Effects of ethinyl estradiol and ibuprofen compared to placebo on endometrial bleeding, cervical mucus and the postcoital test in levonorgestrel subcutaneous implant users.

Background: The study was conducted to evaluate ethinyl estradiol (EE) or ibuprofen (IBU) compared to placebo (PL) on spotting and bleeding (S/B) and a postcoital test (PCT) in women using the levonorgestrel subcutaneous implant. Women experiencing excessive S/B were enrolled in a multicenter prospective randomized study using EE, IBU or PL.

Outcome Measures: Duration of S/B and a PCT were evaluated.

The effect of a venous anastomosis Tyrell vein collar on the primary patency of arteriovenous grafts in patients undergoing hemodialysis.

Purpose: Vein collars and patches are used at the distal anastomoses of infrainguinal prosthetic grafts to improve graft patency. We initiated a randomized, prospective study to determine whether a Tyrell vein collar at the venous anastomosis of forearm loop arteriovenous grafts (AVGs) would improve patency.

Methods: Patients who required new forearm AVGs were randomized to (1) a standard end-to-side graft-vein anastomosis (control group) or (2) a Tyrell vein collar between the graft and the vein (study group).

Twin vaginal birth after cesarean.

Objective: To determine both success rate and maternal-fetal outcome of vaginal birth after cesarean in twin gestations.

Methods: We identified all women from a single center attempting vaginal birth of twins after cesarean from 1988-98. Twin pairs were excluded for delivery < or = 25 weeks gestation, monoamnionicity, nonvertex twin A, or major anomaly or death of either twin.

Intentional iron overdose in pregnancy--management and outcome.

The objectives of our study were to 1) determine if peak maternal serum iron level or toxicity stage after intentional overdose is associated with adverse maternal-fetal outcome, and 2) describe the use of deferoxamine antidote therapy in obstetric patients. A computer search of the English language literature from 1966-1998 used the key words iron toxicity, iron poisoning, deferoxamine, and pregnancy to identify peer-reviewed papers reporting intentional iron overdoses in pregnancy. Two investigators independently extracted data from articles and their references including stage of toxicity (0 = asymptomatic, 1 = gastrointestinal symptoms, 2 = metabolic disturbance, 3 = organ failure), with differences resolved by consensus.

A military application of a medical self-care program.

The cost of health care is a growing concern to the military. Many military clinic appointments and emergency department visits are unnecessary; they are for minor, self-limiting illnesses and injuries that could be treated at home. Military health care can no longer afford the luxury of treating minor illnesses and injuries in the hospital setting.

Fetal intracardiac echogenic foci: does it matter which ventricle?

We sought to determine whether an association exists between the location of intracardiac echogenic foci and fetal aneuploidy or structural cardiac lesions. A search of the English language literature since 1980 revealed nine studies reporting location of intracardiac echogenic foci, fetal chromosomal abnormalities, and cardiac anomalies. Aneuploidy was noted in 10 of 217 fetuses with left ventricular and in one of 18 with right ventricular intracardiac echogenic foci.

Use of surgical pass trays to reduce intraoperative glove perforations.

This randomized prospective study evaluated the surgical pass tray to reduce intraoperative glove perforation during cesarean delivery. Surgical team members were assigned to employ normal instrument pass techniques or surgical pass tray during all cesarean deliveries. Surgical team members were asked to record their surgical role and level of training.

Grief reactions of mothers of adolescents and young adults with traumatic brain injury.

One hundred and two mothers of adolescents and young adults with traumatic brain injury completed a modified Grief Experience Inventory (GEI) (Sanders, Mauger, & Strong, 1985) and rated their child's functioning on a modified Neurobehavioral Rating Scale (NRS) (Levin et al., 1987). More severe grief was reported by mothers who rated their children as having poor neurobehavioral functioning and by mothers of young adult rather than adolescent patients.

Single dose cefazolin prophylaxis for postcesarean infections: before vs. after cord clamping.

The objective of this study was to test the hypothesis that 1 g of cefazolin administered preoperatively is no more effective than the same dose administered after cord clamping in preventing postcesarean infectious morbidity. Ninety consecutive laboring subjects undergoing cesarean delivery at > or = 37 weeks gestation were randomized by computer to receive 1 g of cefazolin intravenously preoperatively or after cord clamping in a double-blinded, placebo-controlled study. The 2 groups were compared for differences in maternal and neonatal demographics, and intrapartum and operative characteristics associated with postcesarean infection.

Management of irregular uterine bleeding and spotting associated with Norplant.

Norplant, a systemic contraceptive, has been used extensively throughout the world. A major problem for consumers utilizing Norplant has been irregular, unpredictable uterine bleeding or spotting. This study seeks to determine whether or not an appropriate treatment could be found that will reduce the incidence of spotting and bleeding.

Graviceptor development in jellyfish ephyrae in space and on Earth.

Graviceptor (rhopalium) development in Aurelia aurita ephyrae which developed on Earth and in space during the nine-day NASA SLS-1 mission was compared. The space-developed ephyrae made graviceptors which were morphologically similar to those of their ground-based controls. Rhopalia of both groups developed statocysts with statoliths, ocelli, ciliated mechanoreceptor cells, and immature touch-plates with one type of hair cell.

Validation of the hemizona assay (HZA) in a monkey model. II. Kinetics of binding and influence of cryopreserved-thawed spermatozoa.

We compared fresh and frozen-thawed cynomolgus monkey spermatozoa tight binding to the zona pellucida under hemizona assay (HZA) conditions. Monkey oocytes were recovered after superovulation and stored in salt solution. Matching hemizonae were obtained by micromanipulation.

Flow cytometric DNA content and clinical outcome in patients with non-small cell lung cancer given postoperative radiation therapy.

DNA content by flow cytometry was assessed in 47 cases from a series of 130 patients with non-small cell lung carcinoma (NSCLC) given radiation therapy postoperatively. This was done in an attempt to identify which patients might benefit, or not benefit, from postoperative radiotherapy. From archival formalin-fixed paraffin-embedded specimens, 16 of the 47 cases (34%) had DNA diploid tumors while 31 cases (66%) were nondiploid.

Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal.

Sixty patients with bilaterally symmetrical impacted third molars participated in this double-blind, within-subject study to quantify the effects of 4 mg of dexamethasone on reducing postsurgical sequelae. Each patient's surgery was staged by mouth side and completed in two appointments 5 to 6 weeks apart. A preoperative dose of dexamethasone given intravenously was randomized to mouth side and surgical appointment; sterile water served as a control.

Surgical management of posthemorrhagic hydrocephalus in 22 low-birth-weight infants.

In order to assess the complication rates of cerebrospinal fluid diversion techniques used at our institution, a retrospective study of the surgical management of posthemorrhagic hydrocephalus was conducted from a population of 547 premature infants admitted to the neonatal intensive care unit from 1987 to 1989. The incidences of periventricular-intraventricular hemorrhage in the 3 years studied were 44%, 37%, and 27%, respectively. Thirty-nine of the infants developed posthemorrhagic hydrocephalus as determined by serial cranial ultrasonography; 22 required cerebrospinal fluid diversion.

Predictors of abnormal cervical cytology: statistical analysis of human papillomavirus and cofactors.

Reported increases in the incidence of human papillomavirus infection have generated speculation that cervical cytological abnormalities may also be increasing. A 10-year retrospective study of cervical cytology in 2,919 college women demonstrated a significant increase in the frequency and severity of cervical-cytological abnormalities (p - 0.0001).

Nuclear roundness factor and local failure from definitive radiation therapy for prostatic carcinoma.

Of 375 patients with prostatic carcinoma treated definitively with radiation therapy at this institution with at least a 5 year follow-up, 23 patients failed locally only, 72 failed with distant metastasis only, 60 had both local and distant failure, while 220 showed no evidence of disease. In search for a possible marker for local failure following radiation therapy, we examined several nuclear morphometric parameters which have been shown to correlate with the biologic aggressiveness of this disease. The 23 locally failed only patients were matched with 23 no evidence of disease patients for stage, grade, treatment modality, prior surgery, age at diagnosis and race.

Ultrasonographic appearance of the endometrium in natural and stimulated in-vitro fertilization cycles and its correlation with outcome.

Ultrasonographic evaluation of the endometrium in 56 IVF patients was performed prospectively. Endometrial thickness and pattern were analysed in 18 natural-cycle and 38 stimulated-cycle patients. Thickness was measured from the echogenic interface of the endometrium-myometrium junction on a transverse section at the level of the fundus.

Possible role of pure human follicle-stimulating hormone in the treatment of severe male-factor infertility by assisted reproduction: preliminary report.

Objective: Experimental clinical trial assessing the potential of systemic follicle-stimulating hormone (FSH) to improve sperm fertilizing ability in in vitro fertilization (IVF).

Design: Retrospective clinical evaluation of severe male factor patients failing fertilization in IVF or showing severe sperm defects.

Setting: Academic tertiary clinical care unit.

Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age.

A study of 1,478 consecutive in vitro fertilization (IVF) cycles was made to determine if basal follicle-stimulating hormone (FSH) levels and age were independent predictors of IVF performance. Regression analyses indicated independent contributions of both basal FSH and age in predicting cancellation rate, peak estradiol, number of oocytes retrieved, fertilized, and transferred, and total and ongoing pregnancy rates. Miscarriage rate was unrelated to both age and basal FSH.

Are three substages of clinical B prostate carcinoma useful in predicting disease-free survival?

The B1 nodule, a 1.5 cm area of induration surrounded on at least two sides by prostatic tissue of normal consistency, was defined by Jewett in 1968 as the stage of prostatic cancer best suited for treatment and cure by radical prostatectomy (RP). The area of prostatic induration suitable for RP was subsequently extended to less than one lobe (Stage B1); this extension of induration was supported by the study of Walsh and Jewett in 1980 showing a 51 percent survival free-of-disease at fifteen-year follow-up.

Relationship between morphology and motion characteristics of human spermatozoa in semen and in the swim-up sperm fractions.

In this study, the authors evaluated the morphology pattern and motion characteristics of human spermatozoa before and after swim-up separation. Samples were divided into two, morphologically different groups according to the percentage of normal sperm forms assessed by the strict criteria of the Norfolk laboratory: "good"(G) and "poor" (P) prognosis patterns. The percentages of normal forms, slightly abnormal forms, and severe head defects were significantly different in the two groups.

Measurement and prediction of hearing loss in a nursing home.

The purpose of this study was to evaluate the abilities of three paper-and-pencil tests to predict pure-tone hearing loss of nursing home residents. The three tests used were the staff version of the Nursing Home Hearing Handicap Index and two tests of mental status, the Mini Mental State and the Short Orientation-Memory-Concentration Test. Testing was done on the residents (n = 122) of a long-term, intermediate-care nursing home.