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T G Stovall

Publications and source records attributed to T G Stovall.

At least 37 records · Page 2Linked to original sources
PubMed1994

A randomized comparison of the Pipelle, Accurette, and Explora endometrial sampling devices.

OBJECTIVES: Our aim was to compare the Pipelle, Accurette, and Explora endometrial sampling devices. STUDY DESIGN: Patients (n = 248) undergoing endometrial biopsy were randomized to one of the three sampling instruments. Diagnostic accuracy, ability to obtain sufficient tissue for histologic diagnosis, and patient discomfort during sampling of the three devices were compared. When available, endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy. Statistical analysis was performed with one-way variance of the means, chi 2, and Kruskal-Wallis statistic. RESULTS: In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings. However, 42% of Accurette biopsies either were failed attempts or obtained insufficient tissue (p < 0.01). Pain scores were similar among the groups. CONCLUSION: The results with the Pipelle and Explora endometrial samplers appear to be comparable. However, given a 42% unusable specimen rate, the Accurette cannot be recommended for routine endometrial sampling.

Adult↗
PubMed1994

Prospective comparison of indwelling bladder catheter drainage versus no catheter after vaginal hysterectomy.

OBJECTIVE: This study compares the postoperative outcomes of patients in whom indwelling bladder catheterization or no catheter was used after vaginal hysterectomy. STUDY DESIGN: One hundred women undergoing inpatient vaginal hysterectomy were randomly assigned to have an indwelling Foley catheter for 24 hours or no catheter after the procedure. Data regarding postoperative morbidity were recorded, and a clean voided urine specimen for urinalysis and culture was obtained 48 hours and 2 weeks after surgery. RESULTS: The study groups were similar with respect to demographics and surgical indications. Two patients in the catheterized group required recatheterization after the catheters were removed. None of the subjects in the no-catheter group required a catheter. There was a significantly higher incidence of fever in the catheter group. No differences were found in the incidence of positive urine cultures between the study groups at 48 hours (8 vs 14, p = 0.227) and 2 weeks (6 vs 1, p = 0.111), respectively. CONCLUSION: Indwelling catheterization appears unnecessary after routine vaginal hysterectomy. However, catheter placement for 24 hours does not contribute significantly to postoperative morbidity.

Adult↗
PubMed1994

Medical management of ectopic pregnancy.

By combining diagnostic modalities such as serial human chorionic gonadotropin titers, transvaginal sonography, and suction curettage, most unruptured ectopic pregnancies can be diagnosed without laparoscopy. When the diagnosis can be made in this manner, methotrexate may be the treatment of choice. It certainly should be considered as an alternative form of treatment in patients with an unruptured ectopic pregnancy. A randomized clinical trial comparing systemic methotrexate with laparoscopic salpingostomy in patients who are methotrexate eligible would be helpful.

Chorionic Gonadotropin↗
PubMed1994

A model for resident surgical training in laparoscopic sterilization.

OBJECTIVE: To measure the effects of a specific instructional program designed to teach residents laparoscopic sterilization. METHODS: The teaching module consisted of a 40-minute videotape and monograph, which each resident studied 1-3 days before beginning a 4-5-week rotation on which he or she performed laparoscopic sterilization procedures. The change in knowledge was measured by comparing pre- and post-test assessments. Twenty-three PGY-2 gynecology residents were administered the peer-reviewed and validated pre-test, which consisted of 31 multiple-choice questions covering the following aspects of laparoscopic sterilization: 1) indications and complications, 2) general aspects of sterilization, 3) sterilization methods, and 4) technical aspects of occlusive device application. A post-test, which consisted of the identical 31 items with the question order changed, was administered after the teaching module was completed. RESULTS: The mean number of correct answers on the post-test (27.2 +/- 2.3, range 22-31) was significantly higher (P < .05) than the mean number of correct answers on the pre-test (17.9 +/- 3.4, range 13-24). There was no difference in residence scores if the module was completed early or late in the academic year or during the first or second year that the program was in effect. CONCLUSION: This study demonstrates that knowledge of a specific surgical technique can be measured and that structured learning packages can be effective. Efforts to teach residents a specific curriculum can have a significant effect on their fund of knowledge. Other specially designed programs may be applicable to procedures commonly performed by gynecologic residents.

Curriculum↗
PubMed1994

Chromopertubation at laparoscopic tubal occlusion.

OBJECTIVE: To evaluate the role of chromopertubation following laparoscopic sterilization in terms of occlusive device displacement, infectious complications, and sterilization failures. METHODS: Five hundred consecutive women scheduled for laparoscopic sterilization were randomized to rings, electrocoagulation, or clips for tubal occlusion. Subjects were further randomized to chromopertubation or no chromopertubation. At chromopertubation, any occlusive device displacement or dye spillage was noted. Patients were followed postoperatively for sterilization failure or infectious complications. Statistical analysis used the chi 2 test. RESULTS: At chromopertubation, no device dislodgment, change in position, or dye spillage from the occlusion site was noted. Dye spillage from the end of the fallopian tube occurred in five patients, and immediate repeat tubal occlusion was performed. Six true sterilization failures occurred during the follow-up period. Despite elimination of five apparent failures in the chromopertubation group, there was no significant difference between the no-chromopertubation and chromopertubation groups with regard to failure rate. There were also no significant differences in postoperative wound infections or development of pelvic inflammatory disease. CONCLUSION: Chromopertubation at sterilization is associated with minimal complications but has limited value in eliminating sterilization failures.

Fallopian Tube Patency Tests↗
PubMed1994

Gonadotropin-releasing hormone agonist use before hysterectomy.

OBJECTIVE: Our purpose was to compare the effects of leuprolide acetate in patients with symptomatic uterine leiomyoma before hysterectomy. STUDY DESIGN: Group I (n = 90) included patients with a pretreatment uterine size of 14 to 18 gestational weeks and group II (n = 60) included patients with uteri > 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotropin-releasing hormone agonist. RESULTS: All patients in the two groups with a pretreatment hemoglobin < 11.0 gm/dl randomized to agonist had a significant (p < 0.05) increase (> or = 1.5 gm/dl) in hemoglobin level. Patients in group I who received preoperative agonist were more likely to undergo vaginal hysterectomy (80% vs 13%, p < 0.05) than were patients who did not receive preoperative agonist. Patients undergoing vaginal hysterectomy had a shorter hospital stay, decreased operative blood loss, and a shorter convalescence period than did those undergoing abdominal hysterectomy. In group II, in spite of a mean uterine volume reduction of 51.3%, intraoperative morbidity, operative blood loss, hospital stay, and postoperative convalescence period did not differ between treatment arms. CONCLUSION: The preoperative administration of gonadotropin-releasing hormone agonist in patients with a uterus of 14 to 18 weeks' size increases the use of vaginal hysterectomy, decreases intraoperative blood loss, and shortens hospital stay and convalescence. Preoperative gonadotropin-releasing hormone agonist for patients with a preoperative hemoglobin < 11.0 gm/dl reduces the risk of preoperative transfusion. Preoperative gonadotropin-releasing hormone use in the nonanemic patient with a uterine size > or = 18 weeks' gestational size doses not appear to lower operative morbidity.

Adult↗
PubMed1993

Single-dose methotrexate: an expanded clinical trial.

OBJECTIVE: Our purpose was to report an expanded clinical trial with a nonlaparoscopic approach to ectopic pregnancy diagnosis combined with single-dose intramuscular methotrexate treatment. STUDY DESIGN: A prospective cohort of 120 women with an ectopic pregnancy < or = 3.5 cm in greatest dimension was enrolled. RESULTS: Patients had a mean age of 26.1 +/- 6.2 years, a mean gravidity of 3.2 +/- 1.6, and a mean parity of 0.97 +/- 1.0. The mean human chorionic gonadotropin titer before treatment initiation was 3950 +/- 1193 mIU/ml. Transvaginal ultrasonography visualized cardiac activity in 14 (11.7%) patients, with an ectopic mass visualized in 113 (94.2%). The mean time to resolution in the 113 (94.2%) subjects successfully treated was 35.5 +/- 11.8 days. Four (3.3%) patients required a second methotrexate dose on day 7. No biochemical or clinical side effects occurred. Posttreatment hysterosalpingograms demonstrated tubal patency on the ipsilateral side in 51 of 62 (82.3%) patients. Of those attempting pregnancy, 79.6% were pregnant, 87.2% intrauterine and 12.8% ectopic. The mean time to achieve pregnancy was 3.2 +/- 1.1 months. CONCLUSIONS: This regimen requires minimal laboratory follow-up and eliminates leukovorin recovery, making it the regimen of choice for medical treatment of unruptured ectopic pregnancy.

Adolescent↗
PubMed1993

Surgical management of chronic pelvic pain.

The surgical procedures used for the treatment of chronic pelvic pain, their indications, and success rates are reviewed. A thorough preoperative evaluation is presented that will enable the physician to detect patients at high risk for surgical failure and those who will be more appropriately managed with nonsurgical treatment modalities.

Chronic Disease↗
PubMed1993

Ectopic pregnancy. Diagnostic and therapeutic algorithms minimizing surgical intervention.

Presented are the results of a diagnostic algorithm for ectopic pregnancy incorporating history, physical examination, quantitative human chorionic gonadotropin (hCG), serum progesterone, color-flow vaginal Doppler sonography and endometrial curettage as well as a treatment algorithm combining expectant, medical and surgical management. These algorithms resulted in: (1) earlier diagnosis of ectopic pregnancy, with fewer ruptured ectopic pregnancies; (2) virtual elimination of diagnostic laparoscopy; (3) elimination of culdocentesis; (4) greater use of methotrexate; and (5) increased use of expectant (i.e., nonsurgical and nonmedical) treatment. These algorithms are potentially applicable in other clinical settings and should be considered for use on at-risk populations or when the diagnosis of ectopic pregnancy is in question.

Algorithms↗
PubMed1993

Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.

Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double-lumen sampling device. The most frequent endometrial isolates were Peptostreptococcus and Bacteroides species, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 receiving gentamicin and clindamycin responded to therapy. There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.

Adolescent↗
PubMed1992

Cervical cytology: a randomized comparison of four sampling methods.

OBJECTIVE: The purpose of this study was to compare smear quality and endocervical cell recovery of four cervical smear sampling devices. STUDY DESIGN: Two thousand fifteen patients undergoing routine cervical smears at the University of Tennessee Obstetrics and Gynecology clinics were randomly assigned to a cotton swab-spatula, Cytobrush-spatula, Cervex-Brush, or Bayne Pap Brush. The cytopathology laboratory, blind to method, used specific criteria to grade smears as being optimal, adequate, marginal, or inadequate. Statistical analysis was by the chi 2 and analysis of variance tests. RESULTS: No statistical differences occurred among the groups for nonpregnant patients. For pregnant patients smear quality was improved with both Cytobrush-spatula and Bayne Pap Brush versus cotton swab-spatula (p = 0.0301 and 0.0004, respectively); cotton swab-spatula had fewer endocervical cells than the Cytobrush-spatula (p = 0.0001), Cervex-Brush (p = 0.0288), and Bayne Pap Brush (p = 0.0081). CONCLUSIONS: The cotton swab-spatula and Cytobrush-spatula appear to be the most effective screening methods for nonpregnant and pregnant patients, respectively.

Biopsy↗
PubMed1992

Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing.

OBJECTIVE: Patients' histories of urinary incontinence and the results of several standard clinical tests were correlated with final diagnoses obtained by multichannel urodynamic testing. We used a combination of clinical test results to predict the final diagnoses. STUDY DESIGN: Ninety consecutive women with a primary complaint of urinary incontinence completed a standardized questionnaire and underwent a structured clinical examination consisting of several standard clinical tests. Each patient later underwent multichannel urodynamic testing to obtain a final diagnosis. RESULTS: Although the symptoms of stress incontinence were significantly associated with genuine stress incontinence and mixed incontinence, overlap in patients with detrusor instability did not allow the histories to be useful diagnostically. The only clinical tests showing significant association with the final diagnoses of incontinence were the cough stress test and single-channel medium-fill cystometry. Reliable prediction of the urodynamic diagnosis of incontinence could not be achieved with either of these two tests or with a combination of variables obtained by discriminant analysis. CONCLUSIONS: Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation when it is available.

Adult↗
PubMed1992

Serum progesterone and uterine curettage in differential diagnosis of ectopic pregnancy.

The implementation of a serum P less than 5.0 ng/mL is important because it resolves the differential diagnosis of EP by enabling timely uterine curettage. Curettage with examination of curettings or documentation of falling hCG can be used to prevent unnecessary laparoscopies in patients undergoing spontaneous abortions and can make possible definitive diagnosis and medical treatment of EP completely eschewing anesthesia and surgery.

Curettage↗
PubMed1992

Improved sensitivity and specificity of a single measurement of serum progesterone over serial quantitative beta-human chorionic gonadotrophin in screening for ectopic pregnancy.

The sensitivity and specificity of a single serum progesterone measurement was compared against two beta-human chorionic gonadotrophin (HCG) measurements 48 h apart in screening for abnormal pregnancy, i.e. ectopic pregnancy, completed or incomplete abortion. Of 1120 patients in the first trimester presenting with a positive urinary pregnancy test, 116/1120 (10.4%) had an ectopic pregnancy, 755/1120 (67.4%) had ultrasonographically confirmed intra-uterine pregnancies, and 249/1120 (22.2%) had abnormal intra-uterine pregnancies documented as complete, incomplete or missed abortions. Of the ectopic pregnancies, 113/116 (97.4%) had a serum progesterone level less than 25 ng/ml while 516/755 (68.3%) viable intra-uterine pregnancies had a serum progesterone level greater than or equal to ng/ml. Of the 1120 patients screened, 402 (35.9%) had both a serum progesterone and two HCG measurements and were eligible for inclusion in this study. Setting a cut-off of 25 ng/ml, the sensitivity and specificity of a single serum progesterone measurement was then compared against two serial HCG measurements, utilizing receiver operating characteristic curves. This analysis demonstrated that a single serum progesterone measurement was significantly more sensitive (P less than 0.05) than two HCG measurements in screening for an abnormal pregnancy. In some patients, a single serum progesterone makes possible the diagnosis of ectopic pregnancy 2 days earlier than two HCG determinations because a second blood sample was not required. We conclude that a single serum progesterone measurement should be added to serial HCG determinations as a standard diagnostic screening test for ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1992

Diagnostic efficacy of endovaginal color Doppler flow imaging in an ectopic pregnancy screening program.

The authors compared the diagnostic yield of endovaginal color and pulsed Doppler ultrasound (US) in conjunction with endovaginal sonography with that of endovaginal sonography alone in patients prescreened to be at increased risk for ectopic pregnancy. Pelvic structures were evaluated for overall vascularity and for the presence of characteristic pulsed Doppler US velocity waveforms. The diagnostic sensitivity of the initial endovaginal sonographic examination increased with the addition of color and pulsed Doppler US, from 71% to 87% for ectopic pregnancy, from 24% to 59% for failed intrauterine pregnancy, and from 90% to 99% for viable intrauterine pregnancy. Specificities for endovaginal sonography with color and pulsed Doppler US ranged from 99% to 100%. Use of endovaginal color and pulsed Doppler US increased the percentage of diagnostic initial sonographic examinations from 62% to 82%. The improved diagnostic sensitivity of endovaginal color Doppler US for ectopic pregnancy may ultimately result in earlier treatment, with reduced morbidity and mortality.

Color↗
PubMed1992

Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia.

OBJECTIVE: To compare objectively the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia. METHODS: Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were randomized to Silastic rings (N = 50) or electrocoagulation (N = 52) as the method of tubal occlusion. Sterilization was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain questionnaire. This questionnaire was used to assess pain at 15 minutes, 1 hour, and 24 hours postoperatively. RESULTS: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 versus 21.8 minutes; P = .001), and this group also required less intraoperative anesthesia (P = .004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. No patient in either group required antiemetics or pain medication in the recovery room. CONCLUSION: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilization under local anesthesia when long-acting local agents are used for tubal anesthesia.

Adult↗
PubMed1992

Urethral diverticula: evaluation by urethral pressure profilometry, cystourethroscopy, and the voiding cystourethrogram.

OBJECTIVE: To compare the value of urethral pressure profilometry with that of cystourethroscopy and the voiding cystourethrogram in the evaluation and management of urethral diverticula. METHODS: Twelve women with signs or symptoms of a urethral diverticulum were referred. The initial evaluation included cystourethroscopy and a voiding cystourethrogram. All then underwent urethral pressure profilometry. RESULTS: Nine of 12 patients had urethral diverticula, two had Skene duct cysts, and one had genuine stress incontinence. Both cystourethroscopy and voiding cystourethrography demonstrated diverticula in all patients who had them. Excision was the preliminary surgical plan in these women. Urethral pressure profilometry demonstrated a pressure depression or biphasic curve in all nine cases with diverticula. Stress incontinence was noted in one of these nine women. A biphasic curve was also noted in one woman with a Skene duct cyst and in the one who had genuine stress incontinence only. According to preset criteria for profilometry, excision was the planned operative procedure for all. CONCLUSIONS: Cystourethroscopy and voiding cystourethrography were satisfactory techniques for diagnosing urethral diverticula and planning appropriate surgical treatment. The urethral pressure profile confirmed the presence of a diverticulum, but noted pressure depressions in cases other than diverticula. Profilometry did not change the surgical plan for treating diverticula, but allowed the planning of additional incontinence surgery in one patient.

Adult↗