J Reprod Med
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Comparative Study
The thromboelastogram and circulating lupus anticoagulant.
Abnormal lupus anticoagulant (LA) levels, as measured with the activated partial tissue thromboplastin and tissue thromboplastin inhibition tests, are associated with a predisposition toward thromboembolic phenomena. Thromboelastogram (TEG) measurements have been proposed as a standardized assay to predict such a predisposition. We therefore correlated LA and TEG assessments in 46 women who were either apparently healthy controls or who had abnormal LA levels with such conditions as endometriosis and repeated pregnancy wastage. ⋯ Only nine had concomitant LA and TEG abnormalities. We conclude that LA and TEG apparently are not interchangeable as predictors of a hypercoagulable state. While this study did not address which of the two assays has a better predictive value for thromboembolic phenomena, it suggested that each can identify a different patient population.
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Review Comparative Study
Laparoscopic sterilization. A comparison of current techniques.
Current techniques of laparoscopic sterilization--bipolar electrocoagulation, endocoagulation, silicone ring, Hulka clip and Filshie clip--were analyzed from a large pool of international data. Technical difficulties have been encountered much less with electrocoagulation than with the silicone ring, Hulka clip or Filshie clip. There have been fewer technical failures with bipolar electrocoagulation and endocoagulation than with the ring or clip. ⋯ The pregnancy rates after reversal surgery have been highest with the Hulka and Filshie clip. Electrical methods seem to be preferable in women with pelvic adhesions and tubal pathology. Clips seem to be preferable in women who may be candidates for future sterilization reversal.
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Necrotizing fasciitis is an unusual complication of gynecologic surgery. A woman developed necrotizing fasciitis at the site of suprapubic urinary catheter placement. The diagnostic criteria for necrotizing fasciitis were fulfilled by the patient, whose predisposition for the disease was undiagnosed diabetes mellitus. This rare complication of suprapubic catheter drainage must be considered in high-risk patients presenting with an inflammation at this site of cutaneous trauma.
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Postpartum endometritis (PPE) continues to be a leading cause of morbidity in the puerperium. The patient's endogenous cervicovaginal flora remains the source of the polymicrobial character of this infection. Patients in labor with ruptured membranes for more than three hours who undergo delivery by cesarean section have an increased risk of developing PPE.