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Biomedical subjects

W L Wiser

Publications and source records attributed to W L Wiser.

At least 37 records · Page 2Linked to original sources
PubMed1988

Vaginal birth after cesarean section: the demise of routine repeat abdominal delivery.

In light of the abundant very favorable data and considerable published patient experience regarding vaginal birth after cesarean for selected gravidas, the authors are moved to repeat with emphasis the question asked by Dr. Danforth in his recent treatise on cesarean delivery: "The question now is not whether the dictum of automatic repeat cesarean section is still valid, but rather why we continued to adhere to it for more than 60 years, as though it had been carved in stone." From recently published American data, it is obvious that more providers and more patients must be convinced of the safety, efficacy, and cost effectiveness of a selective program of trial of labor and vaginal delivery following previous cesarean birth if we are to effect a significant reduction in this nation's cesarean birth rate. The policy of "once a cesarean section, always a cesarean section" should be applied correctly only to its intended group of patients with previous uterine fundal or upper-segment incisions. As the advisability of insisting on a trial of labor for all parturients who have no contraindications becomes a signal part of the fabric of obstetric practice in the United States and the remainder of the world, we shall witness the demise of routine repeat abdominal delivery.

Cesarean Section↗
PubMed1988

Meperidine and normeperidine distribution in the rhesus monkey.

Previous work has shown that both meperidine and normeperidine are transferred across the placenta to the fetus. Little is known in primates, however, about the tissue deposition of these compounds. Four pregnant, dated rhesus monkeys within one week of term were anesthetized for cesarean delivery. An equal mixture of meperidine and normeperidine was administered as an intravenous bolus 10 minutes before delivery (1.25 mg/kg). The infants were then sacrificed at 20 minutes after birth and the concentration of the compounds in various organ systems were analyzed by gas-liquid chromatography and mass spectroscopy (GLC-MS). The infant serum 20 minutes after delivery revealed a meperidine concentration of 2.23 micrograms/ml and a normeperidine level of 0.67 micrograms/ml (3:1). In contrast, the tissues analyzed showed a much higher concentration of the metabolite in the liver (1:7), gallbladder (1:3), and brain (1:2). Other tissues, such as muscle and kidney, demonstrated equal levels of the two compounds. The authors conclude that normeperidine is quickly transferred to fetal tissues and to a greater degree than the parent compound in certain organs. The increased distribution, particularly in the brain, could account for the toxic actions in the cerebrum of the derivatives of meperidine.

Animals↗
PubMed1987

Prevention of preterm birth by ambulatory assessment of uterine activity: a randomized study.

Tocodynamometry, used on an ambulatory basis, has been shown to detect uterine activity. The objective of this study was to assess the effectiveness of ambulatory tocodynamometry in the early identification of preterm labor. In this investigation 67 women at risk for preterm labor were randomly divided into two groups: 34 received a uterine activity monitor while 33 patients used palpation. Approximately two thirds of the study sample developed preterm labor. Upon diagnosis of preterm labor, parturients in the control group had cervical dilatation of less than 3 cm (p less than 0.001) and effacement of greater than 50% more often than the monitored group (p less than 0.01). As a result there was a significant decrease in the number of patients who responded to tocolytic therapy in the unmonitored group. Among those with preterm labor the time gained in utero was greater in the monitored group (8.2 +/- 2.7 weeks) compared to the control group (4.2 +/- 2.9 weeks) (p less than 0.05). Subsequently 29 of 34 monitored patients attained term (36 completed gestational weeks) versus only 18 of the 33 patients in the unmonitored group (p less than 0.01). Although the sample size is relatively small, uterine activity monitoring in these very high risk patients resulted in an increased number of suitable candidates for tocolysis and allowed a significantly greater percentage of women to reach term.

Ambulatory Care↗
PubMed1987

Tocolysis with oral magnesium.

Seventeen patients in whom uterine activity responded favorably to parenteral magnesium sulfate were given oral magnesium gluconate for continued tocolysis. The mean serum magnesium level before therapy was 1.44 +/- 0.22 mg/100 ml, whereas 2 hours after initiation of oral magnesium it was 2.16 +/- 0.32 mg/100 ml (p less than 0.05). One patient had nausea without vomiting or diarrhea. These data suggest that magnesium ingested orally can raise the serum magnesium level significantly.

Administration, Oral↗
PubMed1986

Comparative study of flurbiprofen and morphine for postsurgical gynecologic pain.

This single-dose, double-blind, randomized, placebo-controlled study assessed the efficacy and safety of 50 mg of flurbiprofen (Ansaid, Upjohn) in the relief of postoperative pain following cesarean section, as well as vaginal or abdominal hysterectomies. Results show that both 50 mg of oral flurbiprofen and 10 mg of intramuscular morphine sulfate were significantly superior to placebo in 161 patients with respect to pain intensity after medication, pain relief scores, need for additional analgesia, and overall clinical evaluation of pain relief. By two hours after treatment, there were no significant differences between morphine sulfate and flurbiprofen in terms of pain intensity or degree of pain relief. According to investigators' global evaluations of efficacy, both active treatments were statistically superior to placebo. The only adverse reaction occurred in the morphine treatment group. Flurbiprofen administered orally for the relief of moderate to severe pain following major gynecologic surgery appears to be equal to morphine sulfate and superior to placebo in efficacy and safety. Unlike morphine, flurbiprofen is a nonparenteral, uncontrolled substance, and thus patient acceptance is improved while nursing time is decreased.

Adult↗
PubMed1986

External cephalic version of the breech presentation under tocolysis.

External cephalic version with tocolysis at or near term has been advocated to avoid cesarean birth for breech presentation. In our institution this maneuver was successfully performed in 207 of 304 parturients without major complications, and all but six had vertex presentation at delivery. The success of version was inversely correlated with gestational age but was not correlated with ease of version, number of attempts, or placental location. When this 3-year period was compared with the previous three years (1979 to 1981), there was a significant reduction in the number of breech presentations during labor, whereas the total delivery rate remained relatively constant over the 6-year period. It appears that in a carefully selected population, external version near term can be used safely to reduce the need for abdominal birth because of breech presentation.

Breech Presentation↗
PubMed1985

Danazol in the management of ureteral obstruction secondary to endometriosis.

Ureteral obstruction caused by endometriosis is uncommon. It is, however, an important complication that imposes a 25% chance for permanent loss of renal function on the affected side. The standard management is surgical; however, three cases have been reported in which regression of obstruction followed medical therapy. This case report concerns a patient with long-standing partial ureteric obstruction due to endometriosis who was treated for 2 months with danazol. Clinical response of the endometriosis was excellent, but the obstruction persisted, a retroperitoneal ureteroneocystotomy was therefore performed. The ureter was found to be obstructed by dense fibrous tissue that contained endometrial glands. It seems therefore that a trial of danazol may be attempted in selected cases, but that the drug is unlikely to relieve endometriotic ureteric obstruction once dense fibrosis has occurred.

Adult↗
PubMed1985

Plasma prolactin concentrations and pregnancy-induced hypertension.

Human prolactin (PRL) has been related to various pathologic disorders known to be associated with osmoregulation and hypertension. In this study, we compared changes in plasma PRL concentrations in normal pregnant patients to those in patients with severe pregnancy-induced hypertension (PIH). Comparison of plasma PRL concentrations collected antepartum, at delivery, and 48 hours postpartum failed to distinguish women with PIH from those without. Only women with PIH, however, showed a significant rise in systemic PRL concentrations between admission to the study and delivery. Antepartum abnormalities in plasma PRL concentrations associated with PIH may not have been detected because of diurnal variations in PRL secretion.

Adult↗
PubMed1985

A technique for uterine conservation in adolescents with vaginal agenesis and a functional uterus.

Vaginal agenesis in association with a functional uterus occurs infrequently, and usually presents in adolescents. To preserve reproductive function, the uterus must be conserved, and a vagina must be constructed in one operative procedure. The authors describe a surgical technique that combines a modified McIndoe vaginoplasty with uterine conservation in which a special stent is fabricated to insert in the uterine cervix and the neovagina. Factors that must be considered when choosing between a hysterectomy and a uterine conservation procedure also are discussed.

Cervix Uteri↗
PubMed1984

Meperidine and normeperidine metabolism in the rhesus monkey.

Meperidine and its principle metabolite, normeperidine, were given intravenously to four non-human primates prior to cesarean delivery in an equivalent dose for human parturients. The status of the infants regarding neonatal depression was assessed at delivery. Repeated blood samples from both the mother and the neonate were obtained over a period of 4 days. The levels of meperidine and normeperidine were analyzed. The results showed that the metabolism of meperidine and normeperidine in the non-human primate was essentially the same as that observed in the human parturient. In addition, normeperidine appeared to be more toxic than meperidine to the neonate. Finally, there does not appear to be an evidence for neonatal metabolism of meperidine to normeperidine.

Animals↗
PubMed1984

Comparison of two prostaglandins used to terminate midtrimester pregnancy.

One of the most widely used methods of pregnancy termination has involved the use of prostaglandin drugs. Vaginal suppositories containing prostaglandin E2 (PGE2) have been used successfully by many investigators. Because of problems with a long delay between induction and abortion, as well as minor side effects, other prostaglandin agents have been tested. In our study, 17 matched patients given PGE2 vaginal suppositories to induce abortion were compared with a similar group in whom the methyl ester of prostaglandin F2 alpha ( MPGF2 alpha) was used. There was no statistically significant difference between the two groups in side effects, number of patients requiring curettage, or placental expulsion time. Patients treated with PGE2 had a shorter fetal expulsion time (P less than .001), and there were no major complications in either group. It appears from these data that multiple PGE2 vaginal suppositories are equal to or better than the newer single MPGF2a suppository followed by intramuscular injections when used for second trimester terminations.

Abortion, Induced↗
PubMed1984

Management of agenesis of the vagina.

The management of 92 women with vaginal agenesis is presented. All patients were managed by a modified McIndoe procedure. Four women (4 per cent) had intraoperative or postoperative complications, but only one woman had a complication that resulted in failure of vaginal function. We advocate the McIndoe vaginoplasty as the primary technique of management for women with vaginal agenesis.

Adolescent↗
PubMed1983

Vaginal delivery following previous cesarean birth.

Because of the rising cesarean birth rate in the United States, renewed interest in vaginal delivery after prior abdominal operation has been evident. In a prospective collaborative study 789 patients were evaluated for inclusion into this investigation. Of the 717 subjects who entered the study 162 chose to attempt vaginal birth and 101 were successful. Desire for tubal sterilization and the lack of prior vaginal delivery were significant correlates of the group selecting repeat abdominal birth and of those who were unsuccessful when vaginal delivery was attempted. There were eight dehiscences and three uterine ruptures among the 717 patients and none was related to catastrophic outcome for the mother or neonate. Perinatal losses (12) were not related to uterine rupture or method of delivery. There were no significant differences in uterine disruption between patients selecting either route of delivery. Likewise ancillary factors such as a prior febrile puerperium (endometritis), number of prior cesarean births, low-vertical uterine incisions, recurrent operative indications, the use of epidural anesthesia, or oxytocin administration were not discriminating factors in whether women chose to attempt or were successful in completing vaginal delivery after prior abdominal birth. From our data vaginal birth after cesarean section appears to be safe if conducted in a carefully selected population that is closely monitored in a prospective manner.

Cesarean Section↗
PubMed1983

Comparative efficacy of ibuprofen, indomethacin, and placebo in the treatment of primary dysmenorrhea.

Forty-two women with primary dysmenorrhea were successfully enrolled in a double-blind, three-way crossover study in which each patient received either ibuprofen (Motrin), indomethacin (Indocin), or a placebo during each of three successive painful menstrual cycles. Thirty-one patients successfully completed the study. The results showed that ibuprofen and indomethacin were superior to the placebo in their ability to relieve pain and that patients preferred ibuprofen to indomethacin. Ibuprofen was significantly superior to the placebo regarding the number of patients who could pursue normal daily function, whereas indomethacin was not. Four patients reported side effects, all during the indomethacin cycle.

Adolescent↗