OB GYN News articles from November 2001

OB GYN News archives from November 2001

Contraceptive ring gets FDA approval. (Widely Available by Next Summer).
November 1, 2001... NuvaRing, a new intravaginal ring that provides a steady release of etonogestrel and ethinyl estradiol, is being hailed by contraception experts as a welcome addition to the array of birth control options now available. The device, made by...

Offer CF carrier screening to all high-risk couples: discuss testing during preconceptional counseling or at the first prenatal visit. (New ACOG Recommendations).
November 1, 2001... Physicians seeing patients for preconception or prenatal counseling should now be advising them about cystic fibrosis carrier screening, according to the American College of Obstetricians and Gynecologists. Recommendations released by ACOG...

Bethesda system revised to increase precision: 'satisfactory but limited by ...' eliminated. (ASCUS Subcategories Redefined).
November 1, 2001... The 2001 revision of the Bethesda system for reporting Pap smear findings has removed much of the terminology that's been criticized as ambiguous ever since the last revision was made a decade ago. The revised system should now be much...

Doctors confront 'post-terrorism' stress disorder. (Watch for Depression, Anxiety, PTSD).
November 1, 2001... In one of the most poignant moments after passenger jets tore into the World Trade Center Sept. 11, throngs of physicians paced outside some New York City-area emergency rooms where few patients ever arrived, so lethal was the attack. ...

Devise a plan now for dealing with bioterrorism. (Distributing Vaccines, Antibiotics).
November 1, 2001... A bioterrorism victim has come to your office seeking care. You and your staff have been exposed. Now who will provide care for you? The recent bioterrorist events did not present such a risk for physicians, because anthrax is not spread by...

Culture key to diagnosing cutaneous anthrax: may appear hours after exposure. (News).
November 1, 2001... Mailroom workers in high-profile office buildings now fit the occupational profile for people at risk for contracting cutaneous anthrax. An estimated 95% of anthrax cases appear as cutaneous disease, limited until recently to cattlemen,...

Letters.
November 1, 2001... Imaging, Categorizing Previa I agree with Dr. Melinda M. Scully Noah that precise definitions are crucial in the management of placenta previa ("New Placenta Previa Definitions Advocated," Sept. 1, 2001, p. 14). There should be no...

Could you sit 30 minutes less? (Guest Editorial).
November 1, 2001... The benefits of exercise are indisputable, patients want advice on exercise, and yet most physicians do not routinely counsel their patients to become more active. If you doubt the impact of encouraging your patients to exercise, you...

Reimbursement hampers chiamydia screening. (Sexual Risk Assessment also a Problem).
November 1, 2001... QUEBEC CITY -- Official guidelines and study findings play only a small part in motivating doctors to increase screening for chlamydial infection, according to Dr. Kathleen Irwin. Providers know what they are supposed to be doing, but the...

Lesbians/Bisexuals have more Ca risk factors. (Less Likely to have Pelvic Exams).
November 1, 2001... SAN FRANCISCO -- Lesbian and bisexual women have more risk factors for cancer and are less likely to have health insurance, pelvic examinations, or mammograms. The findings were seen in a study that compared national estimates for all...

Most American women screened for breast but not colon cancer. (physicians Need to Step by Screenings).
November 1, 2001... ATLANTA -- Most American women are following the recommended guidelines for mammography but not for colorectal cancer screening, Deborah Holtzman, Ph.D., reported at a conference on cancer sponsored by the Centers for Disease Control and...

Exercise boosts immunity in breast cancer patients. (Killer Cell Cytotoxicity Increased).
November 1, 2001... DENVER -- Moderate endurance exercise counters the impairment of immune function that is characteristic of breast cancer patients, Dr. Christiane Peters reported at the annual meeting of the Endocrine Society. In addition to immunologic...

Any two of amsel's criteria may indicate BV. (Ongoing Study).
November 1, 2001... QUEBEC CITY -- Methods for deeming a patient clinically positive for bacterial vaginosis can be simplified without sacrificing accuracy, Dr. Robert E. Gutman said at the annual meeting of the Infectious Diseases Society for Obstetrics and...

Intravaginal use of topical immune booster tested for cervical dysplasia. (May Spur Spontaneous Resolution of Lgsil).
November 1, 2001... A topical drug that boosts the immune system and is delivered intravaginally may have a role in treating low-grade cervical dysplasia. The prototype agent of this kind, imiquimod (Aldara), has been tested in a recently completed phase II...

Immunologic approach to warts advocated. (External Anogenital Lesions).
November 1, 2001... NASHVILLE, TENN. -- Imiquimod is now the top drug for treating external anogenital warts, Dr. Mark P. Seraly said at the annual meeting of the National Medical Association. "The future for treating many viral infections, especially those...

Desire for fertility should guide endometriosis Tx. (Expert Opinion).
November 1, 2001... BALTIMORE -- Medical management of patients with endometriosis may be worth considering for the woman whose chief compliant is pain, but not if she's interested in preserving or regaining her fertility, Dr. Nikos Vlahos warned. At least...

Simple surgery repairs genital mutilation. (Deinfibulation).
November 1, 2001... NASHVILLE, TENN. -- About 2 million girls and women worldwide undergo female genital mutilation each year, and some of them may eventually present to U.S. physicians. Relatively simple gynecologic surgery can repair many of these...

Most patients pain free after surgical removal of Bartholin's glands. (Vulvar Vestibulitis).
November 1, 2001... PALM BEACH, FLA. -- Up to 97% of patients with vulvar vestibulitis can become totally pain free after surgical excision of the Bartholin's glands, said Dr. Michael Baggish, one of the pioneers of this technique. "It's my belief that this...

Mortality in monoamniotic twins drops to 10%. (Prenatal Diagnosis, Surveillance, Steroids).
November 1, 2001... Prenatal diagnosis of monoamniotic twin pregnancy followed by regular fetal surveillance and appropriate administration of corticosteroids can reduce perinatal mortality from previous estimates of 30%-70% to approximately 10%, according to the...

ART placentas appear thinner, lighter, dichorionic. (Twin Pregnancies).
November 1, 2001... Placentas from twin pregnancies obtained by assisted reproductive technology are thinner, lighter, and more likely to be dichorionic than those from spontaneously conceived twins, said Dr. Yair Daniel and associates at Tel Aviv Sourasky Medical...

Non smoking teens' first pregnancy not high risk. (Second Gestation Greatly Raises Risk).
November 1, 2001... Nonsmoking women aged 15-19 years experiencing a first pregnancy have no higher risk of adverse obstetric outcome than do those aged 20-29, according to a new study from Scotland. In a population-based retrospective cohort study that...

Metronidazole does not reduce preterm delivery. (Asymptomatic Trich Infection).
November 1, 2001... Metronidazole therapy for asymptomatic trichomoniasis infection during pregnancy does not reduce preterm delivery rates and may actually raise the risk of further complications, results of a recent study suggest. In a randomized,...

Depression during pregnancy affects 12%-14%. (Large Cohort Study).
November 1, 2001... Depression during pregnancy is more common than postnatal depression, results of a large cohort study suggest. Of 9,028 women who completed four separately administered questionnaires focusing on the cognitive and affective features of...

Anti-infectives. (Drugs, Pregnancy, and Lactation).
November 1, 2001... I frequently get calls from physicians who have questions about the safety of different anti-infectives during pregnancy or breast-feeding. In this and future columns, I will review what is known about this large class of drugs when used in...

Post rupture: 30 minutes for cesarean is too long. (Expert Opinion).
November 1, 2001... SAN FRANCISCO -- Hospitals that can't deliver babies by crash cesarean section in less than 30 minutes after uterine rupture have no business attempting vaginal birth after a previous C-section, Dr. Thomas M. Goodwin said. In fact, 30...

Miscarriage may raise OCD risk. (Hormonal Changes Faulted).
November 1, 2001... Miscarriage is a significant risk factor for initial or recurrent episodes of obsessive-compulsive disorder, said Pamela A. Geller, Ph.D., of Allegheny University of the Health Sciences, Philadelphia, and her associates. The risk of...

Induction for gestational HT doesn't raise risks. (Morbidity Unaffected by Failed Induction).
November 1, 2001... ST. JOHN'S, NFLD.--Labor induction in women who have severe gestational hypertension won't increase the odds of maternal or neonatal morbidity if it fails, and more than half of the women may have a successful vaginal delivery, reported Dr....

Preterm birth risk rises as gum disease worsens. (Periodontal Disease: A Marker or a Cause?).
November 1, 2001... QUEBEC CITY -- Progression or worsening of periodontal disease is associated with a fivefold increased risk of preterm birth, compared with gum disease that doesn't get worse, Dr. Amy Murtha reported at the annual meeting of the Infectious...

Glyburide, exercise moderate gestational diabetes. (Pregnancy Studies Still Needed for Starlix).
November 1, 2001... STANFORD, CALIF. -- Diet and insulin are no longer the only tools available for the management of gestational diabetes mellitus, Dr. Judy E. Kalinyak said at a conference on perinatal and pediatric nutrition. They've been joined by exercise...

Gestational diabetes poses postpartum problems. (Type 2 Diabetes Risk is Extremely High).
November 1, 2001... STANFORD, CALIF. -- Postpartum counseling of women with gestational diabetes has become more important than ever in light of a recently improved understanding of the disorder's often far-reaching consequences and the availability of an...

Physicians sue to overturn HIPAA privacy rule. (Texas OB.GYN. A Coplaintiff).
November 1, 2001... The Association of American Physicians and Surgeons has filed a lawsuit asking that a new federal privacy regulation be overturned on the basis that it is unconstitutional. Rep. Ron Paul (R-Tex.) signed onto the suit as a coplaintiff. The...

Individual insurance market plagued with inconsistencies. (Study of 19 Insurers).
November 1, 2001... The decisions of who qualifies for health insurance and how much they should pay for it are as individual as the people who review the applications. Despite reforms in several states, the individual insurance market is highly variable and...

Health priorities in congress shift to bioterrorism. (Stem Cells, Medicare go to Back Burner).
November 1, 2001... WASHINGTON -- The attacks of Sept. 11 have pushed issues such as stem cell research, Medicare prescription drug benefits, and health care for the uninsured out of the Congressional limelight, Dean Rosen said at a meeting sponsored by the...

How to reduce medical errors in your practice. (Advice from Past President of AMA).
November 1, 2001... HOUSTON -- Many physicians are trained to believe that somehow they should become perfectionists and never make mistakes during their career, Dr. Nancy Dickey said at the annual meeting of the Texas Academy of Family Physicians. In...

Miferristone prescriptions. (Policy Practice).
November 1, 2001... Six percent of gynecologists and 1% of primary care physicians have provided the abortion drug mifepristone (Mifeprex) since its approval last year by the Food and Drug Administration, says a survey by the Kaiser Family Foundation. "The...

Hipaa concerns. (Policy Practice).
November 1, 2001... Months after its effective date, the American College of Obstetricians and Gynecologists remains concerned that the rules associated with the Health Insurance Portability and Accountability Act (HIPAA) may be changed to give parents greater...

Outpatient mastectomies. (Policy Practice).
November 1, 2001... Outpatient mastectomies are increasing in some states, and women with HMO coverage are more likely to receive them than those with Medicare, Medicaid, or private insurance, a new study says. Data from the Agency for Healthcare Research and...

Ohio abortion ban lifted. (Policy Practice).
November 1, 2001... A federaljudge has struck down an Ohio law banning so-called partial birth abortion on the grounds that it is unconstitutional. The case, Women's Medical Professional Corporation v. Taft, was heard in the U.S. District Court for the Southern...

Adoption bonuses. (Policy Practice).
November 1, 2001... Thirty-five states and the District of Columbia will split $11 million in bonuses for increasing the number of children adopted from their public welfare agencies, according to HHS. HHS says that adoptions are on the rise: Nearly 50,000...

Diabetics and uncontrolled HT. (Hypertension).
November 1, 2001... Nearly 80% of U.S. patients with diabetes and hypertension do not have their blood pressure adequately controlled, based on a random patient sample in 1999. The actual extent of hypertension control today in patients with diabetes may very...

Drinking and diabetes risk. (Diabetes).
November 1, 2001... Regular consumption of two alcoholic drinks per day improves insulin sensitivity and reduces fasting insulin in nondiabetic postmenopausal women, Dr. Michael J. Davies reported at the annual meeting of the Endocrine Society. Fifty-one...

Racial differences in lipid care. (Cardiology).
November 1, 2001... Screening for and treatment of hypercholesterolemia differ appreciably along racial and ethnic lines, even after adjusting for socioeconomic variability. African Americans and Mexican Americans are less likely to undergo cholesterol...

Neuropathic pain syndromes. (Pain).
November 1, 2001... A growing understanding of shared mechanisms has led to more tailored pain therapy using drugs originally for depression or seizures, Dr. Bennet E. Davis explained at a psychopharmacology conference sponsored by the University of Arizona. ...

Intranasal steroids speed sinusitis recovery. (In Addition to Antibiotics).
November 1, 2001... DENVER -- Routinely adding 3 weeks of intranasal corticosteroids to conventional antimicrobial therapy for acute rhinosinusitis accelerates recovery and boosts cure rates, Dr. Rowena Dolor said at the annual meeting of the American Academy of...

Hypertension treatment. (Products).
November 1, 2001... Diovan (valsartan), indicated for the treatment of hypertension, is now available in a tablet. It may be used alone or with other antihypertensive agents. For more information, contact Novartis Pharmaceuticals Corp. at 973-781-8300, or visit...

Soft, durable washcloths. (Products).
November 1, 2001... The WypAll X60 hygienic washcloth is durable, absorbent, soft, as well as drapable. The versatile washcloths can be used for housekeeping tasks in health care facilities or for gentle patient cleansing. Made of fast-absorbing material, they are...

Osteoporosis monitor. (Products).
November 1, 2001... N-MID osteocalcin one-step enzyme-linked immunosorbent immunoassay has been approved for the monitoring of osteoporosis through the measurement of osteocalcin, a marker of bone formation. The assay measures both the intact molecule and the...

Bone strength assessment. (Products).
November 1, 2001... The Omnisense 7000S bone sonometer tracks osteoporosis at point of care by assessing bone strength. The device tests bone mineral density elasticity cortical thickness, and microarchitecture, while eliminating soft-tissue effects. The device...

Topical acne medication. (Products).
November 1, 2001... Vanoxide-HC (benzoyl peroxide 5% and hydrocortisone .05%) is a topical, water-based lotion for the treatment of acne. The benzoyl peroxide in the lotion dries the affected area and prevents the growth of bacteria, while the hydrocortisone...

Allergy relief. (Products).
November 1, 2001... Zyrtec-D 12 Hour (cetirizine HCl/pseudoephedrine HCl), an antihistamine with decongestant, has been approved for the treatment of indoor and outdoor allergies, and nasal congestion. Available in 5 mg tablets, Zyrtec-D 12 Hour is indicated for...

Sharps safety guide. (Products).
November 1, 2001... The "Sharps Safety and Needlestick Prevention" guide features evaluations of needle-stick prevention devices, intravenous therapy devices, and comparative evaluations. The guide also includes first-time reviews of safety scalpels, blunted...

Safety of ablation under question. (Late Complications Seen).
November 15, 2001... ASHLAND, ORE. -- Complications arising months to years after total or global rollerball endometrial ablation raise serious questions about the technique's long-term safety, including the "scary" possibility that women who have undergone the...

HRT linked to increase in urinary incontinence risk: but other research suggests estrogen may protect against irritative symptoms. (Symptoms in 7% on Estrogen, 1% on Placebo).
November 15, 2001... NEW ORLEANS -- Increasing evidence suggests that hormone replacement therapy, once thought to be protective against urinary incontinence, may actually increase a woman's risk for the disorder, experts said at the annual meeting of the North...

Infant GBS risk halved with universal screenings: resultant rise in antibiotic use a drawback. (Compared with Risk-based Approach).
November 15, 2001... QUEBEC CITY -- Universal culture screening of all pregnant women for group B streptococcus reduces by half the risk of a newborn developing early-onset group B streptococcal disease, compared with screening based on a risk-based approach,...

Auscultation vs. fetal heart monitoring. (Guest Editorial).
November 15, 2001... Fetal heart rate monitoring is equally effective whether done electronically or by auscultation, according to many publications. In my opinion, however, electronic fetal heart rate monitoring is associated with higher intervention rates and...

Pro & Con: is supracervical hysterectomy a reasonable option for most women? (Opinion).
November 15, 2001... YES The amount of scientific data supporting this opinion are relatively limited. There is an inherent bias toward doing a total hysterectomy because of historical concerns about the development of cervical cancer. If you want to answer...

Hysteroscopic findings clue adenomyosis diagnosis. (Can Individualize Menorrhagia Therapy).
November 15, 2001... BALTIMORE--A cratered appearance of the endometrial cavity on hysteroscopy can be used to diagnose adenomyosis preoperatively and may be used to individualize therapy for menorrhagia, according to Dr. Andrea Wang. In a prospective study, she...

Predicting HRT response still not a reality. (Beyond One-Size-Fits-All Therapy).
November 15, 2001... NEW ORLEANS -- Research has along way to go before physicians will be able to predict how an individual woman's circulating hormone levels will respond to a specific hormone replacement therapy regimen, Dr. Elizabeth Barrett-Connor said at the...

Autologous fascia advised for incontinence slings. (Rectus or Fascia Lata).
November 15, 2001... ST. LOUIS -- Not all materials for constructing urinary incontinence slings are created equal, Dr. Fred E. Govier said at the 11th International Pelvic Reconstructive and Vaginal Surgery Conference. The hands down best material for a sling...

Combination testing best for ASCUS results. (Repeat Pap Smear and HPV Test).
November 15, 2001... When a Pap smear result indicates atypical squamous cells of undetermined significance, physicians are left with the vexing question of whether to refer the patient to colposcopy since only 5%-10% of these women turn out to have high-grade...

Persistent urinary retention tied to TVT use. (Case Report).
November 15, 2001... Strict adherence to protocols for inserting tension-free vaginal tape should be closely followed, according to the authors of the first report of a case of transurethral penetration of the tape. In the report, Dr. Heinz Koelbl and his...

Many incontinent women don't find wetting a problem. (Survey of 606 Women).
November 15, 2001... DURBAN, SOUTH AFRICA -- Half of women over age 45 in a recent survey reported experiencing urinary incontinence, but only a minority considered it a problem in their daily activities, Dr. Graham Swanson reported at WONCA 2001, the conference of...

Eradication of perinatal HIV may be within reach. (Vertical Transmission Rate is Less than 1%).
November 15, 2001... Twenty years into the AIDS epidemic, obstetrics boasts the brightest victory in battling the virus. Vertical transmission rates in the United States dropped 10-fold after introduction of highly active antiretroviral therapies in the...

Anthrax prophylaxis, treatment during pregnancy. (Ciprofloxacin, Doxycycline, Penicillin).
November 15, 2001... The decision about which drug to prescribe for anthrax prophylaxis or therapy should always be based on what's best for the mother, according to Gerald Briggs, clinical professor of pharmacy at the University of California, San Francisco. ...

Pregnancy just after miscarriage appears safe. (No Increase in Preterm Birth).
November 15, 2001... ASHLAND, ORE. -- There appear to be no adverse neonatal outcomes associated with immediate pregnancy following a single spontaneous abortion, according to a study presented at the annual meeting of the Pacific Coast Obstetrical and...

Hemorrhage management: be practical, prepared. (Postpartum Blood Loss).
November 15, 2001... ASHEVILLE, NC. -- The risk of death from postpartum hemorrhage can be minimized by taking a practical approach to management and being prepared for every eventuality, including hysterectomy, Dr. James E. Ferguson II said at the annual Southern...

Consider tone, tissue, trauma, and thrombin when assessing postpartum hemorrhage risk. (Four T's).
November 15, 2001... AMELIA ISLAND, FLA. -- Think of the four T's-tone, tissue, trauma, and thrombin-in assessing a patient's risk for postpartum hemorrhage and treating it when it occurs, Dr. Hugh W Randall Jr. said during an ob.gyn. update that was sponsored by...

Risk of bad perineal tear higher with midline episiotomy. (Long-Term Pain).
November 15, 2001... The greatest risk factors for third-degree perineal tears during vaginal delivery are midline episiotomy forceps delivery and oxytocin use, said Dr. Barbara Bodner-Adler of the University of Vienna, and her colleagues. Although...

Vaccines, therapeutics, and prophylaxis for selected biological warfare agents. (Rx).
November 15, 2001... The threat of bioterrorism has stimulated renewed interest in the "Blue Book," a pocket-sized manual published by the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md. The fourth edition of the manual, entitled...

Genetic testing for Colon Ca. (GI Disorders).
November 15, 2001... Commercially available genetic testing is now the screening method of choice for hereditary colorectal cancer, Dr. Francis M. Giardiello said at the annual meeting of the American Society of Colon and Rectal Surgeons. Before these tests...

The 'omeprazole test'. (GI Disorders).
November 15, 2001... An "omeprazole test" may be more cost effective than 24-hour pH testing for determining the cause of noncardiac chest pain, Dr. V Alin Botoman said at a gastroenterology update sponsored by the Cleveland Clinic Florida. The omeprazole test...

Laughing to heart health. (Cardiology).
November 15, 2001... A good sense of humor appears to be cardioprotective, Dr. Michael Miller reported at the annual scientific sessions of the American Heart Association. A group of 150 men and women with a history of either myocardial infarction or coronary...

The smokers' MI paradox. (Cardiology).
November 15, 2001... Smokers seem to have better clinical outcomes following an acute MI than nonsmokers do. Now cardiovascular epidemiologists have an explanation for this so-called smokers' paradox. New data suggest a twofold explanation: Compared with...

Screen elderly for Alcoholism. (Mental Health).
November 15, 2001... Physicians are not doing a good job of recognizing alcohol abuse in the general population, but they're doing an even worse job in the geriatric population, Dr. Eric Weintraub said at the annual meeting of the American Association for Geriatric...

Partial eating disorders. (Mental Health).
November 15, 2001... "Partial syndrome" eating disorders, which are considerably more common than the corresponding full-blown conditions, are associated with a substantial degree of psychopathology and deserve clinical attention, Dr. Palmiero Monteleone said at...

New & approved: Aranesp & Foradil & Entocort EC. (Primary Care).
November 15, 2001... Aranesp (darbepoetin alfa, Amgen) A recombinant erythropoiesis-stimulating protein for treating anemia associated with chronic renal failure (CRF), in people on dialysis and those not on dialysis. Like epoietin alfa (Procrit and...

Women in clinical trials. (Policy Practice).
November 15, 2001... The National Institutes of Health has amended its policy on women and minorities in clinical research. The new policy includes updated racial and ethnic categories outlining the minimum standards for the collection and maintenance of data on...

Obstacles to care. (Policy Practice).
November 15, 2001... More than half of American women say that obstacles such as cost and embarrassment keep them from obtaining routine gynecologic care, a new survey says. Other obstacles include language and cultural differences with their physician, discomfort...

Long-lived America. (Policy Practice).
November 15, 2001... Americans are living longer than ever, a new report says. The Centers for Disease Control and Prevention's new report "Deaths: Preliminary Data for 2000" analyzes more than 85% of the death certificates recorded in the United States for 2000....

Insurance myths. (Policy Practice).
November 15, 2001... The assumption that people without health insurance get the care they need is misguided. Also misguided are popular beliefs that the total number of uninsured isn't substantial and that most people who lack health insurance are in families...

Better managed care. (Policy Practice).
November 15, 2001... Health plans are registering improvements in care and service across the board, especially in the areas of controlling or preventing disease, the National Committee for Quality Assurance (NCQA) says in its fifth annual State of Managed Care...

Hassle factor linked to misleading of insurers. (Getting Medical Services Covered).
November 15, 2001... SAN DIEGO -- Would you ever consider lying to an insurer? When researchers posed that question to 1,617 randomly selected American physicians, 77% said they would appeal a decision they disagreed with, while 12% said they would accept the...

Avoiding obstetric pitfalls. (Clinical Pearls).
November 15, 2001... The reason obstetricians pay three times more for malpractice insurance than internists is not because we take care of more complicated patients in the clinic but because we deliver babies. Most of us have learned that things can go bad...