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Biomedical subjects

B L Shull

Publications and source records attributed to B L Shull.

7 recordsLinked to original sources
PubMed1992

Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction.

OBJECTIVES: The objectives of this study were to identify factors that predict long-term success, defined as the absence of anatomic defects, in women undergoing pelvic reconstruction and to identify which defects most frequently persist or recur. STUDY DESIGN: Eighty-one women treated by sacrospinous ligament suspension and pelvic reconstruction between 1984 and 1990 had site-specific analysis performed preoperatively and at consecutive postoperative visits. The findings at the 6-week postoperative visit and subsequent visits were compared for each of five sites: urethra, bladder, cuff, cul-de-sac, and rectum. RESULTS: The Fisher exact test showed that patients with no support defects at the 6-week visit were less likely to require subsequent repair than patients who had any defect at that visit (p = 0.003). Thirteen patients with subsequent or persistent cystoceles had no bladder repair performed at the time of the study procedure. However, even with repair the bladder was the most likely site for persistence or recurrence. CONCLUSION: Absence of any pelvic support defect at the 6-week postoperative visit is associated with a 3% likelihood that the patient will require subsequent reconstructive surgery within 2 to 5 years. The anterior segment provides the greatest challenge to restoration of normal anatomy.

Adult↗
PubMed1991

Urologic surgical techniques.

Surgery for incontinence, other than genuine stress incontinence, is a small part of the general gynecologist's practice. He or she must maintain a high index of suspicion for diverticula and fistulae. Included here are several good review articles that outline the state of the art and include classic references in the bibliography. Patients with cancer with a genitourinary fistula and incontinence may be managed in a variety of ways. Percutaneous nephrostomy and occlusion of the distal ureter may be an option in patients with incurable disease. Continent diversion, such as the Indiana pouch, offers a long-term remedy to the appropriate patient, even one who has been irradiated, as reported by Mannel. Iatrogenic incontinence is distressing to the patient and her doctor. Webster and Kreder offer keen insight into the evaluation of patients who have postoperative, obstructive, voiding dysfunction. They describe an operative correction, the obturation shelf repair, quite similar to the paravaginal defect repair, which restores "normal anatomy" and results in excellent relief of voiding dysfunction in approximately 90% of their patients. Postoperative bladder care is of concern to the doctor, patient, and nursing staff. Noble's article on the timing of catheter removal is innovative and practical.

Diverticulum↗
PubMed1990

46,XY gonadal dysgenesis: three case reports demonstrating an evolution in management.

Treatment of phenotypic females with XY gonadal dysgenesis is evolving. In the past, these patients have routinely undergone hysterectomy with bilateral gonadectomy. Since the major concern in women with XY gonadal dysgenesis is ovarian malignancy, these patients need not only gonadectomy but frozen section and appropriate surgical staging based on histologic findings. However, even women with stage I dysgerminoma do not require hysterectomy. The state of the art in reproductive endocrinology makes it possible for us not only to offer them the development of secondary sexual characteristics with cyclic replacement therapy, but also the opportunity for childbearing with the use of embryo transfer.

Adolescent↗
PubMed1989

A six-year experience with paravaginal defect repair for stress urinary incontinence.

One hundred forty-nine consecutive patients who had surgery from May 1890 through December 1986 were evaluated to assess the functional and anatomic results of the paravaginal defect repair for stress urinary incontinence. All patients had their preoperative assessment, operative procedure, and postoperative follow-up managed by the authors. Twelve percent of the patients had one or more previous surgical procedures for urinary incontinence. Sixteen percent of the patients had the preoperative diagnosis of urinary incontinence with mixed components of true stress incontinence and detrusor instability. Postoperatively, 6% of all patients developed evidence of cuff prolapse; 5% had an enterocele. In none of those patients did the defect prolapse to the hymen. Five percent of the patients had postoperative evidence of a persistent cystocele, all of which were smaller than they had been preoperatively. An assessment of the anatomic results of the repair demonstrates that meticulous attention must be paid to the proper repair of the paravesical defect, to support of the vaginal cuff, and to management of the cul-de-sac of Douglas to minimize postoperative anatomic defects. Ninety-seven percent of patients had excellent functional results with no postoperative complaints of stress urinary incontinence.

Adult↗
PubMed1989

Testicular feminization syndrome: a case study of four generations.

This report deals with the complete form of testicular feminization in four generations of a single kindred. The four siblings who have had orchiectomy had no evidence of testicular malignancy. Because all four of the postpubertal patients have the complete form of the disorder, the prepubertal member is being managed expectantly, awaiting the onset of female secondary sexual characteristics at puberty. Other carriers may be identified as reproductive function continues.

Adolescent↗
PubMed1988

Combined plastic and gynecological surgical procedures.

The purpose of the present study was to determine the extent to which the planned combination of one of several major plastic and gynecological surgical procedures may alter patient morbidity and postoperative hospitalization when compared with similar procedures carried out separately. A review of 10 consecutive years of operative procedures produced 63 patients who underwent combined gynecological and plastic surgical procedures. Thirty-three of the combined-surgery patients could be suitably matched with 2 control patients each to compare complications and length of hospital stay. The requirement for transfusion was significantly greater (p = 0.01) in the combined-surgery versus the paired-control groups. No other complications, however, were increased in the combined-surgery patients. There was a significant reduction (p = 0.005) in hospital stay of 1.92 postoperative days for two groups of combined-surgery patients versus the control groups. In all combined-surgery patients, patient response was favorable. Recommendations on preoperative planning and intraoperative and postoperative management are discussed. There is a perception in the surgical community that combining procedures unacceptably increases morbidity. For the past 12 years plastic and gynecological surgeons in our institution have offered combined procedures to our patients, with positive results and favorable patient response. A search of recent medical literature demonstrated several references to the planned combination of plastic and gynecological or general surgical procedures [2, 4, 5]. However, the only study with matched control patients dealt exclusively with abdominoplasty in association with one of five major gynecological procedures.

Blood Transfusion↗