J Reprod Med
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Randomized Controlled Trial Comparative Study Clinical Trial
Laparoscopy. Gasless vs. CO2 pneumoperitoneum.
To compare gasless laparoscopy with conventional laparoscopy using CO2 pneumoperitoneum. ⋯ The markedly increased technical difficulty and absence of clear clinical benefits for the healthy patient led to the conclusion that laparoscopy with CO2 pneumoperitoneum is preferable for routine LTC and most laparoscopic procedures in the pelvis. Gasless laparoscopy may be of benefit for the fragile patient with a compromised cardiovascular system who may suffer complications from hypercarbenemia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.
Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. ⋯ There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postpartum tubal sterilization. A comparative study of the Hulka clip and modified Pomeroy technique.
To assess the feasibility of Hulka clip application for postpartum sterilization, 50 women were enrolled in a randomized, prospective study comparing modified Pomeroy tubal ligation and Hulka clip application. Hulka clip tubal occlusion in the postpartum period compared favorably with the commonly performed postpartum sterilization technique. Because of the simplicity of the technique and its greater potential reversibility, Hulka clip application may have advantages over standard postpartum sterilization techniques and should be considered for use in the postpartum period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nalbuphine after major gynecologic surgery. Comparison of patient-controlled analgesia and intramuscular injections.
A randomized investigation compared the efficacy and safety of nalbuphine administered by two methods, a patient-controlled infuser system and intramuscular (IM) injections, after major gynecologic surgery. Forty-seven patients were randomly assigned to receive nalbuphine by either method. The 22 patients using the infuser were given a 2.0-mg, incremental dose with a 10-minute lock-out interval between doses. ⋯ Although patients with the infuser had the ability to self-administer more medication, they did not use higher doses of nalbuphine than did the IM group. The additional cost of the infuser system was offset by the satisfaction expressed by the patients and by the improved nursing efficiency. Nalbuphine administered with a patient-controlled infuser provided an effective balance between analgesia and sedation and offered advantages over IM injections.
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Randomized Controlled Trial Comparative Study Clinical Trial
Abdominal instillation of high-molecular-weight dextran or lactated Ringer's solution after laparoscopic surgery. A randomized comparison of the effect on weight change.
Abdominal fluid retention after the instillation of lactated Ringer's solution into the abdomen after operative laparoscopy was evaluated by comparing the serial weights of patients receiving lactated Ringer's after surgery to those of patients treated with the abdominal instillation of high-molecular-weight dextran and to those of negative controls. Twenty-four patients were randomized to receive either lactated Ringer's or high-molecular-weight dextran after operative laparoscopy. ⋯ The weight gain remained significantly greater than in the negative controls on postoperative days 3 and 4 in patients treated with dextran. Since the "flotation" effect of dextran in preventing pelvic adhesions is likely to be most pronounced in the immediate postoperative period, the findings suggest the need for a reinterpretation of adhesion prevention studies in which the use of dextran was compared to that of lactated Ringer's solution or to saline as a negative control.