Lee Youkeles

Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy

We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P=NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P < 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P < 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P < 0.005), and abnormal menses (P < 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P < 0.05), and IBS was present more often when pain was a reason for hysterectomy (P < 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P < 0.01) and lower pain improvement ratings (P < 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non- IBS patients (P < 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.

Prenatal and intrapartum high-risk screening: II. Risk factors reassessed☆

A method of identifying the high-risk pregnancy by a quantitative assessment of prenatal, intrapartum, and neonatal factors is presented. Calculating the probabilities of neonatal risk can be done with a hand-held calculator. The technique described provides a method of assessing the importance of perinatal variables and determining the effect of the process of health care on outcome.

Acute nonvariceal upper gastrointestinal bleeding. Care in three different San Diego practice settings.

We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n = 138), health maintenance organization (HMO) (n = 105), and university (n = 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (less than 9%) and death (less than 5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were less than 7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.

Determinants of the intravenous diazepam dose required for gastroscopy

Factors influencing the intravenous dose of diazepam required by 100 consecutive outpatients being prepared for peroral endoscopy were evaluated. Eleven patients reported a history of using 2 or more doses of benzodiazepine a week and required 0.48 +/- 0.1 mg/kg of diazepam compared with 0.30 +/- 0.02 mg/kg (P < 0.01) needed by 89 patients who reported less frequent or no use. The log (dose/kg) was negatively correlated with age (r = 0.51, P < 0.01), and the log dose was positively correlated with weight to a lesser degree (r = 0. 31, P < 0.01). In the larger group of patients who reported less than twice-weekly or no benzodiazepine use, no effect of alcohol use on dose was found. The dose was unrelated to sex. The findings emphasize the importance of individualizing intravenous doses of diazepam.

Contraceptive choice and dysplasia: Changes following the 1970 senate hearings

An initial shift away from the pill was followed by a rebound toward the prehearing pattern of contraceptive choice; pill preference, however, is no longer a meaningful indicator of the cancer precursor, dysplasia of the cervix.