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Biomedical subjects

V L Seltzer

Publications and source records attributed to V L Seltzer.

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

Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use.

The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.

Adult↗
PubMed1991

Accommodating to restrictions on residents' working hours.

In 1988, New York became the first state to implement regulatory measures limiting housestaff work hours. Because restrictions on residents' work hours will have such profound and far-reaching implications for how obstetrics and gynecology residencies are conducted, the Council on Resident Education in Obstetrics and Gynecology (CREOG) requested that a survey be conducted to solicit information from program directors of U.S. obstetrics and gynecology residencies who had already begun to alter their call schedules. Two hundred and ninety-six programs were contacted, and representatives of those that had implemented changes were requested to respond. Eighty-two responses were received; 26 of these contained information that could be collated. From these 26 responses the authors have structured a prototypic call schedule and presented its application. A key feature necessary to implement the new type of schedule is the use of a night float system. It is concluded that changes can and will be made by obstetrics and gynecology residencies. Creative scheduling, as described in this article, is essential and will facilitate the task; however, the current standards of education and patient care will be difficult to maintain without additional economic and human resources.

Gynecology↗
PubMed1990

Adenofibroma of the uterus: multiple recurrences following wide local excision.

The uterine adenofibroma is a form of mixed mesodermal tumor in which both epithelial and stromal components are benign. A case is presented in which a patient with this lesion was treated with excision of the tumor rather than hysterectomy. Two years later, she developed a recurrence of the lesion, which was again treated with wide local excision. A hysterectomy was done 9 months later, and a polypoid lesion was noted in the fundus of the uterus which on histologic examination was thought to be potentially either an adenofibroma precursor or a maturation of the previous cellular adenofibroma. Since uterine adenofibroma usually occurs in older patients, the standard treatment has been hysterectomy. Because of this patient's age, she was initially treated with a more conservative approach. However, despite the fact that the uterine adenofibroma is a benign lesion, it has an obvious potential to recur when treated conservatively.

Adenofibroma↗
PubMed1990

Serum estradiol as an aid in the diagnosis of ectopic pregnancy.

The value of serum beta-hCG measurement in the diagnosis of ectopic pregnancy is well established, and there have been recent studies on the use of serum progesterone levels. However, we have been unable to find any reports on the potential application of serum estradiol (E2) assays in the diagnosis of ectopic pregnancy. We therefore concurrently measured serum E2, progesterone, and beta-hCG in 100 women with ectopic pregnancies, as well as in 69 controls with normal intrauterine pregnancies and 36 women with threatened abortion. The mean (+/- standard deviation) E2 levels for ectopic-pregnancy patients, the normal controls, and the women with threatened abortion were 281.1 +/- 115.6, 788.2 +/- 45.5, and 788.8 +/- 40.6 pg/mL, respectively; the mean levels in the ectopic group were significantly different (P less than .0001) from those of the other two groups. All but one of the ectopic pregnancies had values below 650 pg/mL for E2 and 23 ng/mL for progesterone, and all but one of the normal intrauterine pregnancies had values above these levels. Our data suggest that the addition of the estradiol assay, with or without progesterone, to the early evaluation of patients suspected of having an ectopic pregnancy may be helpful in diagnosis.

Chorionic Gonadotropin↗
PubMed1990

Treatment of pulmonary endometriosis with a long-acting GnRH agonist.

We report the case of a patient who was successfully treated with a long-acting GnRH agonist for pulmonary endometriosis. This 28-year-old woman had symptomatic pleural endometriosis, documented by biopsies, as well as symptomatic pelvic endometriosis. Two surgical procedures, consisting of excision of pleural endometriotic tissue and partial pleurectomies, failed to relieve her chest symptoms. Little relief was achieved with pseudopregnancy treatment. Satisfactory symptomatic improvement was obtained with danazol, but this medication had to be discontinued because of severe side effects. Trial of a GnRH agonist, leuprolide acetate, achieved complete remission of her chest symptoms; in addition, the patient became pregnant immediately after cessation of therapy. Gonadotropin-releasing hormone agonist therapy may be an important therapeutic alternative for women with pulmonary endometriosis who cannot tolerate danazol treatment and in whom surgical therapy fails to relieve the chest symptoms.

Adult↗
PubMed1990

Cervical os obliteration after laser surgery in patients with amenorrhea.

Thirty-eight postmenopausal women and one with pituitary amenorrhea underwent cervical laser surgery. The cervical canal of each patient was patent 2 weeks later. Eighteen of the 30 women reevaluated 4-48 months later had total obliteration of the cervical canal. In some patients, the cervix was obliterated and flush with the vaginal vault so that it could not be identified. Five other patients had severe cervical stenosis. Factors contributing to cervical os obliteration appeared to be the depth of the cervical defect, the lack of the physical action of blood passing through the cervical canal, and the hypoestrogenic state. This outcome makes continued adequate cytologic and colposcopic surveillance of these patients impossible and leaves them at risk for developing unrecognized cervical and endometrial disease.

Adult↗
PubMed1989

The multicentric nature of disease related to human papillomavirus infection of the female lower genital tract.

Two hundred fifty-one consecutive patients from our colposcopy clinic were evaluated to establish the extent to which human papillomavirus (HPV) infection is a disease of the entire female lower genital tract. Colposcopic examinations and biopsies of the cervix and vulva were performed on all patients. Two hundred two women had cervical disease, of whom 164 (81%) also had vulvar disease. The percentage was the same regardless of the severity of the cervical disease. One hundred ninety-four of the patients had vulvar disease and of these, 164 (85%) also had cervical disease. Twenty-nine of 37 women (78%) with overt vulvar condylomata had cervical disease; 15 of these presented without a Papanicolaou smear, and 13 had cervical disease. We conclude that HPV infection of the female lower genital tract is a multicentric disease. All patients with evidence of HPV infection should undergo colposcopic evaluation of the entire lower genital tract. The significance that this will have on future attempts to cure this infection needs to be studied.

Condylomata Acuminata↗
PubMed1989

Teenagers' awareness of the acquired immunodeficiency syndrome and the impact on their sexual behavior.

One hundred female teenagers attending a teenage pregnancy program were studied to determine the extent of their awareness about acquired immunodeficiency syndrome (AIDS) and the impact of such knowledge on their sexual behavior. Ninety-eight knew that AIDS is a disease, 45 stated that it is fatal, and all knew that it can be transmitted by sexual intercourse. After becoming aware of AIDS, 59 changed their sexual habits, 41 decreased their number of sexual partners, and 13 who had not used condoms started using them. However, only seven obtained more information about their partners' sexual and social histories, and half of those who decreased their number of partners still continued relationships with more than one. The survey showed that the publicity about AIDS has resulted in a favorable change in the sexual practices of these teenagers. However, it also indicated a need for further improvement in specific areas of education, such as the value of obtaining more information about sexual partners, more awareness of the importance of multiple-partner relationships in the spread of AIDS, and more emphasis on the important role of condoms in preventing AIDS virus transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Parovarian cystadenocarcinoma of low-malignant potential.

In the world's literature, only 16 patients with parovarian malignancies have been described, five of which have been of low-malignant potential. All but one of these low-malignant potential lesions have been serous tumors. This is the second low-malignant potential parovarian tumor to be described with mucinous and serous components as well as hobnail cells. These tumors occur almost exclusively in young women, yet they are so rare that no treatment plan has been developed. We propose that until more data becomes available, these low-malignant potential lesions be treated as are their ovarian counterparts with staging laparotomy and surgery which conserves reproductive functioning being appropriate for women who meet the rigid clinical and histologic criteria for a very early potentially nonaggressive tumor, and complete extirpative surgery for those who do not.

Adult↗
PubMed1988

Comparison of the adrenocorticotropic hormone stimulation test with and without prior dexamethasone suppression in the diagnosis of congenital adrenal hyperplasia.

A comparison was made of the ACTH stimulation test with and without prior dexamethasone suppression in 10 patients, each of whom served as her own control. It was found that it is not necessary to administer DEX before the test, the specificity and sensitivity of both tests being the same in the diagnosis of CAH, although the calculated values are lower when DEX is given. Further investigation with HLA typing and ACTH stimulation testing is necessary to establish whether either or both types of ACTH stimulation tests are capable of discriminating between the heterozygotic and homozygotic varieties of CAH.

Adrenal Hyperplasia, Congenital↗
PubMed1987

Clearance of continuous intravenous morphine for severe cancer pain.

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.

Female↗
PubMed1986

Prevalence of and markers for the attenuated form of congenital adrenal hyperplasia and hyperprolactinemia masquerading as polycystic ovarian disease.

To determine the prevalence of the attenuated form of congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPPN) relative to polycystic ovarian disease (PCOD), 100 consecutive women presenting with the classic clinical features of PCOD were evaluated by basal hormonal profiles and subsequent adrenocorticotropic hormone (ACTH) stimulation tests. The study also sought biochemical markers for CAH other than ACTH stimulation. The prevalences were found to be as follows: PCOD, 65%; PCOD with HPPN, 9%; HPPN, 3%, end-organ hypersensitivity (EOH), 4%; homozygotic CAH, 4%; and heterozygotic CAH, 15%. Other than the differential response to ACTH, the only other biochemical markers observed for homozygotic CAH were significantly higher basal levels of testosterone (T) and 17 alpha-hydroxyprogesterone (17-OHP). Luteinizing hormone/follicle-stimulating hormone ratio, androstenedione, and dehydroepiandrosterone sulfate all showed no significant differences between homozygotic CAH, heterozygotic CAH, HPPN, PCOD, and EOH. This study establishes the relative prevalences of the syndromes commonly mimicking PCOD. We also conclude that the observed low incidence of CAH does not justify routine ACTH testing on all patients presenting with features of PCOD--however, our data suggest that patients with basal serum levels of T and 17-OHP greater than 50% above the upper limit of normal should undergo this dynamic test, especially if there are also certain clinical features suggestive of CAH.

17-alpha-Hydroxyprogesterone↗
PubMed1986

Effect of advancing pregnancy on the glucose tolerance test and on the 50-g oral glucose load screening test for gestational diabetes.

To determine the validity of the 50-g, one-hour glucose screening test for gestational diabetes in relation to the duration of pregnancy, 101 patients from a high-risk population had the screening test in the first trimester and glucose tolerance tests (GTT) in the second and third trimesters. The sensitivity (88%) and specificity (82%) of the screening test were similar to values reported when the test is performed later in pregnancy. However, immediate follow-up GTTs in the second trimester revealed only 25% instead of 88% of the gestational diabetic patients uncovered by the positive screening tests. Guidelines for screening for gestational diabetes should include follow-up with a third-trimester GTT on all patients who have positive screening tests even in the presence of normal follow-up second trimester GTTs.

Blood Glucose↗
PubMed1986

Cervical cancer detected by cervicography in a patient with negative cervical cytology.

The existence of false negative cervical cytology is well recognized. Cervicography was introduced in part to minimize the incidence of false negative smears, but its use has been controversial. A case is presented of a patient with occult cervical cancer whose initial Papanicolaou smear was atypical (class II) and follow-up smear was negative. The patient's cancer was detected by cervicography. Detection of the patient's disease would have been delayed were it not for cervicography.

Aged↗
PubMed1985

Status epilepticus in pregnancy. A case report.

Status epilepticus is a serious emergency that rarely complicates the management of the pregnant patient with seizure disorders. Because of concerns regarding the safety of anticonvulsion medications, this condition may appear with increasing frequency. Our management of such a case resulted in a healthy mother and infant.

Adolescent↗