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Biomedical subjects

A Bergman

Publications and source records attributed to A Bergman.

At least 199 records · Page 11Linked to original sources
PubMed1988

Ultrasonic prediction of stress urinary incontinence development in surgery for severe pelvic relaxation.

Forty-six patients with a third-degree cystocele with no complaints of genuine stress urinary incontinence underwent complete urodynamic evaluation including ultrasonic evaluation before and 3 months postoperatively. Ultrasound examination was able to predict in 46 patients those requiring urethropexy surgery for support of their bladder base (n = 22). The 24 patients with good bladder base support by ultrasound did not develop genuine stress urinary incontinence. The use of ultrasound in women with third-degree cystocele appears to predict which patients will require urethropexy surgery in addition to their cystocele repair.

Adult↗
PubMed1988

Combined detrusor instability and stress urinary incontinence: where is the primary pathology?

Thirty-nine patients (from a total of 307 women) with clinical and urodynamic diagnosis of stress urinary incontinence had cystometric findings consistent with detrusor instability. Detailed multichannel urethrocystometry of these 39 patients revealed that urethral relaxation preceded the bladder contraction by 2-5 s. These patients were randomly allocated to either medical treatment (n = 21) by Ditropan 5 mg t.i.d. for 6 weeks prior to the surgical procedure, or to surgical treatment (n = 18) with no attempt to treat the bladder instability prior to surgery. All patients had repeat clinical and urodynamic evaluation at 3-12 months postoperatively. Six of the 39 patients (15%) still had urethral relaxation and bladder contractions on postoperative urethrocystometry. Four of these 6 patients still had stress urinary incontinence and urethral funneling. These 4 were considered surgical failures. Two of the 39 (5%) had postoperative detrusor instability in spite of good surgical results. This series suggests that in women with combined stress urinary incontinence and bladder instability, where bladder contraction is preceded by urethral relaxation, there is a more than 90% chance that bladder instability will disappear after successful operation for stress urinary incontinence.

Adult↗
PubMed1988

Private sector initiatives in case management.

Case management for high-cost patients is offered by virtually all private insurers and many health management firms. Despite the proliferation of the service, little is known about the process of case management, how it varies among vendors, what its impact is on short- and long-run patient costs, and what its effects are on quality. In this article, the authors present the results of a survey of insurance-based programs that reveal some process variations that could lead to differences in program effectiveness and cost.

Catastrophic Illness↗
PubMed1988

Role of cystourethrography in the preoperative evaluation of stress urinary incontinence in women.

Thirty-two women with stress urinary incontinence and 27 control continent patients with pelvic relaxation underwent a detailed clinical and urodynamic evaluation of the lower urinary tract. All patients underwent a standard chain urethrocystographic evaluation to detect anatomic pathology of the lower urinary tract. Urethrocystographic study included an evaluation of the posterior and anterior urethral angle, funneling of the proximal urethra on straining, the position of the urethrovesical junction and flattening of the bladder base. No differences were seen in the incidence of radiographic findings in women with pelvic relaxation with or without stress urinary incontinence. All five cystographic criteria were similar in the continent and stress incontinence patients. Static urethrocystography cannot differentiate women with and without stress urinary incontinence from among those with pelvic relaxation and thus should not be relied upon in the evaluation of women with urinary incontinence.

Adult↗
PubMed1988

Use of fetal cardiotocographic monitor in the evaluation of urinary incontinence.

Thirty-five women (mean age 52 years, mean parity 3) were evaluated consecutively for urinary incontinence. Stability of the bladder was evaluated by standing provocative water urethrocystometry, using a microtip pressure transducer and a multichannel electrophysiologic recorder. Cystometry was repeated immediately after emptying of the bladder. Second cystometry (standing provocative) was performed using a fetal cardiotocographic monitor for pressure recording. The simple cystometry (using the cardiotocograph technique) was very sensitive when evaluating women with a stable bladder (n = 25) and less sensitive when detecting bladder instability (n = 10). We conclude that the use of this simple technique is a viable option if urodynamic equipment is unavailable. There is no need for further evaluation in patients with findings of a stable bladder, but if bladder instability is detected, further in-depth evaluation is required.

Adult↗
PubMed1988

Local steroid application for hyperplastic dystrophy of the vulva. Clinical and pathologic evaluation.

Fifteen women complaining of vulvar pruritus of at least three months' duration were evaluated clinically and noted to have white lesions of the vulva consistent with hyperplastic dystrophy. Histologic evaluation confirmed the diagnosis, and all the patients were treated with local application of halocidine cream and crotamiton cream. After six weeks of therapy a repeat clinical and histologic evaluation revealed 13 of the 15 patients to be completely relieved of the vulvar pruritus, and 12 of the 13 were histologically demonstrated to have complete reversal of the hyperplastic process to normal skin. The other two denied any improvement in their pruritus and were histologically noted to have persistence of the hyperplastic process. A good clinical and histologic correlation was noted following local steroid application in patients with histologically proven hyperplastic dystrophy.

Adult↗
PubMed1987

Urodynamic appraisal of the Marshall-Marchetti test in women with stress urinary incontinence.

To determine the reliability of the Marshall-Marchetti test as a diagnostic and prognostic preoperative screening test for stress urinary incontinence, the changes observed in urethral pressure profiles under resting and stressful situations were recorded and compared following varying degrees of elevation of the urethra and the urethrovesical junction. The characteristic similarity of changes was evident in the functional profile length, urethral closure pressure, and cough pressure profile of the urethra during performance of the Marshall-Marchetti test and intentional urethral occlusion. This study clearly invalidated the Marshall-Marchetti test by objectively demonstrating that the Marshall-Marchetti test restored continence under stress of coughing by occluding the urethra and the urethrovesical junction.

Adult↗
PubMed1987

Genital condylomata acuminata in pregnancy: effectiveness, safety and pregnancy outcome following cryotherapy.

Fifty-one patients, 16 in the second trimester and 35 in the third, were treated by cryotherapy for genital condylomata acuminata; 19 of them had cervical cryotherapy in the second and third trimesters for cervical involvement. Cryosurgical treatment was performed on an out-patient basis, with no general anaesthesia or analgesia, and repeated every 2 weeks until resolution of the condylomata. Male partners were treated as necessary. Patients were followed every 2 weeks before and after delivery until 6 weeks postpartum. The newborn infants were examined for the presence of genital or laryngeal condylomata. Most women required two cryosurgical treatment sessions before complete resolution of condylomata; all resolved in pregnancy and no patient had residual disease at 6 weeks postpartum. There was no case of preterm premature rupture of membranes or premature delivery following cryotherapy, and no case of fetal injury. Labour and delivery were unaffected even by cervical cryotherapy.

Adult↗
PubMed1987

3,3'4,4'-Tetrachlorobiphenyl in pregnant mice: embryotoxicity, teratogenicity, and toxic effects on the cultured embryonic thymus.

3,3',4,4'-Tetrachlorobiphenyl (TCB) is a known ligand of the Ah-receptor. When TCB was given to Ah-responsive C57BL/6 mice at gestation day 11, 12 or 13, a pattern of embryotoxic effects similar to those of TCDD was produced. This pattern included death and resorptions of the conceptus (peak sensitivity at day 11), as well as characteristic malformations such as cleft palate, dilated kidney pelvis (peak sensitivity day 12), and thymus hypoplasia (peak sensitivity day 13). The ED50 for cleft palate induction was found to be about 100 mg/kg, as compared to 30 micrograms/kg for TCDD (earlier results). The binding affinity of TCB for the Ah-receptor has been reported to be two orders of magnitude lower than that of TCDD. When TCB was introduced into a thymus organ culture (thymi taken from day-14 embryos), the lymphoid cell development was inhibited with an approximate EC50 of 5 X 10(-8) M. This is approximately 100 times higher than that of TCDD and in good agreement with the receptor binding affinities of both compounds. The difference in in vivo toxicity between TCB and TCDD can be explained by a more rapid metabolism and excretion of TCB.

Administration, Oral↗
PubMed1987

Barbiturate narcosis and estrogen levels in women.

Pregnant women with high estrogen levels were more sensitive to barbiturate-induced narcosis and hypothermia than nonpregnant and postmenopausal women. Within each group, there was a negative correlation between estrogen level and decreased sensitivity to barbiturates. It appears that estrogen alters resistance to barbiturates through its effect on the activity of dopamine receptors.

Adult↗
PubMed1987

Metabolism of 2,3,4',6-tetrachlorobiphenyl: formation and tissue localization of mercapturic acid pathway metabolites in mice.

2,3,4',6-Tetrachlorobiphenyl (tetraCB) and the corresponding 14C-labelled compound (14C-tetraCB) were synthesized. Two reference compounds, 4-methylthio- and 4-methylsulphonyl-2,3,4',6-tetrachlorobiphenyl were also prepared and characterized. TetraCB and 35S-cysteine were given to groups of female mice. Formation of methyl[35S]sulphonyl-tetraCB was indicated by the presence of extractable sulphuric acid-soluble radioactivity in lung, liver, kidney and fat of the tetraCB-treated mice. As demonstrated by gel permeation chromatography followed by gas chromatography-mass spectrometry, the tissues of the tetraCB-treated mice contained mainly methylsulphonyl-tetraCB, minor amounts of tetraCB and traces of methylthiotetraCB. The major compound present in lung was 4-methylsulphonyl-tetraCB, indicating the presence of specific binding sites for this metabolite in lung tissue. According to autoradiography of mice injected with 14C-tetraCB, these binding sites were present mainly in the tracheo-bronchial mucosa.

Acetylcysteine↗
PubMed1987

Case mix and charges for inpatient and outpatient chemotherapy.

Case mix and charges for chemotherapy treatment were examined by an analysis of the inpatient discharges for DRG 410 (chemotherapy) from eight teaching hospitals and of outpatient visits from two teaching hospitals. Discharges for ovarian cancer were the most common and the least expensive, costing $1,600 or half as much as the most costly, less common conditions (leukemia and testicle cancer). Diagnosis explained 13 percent of the inpatient charge variation; metastasis explained less than 1 percent. Outpatient chemotherapy overlapped with inpatient among only 3 of the 10 most common diagnoses. The implication is that the two settings are complementary with regard to chemotherapy administration.

Ambulatory Care↗
PubMed1987

Role of the Q-tip test in evaluating stress urinary incontinence.

The Q-tip test was applied on 105 patients. Fifty-one had stress urinary incontinency (SUI), 28 had bladder instability by clinical and urodynamic criteria, and 36 had mild or moderate pelvic relaxation without urinary pathology. More than 90% of the patients with SUI and no previous surgery had a positive Q-tip test, with 90% test sensitivity in this group. More than one-third of the patients with bladder instability and almost one-half of the patients with pelvic relaxation and no urinary incontinence had a positive Q-tip test, for low test specificity. The Q-tip test is a simple clinical tool for diagnosing pelvic relaxation, which at times leads to SUI. Almost all patients with primary SUI have pelvic relaxation. The Q-tip test alone does not stand as a diagnostic test. When it is positive, the diagnosis of genuine stress incontinence is possible although not absolute. A negative test should cause one to question the diagnosis of genuine stress incontinence, and sophisticated and more expensive tests should be ordered before establishing a final diagnosis.

Adult↗
PubMed1987

Bladder training after surgery for stress urinary incontinence: is it necessary?

Eighty-nine consecutive patients with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence entered this study. Forty women had a revised Pereyra procedure and 49 had a Burch retropubic urethropexy. All had a suprapubic Bonnano catheter for postoperative bladder drainage. Postoperatively, patients were randomly allocated to "bladder training" (N = 44) or "nonbladder training" (N = 45) protocols. "Bladder training" consisted of scheduled clamping and unclamping of the catheter, whereas the "nonbladder training" patients had continuous bladder drainage throughout their postoperative period. Postvoiding residual urine volume was measured twice daily after the patient had voided with a symptomatically full bladder. The catheter was removed once residual volume was 50 mL or less. The bladder training protocol had no effect on resumption of spontaneous voiding after surgery. There was no significant change in length of postoperative bladder catheterization or in urinary tract infection rate among women with or without bladder training.

Adult↗
PubMed1987

Cervical cryotherapy for condylomata acuminata during pregnancy.

Twenty-eight patients were treated by cryotherapy for cervical condylomata acuminata during the second and third trimesters of pregnancy. Most required two treatment sessions before the condylomata resolved. All women responded favorably and none had residual disease at six weeks' postpartum. No neonate was affected. Cryotherapy for cervical condylomata acuminata had no identifiable adverse effect on pregnancy. There were no cases of rupture of membranes or labor starting as a consequence of treatment. There was no scarring to the cervix and deliveries were normal. We conclude that cryotherapy for cervical condylomata acuminata is an effective and safe procedure during the last two-thirds of pregnancy.

Adult↗