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Biomedical subjects

D K Edmonds

Publications and source records attributed to D K Edmonds.

At least 19 recordsLinked to original sources
PubMed2006

Congenital abnormalities of the genital tract: management or mismanagement?

Congenital malformations of the genital tract are uncommon and their management requires skill that is only available in a very few centres worldwide. The management requires sensitivity both in terms of the psychological welfare of the patient and the physical welfare and these must be combined together to provide such support. Management of patients outside of these environments is less than optimal and this article seeks to exemplify a principle of management excellence.

Congenital Abnormalities↗
PubMed2005

Sexual function in women treated with dilators for vaginal agenesis.

OBJECTIVE: To discover the sexual satisfaction of young women treated with vaginal dilators for vaginal agenesis. DESIGN: Anonymous questionnaire study. MAIN OUTCOME MEASURES: Comparison of sexual desire arousal lubrication, orgasm satisfaction and pain with a normal population. RESULTS: There was no significant difference between the study population and controls for the domains of sexual desire, sexual arousal, and satisfaction with a sexual relationship. There was, however, a significant difference for vaginal lubrication and orgasm where the Rokitansky patients scored lower. 22.3% of patients reported some degree of dyspareunia following vaginal penetration. However, this did not affect their enjoyment of the sexual act. CONCLUSION: The use of graduated vaginal dilators for patients with Mullerian agenesis is highly successful in creating a neovagina. Although the lack of adequate lubrication, pain and difficulty in reaching orgasm is significantly higher in this group, the patients subsequently enjoy sexual satisfaction that is comparable to a normal population.

Adolescent↗
PubMed2005

Retroperitoneal solitary fibrous tumour arising from the pelvis in women--a case report and review of literature.

A solitary fibrous tumour is an unusual spindle cell neoplasm that most frequently occurs in the pleura based intrathoracic region. In recent years attention has been drawn towards solitary fibrous tumours arising in extrathoracic sites. They are usually benign but malignant solitary fibrous tumours have also been reported (Nielson et al. 1997). There is far less information about the clinical behaviour of an extra thoracic solitary fibrous tumour unlike intrathoracic tumours which is well reported in many case series (England et al. 1989). Although solitary fibrous tumours are well described lesions, the occurrence of similar tumours in the pelvic retroperitoneum of women and presenting as pelvic mass have been reported only sporadically. Because of the rarity, unpredictable behaviour; lack of information available about the clinical behaviour (recurrence and metastasis) and lack of follow up protocol, we are reporting this case which we encountered along with the review of previously reported cases.

Diagnosis, Differential↗
PubMed2001

Vaginal and uterine anomalies in the paediatric and adolescent patient.

The past year has brought a number of interesting developments in the world of paediatric and adolescent gynaecology. These primarily relate to the genetics of the biology of sexual differentiation, which is now beginning to gain considerable understanding. A number of case reports and surgical procedures have also been described, although they have contributed only minimally to our existing understanding. Data on prevalence has always been difficult in congenital abnormalities, and some data are also now emerging to support the figures quoted in the literature.

Adolescent↗
PubMed2000

Congenital malformations of the genital tract.

Congenital abnormalities of the genital tract are a source of major morbidity for teenage girls. Careful counseling is as important as the surgical approach to management. It is imperative that specialist centers are established worldwide to deal with these problems. Centralization of services will ensure these girls receive the highest quality care.

Adrenal Hyperplasia, Congenital↗
PubMed1999

Dysfunctional uterine bleeding in adolescence.

Dysfunctional uterine bleeding in adolescence is usually not a pathological process but a physiological adjustment in the achievement of normal reproductive status. The source of the problem in the vast majority of patients lies in the development of an intact hypothalamo-pituitary ovarian axis which exhibits normal pulsatile gonadotrophin release. The achievement of this in point usually resolves the dysfunctional bleeding problem. Management of these problems is dependent on the clinical impact of blood loss and only requires medication when menstrual loss needs to be controlled. Special circumstances, such as mentally retarded children, require special attention in order to fulfil a number of clinical difficulties and almost always require medical intervention.

Adolescent↗
PubMed1997

Elevated serum lipoprotein(a) levels in young women with endometriosis.

Elevated serum lipoprotein(a) [Lp(a)] levels increase the risk of cardiovascular disease if levels of low-density lipoproteins (LDLs) are also high. The biological function of Lp(a) is unknown, but plasma levels may be elevated in inflammatory disease. Endometriosis is a common gynecologic disorder in which endometrial tissue is found outside of the lining of the uterine cavity. There is an immune component to this condition whereby the number of peritoneal macrophages is increased and the level of prostanoids and cytokines in peritoneal fluid is elevated. In the present study, we measured serum lipid, lipoprotein, and apolipoprotein levels in 29 women with endometriosis and in 29 matched healthy controls. Fasting serum triglyceride and apolipoprotein (apo) Al levels were higher in women with endometriosis (+28.1%, P < .001, and +12.3%, P < .01, respectively), but there were no significant differences in LDL or high-density lipoprotein (HDL) cholesterol levels. Serum Lp(a) levels were fivefold higher (P < .01) in the patients (median, 15.0 mg/dL; range, 0.05 to 60.0) than in controls (median, 3.1 mg/dL; range, 0.05 to 57.2). The distribution of apo(a) isoforms was similar in the two groups, but in women with endometriosis the individual apo(a) isoforms tended to be associated with higher serum Lp(a) levels. Endometriosis may represent a relatively common condition in which to investigate the role of Lp(a) in human metabolism.

Adult↗
PubMed1997

External cephalic version at term: a survey of consultant obstetric practice in the United Kingdom and Republic of Ireland.

OBJECTIVE: To undertake a survey of external cephalic version (ECV) in the United Kingdom and Republic of Ireland. DESIGN: In June 1995 every consultant obstetrician and gynaecologist in the United Kingdom and Republic of Ireland was sent a postal questionnaire which asked whether ECV was routinely performed for breech presentation after 37 weeks of gestation, assuming no contraindications. If consultants did not perform ECV, a supplementary question inquired whether they referred patients to a colleague who would perform ECV. The questionnaires were colour coded for country and dispatched from the Postgraduate Education Department of the Royal College of Obstetricians and Gynaecologists (RCOG). RESULTS: Overall, 78% of questionnaires were returned. The percentage of consultants routinely practising ECV in each country was as follows: Northern Ireland 82%; Scotland 64%; Republic of Ireland 64%; England 43%; and Wales 41%. When these figures were compared with the latest RCOG Annual Statistical Returns for breech delivery and caesarean section for breech delivery, there was an inverse correlation between the percentage of obstetricians performing ECV in any one country and the incidence of breech delivery (P < 0.001). There was a similar inverse correlation for the percentage of obstetricians performing ECV and the caesarean section rate for breech delivery (P < 0.001). CONCLUSION: Although postal survey results are not necessarily an accurate reflection of what happens in clinical practice, these data are supported by evidence from the Cochrane Database of Systematic Reviews indicating that ECV after 37 weeks reduces the incidence of both breech delivery and caesarean section for breech delivery.

Breech Presentation↗
PubMed1996

Booking ultrasound examinations performed by obstetric senior house officers--time to reevaluate?

We evaluated the proficiency of obstetrics senior house officers, not formally trained in ultrasonography, in assessing fetal viability, the number of fetuses and gestational age. Of 366 women who had an ultrasound examination at the first antenatal visit, 7 (2.1%) had nonviable pregnancies and 7 pairs of twins were correctly identified. Of these women, 329 had a detailed anomaly scan at 18-20 weeks. No anomalies were detected at either scan. Of the booking scans performed by the senior house officers, 89.4% correctly assessed the gestational age of the pregnancy when compared to the anomaly scan (+/- 1 week). One in 10 of the scans performed by the senior house officers was inaccurate. This is important particularly when being used for risk assessment in serum screening for Down syndrome. At present the early ultrasound scan should be performed by more formally trained personnel.

Clinical Competence↗
PubMed1996

Add-back therapy in the treatment of endometriosis: the European experience.

Add-back hormone replacement therapy (HRT) can alleviate the undesirable hypo-oestrogenic effects of the gonadotrophin-releasing hormone (GnRH) agonists, including loss in bone mineral content. However, this approach presents a dilemma in patients with endometriosis as the re-introduction of oestrogen could re-stimulate the endometriotic process. There have been three recently published European studies investigating the combination of GnRH agonist plus add-back HRT in the treatment of endometriosis. The loss of bone mineral density was significantly diminished in a study using 25 micrograms oestradiol patches combined with continuous medroxyprogesterone acetate (5 mg). Neither this low oestrogen dose nor a full bone-sparing dose of oral oestradiol (2 mg daily) reduced the efficacy of Zoladex (goserelin acetate) in patients with endometriosis. Furthermore, in a small open study the gonadomimetic tibolone totally prevented the loss of bone structure during GnRH agonist therapy. If a GnRH agonist is considered the treatment of choice, then HRT should be used in combination.

Administration, Cutaneous↗
PubMed1995

The elective use of oxytocin infusion during labour in nulliparous women using epidural analgesia: a randomised double-blind placebo-controlled trial.

The obstetric outcome following the elective use of oxytocin infusion was determined in a randomised, double-blind placebo-controlled trial. 93 nulliparous women in a London hospital, who had requested epidural analgesia in labour (</= 6 cm.), were given an infusion of oxytocin (n = 46) or placebo (n = 47). The initial epidural dose was 15 ml of 0.125% bupivacaine, followed by an infusion at 10 ml per h, with 15 ml top-ups if required. When oxytocin was used electively there was a reduction in the length of the first stage of labour from 696 min to 578 min, (P < 0.05) even though more than half of the control group (53%) required oxytocin augmentation. There was no significant difference between the number of operative deliveries (34 [74%] vs 35 [74%]). The rotational delivery rate was less in the study group (2 [4%] vs 5 [11%]), though this did not reach significance. There were no adverse effects on the fetus, as judged by cord pH measurement, Apgar score, admission to the special care baby unit and neonatal jaundice. The prophylactic use of oxytocin in nulliparous women with epidurals reduces the length of the first stage of labour and appears to be safe. It does not reduce the operative delivery rate.

Journal Article↗
PubMed1995

Gonadotropin-releasing hormone analogue (goserelin) plus hormone replacement therapy for the treatment of endometriosis: a randomized controlled trial.

OBJECTIVE: To determine whether treatment of endometriosis with a GnRH analogue (GnRH-a; goserelin) combined with continuous estrogen and progestogen hormone replacement therapy (HRT) would prevent the hypoestrogenic effects, including loss of bone density, while maintaining efficacy for treatment of endometriosis. DESIGN: Randomized controlled trial. PATIENTS: Fifty premenopausal women with laparoscopically diagnosed endometriosis (revised American Fertility Score for endometriosis implants equal to four or greater) and significant symptoms of dysmenorrhoea, dyspareunia, and other pelvic pain. INTERVENTION: Patients were randomized to receive either goserelin alone, 3.6 mg SC depot every 4 weeks for 24 weeks, or goserelin, 3.6 mg SC depot every 4 weeks for 24 weeks, plus HRT (25 micrograms transdermal 17 beta E2 daily and 5 mg medroxyprogesterone acetate orally daily) for 20 weeks commencing with the second goserelin injection. RESULTS: There was a significant reduction in the extent of pelvic endometriosis in both groups, with no difference between the groups. Both groups experienced an improvement in symptoms and signs, again with no difference between groups. Hypoestrogenic side effects of hot flushes and loss of libido were significantly less in the group that received HRT. The amount of bone mineral density loss was significantly less in the HRT group at the lumbar spine, although it was not prevented completely. CONCLUSION: The addition of HRT to GnRH-a for the treatment of endometriosis did not reduce the efficacy of treatment, and adverse hypoestrogenic effects were decreased, although not abolished.

Adult↗
PubMed1995

Asthenozoospermia and the human sperm mid-piece.

This study provides a quantitative comparison between surface and ultrastructural features of motile spermatozoa in asthenozoospermic and fertile men. The study group consisted of 10 individuals with persistent asthenozoospermia and the controls were 10 fertile donors to a sperm bank. Scanning electron microscopy and image analysis were used to objectively measure sperm mid-piece and tail dimensions. Sperm mid-piece length was significantly shorter (P < 0.01) in asthenozoospermic subjects compared with the controls, with mid-piece width and tail length being comparable. Mid-piece ultrastructure was then examined with the transmission electron microscope and the number of mitochondrial gyres and their configuration recorded. At the ultrastructural level the asthenozoospermic subjects demonstrated significantly fewer mitochondrial gyres (P < 0.001) than their fertile counterparts. Energy for sperm movement is provided by mitochondria and a deficit in these organelles in the sub-fertile cohort provides an explanation for poor sperm function in these subjects.

Energy Metabolism↗
PubMed1995

Endocrine effects of GnRH analogue with low-dose hormone replacement therapy in women with endometriosis.

OBJECTIVE: GnRH analogues are being used increasingly for a number of oestrogen dependent conditions in women. The resultant profound hypo-oestrogenism is a disadvantage, however, but the preservation of pituitary sensitivity to negative feedback by oestradiol is not well defined. We have determined the effect on gonadotrophins and inhibin of GnRH analogue plus low-dose continuous combined hormone replacement therapy in comparison with GnRH analogue therapy alone. DESIGN: Randomized controlled trial. PATIENTS: Fifty premenopausal women with endometriosis randomized to treatment with goserelin alone (Group 1) or goserelin plus 17 beta-oestradiol and medroxyprogesterone acetate (Group 2). MEASUREMENTS: FSH, LH, oestradiol, oestrone, inhibin before and during treatment. RESULTS: Oestradiol and oestrone were suppressed in both groups, but Group 2 had significantly higher oestradiol during the hormone replacement therapy period. LH was suppressed in both groups. In Group 1, FSH levels recovered during treatment but, in contrast, in Group 2, FSH levels remained suppressed throughout treatment. Inhibin was significantly lower in Group 2, but not in Group 1, during treatment compared to pretreatment. CONCLUSIONS: Pituitary secretion of FSH appears to remain responsive to feedback control by oestradiol during GnRH analogue therapy and is incompletely suppressed, unlike LH which remains completely suppressed. The possible mechanisms for this are discussed.

Adult↗