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Biomedical subjects

A C Drogendijk

Publications and source records attributed to A C Drogendijk.

At least 19 recordsLinked to original sources
PubMed1995

Short-term results and long-term patients' appraisal of abdominal colposacropexy for treatment of genital and vaginal vault prolapse.

OBJECTIVE: To evaluate short-term results and long-term patients' satisfaction of abdominal colposacropexy performed for massive genital prolapse in our institute during a 14-year period. STUDY DESIGN: A retrospective analysis was performed of 101 consecutive women who underwent abdominal colposacropexy. The procedure consisted of retroperitoneal interposition of a Mersilene mesh between a prolapsed vaginal vault or uterus and the anterior surface of the sacrum. A questionnaire was used to evaluate patients' satisfaction after surgery. RESULTS: In the short-term there was an acceptable rate of complications of surgery, comparable with that reported in the literature. Prolapse-related complaints evaluated by questionnaire were markedly diminished after surgery. Pain and functional complaints were only partly improved in a subgroup of patients. Only 32% of the patients responded that they were fully cured after operation. CONCLUSIONS: Abdominal colposacropexy shows a particularly favorable result on prolapse-related complaints. Functional complaints and pain are not substantially relieved by this procedure. The complication rate of surgery is acceptable.

Adult↗
PubMed1994

Determinants of first prescription of hormone replacement therapy. A follow-up study among 1689 women aged 45-60 years.

The aim of the present study was to ascertain the cumulative incidence of first hormone replacement therapy (HRT) and the factors that predict its prescription. In a general population 1689 women were followed for 9 months in order to trace first HRT prescriptions. Determinants (well-being, attitude towards menopause, menopausal status and another 9 variables) were measured by means of a questionnaire. Data analyses were performed for all women and for women with or without typical climacteric complaints. The cumulative 9 month incidence of HRT was 6.2%. For women without typical complaints a lower level of well-being (odds ratio 5.5; 95% CI 1.9-15.5) and the former use of the contraceptive pill (odds ratio 4.6%; 95% CI 1.0-20.5) were independently associated with HRT prescription. For women with typical complaints a positive attitude towards 'menopause should be treated' (odds ratio 3.8; 95% CI 1.8-8.0) was a determinant of HRT prescription. The cumulative incidence of HRT prescription is high, but from additional data it is apparent that within a period of 1 year and 9 months the majority of women stop taking HRT. For women without typical complaints, physicians prescribe HRT five times more often to those with a lower level of well-being. For women with typical complaints the physician's prescription is primarily related to the woman's attitude towards (medical) treatment of the menopause.

Age Factors↗
PubMed1992

Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences.

We investigated the prevalence and the consequences of urinary incontinence in a group of 1299 women aged 35 to 79. Incontinence was present in 344 women (26.5%), in 5.9% the incontinence occurred at least once daily. The prevalence was highest in the younger age-groups and lowest between 65 and 69 years of age, thereafter it increased again. Almost half of the incontinent women used protective sanitary towels. In contrast to this, only 13.3% considered themselves handicapped by their symptoms, and only 28.2% had ever sought medical help, although the symptoms had been present for as long as 7.5 years on average. The major reason for not seeking medical help was that the symptoms were not considered to be so serious.

Adult↗
PubMed1992

Extra-uterine endometrial stromal sarcoma with DNA flow cytometric analysis.

A case of a primarily extra-uterine low-grade endometrial stromal sarcoma is described. The patients clinical course, including various surgical, chemotherapeutical and hormonal therapies, is outlined and discussed. Transition from benign endometriosis to clinically malignant endometrial stromal sarcoma is illustrated by microscopy and DNA flow cytometry. A change in nuclear DNA content is demonstrated. This is possibly a useful aid in identifying the malignant potential of this tumor with such a misleading microscopic appearance.

Adult↗
PubMed1992

The menopause, urinary incontinence and other symptoms of the genito-urinary tract.

In a study on incontinence and other symptoms of the genito-urinary tract in postmenopausal women covering their prevalence, consequences and predisposing factors, the prevalence of incontinence was found to be 26.4%. Daily incontinence was present in postmenopausal women more than twice as often as before the menopause (P < 0.05). The frequency of medical consultation for such incontinence was low; only 26.1% of the postmenopausal women had ever seen their doctor about it. Urgency, nocturia and dyspareunia were more prevalent in postmenopausal women, while vaginal itching and discharge were more frequent in premenopausal women (P < 0.05). The prevalence of incontinence and the other genito-urinary symptoms was higher after surgical than after natural menopause. Multivariate analysis showed the menopause to be the only factor that contributed significantly to the onset of incontinence (P < 0.001).

Adult↗
PubMed1992

Melatonin and melatonin-progestin combinations alter pituitary-ovarian function in women and can inhibit ovulation.

Although melatonin (MEL) controls seasonal reproductive cyclicity in some mammalian species, its role in women is controversial. In this study data are presented related to the influence of MEL or MEL-progestin combinations on the pituitary-ovarian axis and ovulation in 32 women. MEL was administered in a dosage of 300 mg to 12 women for 4 months [to 8 women daily (days 1-30) and to 4 women on days 5-17 of the cycle]. MEL was also combined with the synthetic progestin norethisterone (NET) in an attempt to evaluate MEL's effect on a partially suppressed pituitary-ovarian axis. In 16 women, 4 combinations were tested on 4 women each on days 1-21: dosages of 300 mg MEL/0.75 mg NET, 75 mg MEL/0.75 mg NET, 7.5 mg MEL/0.75 mg NET, and 75 mg MEL/0.30 mg NET. In addition, 2 women were medicated with 300 mg MEL alone, and 2 were medicated with 300 mg MEL/0.15 mg NET on days 1-21 for 2 months. During the study, LH, FSH, estradiol (E2), and progesterone (P4) blood levels were determined at regular intervals. After a period of 4 months, daily administration of 300 mg MEL (days 1-30) caused significantly decreased mean LH levels compared to those in 8 nonmedicated controls (P less than 0.001). Also compared to nonmedicated control data, a significant inhibition of P4 in the first and fourth medication months (P less than 0.001) was observed. LH and E2 inhibition reached significance in the fourth medication month (P less than 0.005). Also, the treatments of 300 mg MEL (days 5-17) and 75 mg MEL combined with 0.3 mg NET caused a significant decrease in LH, E2, and P4 levels compared to those in the nonmedicated control group in the first and fourth medication months (P less than 0.05). The data further suggest an additive or synergistic effect between MEL and NET. The medications did not alter sleep-wake rhythms and were not complicated by any side-effects. The presented data suggest that MEL and MEL/NET combinations inhibit ovarian function in women, and that MEL/NET combinations can emerge as effective oral contraceptives.

Adult↗
PubMed1992

A modified technique to create a neovagina with an isolated segment of sigmoid colon.

The creation of a functional vagina in patients with congenital vaginal aplasia or male transsexualism is a challenging problem. A group of 40 patients, including 23 male transsexuals, in whom a neovagina was created using a sigmoid transplant, is reported. The technique, a modification of Kun's "colocolpopoiesis," is described in detail. Ten patients showed some direct postoperative complications and five were readmitted the first six weeks postoperatively for a variety of reasons. No extensive complication occurred. Thirty-two patients were evaluated at the routine six week postoperative check-up. Four patients had had intercourse at that time and an adequate vagina was found in 21 other patients. It is concluded that this modification of Kun's technique, known as colocolponeopoiesis, has had, at short term in the majority of patients, functionally good results and an acceptable complication rate.

Adolescent↗
PubMed1991

The influence of contamination of culture medium with hepatitis B virus on the outcome of in vitro fertilization pregnancies.

Heat-inactivated human serum is added to the culture medium used for in vitro fertilization and other forms of assisted conception. Because one batch of pooled serum contained hepatitis B virus, an epidemic occurred among women participating in the treatment program. Seventy-nine women had serologic proof of hepatitis B infection. This incident gave the opportunity to study the effect of hepatitis B virus on pregnancy outcome and the newborn. The situation is unique because the preimplantation embryo was exposed to hepatitis B virus or the pregnancy was complicated by a (sub)clinical infection. Twenty-four women were or became pregnant while having an acute hepatitis B infection. Five pregnancies ended in abortion. The remaining 19 pregnancies ended in the birth of 24 children. No evidence for any harmful effect of exposure to hepatitis B virus in the embryonic or fetal period on the newborn could be found.

Adult↗
PubMed1988

Clinical and laboratory findings in women with bacterial vaginosis and trichomoniasis versus controls.

We report comprehensively on the clinical and laboratory findings in 30 women with bacterial vaginosis (BV), 30 with vaginal trichomoniasis and 30 with normal secretions. Women with trichomoniasis were more often divorced (chi 2 test, p much less than 0.001), more often complained of dyspareunia (chi 2 test, p less than 0.05), frequently had discharge present in the vaginal vestibule, and showed one or more signs of vaginitis in half the cases. A 'moth-eaten' cervix was seen in only four women (13%) with trichomoniasis, but can be considered pathognomonic of the condition. While the main characteristics of vaginal secretions, i.e. amount, consistency, colour, absence or presence of gas and odour, are only poorly discriminative between BV and trichomoniasis, they can be of much help in distinguishing between 'abnormal' and--probably--normal secretions. Parabasal cells were found in the wet mount of 19 women (73%) with trichomoniasis. Epithelial cell clusters were a prominent finding in controls but were virtually absent in the other two groups. We detected curved rods in 15 women (50%) with BV, but in none of the women with trichomoniasis or normal secretions. There were only minor differences in the results of bacterial cultures in cases of BV and trichomoniasis. Bacteroides and Peptostreptococcus species were the predominant anaerobes in both groups. Gardnerella vaginalis was significantly more often isolated from women with BV than from controls (chi 2 test for trend, p less than 0.001). Gas-liquid chromatography showed the presence of succinate in only two cases of BV. Lactate was found in all controls but one. Ethylation of vaginal samples probably reduces the risk of over-emphasizing the presence of succinate and lactate. It is concluded that BV and trichomoniasis are both characterized by the overgrowth of anaerobic bacteria and that there is a considerable overlap in clinical and laboratory findings. Microscopy of the wet mount should be considered the most powerful diagnostic tool.

Adolescent↗
PubMed1988

Some aspects of the diagnosis of specific vaginal infections in the Rotterdam STD clinic population.

We studied specific vaginal infections in 351 consecutive women who visited the Rotterdam STD clinic. Prostitutes less often had vaginal or vulvar complaints than non-prostitutes (Fisher test, p less than 0.01), but more often had abnormal discharge (Fisher test, p less than 0.001). Normal secretions were found in 52% of the women. Clue cell-positive discharge (CCPD) was by far the most prevalent vaginal disease entity (32%). The wet mount showed pseudo-hyphae in 14 women (4%) and Trichomonas vaginalis was detected in 20 (6%). Microscopy (normal saline, no KOH 10%) had an overall sensitivity of 18% in the diagnosis of vaginal yeast infection. The sensitivity substantially rose with the 'degree' of infection. In the case of trichomoniasis the sensitivity was 55%. The rates of positive cultures of Candida species, T. vaginalis, N. gonorrhoeae and C. trachomatis were 21%, 13%, 9% and 10% respectively. Symptoms and signs were not of much help in the correct classification of the different diagnostic categories due to considerable overlap. However, curdy secretions are indicative of candidal infection. Tests for anaerobic overgrowth showed a 99% correct classification of normal secretions, which implies that smelling the vaginal secretions on the withdrawn speculum is a major diagnostic office procedure.

Adult↗
PubMed1988

Ultrasonically guided percutaneous and transvaginal follicle aspiration; a comparative study.

In this study we compare the efficacy of ultrasonically guided percutaneous oocyte collection for in-vitro fertilization with ultrasonically guided transvaginal oocyte collection. Forty-seven patients were prospectively randomized into two groups. Twenty-four patients underwent percutaneous follicle aspiration and 23 patients underwent a transvaginal puncture. The number of aspirated oocytes per patient showed a statistically significant difference in the two groups: 2.5 for the percutaneous puncture versus 5.2 for the transvaginal procedure. The number of embryos per patient was 2.7 in the transvaginal puncture group versus 1.6 in the percutaneous puncture group. This difference was not statistically significant. The clinical pregnancy rate per patient was 12.5% with the percutaneous approach and 30.4% with the transvaginal technique. This difference was also not statistically significant. Since the transvaginal procedure also creates less discomfort to the patient and is less time-consuming it is concluded that this approach is preferable to the percutaneous puncture technique in obtaining oocytes for in-vitro fertilization.

Embryo Transfer↗