1
|
Kramer KJ, Ottum S, Gonullu D, Bell C, Ozbeki H, Berman JM, Recanati MA. Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus. PLoS One 2021; 16:e0261085. [PMID: 34882735 PMCID: PMC8659682 DOI: 10.1371/journal.pone.0261085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population. METHODS AND FINDINGS We followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent's Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence. CONCLUSION These results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.
Collapse
Affiliation(s)
- Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Medical Centers Manhattan, New York, New York, United States of America
| | - Sarah Ottum
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Damla Gonullu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Capricia Bell
- Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Hanna Ozbeki
- Milken Institute of Public Health, George Washington University, Washington, DC, United States of America
| | - Jay M. Berman
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Maurice-Andre Recanati
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail:
| |
Collapse
|
2
|
Berman JM, Bradley L, Hawkins SM, Levy B. Uterine Fibroids in Black Women: A Race-Stratified Subgroup Analysis of Treatment Outcomes After Laparoscopic Radiofrequency Ablation. J Womens Health (Larchmt) 2021; 31:593-599. [PMID: 34287028 PMCID: PMC9063135 DOI: 10.1089/jwh.2020.9001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The disease and treatment burden of uterine fibroids (UF) in Black women is substantially greater compared with other racial groups, with higher rates of complications and poorer outcomes with both hysterectomy and myomectomy. The inequities in the access Black women have to minimally invasive routes of surgery contribute to their burden of illness. Laparoscopic radiofrequency ablation (LAP-RFA) is a minimally invasive, safe, and effective uterine-sparing treatment option. Methods: This subgroup analysis of the LAP-RFA Pivotal Trial stratified outcomes by race comparing White women (n = 28, 21%) versus Black women (n = 46, 34%). Results: At baseline, Black women had more fibroids on average (7.3 vs. 3.7; P ≤ 0.001), a greater symptom severity score (SSS) (P ≤ 0.001), and a lower health-related quality of life (HRQoL) score (P = 0.005) than White women. At 36 months post-treatment with LAP-RFA, the statistical differences that existed with baseline SSS and HRQoL score were eliminated between Black and White women. Menstrual blood loss (140.1 mL vs. 127.02 mL; P = 0.44) and mean fibroid volume reduction (47.5 cm3 vs. 36.0 cm3; P = 0.17) were similar between Black and White women at 12 months. Although not statistically significant, the intraoperative total blood loss and uterine blood loss was lower in Black women than White women, despite greater operative time (160 minutes vs. 137 minutes; P = 0.09). Conclusions: These results are promising in providing an alternative uterine-sparing option for Black women and may help to provide a minimally invasive option that can address some of the racial inequities in care for Black women with UF.
Collapse
Affiliation(s)
- Jay M Berman
- Wayne State University Medical School, Detroit, Michigan, USA
| | - Linda Bradley
- Department of OB-GYN and Reproductive Biology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Soyini M Hawkins
- Fibroid and Pelvic Wellness Center of Georgia, Peachtree Corners, Georgia, USA
| | - Barbara Levy
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
3
|
Berman JM, Shashoua A, Olson C, Brucker S, Thiel JA, Bhagavath B. Case Series of Reproductive Outcomes after Laparoscopic Radiofrequency Ablation of Symptomatic Myomas. J Minim Invasive Gynecol 2020; 27:639-645. [DOI: 10.1016/j.jmig.2019.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 11/24/2022]
|
4
|
Berman JM. An Observational Study of Reproductive Outcomes in Clinical Trials and Commercial Settings After Laparoscopic Radiofrequency Ablation of Symptomatic Myomas. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
5
|
Dean J, Kramer KJ, Akbary F, Wade S, Hüttemann M, Berman JM, Recanati MA. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC Womens Health 2019; 19:70. [PMID: 31138184 PMCID: PMC6537409 DOI: 10.1186/s12905-019-0766-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/13/2019] [Indexed: 12/03/2022]
Abstract
Background To determine whether oral norethindrone acetate is superior to combined oral contraceptives (OCP) in delaying menstruation and preventing breakthrough bleeding when started late in the cycle. Methods This article comprises of a case control study followed by a pilot randomized controlled study. In the first study, four women who presented late in their cycle and desired avoiding vaginal bleeding within 10 days before a wedding were started on norethindrone 5 mg three times daily and compared to age matched controls started on OCPs. Subsequently, a randomized controlled pilot study (n = 50) comparing OCPs to norethindrone for the retiming of menses was conducted. Percentage of women reporting spotting were compared with level of statistical significance set at p < 0.05. Results Of the norethindrone treated group, only 2 women (8%) reported spotting compared with 10 women (43%) in the control group (p < 0.01). Norethindrone recipients experienced significant weight gain, which resolved after cessation of therapy and had heavier withdrawal bleed (p < 0.04) when compared to controls. Patient satisfaction was significantly higher in the norethindrone group, with 80% willing to choose this method again. Time to conceive was significantly shorter in the norethindrone group (p < 0.03). Conclusions Norethindrone, begun on or before cycle day 12, is superior for women who desire to avoid breakthrough bleeding and maintain fertility when compared to OCPs. It is an ideal approach in patients presenting late in their cycle and who desire delaying menses as well as in circumstances when even minute amounts of breakthrough bleeding cannot be tolerated. Trial registration Clinicaltrials.gov NCT03594604, July 2018. Retrospectively registered.
Collapse
Affiliation(s)
- Joshua Dean
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Katherine J Kramer
- Department of Obstetrics and Gynecology, St. Vincent's Catholic Medical Centers, New York, NY, 10011, USA
| | - Fauzia Akbary
- Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Shaunte Wade
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jay M Berman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA
| | - Maurice-Andre Recanati
- NIH-Women's Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA.
| |
Collapse
|
6
|
Hoyos LR, Leon-Peters J, Berman JM, Hertz M. Pregnancy following hysteroscopic sterilization at an Urban Abortion Clinic- A case series: Are We looking in the wrong places? Contraception 2016; 94:78-80. [PMID: 27000998 DOI: 10.1016/j.contraception.2016.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. However, recent evidence suggests that the failure rate may be higher than previously reported. We describe women with a history of HS presenting for abortion at a 3-site urban abortion clinic. STUDY DESIGN Retrospective case series of patients with previous HS who presented to a 3-site urban abortion clinic for pregnancy termination from October 2012 to February 2015. RESULTS In 28months, 9 patients with prior HS had failure of the method and then an abortion. CONCLUSIONS This study identifies a number of failures from a setting previously unaccounted. It suggests that perhaps the failure rate is higher than previously reported. The cases here presented, from a 3-site urban abortion clinic over 28months, almost match and sometimes surpass the number of failures reported in multicenter case series in the literature. Surveys of other abortion clinics in the U.S. and elsewhere might also discover other patients whose HS had failed. IMPLICATIONS We identified a number of hysteroscopic sterilization failures at termination of pregnancy at a 3-site urban abortion clinic. We hypothesize that the HS failure rate underestimates the true method failure because previous analysis have excluded cases such as these.
Collapse
Affiliation(s)
- Luis R Hoyos
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Jocelyn Leon-Peters
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Jay M Berman
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Michael Hertz
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| |
Collapse
|
7
|
Lukes AS, Roy KH, Presthus JB, Diamond MP, Berman JM, Konsker KA. Randomized comparative trial of cervical block protocols for pain management during hysteroscopic removal of polyps and myomas. Int J Womens Health 2015; 7:833-9. [PMID: 26543383 PMCID: PMC4621276 DOI: 10.2147/ijwh.s50101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of two cervical block protocols for pain management during hysteroscopic removal of intrauterine polyps and myomas using the MyoSure® device. Patients and methods This was a randomized, comparative treatment trial conducted by five private Obstetrics and Gynecology practices in the USA. Forty premenopausal women aged 18 years and older were randomized to receive either a combination para/intracervical block protocol of 37 cc local anesthetic administered at six injections sites in association with the application of topic 1% lidocaine gel, or an intracervical block protocol of 22 cc local anesthetic administered at three injections sites without topical anesthetic, for pain management during hysteroscopic removal of intrauterine polyps and/or a single type 0 or type 1 submucosal myoma ≤3 cm. The main outcomes were a composite measure of procedure-related pain and pain during the postoperative recovery period, assessed by the Wong-Baker Faces Rating Scale (0= no pain to 10= maximum pain). The lesion characteristics, procedure time, and adverse events were summarized. Results A total of 17 polyps and eight myomas were removed in the para/intracervical block group, with diameters of 1.3±0.5 cm and 1.8±0.8 cm, respectively. In the intracervical block group, 25 polyps with a mean diameter of 1.2±0.7 cm and 7 myomas with a mean diameter of 1.9±0.9 cm were removed. The mean tissue resection time was 1.2±2.0 minutes and 1.2±1.4 minutes for the para/intracervical and intracervical block groups, respectively. The mean composite procedure-related pain score was low for both cervical block protocols, 1.3±1.4 in the para/intracervical block group vs 2.1±1.5 in the intracervical block group. During the postoperative recovery period, the mean pain scores were 0.3±0.7 vs 1.2±1.7 for the para/intracervical and intracervical block groups, respectively. There were no serious adverse events. Conclusion The MyoSure procedure for removal of polyps and myomas was well tolerated, with low pain scores reported for both the para/intracervical and intracervical block protocols.
Collapse
Affiliation(s)
- Andrea S Lukes
- Carolina Women's Research and Wellness Center, Durham, NC, USA
| | - Kelly H Roy
- Phoenix Gynecology Consultants, Phoenix, AZ, USA
| | | | | | | | | |
Collapse
|
8
|
Berman JM, Bolnick JM, Pemueller RR, Garza Leal JG. Reproductive Outcomes in Women Following Radiofrequency Volumetric Thermal Ablation of Symptomatic Fibroids. A Retrospective Case Series Analysis. J Reprod Med 2015; 60:194-198. [PMID: 26126303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To report reproductive outcomes in women who underwent radiofrequency volumetric thermal ablation (RFVTA) of symptomatic uterine fibroids. STUDY DESIGN Retrospective analysis of fibroid characteristics, treatment parameters, and pregnancy outcomes of 6 subjects in 3 prospective trials of laparoscopic ultrasound-guided RFVTA. RESULTS Despite the requirement that women enrolled in the RFVTA studies did not desire current or future childbearing and were to continue contraception, 6 subjects conceived at between 3.5 and 15 months postreatment. The number of fibroids treated per patient ranged from 1 to 7, measured between 1.0 cm and 7.6 cm at the greatest diameter, and included multiple types (submucosal, intramural, transmural, and subserosal). Five patients (5/6, 83%) delivered full-term healthy infants: 1 by vaginal delivery and 4 by cesarean section. One patient (1/6, 17%) had a spontaneous miscarriage in the first trimester. CONCLUSION Viable, full-term pregnancies are possible after RFVTA. Further, in-depth study of pregnancy outcomes following laparoscopic ultrasound-guided radiofrequency, volumetric ablation of fibroids is warranted.
Collapse
|
9
|
Berman JM, Krewson DP, Livingston JM, Moser D, Schultz MK. Analysis of the safety and reliability of a hydrothermal ablation system: a multicenter, prospective postmarket study. J Reprod Med 2014; 59:299-305. [PMID: 24937973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To obtain information on practitioner experience in the use of the Genesys HydroThermAblator (HTA) System under normal clinical conditions through documentation of the system's acute safety features, in terms of burn rates, and its technical reliability. STUDY DESIGN This was a prospective, observational, multicenter, postmarket interventional clinical trial with outcome measures of acute (within 21 days post-procedure) safety, serious adverse device effects, and technical malfunctions in a population of premenopausal women > or = 18 years of age. RESULTS A total of 992 women (mean age, 41.7 +/- 6.8 years; range, 22-65 years) were enrolled in 18 clinical sites throughout the United States. The Genesys HTA System provided low burn rates in the intent-to-treat (n = 992 [0.4%] [95% CI 0.1-1.0%]) and evaluable (n = 931 [0.2%] [95% CI 0.1-0.8%]) subject populations. Only 1 burn was clinically significant and was defined as a serious adverse device effect (1/992 [0.10%] [95% CI 0.0-0.6%]). Fifty-three (5.1%) technical malfunctions occurred in 44 procedures, and 27 (27/44 [61.4%]) patients completed their procedures after 31 (31/ 53 [58.5%]) technical problems were addressed and resolved. CONCLUSION The Genesys HTA System delivers a safe and reliable treatment option for premenopausal women with heavy menstrual bleeding.
Collapse
|
10
|
Levine DJ, Berman JM, Harris M, Chudnoff SG, Whaley FS, Palmer SL. Sensitivity of myoma imaging using laparoscopic ultrasound compared with magnetic resonance imaging and transvaginal ultrasound. J Minim Invasive Gynecol 2013; 20:770-4. [PMID: 24021910 DOI: 10.1016/j.jmig.2013.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine the efficacy of laparoscopic ultrasound (LUS) as compared with contrast-enhanced magnetic resonance imaging (CE-MRI) and transvaginal ultrasound (TVUS) in detection of uterine myomas. DESIGN Retrospective study of imaging methods used in a trial of LUS-guided radiofrequency volumetric thermal ablation in women with symptomatic myomas (Canadian Task Force classification II-2). SETTING Eleven medical university or private outpatient surgery clinics in the United States (nine sites) and Latin America (two sites). PATIENTS One hundred thirty-five women with symptomatic myomas and objectively confirmed moderate to severe heavy menstrual bleeding. INTERVENTIONS LUS-guided radiofrequency volumetric thermal ablation of myomas. MEASUREMENTS AND MAIN RESULTS Preoperative TVUS scans and CE-MRIs were read at each site, and all CE-MRIs were read by a central reader. LUS-guided scans were obtained intraoperatively by each surgeon by mapping the uterus just before radiofrequency volumetric thermal ablation. The imaging methods and their yields in terms of number of myomas found per subject were as follows: TVUS, 403 myomas (mean [SD] 3 [1.8]; range, 1-8); site CE-MRI, 562 myomas (4.2 [3.8]; range, 1-18); central reader, 619 myomas (4.6 [3.7]; range, 0-20); and LUS, 818 myomas (6.1 [4.9]; range, 1-29) (p < .001). LUS was superior to TVUS, CE-MRI, and the central reader for detection of small (≤1 cm(3)) myomas. Most imaged myomas were intramural: 197 (50.9%) by TVUS, 298 (55.5%) by site CE-MRI, 290 (48.7%) by the central reader, and 386 (48.5%) by LUS. CONCLUSION Compared with CE-MRI and TVUS, LUS demonstrates the most myomas, regardless of size or type.
Collapse
Affiliation(s)
- David J Levine
- Department of Obstetrics and Gynecology, St. John's Mercy Hospital, St. Louis, Missouri.
| | | | | | | | | | | |
Collapse
|
11
|
Berman JM, Puscheck EE, Diamond MP. Full-term vaginal live birth after laparoscopic radiofrequency ablation of a large, symptomatic intramural fibroid: a case report. J Reprod Med 2012; 57:159-163. [PMID: 22523877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND This case study describes the first reported vaginal delivery following radiofrequency ablation (RFA) of fibroids. The subject was among a cohort of women seeking treatment for symptomatic fibroids. She was enrolled in a clinical trial studying outcomes of laparoscopic, ultrasound-guided RFA of symptomatic fibroids. CASE A 38-year-old, G4P3, female was diagnosed with uterine fibroids following a spontaneous abortion and preterm delivery at 21 weeks of a nonviable infant. RFA was performed on 7 fibroids, the largest of which was measured by magnetic resonance imaging (MRI) to be a 6.1-cm, submucosal-intramural, right posterior leiomyoma. The patient conceived approximately 3.5 months after RFA. She had a spontaneous labor at term with an uncomplicated vaginal delivery of a 3,487-g female infant (Apgars: 9, 9). Post-RFA and post-delivery MRI images indicated a myometrial thickness of 9.6 mm throughout, including beneath the ablation site. CONCLUSION The lack of a uterine defect following RFA in this case may have allowed this patient to progress to term without uterine rupture as has been reported with conventional myomectomy. The use of RFA in infertile women needs further study, and the decision to perform a cesarean section in women who have had RFA needs to be evaluated. The potential to treat many fibroid patients without requirement for subsequent cesarean section also needs further study.
Collapse
Affiliation(s)
- Jay M Berman
- Division of Gynecology, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Women's Hospital, 3990 John R, 7 Brush North, Detroit, MI 48201, USA.
| | | | | |
Collapse
|
12
|
Banerjee J, Jeelani R, Berman JM, Diamond MP. Missing IUD and utilization of fluoroscopy for management: a case report. Contraception 2012; 86:285-7. [PMID: 22305915 DOI: 10.1016/j.contraception.2011.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION A missing intrauterine device (IUD) poses challenges in diagnosis and treatment. Extrauterine placement of IUDs may cause difficulty in localization. We report a case where use of fluoroscopy just prior to laparoscopic intervention to remove the missing IUD was beneficial. CASE This case report involves a 35-year-old woman who was diagnosed with a missing thread 2 years after insertion of a levonorgestrel IUD (Mirena). Initial diagnostic workup consisting of abdominal X-ray, an ultrasound and diagnostic laparoscopy failed to localize the IUD. We performed an office pelvic ultrasound which confirmed that an IUD was present but could not specifically localize the IUD in the pelvic or abdominal cavity. Hence, we utilized fluoroscopy just prior to laparoscopy to localize and remove the missing device and allow its removal. CONCLUSION Various imaging modalities aid in detecting a missing IUD, but proper selection of fluoroscopy helped to localize extrauterine placement of an IUD device. We suggest that utilization of this imaging method just prior to laparoscopy may be of value in selected cases.
Collapse
Affiliation(s)
- Jashoman Banerjee
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA.
| | | | | | | |
Collapse
|
13
|
Shavell VI, Abdallah ME, Zakaria MA, Berman JM, Diamond MP, Puscheck EE. Misdiagnosis of cervical ectopic pregnancy. Arch Gynecol Obstet 2011; 285:423-6. [DOI: 10.1007/s00404-011-1980-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 06/29/2011] [Indexed: 11/29/2022]
|
14
|
Shavell VI, Mahdi HM, Awonuga AO, Edelman DA, Webber JD, Gidwani RM, Husain M, Berman JM. Appendectomy in the Gynecological Setting: Intraoperative Findings and Corresponding Histopathology. Gynecol Obstet Invest 2011; 71:189-92. [DOI: 10.1159/000317270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/14/2010] [Indexed: 11/19/2022]
|
15
|
Shavell VI, Al-Safi Z, Billis-Gergics LC, Kmak DC, Diamond MP, Berman JM. Reasons for poststerilization hysterosalpingography noncompliance in a clinic population. J Reprod Med 2010; 55:459-463. [PMID: 21291030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Although hysterosalpingography (HSG) is required 12 weeks after hysteroscopic sterilization, HSG compliance in our clinic population is remarkably low. We were interested in determining the reason(s) for HSG noncompliance in this urban-based patient population. STUDY DESIGN University Health Center patients who underwent hysteroscopic sterilization between January 1, 2006, and December 31, 2007, and who did not complete HSG were contacted by telephone to elicit the reason(s) for lack of follow-up. RESULTS Fifty-two patients qualified for inclusion in this study. Consent was obtained from all 14 patients accessible by telephone. Of note, 63.5% of patient-provided phone numbers were not in service at the time contact was attempted (n = 33). Patient-reported reasons for HSG noncompliance included insurance issues (n = 5), failure to remember to schedule HSG (n = 4), HSG scheduling difficulties (n = 2),failure to be informed about the need for HSG (n = 2), and prolonged postoperative vaginal bleeding (n =1). CONCLUSION Reasons for poststerilization HSG noncompliance varied. However, an insurance issue was the most frequently reported reason for noncompliance. not recalling the need to schedule HSG was another common reason for noncompliance. Approaches to increase compliance with poststerilization HSG are needed, particularly in an urban-based, clinic population.
Collapse
Affiliation(s)
- Valerie I Shavell
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, and Hutzel Women's Health Specialists, Detroit Medical Center, Detroit, Michigan 48201, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Shavell VI, Abdallah ME, Diamond MP, Berman JM. Placement of a permanent birth control device at a university medical center. J Reprod Med 2009; 54:218-222. [PMID: 19438163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the Essure placement failure rate and analyze factors associated with failure in an urban, nonstudy population at a university medical center. STUDY DESIGN A retrospective study was conducted of women who underwent attempted Essure hysteroscopic sterilization at the Detroit Medical Center (DMC) from January 1, 2003, to June 30, 2007. RESULTS There were 316 Essure procedures attempted at the DMC from January 2003 through June 2007. Of the 316 attempted procedures, there were 22 device placement failures and 3 documented post-Essure pregnancies. Of the 22 placement failures, 11 were attributed to difficulty visualizing the tubal ostia. Other causes of failure included device malfunction, uterine perforation, tubal perforation, expulsion of the device, tubal spasm, tubal ostia too large for the device and unspecified. Difficulty visualizing the ostia (p < 0.001) and a longer procedure time (p = 0.008) were significantly associated with failure. CONCLUSION The rate of successful placement of the Essure permanent birth control device at the DMC is 92.1%, with a post-Essure pregnancy rate of 0.95%. The majority of placement failures may be attributed to difficulty visualizing the tubal ostia.
Collapse
Affiliation(s)
- Valerie I Shavell
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
17
|
Shavell VI, Abdallah ME, Shade GH, Diamond MP, Berman JM. Trends in Sterilization since the Introduction of Essure Hysteroscopic Sterilization. J Minim Invasive Gynecol 2009; 16:22-7. [DOI: 10.1016/j.jmig.2008.08.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/26/2008] [Accepted: 08/29/2008] [Indexed: 10/21/2022]
|
18
|
Shavell VI, Abdallah ME, Diamond MP, Kmak DC, Berman JM. Post-Essure Hysterosalpingography Compliance in a Clinic Population. J Minim Invasive Gynecol 2008; 15:431-4. [DOI: 10.1016/j.jmig.2008.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 02/22/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
|
19
|
Sherrill RG, Berman JM, Birkemo L, Croom DK, Dezube M, Ervin GN, Grizzle MK, James MK, Johnson MF, Queen KL, Rimele TJ, Vanmiddlesworth F, Sugg EE. 1,4-Benzodiazepine peripheral cholecystokinin (CCK-A) receptor agonists. Bioorg Med Chem Lett 2001; 11:1145-8. [PMID: 11354363 DOI: 10.1016/s0960-894x(01)00164-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A series of 1,4-benzodiazepines, N-1-substituted with an N-isopropyl-N-phenylacetamide moiety, was synthesized and screened for CCK-A agonist activity. In vitro agonist activity on isolated guinea pig gallbladder along with in vivo induction of satiety following intraperitoneal administration in a rat feeding assay was demonstrated.
Collapse
Affiliation(s)
- R G Sherrill
- Department of Medicinal Chemistry, Glaxo Welcome Research and Development, Research Triangle Park, NC 27709, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- J M Berman
- Division of Gastroenterology and Hepatology, Jefferson Medical College, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|
21
|
Abstract
PURPOSE The purpose of our study was to investigate the less commonly demonstrated CT patterns nodular hepatosplenic sarcoidosis. METHOD We studied five women patients, utilizing contrast enhanced incremental or spiral CT. We also performed a literature search of hepatosplenic sarcoid for the years 1966-1995. RESULTS We found five nodular hepatic and/or splenic patterns of sarcoidosis. CONCLUSION We conclude that increased awareness and recognition of these patterns of nodular hepatic/splenic sarcoidosis on CT will greatly improve detection and diagnosis of abdominal sarcoidosis.
Collapse
Affiliation(s)
- G C Scott
- Department of Radiology, Louisiana State University Medical Center, New Orleans 70112-2822, USA
| | | | | |
Collapse
|
22
|
Brooker RF, Butterworth JF, Kitzman DW, Berman JM, Kashtan HI, McKinley AC. Treatment of hypotension after hyperbaric tetracaine spinal anesthesia. A randomized, double-blind, cross-over comparison of phenylephrine and epinephrine. Anesthesiology 1997; 86:797-805. [PMID: 9105223 DOI: 10.1097/00000542-199704000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite many advantages, spinal anesthesia often is followed by undesirable decreases in blood pressure, for which the ideal treatment remains controversial. Because spinal anesthesia-induced sympathectomy and management with a pure alpha-adrenergic agonist can separately lead to bradycardia, the authors hypothesized that epinephrine, a mixed alpha- and beta-adrenergic agonist, would more effectively restore arterial blood pressure and cardiac output after spinal anesthesia than phenylephrine, a pure alpha-adrenergic agonist. METHODS Using a prospective, double-blind, randomized, cross-over study design, 13 patients received sequential infusions of epinephrine and phenylephrine to manage hypotension after hyperbaric tetracaine (10 mg) spinal anesthesia. Blood pressure, heart rate, and stroke volume (measured by Doppler echocardiography using the transmitral time-velocity integral) were recorded at baseline, 5 min after injection of tetracaine, and before and after management of hypotension with epinephrine and phenylephrine. Cardiac output was calculated by multiplying stroke volume x heart rate. RESULTS Five min after placement of a hyperbaric tetracaine spinal anesthesia, significant decrease in systolic (from 143 +/- 6 mmHg to 125 +/- 5 mmHg; P < 0.001), diastolic (from 81 +/- 3 to 71 +/- 3; P < 0.001), and mean (from 102 +/- 4 to 89 +/- 3; P < 0.001) arterial pressures occurred. Heart rate (75 +/- 4 beats/min to 76 +/- 4 beat/min; P = 0.9), stroke volume (115 +/- 17 to 113 +/- 13; P = 0.9), and cardiac output (8.0 +/- 1 l/m to 8.0 +/- 1l/m; P = 0.8) did not change significantly after spinal anesthesia. Phenylephrine was effective at restoring systolic blood pressure after spinal anesthesia (120 +/- 6 mmHg to 144 +/- 5 mmHg; P < 0.001) but was associated with a decrease in heart rate from 80 +/- 5 beats/min to 60 +/- 4 beats/min (P < 0.001) and in cardiac output from 8.6 +/- 0.7 l/m to 6.2 +/- 0.7 l/m (P < 0.003). Epinephrine was effective at restoring systolic blood pressure after spinal anesthesia (119 +/- 5 mmHg to 139 +/- 6 mmHg; P < 0.001) and was associated with an increase in stroke volume from 114 +/- 12 ml to 142 +/- 17 (P < 0.001) and cardiac output from 7.8 +/- 0.6 l/m to 10.8 +/- 1.1 l/m (P < 0.001). CONCLUSIONS Epinephrine management of tetracaine spinal-induced hypotension increases heart rate and cardiac output and restores systolic arterial pressure but does not restore mean and diastolic blood pressure. Phenylephrine management of tetracaine spinal-induced hypotension decreases heart rate and cardiac output while restoring systolic, mean, and diastolic blood pressure.
Collapse
Affiliation(s)
- R F Brooker
- Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston Salem, North Carolina 27157-1009, USA
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
High-resolution, real-time sonography is commonly used for the evaluation of acute scrotal pathology. Pulsed and color Doppler techniques enhance diagnostic accuracy [1, 2]. However, extensive distortion of intrascrotal anatomy can occur with advanced inflammation, infarction, or trauma, leading to decreased specificity of the sonographic examination.
Collapse
Affiliation(s)
- J M Berman
- Department of Radiology, Louisiana State University, New Orleans 70112, USA
| | | | | | | |
Collapse
|
24
|
Abouleish AE, Berman JM. Transfusion vs anesthesia-related hepatitis. JAMA 1996; 275:361-2. [PMID: 8569013 DOI: 10.1001/jama.1996.03530290031029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
25
|
Aquino CJ, Armour DR, Berman JM, Birkemo LS, Carr RA, Croom DK, Dezube M, Dougherty RW, Ervin GN, Grizzle MK, Head JE, Hirst GC, James MK, Johnson MF, Miller LJ, Queen KL, Rimele TJ, Smith DN, Sugg EE. Discovery of 1,5-benzodiazepines with peripheral cholecystokinin (CCK-A) receptor agonist activity. 1. Optimization of the agonist "trigger". J Med Chem 1996; 39:562-9. [PMID: 8558528 DOI: 10.1021/jm950626d] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Directed screening of compounds selected from the Glaxo registry file for contractile activity on the isolated guinea pig gallbladder (GPGB) identified a series of 1,5-benzodiazepines with peripheral cholecystokinin (CCK) receptor agonist activity. Agonist efficacy within this series was modulated by variation of substituents on the N1-anilinoacetamide moiety. Remarkably, a single methyl group confers agonist activity, with an N-isopropyl substituent providing optimal efficacy. Hydrophilic substituents on the anilino nitrogen abolish agonist activity or produce antagonists of CCK. In contrast, hydrophilic electron-donating groups at the para-position of the anilino ring enhance or maintain in vitro and in vivo agonist activity. Despite decreased affinity for the human CCK-A receptor, relative to CCK-8, some of these compounds are equipotent to CCK as anorectic agents in rats following intraperitoneal administration.
Collapse
Affiliation(s)
- C J Aquino
- Department of Medicinal Chemistry, Glaxo Wellcome, Research Triangle Park, North Carolina 27709, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Friederich JA, Heyneker TJ, Berman JM. Anesthetic management of a massively morbidly obese patient. Reg Anesth 1995; 20:538-42. [PMID: 8608074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES A 408-kg patient presented for surgical resection of a lower extremity mass. METHODS A specially designed bed and well-planned transport were used to deliver the patient to the operating room suite. The anesthetic technique included a continuous subarachnoid catheter with tetracaine and epinephrine. Intraoperative monitoring consisted of electrocardiography, pulse oximetry, intraarterial blood pressure, and mental status examinations. Massive intraoperative hemorrhage was treated with rapid volume infusions and vasopressors. RESULTS Resection of a lower extremity mass was accomplished and the patient was eventually discharged from the hospital. CONCLUSIONS The case report emphasizes that prior planning of all aspects of patient care is important in massively morbidly obese patients and that regional anesthesia is a valuable option in these patients.
Collapse
Affiliation(s)
- J A Friederich
- Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1009, USA
| | | | | |
Collapse
|
27
|
Affiliation(s)
- S K Woelfel
- University of Pittsburgh School of Medicine, PA
| | | | | |
Collapse
|
28
|
Berman JM. Occupational entrants in 1990-91. OCCUP Outlook Q 1994; 37:12-23. [PMID: 10125573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- J M Berman
- Office of Employment Projections, Bureau of Labor Statistics
| |
Collapse
|
29
|
Morell RC, Berman JM, Royster RI, Petrozza PH, Kelly JS, Colonna DM. Revised label regarding use of succinylcholine in children and adolescents. Anesthesiology 1994; 80:242-5. [PMID: 8291724 DOI: 10.1097/00000542-199401000-00046] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
30
|
Berman JM, Cosca TA. The job outlook in brief 1990-2005. OCCUP Outlook Q 1993; 36:6-44. [PMID: 10118931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Every 2 years, the Bureau of Labor Statistics publishes a summary of the expected change in employment for about 250 occupations. Here are the most recent projections, along with the available information on the expected competition for jobs.
Collapse
Affiliation(s)
- J M Berman
- Office of Employment Projections, Bureau of Labor Statistics
| | | |
Collapse
|
31
|
Kripke SA, De Paula JA, Berman JM, Fox AD, Rombeau JL, Settle RG. Experimental short-bowel syndrome: effect of an elemental diet supplemented with short-chain triglycerides. Am J Clin Nutr 1991; 53:954-62. [PMID: 1706907 DOI: 10.1093/ajcn/53.4.954] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To determine whether short-chain triglycerides (SCTs, 1:1 triacetin:tributyrin, wt:wt) enhance intestinal adaptation in short-bowel syndrome (SBS), male Sprague-Dawley rats underwent 60% distal small-bowel resection with cecectomy and received either a chemically defined diet (CD) or a CD containing 40% of nonprotein energy as either medium-chain triglycerides (MCTs) or SCTs. After 12 d the SCT group had significantly increased jejunal mucosal weight compared with the MCT and CD groups and had significantly increased segment weight and mucosal protein compared with the CD group. In the colon the SCT group had significantly increased segment and mucosal weights and mucosal protein and DNA compared with both the MCT and CD groups. Body-weight change and measurements of serum ketones, albumin, glucose, and triglycerides revealed no significant differences among groups. SCTs improved jejunal and colonic adaptive growth and maintained comparable nutritional status in SBS when compared with CD alone or CD with MCTs.
Collapse
Affiliation(s)
- S A Kripke
- Philadelphia Veterans Affairs Medical Center, Philadelphia
| | | | | | | | | | | |
Collapse
|
32
|
Berman JM. Arthroscopy update #8. Auxiliary portal for assessing patellofemoral alignment. Orthop Rev 1990; 19:819-20. [PMID: 2235057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An auxiliary arthroscopic portal may be used to improve visualization and evaluation of the patellofemoral joint. A reusable transquadriceps tendon portal, which assesses patellar alignment within a 0 degree to 90 degrees range of motion, is described.
Collapse
Affiliation(s)
- J M Berman
- HCA South Arlington Medical Center, Texas
| |
Collapse
|
33
|
Kripke SA, Fox AD, Berman JM, Settle RG, Rombeau JL. Stimulation of intestinal mucosal growth with intracolonic infusion of short-chain fatty acids. JPEN J Parenter Enteral Nutr 1989; 13:109-16. [PMID: 2496241 DOI: 10.1177/0148607189013002109] [Citation(s) in RCA: 215] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Dietary fiber, which stimulates intestinal mucosal growth, is fermented by anaerobic bacteria in the rat hindgut to the short-chain fatty acids (SCFA) acetate, propionate, and butyrate. Butyrate is the preferred oxidative fuel of the colonocyte in vitro, and the provision of preferred intestinal fuels has been shown to stimulate mucosal proliferation in vivo. This study determined whether chronic colonic infusion of butyrate or a combination of SCFA would stimulate intestinal mucosal growth in an animal deprived of its normal source of SCFA, fiber fermentation in the cecum. Adult male Sprague-Dawley rats were fed a fat- and fiber-free elemental liquid diet and underwent cecectomy, ileocolic anastomosis, and insertion of a proximal colonic infusion catheter. Rats were then assigned to receive either a continuous infusion of butyrate (20 mM, 40 mM, or 150 mM), SCFA (70 mM acetate + 35 mM propionate + 20 mM butyrate), or saline, or to receive no infusion. A seventh group underwent proximal colonic transection and reanastomosis. After 7 days, jejunal, ileal, and proximal colonic segments were analyzed for mucosal weight, protein, RNA, and DNA. In the colon, the 40-mM butyrate infusion resulted in significant elevations in all mucosal parameters relative to all three control groups, saline infusion, no infusion, and transection. Both the 20-mM butyrate and the SCFA groups showed increased colonic mucosal DNA compared to controls. In the jejunum and ileum, mucosal DNA content was significantly greater in the SCFA group than in the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- S A Kripke
- Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | | | |
Collapse
|
34
|
Michaels WH, Thompson HO, Schreiber FR, Berman JM, Ager J, Olson K. Ultrasound surveillance of the cervix during pregnancy in diethylstilbestrol-exposed offspring. Obstet Gynecol 1989; 73:230-9. [PMID: 2643065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty-three diethylstilbestrol (DES)-exposed patients were evaluated through 27 pregnancies to determine their eligibility for admission to a prospective protocol that combined serial ultrasound surveillance of the lower uterine segment-cervical complex with periodic pelvic examinations to diagnose cervical incompetency. Of these, 21 pregnant women, including seven vaginectomy patients, were matched to 84 low-risk controls to determine the following: 1) the effect of DES exposure on reproductive performance, 2) the efficacy of ultrasound selection of cerclage candidates, and 3) the influence of previous partial vaginectomy on reproductive outcome. Five DES-exposed patients were diagnosed as having cervical incompetency and had cerclages placed. There were no missed diagnoses of cervical incompetency. The DES-exposed patients delivered statistically earlier in gestation than did controls (268 +/- 13 versus 276 +/- 10 days). It was not evident that this difference was important clinically, as there were no neonatal deaths, very low birth weight infants, second-trimester losses, or deliveries before 252 days (36 weeks) among the study patients. Previous vaginectomy did not affect the frequency of the diagnosis of cervical failure or the neonatal outcome. After ultrasound surveillance and treatment for incompetent cervix, a majority of our patients delivered at term without cerclage placement. Therefore, routine cerclage placement is not recommended. Knowledge of the ultrasound criteria for diagnosing cervical incompetency is required.
Collapse
Affiliation(s)
- W H Michaels
- Department of Obstetrics and Gynecology, Providence Hospital, Southfield
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
The peptides H-Phe-Gly-Gly-Arg-Ile-Asp-Arg-Ile-NH2 (rANF8-15-NH2), Ac-Phe-Gly-Gly-Arg-Ile-Asp-Arg-Ile-NH2 (Ac-rANF8-15-NH2), and their corresponding retro-inverso-isomeric peptides H-D-Ile-D-Arg-D-Asp-D-Ile-D-Arg-Gly-Gly-D-Phe-NH2 (D-rANF15-8-NH2), Ac-D-Ile-D-Arg-D-Asp-D-Ile-D-Arg-Gly-Gly-D-Phe-NH2 (Ac-D-rANF15-8-NH2), were evaluated for their ability to compete for the binding of 125I-rANF5-28 to cultured spontaneously hypertensive rat (SHR) aortic smooth muscle cell membranes. Their stability toward hydrolysis by the neutral endopeptidase thermolysin was also studied. The octapeptides rANF8-15-NH2 and Ac-rANF8-15-NH2 bound with IC50's of 367 pM and 1900 pM, respectively, but were rapidly hydrolyzed by thermolysin. Retro-inverso-isomers were prepared to provide molecules with an improved enzymatic stability. The retro-inverso-isomers were completely stable to thermolysin but were virtually inactive in the binding assay (IC50 greater than 1 microM).
Collapse
Affiliation(s)
- J M Berman
- Merrell Dow Research Institute, Cincinnati, OH 45215
| | | | | | | |
Collapse
|
36
|
Berman JM, Chen TM, Sargent R, Buck SH, Shea P, Heminger EF, Broersma RJ. Design and synthesis of metabolically stable atrial natriuretic factor analogs. Amino- and carboxy-terminal stabilization. FEBS Lett 1988; 237:76-80. [PMID: 2844589 DOI: 10.1016/0014-5793(88)80175-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two analogs of rat atrial natriuretic factor, rANF7-28-NH2 and [Mpr7,Ala20,D-Arg27]rANF7-27-NH2, were prepared by the solid-phase method. These peptides had 2-fold and 7-fold less affinity, respectively, than rANF1-28 in binding to membranes prepared from cultured aortic smooth muscle cells, and both peptides were 5-fold less potent than rANF1-28 in relaxing serotonin-contracted rabbit aortic rings. rANF7-28-NH2 was rapidly degraded by rat kidney homogenates but [Mpr7,Ala20,D-Arg27]rANF7-27-NH2 had enhanced stability against rat kidney homogenate degradation. However, this in vitro stability did not translate into an extended duration of action in vivo.
Collapse
Affiliation(s)
- J M Berman
- Merrell Dow Research Institute, Cincinnati, OH 45215
| | | | | | | | | | | | | |
Collapse
|
37
|
Berman JM, Pelton JT, Hassman CF, Buck SH, Shea PJ, Ertl P, Heminger EF, Broersma RJ. Synthesis and activity of partial retro-inverso modified atrial natriuretic factor analogs. Int J Pept Protein Res 1988; 32:47-55. [PMID: 2975640 DOI: 10.1111/j.1399-3011.1988.tb00925.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The synthesis and pharmacological activity of partial retro-inverso modified rat atrial natriuretic factor (rANF) analogs is described. The route to these compounds utilized a combination of solution and solid-phase methods. The analogs prepared all contain a reversed amide bond (psi[NHCO]) at the Ser 25 to Phe26 linkage. This bond has been suggested to play a key role in the metabolic inactivation of ANF. The analogs are of comparable potency to the endogenous peptide rANF1-28 in binding to cultured rat vascular smooth muscle cells, in relaxing serotonin contracted rabbit aortic rings, and as natriuretic/diuretic agents in anesthetized rats. None of the peptides has an extended duration of action in vivo.
Collapse
Affiliation(s)
- J M Berman
- Merrell Dow Research Institute, Cincinnati, OH
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Fox AD, Kripke SA, De Paula J, Berman JM, Settle RG, Rombeau JL. Effect of a glutamine-supplemented enteral diet on methotrexate-induced enterocolitis. JPEN J Parenter Enteral Nutr 1988; 12:325-31. [PMID: 3138440 DOI: 10.1177/0148607188012004325] [Citation(s) in RCA: 251] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Administration of an elemental diet to rats given methotrexate (MTX), 20 mg/kg intraperitoneally (ip), results in 100% mortality from severe enterocolitis. Previous studies indicate that glutamine (GLN), which is not present in elemental diets, is the preferred oxidative substrate for the gut and may facilitate intestinal recovery after injury. This study investigated the effects of a glutamine-supplemented elemental diet (GLN-ED) on nutritional status, intestinal morphometry, bacterial translocation and survival in this lethal model of intestinal injury. Three experiments were performed. In the first experiment, rats received an intragastric elemental diet supplemented with either 2% GLN or an equivalent amount of glycine (Control). After 4 days animals received either MTX, 20 mg/kg ip, or saline ip and were killed 3 days later. The GLN-ED resulted in significantly decreased weight loss, improved nitrogen retention, and increased mucosal weight, protein, and DNA content of the jejunum and colon. In the second experiment rats were assigned to diet as in the first experiment, but all animals received MTX. Control diet animals died within 120 hrs of MTX administration. The GLN-ED group had significantly longer survival time and decreased mortality. In the third experiment animals were assigned to diet and MTX as in the first experiment. Ninety-six hrs later aortic blood cultures revealed enteric bacteremia in animals administered MTX. GLN-ED resulted in a significant reduction in the incidence of bacteremia. These experiments showed that a GLN-ED significantly improved nutritional status, decreased intestinal injury, decreased bacterial translocation, and resulted in improved survival in a lethal model of enterocolitis.
Collapse
Affiliation(s)
- A D Fox
- Department of Surgery, University of Pennsylvania, Philadelphia 19104
| | | | | | | | | | | |
Collapse
|
39
|
Fox AD, Kripke SA, Berman JM, McGintey RM, Settle RG, Rombeau JL. Dexamethasone administration induces increased glutaminase specific activity in the jejunum and colon. J Surg Res 1988; 44:391-6. [PMID: 2896275 DOI: 10.1016/0022-4804(88)90181-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Exogenous glucocorticoids markedly increase the in vivo uptake and utilization of glutamine by the intestine. Since glutamine is the major oxidative fuel for the small intestine, we investigated whether glucocorticoids induce changes in the specific activity of the enzymes that mediate glutamine degradation (glutaminase) and synthesis (glutamine synthetase). Male Sprague-Dawley rats received a 7-day elemental diet. On Day 5, animals were randomized to one of four groups and received either saline (Control) or one of three doses of dexamethasone im: 0.1 mg/kg (Lodex); 0.3 mg/kg (Middex); or 0.6 mg/kg (Hidex). Forty-eight hours later jejunal and colonic segments were assayed for protein, glutaminase, and glutamine synthetase activity. A stress dose of dexamethasone (Hidex) produced a significant increase in both jejunal and colonic glutaminase specific activity (P less than 0.02 vs Control and P less than 0.05 vs Control, respectively). These data suggest a mechanism whereby glucocorticoids increase the intestinal utilization of glutamine by increasing the specific activity of intestinal glutaminase.
Collapse
Affiliation(s)
- A D Fox
- Department of Surgery, University of Pennsylvania, Philadelphia
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
Total parenteral nutrition (TPN) is associated with intestinal mucosal atrophy. Acetoacetate is oxidized in preference to glucose by both enterocytes and colonocytes and is not present in TPN. The purpose of this study was to determine whether replacement of a portion of glucose calories with monoacetoacetin, the glycerol ester of acetoacetate, could inhibit TPN-associated intestinal atrophy. Male Sprague-Dawley rats (200-250 g) underwent superior vena caval cannulation and were assigned to receive chow ad libitium (CHOW), TPN with 0.86 M monoacetoacetin (ACAC), or TPN with 0.86 M glycerol to control for the glycerol component of monoacetoacetin (GLYC). Nitrogen balance was measured over 7 days after which time the animals were weighed and sacrificed. Jejunal and colonic segments were harvested and the mucosal weight, protein, RNA, and DNA contents measured. All groups showed comparable weight gain. Cumulative nitrogen balance was positive for both TPN groups. Significant decreases in mucosal parameters occurred in both TPN groups compared to the CHOW group, but atrophy was significantly inhibited in both jejunum and colon of the ACAC group compared to the GLYC group. Thus, the substitution of monoacetoacetin for glucose calories in parenteral nutrition solutions inhibited TPN-related atrophy of intestinal mucosa while maintaining normal growth.
Collapse
Affiliation(s)
- S A Kripke
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
The major rat kidney in vitro degradation products of the rat atrial natriuretic factor analog, H-Cys7-Phe-Gly-Gly-Arg-Ile-Asp-Arg-Ile-Gly-Ala-Gln-Ser-Gly-Leu-Gly -Cys-Asn-Ser-Phe-Arg-Tyr28-NH2 (with a Cys27-Cys23 disulfide bridge), have been identified. The degradation products are the C-terminal modified compounds rANF7-27, rANF7-26, and rANF7-25.
Collapse
|
42
|
Berman JM, Bertoldi IM. Preparation of atropine sulfate ampuls for high-dose therapy. Am J Hosp Pharm 1985; 42:1046. [PMID: 4003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
43
|
Berman JM, Goodman M. Synthesis of cyclic and acyclic partial retro-inverso modified enkephalins. Int J Pept Protein Res 1984; 23:610-20. [PMID: 6469459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The cyclic partial retro-inverso modified enkephalins, H-Tyr-cyclo[-D-Glu-Gly-gPhe-D-Leu-] (I), H-Tyr-cyclo[-D-A2bu-Gly-gPhe-R&S-mLeu-] (IIf, IIs), and H-Tyr-cyclo[-D-Glu-Gly-Phe-gLeu-] (III), have been synthesized by solution methodology. In a like manner, their corresponding acyclic analogs Ia-IIIa containing D-Ala2 have also been prepared. Gem-diaminoalkyl residues were generated by conversion of Boc-dipeptide carboxamide to the corresponding gem-diaminoalkyl "dipeptide" salt using [bis(trifluoroacetoxy)iodo] benzene. Cyclizations were achieved at high dilution utilizing diphenylphosphoryl azide as the coupling reagent.
Collapse
|
44
|
Abstract
Oral activated charcoal was administered to 4 patients with theophylline toxicity, who had gastrointestinal and neurologic symptoms as well as cardiac arrhythmias. Administration of oral charcoal significantly reduced the theophylline half-life in the serum of each patient. The charcoal was well tolerated and symptoms of toxicity rapidly resolved. We conclude that administration of oral charcoal rapidly reduces the serum theophylline concentration and should be used as the initial treatment in patients with theophylline toxicity.
Collapse
|
45
|
Mahutte CK, True RJ, Michiels TM, Berman JM, Light RW. Increased serum theophylline clearance with orally administered activated charcoal. Am Rev Respir Dis 1983; 128:820-2. [PMID: 6638669 DOI: 10.1164/arrd.1983.128.5.820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of this study was to determine whether the oral administration of activated charcoal would increase the clearance of theophylline. Seven normal subjects received aminophylline intravenously (8 mg/kg) on 2 separate days. On Day 1 at 2-h intervals starting immediately after the completion of the aminophylline infusion, subjects ingested 4 doses of a slurry of activated charcoal (30 g each). On Day 2 they received no charcoal. The order of the days the subjects received charcoal or no charcoal was randomized. Plasma theophylline levels were determined by an enzyme immunoassay (Syva) every 2 h after the completion of the intravenous infusion. The theophylline half-life was reduced with charcoal from 10.2 to 4.6 h (p less than 0.001), and clearance increased from 35.6 to 72.6 ml/kg/h (p less than 0.001). In a patient with an initial serum theophylline concentration of 31.0 micrograms/ml and signs of toxicity (arrhythmias and seizures), the administration of charcoal (4 doses of 30 g every 2 h) reduced the half-life from 34.4 to 5.7 h concomitant with rapid resolution of signs of toxicity. We conclude that orally administered activated charcoal significantly enhances the clearance of theophylline and offers a new therapeutic modality in the treatment of theophylline toxicity.
Collapse
|
46
|
Berman JM, Goodman M, Nguyen TM, Schiller PW. Cyclic and acyclic partial retro-inverso enkephalinamides: Mu receptor selective enzyme resistant analogs. Biochem Biophys Res Commun 1983; 115:864-70. [PMID: 6312999 DOI: 10.1016/s0006-291x(83)80014-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The cyclic partial retro-inverso modified enkephalins, H-Tyr-cyclo[-D-Glu-Gly-gPhe-D-Leu-] (I), H-Tyr-cyclo[-D-A2bu-Gly-gPhe-R&S-mLeu-] (IIf, IIs), H-Tyr-cyclo[-D-Glu-Gly-Phe-gLeu-] (III), and their corresponding acyclic analogs, H-Tyr-D-Ala-Gly-gPhe-D-Leu-For (Ia), H-Tyr-D-Ala-Gly-gPhe-R,S-mLeu-NH2 (IIa), H-Tyr-D-Ala-Gly-Phe-gLeu-For (IIIa) have been evaluated in in vitro bioassays. Relative to Leu-enkephalin, the modified compounds are more potent in the guinea pig ileum assay and more effectively displace [3H]naloxone from rat brain receptors, while they are generally less potent in the mouse vas deferens assay and only weakly able to displace [3H] (D-Ala2, D-Leu5)enkephalin. The analogs are highly resistant to proteolytic degradation by rat brain membrane preparations that readily hydrolyze Leu-enkephalin.
Collapse
|
47
|
Kawai M, Nyfeler R, Berman JM, Goodman M. Peptide sweeteners. 5. Side-chain homologues relating zwitterionic and trifluoroacetylated amino acid anilide and dipeptide sweeteners. J Med Chem 1982; 25:397-402. [PMID: 7069717 DOI: 10.1021/jm00346a013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Side-chain homologues of sweet trifluoroacetyl-alpha-L-aspartyl-p-cyanoanilide have been synthesized and tasted. Removal of the trifluoroacetyl group only changes the potency of sweet taste, not the taste property. These results have been compared with the structure-taste relationships of dipeptide sweeteners. An informative discontinuity of taste effects was found to exist with novel aminomalonyl dipeptide derivatives. The results are explained on topochemical grounds.
Collapse
|
48
|
Berman JM, Piola JC, Girolami HR, Fumagalli OA, Sain OL. Self-medication with aspirin in hospitalized patients in Argentina. Am J Hosp Pharm 1981; 38:1775-6. [PMID: 7304637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
49
|
Berman JM. Diagnosis of laryngeal trauma. Ear Nose Throat J 1981; 60:352-5. [PMID: 7261972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
50
|
Abstract
Over a three-day period, pharyngitis, neck swelling, deep voice, dysphagia, fever, and cellulitis of the anterior neck and upper chest developed in a 63-year-old woman. Sixteen hours following the institution of intravenous ampicillin, septic shock developed and the patient became comatose. Ampicillin-resistant Hemophilus influenzae type B was found in a culture taken from her blood and pharynx. In patients who have an upper respiratory tract infection and severe cellulitis of the neck, initial therapy should include chloramphenicol because of the possibility of ampicillin-resistant Hemophilus influenzae infection.
Collapse
|