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Biomedical subjects

A Bergman

Publications and source records attributed to A Bergman.

At least 163 records · Page 9Linked to original sources
PubMed1990

Low urethral pressure and stress urinary incontinence in women: risk factor for failed retropubic surgical procedure.

Nineteen women with stress urinary incontinence (SUI) and low urethral pressure were compared with 106 patients with SUI and normal urethral pressure. All underwent either a revised Pereyra procedure or Burch retropubic urethropexy, and all had detailed clinical and urodynamic evaluations before their operation and one year postoperatively. Surgical procedures effectively stabilized the bladder base and enabled adequate abdominal pressure transmission to the urethra in both groups of women. In spite of these urodynamic findings, the failure rate in women with stress urinary incontinence and low urethral pressure was significantly higher compared with women with good urethral pressure (50% vs 23% for the Pereyra procedure and 33% vs 12% for the Burch procedure [p less than 0.05]), indicating an etiology for their incontinence other than poor support to the urethrovesical junction; therefore, the need for another approach to cure stress incontinence.

Adult↗
PubMed1990

Bioaccumulation of 4-nonylphenol in marine animals--a re-evaluation.

The bioaccumulation of 4-nonylphenol (NP) has been studied in shrimps (Crangon grangon L.), mussels (Mytilus edulis L.) and sticklebacks (Gasterosteus aculeatus L.) exposed to (14)C-NP in running seawater. NP was extracted with high recovery from tissues which were pretreated with pancreatic enzymes. The bioconcentration factor determined of NP in fish was 1300 and in mussels, 3400. These values are 5 and 340 times higher, respectively, than values reported earlier.

Journal Article↗
PubMed1990

Pathological findings indicative of distemper in European seals.

The first recorded cases of the recent epizootic were harbour seals observed at the Danish island of Anholt, 12 April 1988. The disease then spread throughout the sea waters of north-western Europe. The total mortality in Europe up to November 1988, was estimated to be at least 17,000 seals. The mortality rate in Danish-Swedish waters was about 60%. Autopsies including sampling for histology of most organs were performed on 37 harbour seals and 12 grey seals, collected mainly at the Swedish west coast and in the southern Baltic. In most of the harbour seals and in three of the grey seals we found histological changes in the upper and lower respiratory tracts, in the lower urinary tract and in the lymphatic system consistent with those diagnostic of distemper viral infection in the canine. These diagnostic criteria were: presence of intracytoplasmic eosinophilic inclusion bodies of epithelial cells of the trachea and the urinary bladder, interstitial pneumonia, and atrophy of lymphatic organs due to depletion of lymphocytes. Our findings in pathology of a canine distemper-like disease in the seals were presented in late August 1988, together with the Dutch findings in virology by Dr. Osterhaus and collaborators.

Animals↗
PubMed1990

Two approaches to measuring quality in medical case management programs.

In a study of the quality of care in a medical case management program, five physician experts, applying criteria to medical records, found the care provided appropriate in a majority of 40 cases (10 each of head injury, spinal cord injury, high-risk infants, and AIDS). Nurses interviewing parents of 30 high-risk infants found general satisfaction with case management.

Adaptation, Psychological↗
PubMed1990

Technology and outpatient review: a preliminary evaluation.

Most health care utilization and cost control programs focus on inpatient care or on high-cost, catastrophic illnesses or injuries. Recently, however, Parkside Health Management Corporation has developed a utilization review program that targets treatments and high-technology procedures performed primarily in an outpatient setting, as well as specific inpatient procedures not included in other review programs. These include chiropractic, podiatric, and physical therapy treatments; cesarean section; and endoscopy, ultrasound in pregnancy, and lithotripsy. The treatments/procedures examined in this program, called Technology and Outpatient Review (TOR), account for approximately 6% of claims expenses. Bigel Institute for Health Policy researchers are evaluating a pilot test to determine TOR's effect on health care costs and utilization, appropriateness, and patient satisfaction.

Ambulatory Care↗
PubMed1990

Plasma substitution with 3% dextran-60 in orthopaedic surgery: influence on plasma colloid osmotic pressure, coagulation parameters, immunoglobulins and other plasma constituents.

To study the effects on plasma proteins, blood coagulation and fibrinolysis of dextran-60, given as plasma volume substitute in a 3% solution, 57 patients were studied preoperatively and for 8 days postoperatively in conjunction with elective orthopaedic surgery. Three groups were formed according to the blood loss during the day of surgery: Group I (n = 22) less than 30%, Group II (n = 24) 30-50% and Group III (n = 11) greater than 50% of the estimated blood volume. Dilution to a haemoglobin concentration of 110 g.1-1 was intended and erythrocytes transfused accordingly. No platelets were transfused. All patients received similar amounts of crystalloids. Nine patients in Group III received plasma and/or albumin solution for further volume replacement once the maximum dose of dextran (1.5 g.kg-1) was reached. Dextran-70 was given on days 1 and 3 postoperatively for thromboprophylaxis. No patient exhibited clinical signs of thrombosis or embolism. Mean postoperative bleeding times were longer than preoperatively, but still within the normal range in all groups. They were both pre- and postoperatively slightly longer in Group III, compared to the other groups, perhaps due to mild haemostatic disorders and/or undisclosed antiphlogistic therapy. Postoperative colloid osmotic pressures decreased by 11-19% in the three groups. Dilution of plasma constituents was also seen in the postoperative fall of platelet counts and of albumin, antithrombin and Factor X levels, most marked in Group III. Albumin levels on day 8 were still only 77-83% of preoperative values. IgG and IgM were decreased and the IgG level was still only 75% of preoperative on day 8.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Changes in urethral cytology following estrogen administration.

Estrogen vaginal cream was given to 10 postmenopausal women with a diagnosis of genuine stress urinary incontinence. Clinical evaluation and urethral cytology from the midurethra were performed before and after 6 weeks of estrogen treatment. A favorable clinical response was obtained in 50% of the treated patients, in whom signs and symptoms of incontinence disappeared or significantly improved, by subjective and objective evaluation. Cytologic changes at the midurethra correlated well with clinical response to estrogens. Patients with a favorable response to treatment showed a positive 'maturation index' of squamous epithelium, changing towards more intermediate and superficial cells, and less transitional cells (p less than 0.05). Patients with a poor clinical response to estrogens had no significant change in urethral cytology after 6 weeks of therapy. Our results suggest that improvement or cure of stress incontinence after estrogen administration in postmenopausal women is achieved by affecting the 'urethral mucosal factor'.

Estrogens↗
PubMed1990

A methylsulphonyl metabolite of a polychlorinated biphenyl can serve as a ligand for alpha 2mu-globulin in rat and major-urinary-protein in mice.

1. Kidneys from rats given an intraperitoneal dose of 4,4'-bis[( 3H]methylsulphonyl)-2,2',5,5'- tetrachlorobiphenyl[(CT3SO2)2TCB)] contained (CT3SO2)2TCB associated with a protein which has been isolated and characterized by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblot and immunodiffusion analysis to be alpha 2 mu-globulin (alpha 2 mu). 2. The same radioactive alpha 2 mu-globulin complex was isolated from urine of rats given an i.p. dose of (CT3SO2)2TCB. This complex represented 12.3% (0.27% dose) and 9.3% (0.06% dose) of the radioactivity excreted in 0-24 h and 24-48 h urine, respectively. 3. The radioactivity was extractable from alpha 2 mu and characterized by t.l.c. (co-chromatography in two solvent systems) to be (CT3SO2)2TCB. 4. A radioactive-protein complex was isolated from urine of mice given an i.p. dose of (CT3SO2)2 TCB. The radioactive-protein complex was characterized to be mouse major urinary protein (MUP) by SDS-PAGE, immunoblot and immunodiffusion analysis. This complex was not detected in mouse kidney. 5. Urinary excretion of radioactive-MUP complex represented 51.7% (2.3% dose) and 28% (1.3% dose) of the radioactivity excreted in 0-24 h and 24-48 h urine, respectively.

Alpha-Globulins↗
PubMed1990

Prostaglandins for enhancing detrusor function after surgery for stress incontinence in women.

Sixty-nine women with a clinically and urodynamically proven diagnosis of genuine stress incontinence underwent urethropexy in the form of the revised Pereyra procedure (n = 28) or Burch colposuspension (n = 41). Postoperatively the patients were assigned randomly to one of three study groups. Group 1 received a daily saline injection to the bladder (control group, n = 24), group 2 received daily intravesical injections of 250 mg of prostaglandin F2 alpha (PGF2 alpha) (n =23), and group 3 received a daily 10-mg PGE2 (PGE2) vaginal suppository (n = 22). The patients' suprapubic catheter was removed once the postvoiding residual urine volume was less than or equal to 50 mL. Both PGE2 and PGF2 significantly reduced the length of time required for postoperative bladder drainage after both the Burch and Pereyra procedures as compared to that in the control group (P less than .05). Hospital stay and bacteriuria were reduced as well in women receiving postoperative prostaglandins as compared to the control group. Clinically there were no differences between PGE2 and PGF2 alpha. Both produced no side effects, were well tolerated by the patients and were effective in reducing both the number of days required for bladder catheterization and the incidence of significant bacteriuria when administered after the surgical procedures.

Adult↗
PubMed1989

Effects of estrogen on urethral function in women with urinary incontinence.

In a prospective study, 2 gm of conjugated estrogen vaginal cream was administered daily for a total of 6 weeks in a group of 11 postmenopausal women with urodynamically proved genuine stress incontinence. Midurethral cytologic studies and a complete clinical and urodynamic evaluation were performed twice at 6-week intervals. Clinically, six of the 11 patients (54.5%) were cured or improved significantly after estrogen treatment, whereas the other five patients (45.5%) were clinically unchanged. The favorable clinical response correlated with urodynamic findings of increased urethral closure pressure and improved abdominal pressure transmission to the proximal urethra (p less than 0.05); in the patients who had a poor clinical response to estrogens, no significant changes in urethral dynamics were noted. Changes in urethral cytologic findings also correlated well with clinical and urodynamic findings. Patients with a favorable response to estrogen showed a maturation change from transitional to intermediate squamous epithelium (p less than 0.02), whereas nonresponders showed no significant changes in urethral cells.

Administration, Intravaginal↗
PubMed1989

Comparison of three different surgical procedures for genuine stress incontinence: prospective randomized study.

One hundred seven consecutive patients with clinical and urodynamic findings of genuine stress incontinence not previously treated were prospectively allocated in a randomized manner to one of three surgical procedures: anterior colporrhaphy, revised Pereyra procedure, or Burch retropubic urethropexy. Randomization included the surgical procedure and choice of surgeon (one of the three authors). Clinical and urodynamic evaluations were repeated at 3 months and 1 year after surgery. Differences in cure rates among the three procedures at the 3-month postoperative evaluation were insignificant (82%, 84%, and 92% for the anterior colporrhaphy, Pereyra, and Burch respectively) but became statistically significant at the 1 year postoperative evaluation (cure rates of 65%, 72%, and 91% for the anterior colporrhaphy, Pereyra, and Burch respectively, p less than 0.05). In our hands the Burch procedure stabilized the urethrovesical junction and prevented its descent during straining (evaluated by a postoperative Q-tip test) more effectively than either the Pereyra or anterior colporrhaphy. No procedure resulted in severe postoperative voiding difficulties. The present prospective randomized study demonstrates that in our hands the abdominal retropubic operation for genuine stress incontinence in patients not previously operated on results in a higher cure rate when compared with anterior colporrhaphy or Pereyra procedure.

Adult↗
PubMed1989

Primary stress urinary incontinence and pelvic relaxation: prospective randomized comparison of three different operations.

There were 289 women with clinical and urodynamic diagnosis of primary stress urinary incontinence, stable bladder, and pelvic relaxation who underwent a single-stage surgical procedure because of incontinence and pelvic relaxation. Patients underwent one of three surgical procedures because of stress incontinence--anterior colporrhaphy, revised Pereyra procedure, or Burch retropubic urethropexy. Decisions with regard to the type of bladder neck suspension and the surgeon were made randomly with a randomization table. Each patient had a complete clinical and urodynamic evaluation before surgery and at 3 and 12 months after surgery. Cure rate as defined by strict clinical and urodynamic criteria was not significantly different among the three groups at the 3-month postsurgical evaluations; however, at the 12-month postsurgical evaluations, the cure rate among women who underwent Burch urethropexy (n = 101) was significantly higher than that of either Pereyra or anterior colporrhaphy (cure rates were 87%, 70%, and 69%, respectively; p less than 0.01). The Burch urethropexy was more effective than the Pereyra procedure or anterior colporrhaphy in the stabilization of the bladder base and resulted in a significantly better cure rate in women with primary stress urinary incontinence and pelvic relaxation.

Evaluation Studies as Topic↗
PubMed1989

In vitro macromolecular binding of 2-(2-chlorophenyl)-2-(4-chlorophenyl)-1,1-dichloroethane (o,p'-DDD) in the mouse lung and liver.

The activation and covalent binding of 14C-labelled 2-(2-chlorophenyl)-2-(4-chlorophenyl)-1,1-dichloroethane (o,p'-DDD) in mouse lung and liver S-9 preparations were examined in vitro. These results showed an oxidative cytochrome P-450 mediated transformation of o,p'-DDD to metabolite(s) that bind covalently to proteins, phospholipids and to added naked DNA in both lung and liver. The apparent Km-values for the covalent binding of o,p'-DDD to protein were 0.25 microM and 3.30 microM in lung and liver, respectively. Addition of glutathione to the incubation medium decreased the binding of o,p'-DDD more efficiently in the liver than in the lung. Thus, the selective lung binding of o,p'-DDD previously observed in vivo seems to result from an in situ activation. The tissue selectivity in vivo is suggested to be due to the low apparent Km in the lung favouring bioactivation at low, ecotoxicologically relevant doses, as well as to a less pronounced protection by glutathione in the lung.

Animals↗
PubMed1989

Role of ultrasound in urinary incontinence evaluation.

Transrectal ultrasound was used to assess anatomic support of the urethrovesical junction (UVJ) in continent and stress incontinent women. UVJ drop on straining of less than 1 cm as assessed by transrectal ultrasound correlated well with good support to the UVJ. Drop of UVJ of more than 1 cm on straining correlated with poor support to bladder neck and stress urinary incontinence. The transrectal technique is quick and easy to perform and interpret.

Female↗
PubMed1989

Changes in urethral resistance after surgery for stress urinary incontinence.

Seventy women with stress urinary incontinence underwent simultaneous voiding-urethrocystometry using microtip transducers and an 8-channel recorder, before and three to twelve months after either the modified Burch (48/70) or the modified Pereyra (22/70) retropubic urethropexy. Increase in urethral resistance (p less than 0.005) was more marked following the Pereyra procedure (0.042 +/- 0.039 to 0.07 +/- 0.061) and 30 percent experienced postoperative voiding difficulties, compared with the Burch procedure (0.035 +/- 0.029 to 0.055 +/- 0.03) where 20 percent experienced postoperative voiding difficulties. Of those patients who voided without a detrusor contraction prior to surgery (35/70), in 50 percent a detrusor contraction component developed to their voiding mechanism postoperatively (p less than 0.05) and overcame the increased urethral resistance with no postoperative voiding difficulties. In the remaining 50 percent a detrusor contraction failed to develop during postoperative voiding and 90 percent of them demonstrated reduced flow rates and increased use of Valsalva maneuver, and needed prolonged postoperative bladder drainage prior to resumption of spontaneous voiding (p less than 0.005). Inability to develop a detrusor contraction during voiding in face of increased urethral resistance promoted by the incontinence surgery provided a suitable explanation for post surgery voiding difficulties in 20 to 30 percent of patients.

Adult↗