A State-wide Assessment Of The Obstetric, Anesthesia, And Operative Team Personnel Who Are Available To Manage The Labors And Deliveries And To Treat The Complications Of Women Who Attempt Vaginal Birth After Cesarean Delivery
experience; obstetric personnel; Obstetrics & Gynecology; section; trial; uterine rupture; vaginal birth after cesarean delivery
OBJECTIVE: The purpose of this study was to determine on a state-wide basis the range of obstetric, anesthesia, and surgical team personnel who were available immediately to manage the labors and deliveries of women who attempted vaginal birth after cesarean delivery. Additionally, we tried to determine whether hospitals had stopped performing vaginal births after cesarean delivery or made changes in their policies regarding vaginal birth after cesarean delivery as a result of recent American College of Obstetricians and Gynecologists recommendations. STUDY DESIGN: Available immediately was defined as "being present in the hospital." All hospitals that provided obstetric care in the State of Ohio were surveyed to determine whether an obstetrician with cesarean privileges, an anesthesiologist, or an anesthetist capable of independently administering anesthesia for a cesarean section, and a surgical team were available immediately when women attempted vaginal birth after cesarean delivery. The hospitals were also asked whether they had stopped allowing vaginal births after cesarean delivery or had made changes in their vaginal birth after cesarean delivery policies in response to the recent recommendations of the American College of Obstetricians and Gynecologists. Data were computerized and analyzed by the chi(2) test. RESULTS: Seventy-seven (93.9%), 35 (100%), and 13 (100%) of level I, II, and III hospitals performed vaginal births after cesarean delivery. An obstetrician was immediately available in 27.3%, 62.9%, and 100% of level I, II, and III institutions, respectively (P less than or equal to .001). Anesthesia availability was 39%, 100%, and 100% of level I, II, and III institutions, respectively (P less than or equal to .001). A surgical team was available in 35.1%, 97.1%, and 100% of level I, II, and III hospitals, respectively (P less than or equal to .001). A complete complement was available in 15.6%, 62.9%, and 100% of level I, II and III institutions, respectively (P less than or equal to .001). Two hospitals had stopped the performance of vaginal births after cesarean delivery, and 10 additional hospitals were considering stopping the performance of vaginal births after cesarean delivery. Policy changes had been adopted in 15 institutions, and 4 other institutions were considering changes. CONCLUSION: Most level I and many level II hospitals provide less than optimum staffing when women are attempting vaginal birth after cesarean delivery. Because vaginal births after cesarean delivery are equally distributed among level I, II, and I I I institutions in this state, many women may be attempting vaginal birth after cesarean delivery under less than optimal conditions. The data suggest the need for changes in staffing or referral patterns to safely meet the Healthy People 2010 goal of increasing the vaginal birth after cesarean delivery rate nationally.
Lavin J P; DiPasquale L; Crane S; Stewart J
American Journal of Obstetrics and Gynecology
2002
2002-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1067/mob.2002.124282" target="_blank" rel="noreferrer noopener">10.1067/mob.2002.124282</a>
Laparoscopic Port Site Implantation With Ovarian Cancer
laparoscopy; Obstetrics & Gynecology; ovarian cancer; port site
We report the cases of 3 patients in whom tumor implantation developed at the port site at which ovarian cancer was removed laparoscopically. The 3 patients, who were aged 30, 32, and 40 years, all had an ovary that did not appear cancerous removed by laparoscopy through a port site. All 3 patients underwent reexploration within 3 weeks and were found to have tumoral spread and port site implantation of tumor. When ovarian cancer is removed laparoscopically, the potential exists for intra-abdominal tumoral spread. When surgical staging is undertaken after laparoscopic removal of ovarian cancer, the port site should be excised in a full-thickness fashion.
Hopkins M P; von Gruenigen V; Gaich S
American Journal of Obstetrics and Gynecology
2000
2000-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1067/mob.2000.103251" target="_blank" rel="noreferrer noopener">10.1067/mob.2000.103251</a>
The Effects Of Carbon Dioxide Pneumoperitoneum On Seeding Of Tumor In Port Sites In A Rat Model
colon cancer; implantation; laparoscopy; Obstetrics & Gynecology; ovarian cancer; rats; recurrence; tumor implantation
OBJECTIVES: The use of laparoscopic surgical techniques for the resection of intraperitoneal malignancies has been rapidly increasing in recent years; concomitantly, tumor recurrences at trocar sites have also been reported. These reports bring into question the appropriateness of pneumoperitoneum and laparoscopic techniques for carcinoma removal. We hypothesized that the carbon dioxide pneumoperitoneum and instrumentation used during laparoscopic procedures contribute to a greater incidence of tumor implantation into the ventral peritoneal wall wound sites than seen with laparotomy. This study, which used port placement and carbon dioxide pneumoperitoneum in an animal model, was designed to determine the relative incidences of tumor implantation into wound sites of the ventral peritoneal wall for laparoscopy and laparotomy STUDY DESIGN: Viable MAT B III rat mammary adenocarcinoma cells were injected into the lower right quadrant of the peritoneal cavity of Fisher 344 rats (1 x 10(5) cells/rat). The animals were then divided into 4 groups: 1 group (n = 9) served as a control group and received no further manipulations; another (n = 8) underwent a midline laparotomy; another (n = 8) had four 18-gauge trocars inserted into the peritoneal cavity; and the last (n = 8) underwent induction of a 7- to 8-mm Hg carbon dioxide pneumoperitoneum in addition to the insertion of four 18-gauge trocars. All animals were maintained under surgical conditions for 2 hours. Animals were killed at 7 days, and the ventral peritoneal wall was examined for macroscopic evidence of tumor formation. RESULTS: A total of 32 possible sites of tumor implantation were measured. The control group showed no significant macroscopic evidence of tumor translocation tio the ventral peritoneal wall. Among the 32 measured sites the laparotomy group had an overall lower incidence of tumor implantation at the peritoneal wall wound sites (n = 5) than did the group with the trocars alone (n = 20) group (P = .003) and the group with trocars plus carbon dioxide insufflation (n = 29, P < .0001). The group with trocars alone had a lower incidence of tumor implantation than did the group with trocars plus carbon dioxide pneumoperitoneum (P = .02). CONCLUSIONS: Trocar use during laparoscopic surgical procedures led to greater translocation of free tumor cells to peritoneal wall wound sites than did laparotomy in this animal model. The addition of carbon dioxide pneumoperitoneum further increased implantation of tumor cells at trocar sites. These results provide evidence that the use of laparoscopic techniques for resection of intraperitoneal malignancy needs further long-term study.
Hopkins M P; Dulai R M; Occhino A; Holda S
American Journal of Obstetrics and Gynecology
1999
1999-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/s0002-9378(99)70372-8" target="_blank" rel="noreferrer noopener">10.1016/s0002-9378(99)70372-8</a>
Fatal Intrapartum Pulmonary Embolus During Tocolysis
Obstetrics & Gynecology
Girz B A; Heiselman D E
American Journal of Obstetrics and Gynecology
1988
1988-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/0002-9378(88)90798-3" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(88)90798-3</a>
NECROTIZING FASCIITIS OF THE TOTAL ABDOMINAL-WALL AFTER STERILIZATION BY PARTIAL SALPINGECTOMY - CASE-REPORT AND REVIEW OF LITERATURE
Obstetrics & Gynecology
Cederna J P; Davies B W; Farkas S A; Sonta J A; Sworniowski T
American Journal of Obstetrics and Gynecology
1990
1990-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/s0002-9378(11)90687-5" target="_blank" rel="noreferrer noopener">10.1016/s0002-9378(11)90687-5</a>
SENSITIVITY AND SPECIFICITY OF RAPID BACTERIAL VAGINOSIS TESTING IN THE SYMPTOMATIC PREGNANT PATIENT
Obstetrics & Gynecology
Wolfe K; Davis J K; Gil K
American Journal of Obstetrics and Gynecology
2008
2008-12
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2008.09.520" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2008.09.520</a>
Digital rectal fecal occult blood screening during gynecologic examination
cancer; Obstetrics & Gynecology; occult blood screening; pelvic examination
Objective: The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination. Study design: We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination. Results: Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer. Conclusion: Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results. (C) 2004 Elsevier Inc. All rights reserved.
Willis F L; Fanning J
American Journal of Obstetrics and Gynecology
2004
2004-05
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2004.01.072" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.01.072</a>
The impact of obesity and age on quality of life in gynecologic surgery
adults; anemic cancer-patients; body-mass index; complications; Elderly; endometrial cancer; epoetin-alpha; gynecologic surgery; life; morbidity; obesity; Obstetrics & Gynecology; population; quality of; sf-36; trial; validation
Objective: This study was undertaken to prospectively evaluate the effect of early stage endometrial cancer, age, and obesity on quality of life (QOL). Study design: Women undergoing surgery for endometrial cancer or an adnexal mass determined at surgery to be benign (controls) were enrolled preoperatively and followed for 6 months. Results: Seventy-nine women completed the study. Functional Assessment of Cancer Therapy (FACT-G) scores increased significantly in all women; however, significant differences by patient weight and age were obtained. Obesity was associated with decreased physical FACT-G and SF-36 scores. Older women had lower SF-36 physical scores, higher emotional scores, and less change over time. Conclusion: Women with early endometrial cancer had similar changes in QOL as those who received surgery for benign disease. Obese and elderly women had domain alterations. Given the aging population and rising incidence of obesity, these results emphasize the need for QOL interventions in postoperative gynecologic care of these patients. (C) 2005 Mosby, Inc. All rights reserved.
Von Gruenigen V E; Gil K M; Frasure H E; Jenison E L; Hopkins M P
American Journal of Obstetrics and Gynecology
2005
2005-10
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2005.03.038" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2005.03.038</a>
LACERATION OF A PLACENTAL VEIN - INJURY POSSIBLY INFLICTED BY FETUS
Obstetrics & Gynecology
Tuggle A Q; Cook W A
American Journal of Obstetrics and Gynecology
1978
1978
Journal Article
<a href="http://doi.org/10.1016/0002-9378(78)90670-1" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(78)90670-1</a>
FeasibiLity of laparoscopic debulking with electrosurgical loop excision procedure and argon beam coagulator at recurrence in patients with previous laparotomy debulking
2nd; debulking; laparoscopy; model; Obstetrics & Gynecology; ovarian-cancer; ovarian-cancer
Objectives: Our purpose is to assess the feasibility and success of laparoscopic ovarian debulking with electrosurgical loop excision procedure (LEEP) and argon beam coagulator (ABC). Methods: Thirty-six consecutive asymptomatic patients with chemosensitive stage III or IV ovarian cancer who had undergone prior laparotomy debulking and chemotherapy, underwent laparoscopic debulking at the time of elevated CA 125. Preoperative abdominal/pelvic computed tomography was negative. Operative laparoscopy was performed through an open technique in the left upper quadrant. Tumors were debulked laparoscopically by using the LEEP and the ABC. Results: Of 36 patients, 34 (94%) underwent successful laparoscopic debulking without requiring laparotomy. Of 34 patients, 32 (94%) had all visible disease resected at laparoscopy; 6% had surgical complications. Median time for surgery was 2.6 hours, median blood loss 70 mL, and median hospital stay 1 day. Seventy-four percent had a complete response after laparoscopic debulking and chemotherapy with a median progression free survival of 1.1 years. Conclusion: We present the first report of laparoscopic ovarian debulking using LEEP and ABC after elevation of CA 125 in chemosensitive, asymptomatic patients who had undergone prior laparotomy debulking. Laparoscopic debulking appears feasible (94%), successful (94%), and safe (6% complications). Prospective randomized trials are needed to determine the optimal management of asymptomatic, chemosensitive patients with elevated CA 125. (C) 2004 Elsevier Inc. All rights reserved.
Trinh H; Ott C; Fanning J
American Journal of Obstetrics and Gynecology
2004
2004-05
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2004.02.034" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.02.034</a>
BREAST-CANCER SCREENING IN A PRIVATE WOMENS CLINIC
Obstetrics & Gynecology
Tifft J G; Jarjoura D
American Journal of Obstetrics and Gynecology
1988
1988-06
Journal Article
<a href="http://doi.org/10.1016/0002-9378(88)90374-2" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(88)90374-2</a>
3-MILLENNIUM ANTIQUITY OF THE LITHOKELYPHOS VARIETY OF LITHOPEDION
ectopic pregnancy; fetal death; lithopedion; native american; Obstetrics & Gynecology; paleopathology
Identification of a 3100-year-old lithopedion in the Archaic Southwest antedates its first clinical notation by 21 00 years. It was only the ''autopsy'' of time (excavation of the site) that allowed its presence to be brought to light.
Rothschild B M; Rothschild C; Bement L C
American Journal of Obstetrics and Gynecology
1993
1993-07
Journal Article
<a href="http://doi.org/10.1016/0002-9378(93)90148-c" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(93)90148-c</a>
DRUG PRESCRIBING FOR CHRONIC MEDICAL DISORDERS DURING PREGNANCY - AN OVERVIEW
Obstetrics & Gynecology
Rayburn W F; Lavin J P
American Journal of Obstetrics and Gynecology
1986
1986-09
Journal Article
<a href="http://doi.org/10.1016/0002-9378(86)90280-2" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(86)90280-2</a>
Breast cancer screening in a private women's clinic.
Adult; Female; Humans; Middle Aged; Ohio; Biopsy; Hospitals; Lymphatic Metastasis; Costs and Cost Analysis; *Mass Screening/economics; Breast Neoplasms/economics/*epidemiology; Breast/pathology; Mammography/economics; Needle/economics; Proprietary
A review of 6109 mammograms representing 4332 patients seen over 4 years is presented. The American Cancer Society guidelines for mammography screening were followed. Forty-five percent of all tumors were nonpalpable; in 12% of these the lymph nodes were positive for cancer. In the group with palpable breast cancers, 62% had positive lymph nodes. Screening mammography results in an increased number of localization biopsies. Biopsy rates were compared with several series. Costs for mammography screening programs were reviewed and related to the cost of each breast cancer detected. In our series the cost per cancer detected was $13,000. This study provides evidence to justify the American Cancer Society guidelines.
Tifft J G; Jarjoura D
American journal of obstetrics and gynecology
1988
1988-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/0002-9378(88)90374-2" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(88)90374-2</a>
The effect of various insufflation gases on tumor implantation in an animal model.
*Carbon Dioxide; *Helium; *Neoplasm Transplantation; *Nitrous Oxide; *Peritoneal Cavity; *Pneumoperitoneum; Adenocarcinoma/pathology; Animals; Artificial; Cultured; Inbred F344; Injections; Intraperitoneal; Peritoneal Neoplasms/pathology; Rats; Tumor Cells
OBJECTIVE: The expanded use of laparoscopy has led to reports of tumor dissemination and spread to laparoscopic port sites. We previously showed that carbon dioxide insufflation produced tumor dissemination compared with laparotomy. It is unknown whether the type of gas used influences this dissemination. Although carbon dioxide is commonly used during laparoscopy, helium and nitrous oxide could be used. This study was undertaken to compare the effects of carbon dioxide, helium, and nitrous oxide gas on tumor spread in an animal model to determine whether the type of gas used for the pneumoperitoneum would affect tumor spread. STUDY DESIGN: Viable MATB mammary adenocarcinoma cells were injected into the peritoneal cavity of Fisher 344 rats (1 x 10(5) cells/rat). The animals were then divided into three groups. Four 18-gauge angiocaths were inserted into each of four quadrants of the peritoneal cavity, and induction of pneumoperitoneum with helium, nitrous oxide, or carbon dioxide gas was done at approximately 7 mm Hg for 2 hours. Animals were killed at 7 days and the ventral peritoneal wall and abdominal cavity were examined for evidence of tumor formation. Tumor implants were counted for each of the four quadrants on the anterior peritoneal wall and for the total abdominal cavity. RESULTS: A total of 39 rats were studied with 13 animals per group. The total number of implants was calculated for the groups: carbon dioxide, n = 57; helium, n = 62; nitrous oxide, n = 66. There was no significant difference in the total number of implants according to the type of gas or the size of implants. When implants that were \textless5 mm were analyzed, the four quadrants of the anterior peritoneum showed a random difference in tumor disbursement between one quadrant in the helium (n = 15) and one quadrant in the nitrous group (n = 23). However, when the three gasses were compared with all four quadrants, there was no statistical significance (carbon dioxide, n = 35; helium, n = 38; nitrous oxide, n = 44). CONCLUSION: There is no difference in tumor implantation when with use of carbon dioxide, helium, or nitrous oxide gas in an animal model. Thus, carbon dioxide insufflation does not appear to increase tumor spread compared with other gasses.
Hopkins Michael P; von Gruenigen Vivian; Haller Nairmeen Awad; Holda Sheri
American journal of obstetrics and gynecology
2002
2002-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1067/mob.2002.126644" target="_blank" rel="noreferrer noopener">10.1067/mob.2002.126644</a>
A comparison of costs associated with screening for gestational diabetes with two-tiered and one-tiered testing protocols.
Cost-Benefit Analysis; Diabetes; Female; Gestational/*diagnosis/*economics; Glucose Tolerance Test/*economics/*methods; Humans; Mass Screening/economics; Pregnancy; Time Factors
OBJECTIVE: The Fourth International Workshop on Gestational Diabetes recently suggested that two techniques, a 2-tiered protocol and a 1-tiered protocol, to screen for gestational diabetes mellitus are acceptable alternatives. This study was undertaken to compare the direct costs and patient time expenditures associated with implementing both techniques. STUDY DESIGN: A MEDLINE search was undertaken to determine the prevalence of positive and negative screening results. Direct costs of testing were estimated by determining the range of supply costs from manufacturers' catalogs and the labor costs by estimating the time required to perform each procedure and multiplying by the appropriate range of wages; these costs were then multiplied by the appropriate range of the number of procedures required to implement both protocols, and the totals were summed. Patient time expended was estimated by assigning test times of 1, 2, and 3 hours for the 50-g screening glucose challenge test, the 75-g oral glucose tolerance test, and the 100-g oral glucose tolerance test, respectively. If additional visits were required, 2 travel-time units were assigned each time a patient underwent a procedure. These units were multiplied by the range of patients undergoing various tests to implement the alternative protocols. RESULTS: We identified low and high direct costs, test times, and travel units per patient screened by the 1- and 2-tiered testing protocols. Low and high direct costs were $3.46 and $7.88, respectively, for the 2-tiered protocol and $5.64 and $10.88, respectively, for the 1-tiered protocol (relative ratios, 1.63 for low direct costs in each protocol and 1.38 for high direct costs in each protocol). Low and high test times were 1.4 and 1.5 hours, respectively, for the 2-tiered protocol and 2.0 and 2.0 hours, respectively, for the 1-tiered protocol (relative ratios, 1.47 for low test times in each protocol and 1.32 for high test times in each protocol). Low and high travel units for the 2-tiered protocol were 0.2 and 0.3, respectively, when the glucose challenge test was given at the prenatal visit, and 2.2 and 2.3, respectively, when the test was not given at that time. Low and high travel units for the 1-tiered protocol were 8.3 and 5.8, respectively, when the glucose challenge test was given at the prenatal visit, and 0.89 and 0.85, respectively, when the test was not given at that time. CONCLUSIONS: The 2-tiered protocol appears to be associated with lower direct implementation costs and less patient time expenditure than the 1-tiered scheme. The 1-tiered protocol is associated with slightly less travel time, but this is unlikely to offset the test time advantage of the 2-tiered protocol. Until further data regarding the relative clinical utility of the 2 protocols become available, these factors may be important for clinicians in deciding which screening format to follow.
Lavin J P Jr; Lavin B; O'Donnell N
American journal of obstetrics and gynecology
2001
2001-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1067/mob.2001.109401" target="_blank" rel="noreferrer noopener">10.1067/mob.2001.109401</a>
Panniculectomy at the time of gynecologic surgery in morbidly obese patients.
*Gynecologic Surgical Procedures; Adult; Aged; Evaluation Studies as Topic; Female; Humans; Hysterectomy; Incidence; Middle Aged; Morbid/*surgery; Obesity; Retrospective Studies; Surgical Wound Dehiscence/epidemiology; Time Factors; Wound Infection/epidemiology
OBJECTIVE: Our goal was to demonstrate that panniculectomy performed at the time of gynecologic surgery aids in reducing the operative time and exposure and does not increase the wound infection rate in morbidly obese patients. STUDY DESIGN: A retrospective survey was performed of massively obese patients who underwent panniculectomy at the time of gynecologic surgery at Northeastern Ohio Universities College of Medicine consortium hospitals from 1990-1999. Data collected during surgery included the patient's weight, operative opening and closing times, blood loss, and weight of the removed panniculus adiposus. Postoperative wound infection rates were monitored, and patients were followed up for 6 months. RESULTS: Seventy-eight patients underwent the following operations: radical hysterectomy (n = 19), extrafascial hysterectomy (n = 18), standard hysterectomy (n = 32), or other gynecologic surgery (n = 9). The average blood loss was 71 mL. Opening and closing times were 27 and 33 minutes, respectively, adding a minimal amount of operative time to the required gynecologic surgery. The average removed panniculus adiposus weighed 4745 g. Efficiency in obtaining exposure to the operative site was noted. A total of 2 wound infections were recorded in the postoperative period. In 1 case debridement was required, and in the other healing occurred by secondary intention. Minimal separation occurred in 4 other cases and required no intervention. CONCLUSION: Massively obese patients can safely undergo panniculectomy simultaneously with a gynecologic procedure. The difficulty with operative exposure is reduced, and these patients are better served intraoperatively. Postoperatively, the wound infection rates quoted for this population were markedly improved from prior studies and involved a larger group of patients.
Hopkins M P; Shriner A M; Parker M G; Scott L
American journal of obstetrics and gynecology
2000
2000-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1067/mob.2000.107333" target="_blank" rel="noreferrer noopener">10.1067/mob.2000.107333</a>
The myths of laparoscopic surgery.
*Laparoscopy/economics; Costs and Cost Analysis; Female; Female/surgery; General Surgery/education; Genital Neoplasms; Gynecologic Surgical Procedures/methods; Humans
Laparoscopic surgery has been rapidly accepted without rigorous scientific study. New procedures and technologies have advanced rapidly, and most gynecologists have embraced these techniques. I believe that the new technology has given rise to the following myths: (1) that there are associated cost savings, (2) that new technology is always better than the old, (3) that a steep learning curve is acceptable, (4) that market share will be lost without the new techniques, (5) that oncologic surgery is not different when performed laparoscopically, (6) that operations are the same with the laparoscope, and (7) that every gynecologist can do these procedures. A critical evaluation of new technology and of laparoscopic techniques needs to be performed.
Hopkins M P
American journal of obstetrics and gynecology
2000
2000-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1067/mob.2000.106053" target="_blank" rel="noreferrer noopener">10.1067/mob.2000.106053</a>
The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes.
*Bed Rest; Cardiovascular/*epidemiology; Female; Fetal Membranes; Humans; Obstetric Labor; Pregnancy; Pregnancy Complications; Premature Rupture/*therapy; Premature/*therapy; Puerperal Disorders/epidemiology; Pulmonary Embolism/epidemiology; Retrospective Studies; Risk Factors; Venous Thrombosis/*epidemiology
OBJECTIVE: This study was undertaken to determine the prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. STUDY DESIGN: A retrospective chart review was undertaken of all women who had bed rest of \textgreater/=3 days' duration prescribed as part of the treatment of premature labor or preterm premature rupture of membranes in the Akron General Medical Center Perinatal Unit during the period January 1, 1997-December 31, 1998. The prevalence of thromboembolic events in this population was determined. The charts of all additional gravid women with antepartum or postpartum deep vein thrombosis or pulmonary embolism diagnosed during the study period were also reviewed. The prevalence of these disorders among the pregnant population for whom extended bed rest was not prescribed as part of the treatment of premature labor or preterm premature rupture of membranes was also calculated. Statistical comparison of the prevalences in the 2 populations was undertaken by means of the chi(2) analysis with the Fisher exact test. RESULTS: There were 192 patients admitted during the study period who had extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. Three of these women had thromboembolic events, for a prevalence of 15.6 cases per 1000 women. Five additional gravid women were admitted for the treatment of deep vein thrombosis or pulmonary embolism. There were 6164 deliveries among women not treated with extended bed rest for premature labor or preterm premature rupture of membranes during this period. Thus the prevalence of these phenomena among the remaining pregnant women was 0.8 cases per 1000 women. The prevalences of these disorders in the 2 populations were highly significantly different. CONCLUSION: The prevalence of thromboembolic events among women for whom extended bed rest is prescribed as part of the treatment of premature labor or preterm premature rupture of membranes is significantly increased with respect to that among gravid women who do not receive this therapy and is substantially higher than previously reported. If this finding is confirmed in other populations, it may be prudent to undertake further studies to determine whether this prevalence can be reduced.
Kovacevich G J; Gaich S A; Lavin J P; Hopkins M P; Crane S S; Stewart J; Nelson D; Lavin L M
American journal of obstetrics and gynecology
2000
2000-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1067/mob.2000.105405" target="_blank" rel="noreferrer noopener">10.1067/mob.2000.105405</a>
The effect of intermittent-release intraperitoneal chemotherapy on wound healing.
Animals; Antineoplastic Agents/administration & dosage/*pharmacology; Carboplatin/administration & dosage/*pharmacology; Infusions; Laparotomy; Male; Paclitaxel/administration & dosage/*pharmacology; Parenteral; Rats; Sprague-Dawley; Tissue Adhesions/chemically induced; Wound Healing/*drug effects
OBJECTIVE: Our purpose was to study the effect on wound healing when intraperitoneal chemotherapy was instilled on a daily basis. STUDY DESIGN: Intraperitoneal carboplatin, Taxol, or saline solution was instilled daily into 70 rats after they underwent laparotomy. The animals were killed and analyzed for adhesions. An area measuring 5 x 5 cm including the incision was also harvested for biomechanical testing. The wound thickness was measured, and the Shore Western Materials Testing System (Monrovia, Calif.) was used to test the force required to break the wound, the stress, and the stiffness. RESULTS: Groups of 10 rats received saline solution control, carboplatin 6 mg/kg, 7 mg/kg, 8 mg/kg, or Taxol 2.5 mg/kg, 3.0 mg/kg, or 3.5 mg/kg. The total dose was divided into seven equal amounts, administered daily. No significant adhesions developed in any of the animals. The carboplatin group experienced no significant decrease in wound thickness whereas the higher-dose Taxol group had a significant decrease in thickness from 1.06 mm to 0.72 mm (p = 0.02). The wound-breaking strength (force) also decreased for the highest-dose Taxol group from 710 gm to 411 gm (p = 0.02). The wound stiffness was also decreased from 69 gm/mm to 46 gm/mm (p = 0.01). The other measured parameters for both the Taxol and carboplatin groups were not significantly decreased when compared with those of controls. CONCLUSION: The immediate instillation of divided daily carboplatin did not influence wound strength whereas the use of Taxol on a similar schedule significantly decreased wound strength.
Hopkins M P; von Gruenigen V E; Holda S; Weber B
American journal of obstetrics and gynecology
1997
1997-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9378(97)70606-9" target="_blank" rel="noreferrer noopener">10.1016/s0002-9378(97)70606-9</a>
Robotic radical hysterectomy.
*Robotics; Adult; Carcinoma/*surgery; Female; Humans; Hysterectomy/*methods; Treatment Outcome; Uterine Cervical Neoplasms/*surgery
OBJECTIVE: Advanced laparoscopic procedures are increasing being used in gynecologic surgery. The da Vinci robotic system (Intuitive Surgical Corporation, Sunnyvale, CA) can further augment laparoscopic surgery. We describe our initial experience using the da Vinci robotic system to perform radical hysterectomy. STUDY DESIGN: Twenty consecutive patients with primary stage IB-IIA cervical carcinoma underwent class 3 radical hysterectomy with the use of the da Vinci robotic system. Median age was 44 years, median weight was 69.9 kg, 65% of patients had medical comorbidity, and 40% had prior abdominal surgery. RESULTS: All 20 patients successfully underwent robotic radical hysterectomy. Median operative time was 6.5 hours (3.5-8.5 hours) and median blood loss was 300 mL. All patients were discharged on the first day after surgery. At median follow-up of 2 years (0.6-3 years), 90% of patients are alive and disease free. CONCLUSION: We report the first series of robotic radical hysterectomy for early stage cervical cancer. All cases were successfully performed robotically with minimal complications and all patients were discharged on postoperative day 1.
Fanning James; Fenton Bradford; Purohit Manisha
American journal of obstetrics and gynecology
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2007.11.002" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2007.11.002</a>
Cost-effectiveness analysis of the treatment of large leiomyomas: laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy.
80 and over; Adult; Aged; Cost-Benefit Analysis; Female; Humans; Hysterectomy; Hysterectomy/*economics; Laparoscopy/economics; Leiomyoma/*surgery; Middle Aged; Uterine Neoplasms/*surgery; Vaginal/economics
OBJECTIVE: The purpose of this study was to perform a cost-effectiveness analysis comparing the treatment of large leiomyomas by laparoscopic assisted vaginal hysterectomy (LAVH) versus abdominal hysterectomy (AH). STUDY DESIGN: Twenty consecutive LAVH were compared to 20 consecutive AH for leiomyoma \textgreater or = 250 g. Hospital costs were obtained through Healthcare cost accounting system. The 6 principles of cost-effectiveness analysis were used. RESULTS: The groups were similar in respect to age, weight, race, medical comorbidities, blood loss, and operative time. Median uterine weight (513 g) was approximately 20% \textgreater for LAVH. Length of stay and pain was significantly less for LAVH. Total hospital cost for AH was approximately 12% less expensive ($4394 vs $5023, P = .18). CONCLUSION: Because of multiple benefits of LAVH versus AH and no significant difference in cost, we believe LAVH is an acceptable treatment for large leiomyoma.
Mittapalli Raja; Fanning James; Flora Robert; Fenton Bradford W
American journal of obstetrics and gynecology
2007
2007-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2006.12.029" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2006.12.029</a>
Carboplatin and paclitaxel for the treatment of advanced or recurrent endometrial cancer.
Adult; Aged; Antineoplastic Agents; Antineoplastic Agents/administration & dosage; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use; Carboplatin/administration & dosage; Drug Administration Schedule; Endometrial Neoplasms/*drug therapy; Female; Humans; Local/drug therapy; Middle Aged; Neoplasm Recurrence; Paclitaxel/administration & dosage; Phytogenic/administration & dosage; Survival Analysis; Treatment Outcome
OBJECTIVE: The purpose of this study was to determine the activity and toxicity of carboplatin and paclitaxel (taxol) in the treatment of advanced or recurrent endometrial cancer. STUDY DESIGN: This was a retrospective review of 18 consecutive patients with advanced (stage 4) or recurrent endometrial adenocarcinoma that had been treated with outpatient carboplatin and taxol. Taxol was delivered at 135 mg/m 2 over 3 hours, and carboplatin was delivery at an area under the curve of 5 over 1 hour. Cycles were repeated every 21 days. RESULTS: The overall response rate was 63% with 28% of patients who had a partial response and 35% of patients who had a complete response. Kaplan-Meier test was used to estimate the median survival time of 27 months and the median progression free survival time of 24 months. No patient had neutropenia, thrombocytopenia or grade 3 vomiting, neurosensory toxicity, or renal toxicity. CONCLUSION: Carboplatin and taxol for the treatment of advanced or recurrent endometrial cancer appear to be active regimens with minimal toxicity.
Akram Tahira; Maseelall Priya; Fanning James
American journal of obstetrics and gynecology
2005
2005-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2004.12.032" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.12.032</a>
Resident physician attire: does it make a difference to our patients?
*Internship and Residency; *Physician-Patient Relations; Attitude of Health Personnel; Clothing/*standards; Female; Gynecology/*education/methods; Humans; Male; Obstetrics/*education/methods; Ohio; Patient Satisfaction; Physicians; Social Perception; Surveys and Questionnaires; Women
OBJECTIVES: This study was performed to examine the preferences of patients regarding physician attire, and if their perception of physician competence was influenced by the physicians' clothing style. METHODS: Patients attending the obstetrics and gynecology clinic in which residents provided the majority of direct patient care were invited to participate in this study by completing a questionnaire. Patients were first asked to respond to 3 questions about their preference regarding physician attire. They were then asked to examine a series of photographs illustrating a variety of physician clothing styles worn by a model. Patients were asked to respond to 2 questions: 1). If your doctor is dressed in this outfit, would that make you more or less comfortable talking to your physician?, and 2). If your doctor is dressed in this outfit, would it make you feel more or less confident in his/her abilities? RESULTS: The majority of the respondents expressed no preference for their physician wearing a white coat (60%/110/183), or they did not respond that a physician's dress influenced their comfort level (63%/111/179) or the confidence (62%/114/181) they had in their physician. However, for both male and female physician models, the comfort level of patients and their perceptions of physician competence were the highest in response to images of physicians dressed in scrubs with a white coat, and least for casual dress. CONCLUSION: Resident physician attire makes a difference to patients. Our patients prefer the white coat with surgical scrubs. Casual clothing is less well liked by our patients.
Cha Ann; Hecht Bryan R; Nelson Karl; Hopkins Michael P
American journal of obstetrics and gynecology
2004
2004-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2004.02.022" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.02.022</a>
Stimulation of distal airspace fluid clearance in guinea pigs involves bumetanide-sensitive ion transport.
*Ion Transport; Absorption; Adrenergic; Adrenergic beta-Antagonists/pharmacology; Animals; beta/physiology; Body Fluids/*metabolism; Bumetanide/*pharmacology; Diuretics/*pharmacology; Epinephrine/blood; Epithelium; Fetus/metabolism; Gestational Age; Guinea Pigs; Lung/*embryology/metabolism; Newborn; Propranolol/pharmacology; Receptors
OBJECTIVE: This study was undertaken to test the hypothesis that beta-adrenoceptor stimulation of fetal lung fluid absorption in near-term guinea pig fetuses involves bumetanide-sensitive ion transport. STUDY DESIGN: Fetuses were obtained from timed-pregnant guinea pigs at 61 to 69 days' gestation with and without oxytocin-induced preterm labor. The fetuses were placed on continuous positive airway pressure oxygenation, and an isosmolar 5% albumin solution was instilled into the lungs. Distal airspace fluid clearance was measured over 1 hour from the increase in distal airspace protein concentration as fluid was reabsorbed with and without the Cl(-) transport inhibitor bumetanide. RESULTS: Fetal lungs began to absorb distal airspace fluid at 64 to 66 days' gestation, and at birth, distal airspace fluid clearance rapidly quadrupled. Labor induction by oxytocin stimulated distal airspace fluid clearance. Distal airspace fluid clearance, when present, was sensitive to propranolol-inhibition and depended on beta-adrenoceptor stimulation. Fluid secretion at 61 days' gestation was reduced by bumetanide instillation. Bumetanide addition was only inhibitory when distal airspace fluid clearance was propranolol-sensitive. CONCLUSION: Beta-adrenoceptor stimulation from endogenous fetal epinephrine increased fetal distal airspace fluid clearance and involved bumetanide-sensitive ion transport.
Ye Xin; Norlin Andreas; Folkesson Hans G
American journal of obstetrics and gynecology
2004
2004-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2003.09.074" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2003.09.074</a>