Obstetrics and gynecology
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Obstetrics and gynecology · Dec 1994
Prompt diagnosis of ectopic pregnancy in an emergency department setting.
To evaluate quantitative hCG measurements and transvaginal ultrasound in the diagnosis of ectopic pregnancy in patients presenting to the emergency department. ⋯ A protocol of quantitative hCG levels (available within hours of presentation to an emergency department) combined with transvaginal ultrasound is effective in diagnosing ectopic pregnancy.
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Obstetrics and gynecology · Dec 1994
The cost-effectiveness of prenatal carrier screening for cystic fibrosis.
To evaluate the economic consequences of routinely offering cystic fibrosis-carrier screening to pregnant white women under 35 years of age. ⋯ A prenatal cystic fibrosis-carrier screening program would not save the health care payer money under most assumptions, but may be justified if the benefit of the early information provided to expectant parents is judged worth the cost.
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Obstetrics and gynecology · Dec 1994
Comparative StudyBlood transfusion for radical hysterectomy before and after the discovery of transfusion-related human immunodeficiency virus infection.
To compare the patterns of perioperative blood transfusion in patients undergoing radical hysterectomy in time periods before and after the discovery of transfusion-related human immunodeficiency virus (HIV) infection. ⋯ During the perioperative period for radical hysterectomy and pelvic lymphadenectomy, the incidence of blood transfusion at our institution has markedly decreased over the past decade without immediate adverse effects on postoperative recovery. The reasons for this are probably multifactorial. However, the contribution of increased concern about transfusion-related HIV infections must be considered. Preoperative autologous donation can notably decrease the need for homologous transfusion.
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Obstetrics and gynecology · Nov 1994
Randomized Controlled Trial Clinical TrialPostoperative pain after local anesthetics for laparoscopic sterilization.
To test the effectiveness of intraperitoneal local anesthesia in relieving postoperative pain after laparoscopic sterilization. ⋯ Intraperitoneal instillation of lidocaine-epinephrine combined with mesosalpinx infiltration of lidocaine during tubal sterilization produces effective, long-lasting analgesia and improves the postoperative course.
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Obstetrics and gynecology · Oct 1994
Review Case ReportsGiant uterine fibromyoma producing secondary polycythemia.
Although the association between large uterine fibromyomas and secondary polycythemia has been described previously, the mechanism has not been elucidated definitively. Investigators have measured erythropoietin levels in fibromyomas to determine whether these tumors are causing the polycythemia by erythropoietin overproduction; however, these studies were performed before the availability of recombinant erythropoietin assays. ⋯ This case provides evidence for three of the postulated mechanisms by which uterine fibromyomas may cause polycythemia. First, the patient was hypoxic, suggesting shunting within the tumor. Second, the leiomyoma was compressing the ureters, so the kidneys may have been inappropriately producing excess erythropoietin. Third, the tumor itself may have been producing the erythropoietin. In any case, the erythropoietin level in this patient was inappropriately high, providing useful evidence that her polycythemia was secondary to her fibromyoma.