were disease severity (P < 0.001), premorbid sexual adjustment (P < 0.05), and relationship quality (P < 0.05). Results suggest that the impact of systemic lupus erythematosus on sexual response may best be understood by considering a combination of interpersonal, psychological, and medical conditions in a patient's life.

Adult↗
PubMed1993

Malignant mixed mullerian tumors of the fallopian tube.

Malignant mixed mullerian tumors of the female genital tract are rare and occur least commonly in the fallopian tube. A case is reported and 51 other cases in the literature are reviewed. The mean age at diagnosis is 59 years. Abdominal pain is the most common presenting complaint. A pelvic or abdominal mass is present in 75% of patients. The diagnosis is not usually established until surgery, with the most common preoperative diagnosis being ovarian malignancy. Seventy-five percent of cases had tumor extension beyond the fallopian tube at the time of surgery. Treatment has focused on surgery with postoperative radiation and/or chemotherapy. Prognosis is poor, with fewer than half of patients surviving 2 years. Recent reports suggest improved outcome with platinum-based chemotherapy but data are limited.

Aged↗
PubMed1993

Persistence of gestational trophoblastic disease for longer than 1 year following evacuation of hydatidiform mole.

BACKGROUND: A spontaneous fall in the radioimmunoassay for the beta subunit of hCG to less than 2 mIU/mL documents regression of hydatidiform mole following evacuation of a molar pregnancy. Continued negative hCG levels for the year after evacuation indicates the absence of risk for persistent gestational trophoblastic disease. This report describes an unusual case of recurrent nonmetastatic gestational trophoblastic disease 16 months after initial evacuation. CASE: A 29-year-old woman presented at 19 weeks' gestation with severe preeclampsia and vaginal bleeding. Pelvic ultrasonography demonstrated a molar pregnancy. Pathology following uterine evacuation confirmed a hydatidiform mole. Serial hCG levels fell progressively to less than 2 mIU/mL over the following 25 weeks. She remained compliant with oral contraceptive pills despite having no sexual activity. Sixteen months after uterine evacuation, recurrence of gestational trophoblastic disease was documented by a rising beta-hCG, negative pelvic ultrasound, normal liver function tests, and normal computed tomography of the head. Endometrial curettage showed no chorionic villi or molar tissue. She was treated with five courses of actinomycin D and has remained disease-free for the following 5 years. CONCLUSION: This late recurrence of gestational trophoblastic disease suggests that those with a molar pregnancy may benefit from surveillance beyond 1 year after uterine evacuation.

Adult↗
PubMed1993

A randomized comparison of 15- and 40-minute dosing protocols for labor augmentation and induction.

OBJECTIVE: To compare two low-dose oxytocin protocols in terms of fetal distress, uterine hyperstimulation, cesarean delivery rate, maximum dose of oxytocin, and length of labor. METHODS: We randomized 865 patients into 15-minute (incremental dose 1 mU/minute until 5 mU/minute, then 1 or 2 mU/minute) or 40-minute (incremental dose 1.5 mU/minute until 7 mU/minute, then 1.5 or 3.0 mU/minute) low-dose protocols. Before oxytocin use, all subjects were stratified according to parity and purpose of oxytocin, ie, for induction or augmentation of labor. RESULTS: The 40-minute dosing protocol had a significantly lower maximum dose of oxytocin (augmentation, 6.5 versus 8.2 mU/minute, P < .001; induction, 11.5 versus 14.5 mU/minute, P < .001), a lower incidence of uterine hyperstimulation (augmentation, 18.8 versus 31.8%, P < .001; induction, 19.1 versus 33.0%, P < .002), and less fetal distress (augmentation, 15.5 versus 26.1%, P < .005). No significant differences were found in the cesarean rate or length of labor. CONCLUSION: A dosing interval of 40 minutes led to lower incidences of uterine hyperstimulation and fetal distress, and decreased the maximum dose of oxytocin, without affecting the length of labor or the cesarean rate.

Adult↗
PubMed1992

Serous carcinoma of the peritoneum after oophorectomy.

BACKGROUND: Prophylactic oophorectomy in premenopausal women has been recommended to prevent ovarian cancer. However, serous carcinoma of the peritoneum, which is indistinguishable from ovarian carcinoma, can occur after oophorectomy. CASES: Two cases are reported of serous carcinoma of the peritoneum after oophorectomy. Presentation, management, and outcome are similar to those for ovarian carcinoma. CONCLUSION: More data are needed to quantify the risk of carcinoma after oophorectomy. Such knowledge may change the risk-benefit calculations of recommending prophylactic oophorectomy to premenopausal women at a certain age, and must be discussed with the patient who is considering prophylactic oophorectomy with or without other planned surgery.

Carcinoma, Papillary↗
PubMed1991

Laparoscopic cholecystectomy during pregnancy.

Cholelithiasis and cholecystitis frequently necessitate cholecystectomy. Laparoscopic cholecystectomy, by avoiding a laparotomy incision, greatly reduces recovery time and thus may reduce postoperative complications. We describe the first reported case of laparoscopic cholecystectomy during pregnancy. This technique should be considered as an alternative to laparotomy in selected patients.

Adult↗
PubMed1990

Uterine thickness determination using real-time ultrasonography: a guide for intracavitary brachytherapy in the treatment of endometrial carcinoma.

Two patients with medically inoperable stage I endometrial carcinoma were treated with intracavitary implants alone using Simon capsules, tandems, and ovoids. In both cases, uterine thickness was measured during the implant procedure by realtime ultrasonography. Tumor doses in both patients were then calculated to the midmyometrium and to the serosal surface of the uterus. These estimates, rather than the usual milligram-hours or points A and B, were used to make treatment decisions.

Brachytherapy↗
PubMed1990

Ultrasound for diagnosing and preventing malplacement of intrauterine tandems.

Postoperative B-mode ultrasound was used to evaluate final tandem position in 50 consecutive placements (28 patients). In 34% (17 of 50), the tandem was found to be suboptimally positioned; in 24% (12 of 50), it penetrated the myometrium; and in 10% (five of 50), it frankly perforated the uterus. The uterine fundus was the region most commonly perforated, and the anterior myometrium was the site most frequently penetrated. In all cases in which postoperative ultrasound showed malpositioning, the clinical and radiographic assessment indicated proper intracavitary placement. Ultrasound affected clinical management in 42% (21 of 50) of the placements involving 61% (17 of 28) of the patients. To improve tandem placement, we used intraoperative real-time ultrasound to guide 73 consecutive surgical insertions. Ultrasound clearly visualized the procedure, allowing tandems to be positioned with confidence even in the most difficult cases. The immediate feedback from intraoperative ultrasound eliminated malplacements and thus the need for a second anesthesia to reposition the tandem.

Brachytherapy↗