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Biomedical subjects

G Lose

Publications and source records attributed to G Lose.

At least 109 records · Page 6Linked to original sources
PubMed1992

The symptom of stress incontinence caused by pregnancy or delivery in primiparas.

Three hundred five primiparas were interviewed repeatedly about stress incontinence before and during pregnancy and after delivery. Eleven (4%) had stress incontinence before pregnancy and 98 (32%) during pregnancy, whereas 21 (7%) developed it after delivery. According to the International Continence Society definition, the corresponding frequencies were one (0.3%), three (1%), and one (0.3%), respectively. Obstetric factors such as length of the second stage of labor, head circumference, birth weight, and episiotomy seemed to be associated with, whereas cesarean delivery seemed to protect against, the development of stress incontinence after delivery. Three months after delivery, the statistically significant influence of the obstetric factors had vanished, as stress incontinence had disappeared in most women. However, 1 year after delivery eight of 292 women (3%) had stress incontinence, three with onset during pregnancy and five with onset after delivery. Three of these eight had stress incontinence according to International Continence Society criteria; four women wanted treatment. The symptom of stress incontinence occurs as a natural consequence of pregnancy and delivery and generally resolves in the puerperium. However, pregnancy and delivery carry a small risk (1% or less) of initiating persistent stress incontinence. The importance of various obstetric factors seems transient and their etiologic role remains unclear.

Adolescent↗
PubMed1991

[The relationship between low pH in the umbilical cord artery in neonates and later development of cerebral paresis].

Routine determination of the pH in umbilical arterial blood immediately after delivery is a commonly employed variable for assessing the risk of subsequent cerebral paresis caused by hypoxia. Opinions differ regarding the lower limit for normal NS-pH (acidosis limit) and this is due mainly to variable conceptions of what a normal delivery is. Lower limits from 7.04 to 7.14 are thus observed if the limit -2 SD is chosen. Even if the limit of 7.04 is chosen, only very few of the infants who are acidotic on delivery subsequently develop cerebral paresis. The most important reason for this is that the prevalence of cerebral paresis developed as a result of hypoxia during delivery is very low and that a low NS-pH value most probably originates from a neonate who recovers without cerebral paresis. Another reason is that the relationship between the pH value and the degree of hypoxia is far from perfect and this holds also true for the relationship between the degree of hypoxia and cerebral paresis. It is therefore concluded that in connection with cerebral paresis, NS-pH does not fulfill the requirements of a diagnostic test. Determination of NS-pH may, on the other hand, be of significance for neonatal treatment as the combination of a low Apgar score and NS-pH is a reasonable predictor for the neonatal morbidity.

Cerebral Palsy↗
PubMed1991

[Postoperative urinary retention].

Postoperative retention of urine (PU) is a common complication which may occur after any surgical intervention. It may affect both sexes in all age groups and result in considerable morbidity. The frequency depends upon the type of operation and its duration but statements in the literature vary greatly on account of inaccurate and varying definitions and uncertain diagnostic criteria. Intervention in the true pelvis results in the highest frequencies of postoperative urinary retention. The method of anesthesia is of lesser significance. Spinal anesthesia and epidural morphine constitute, however, a particular risk for the development of postoperative retention of urine. The pathological physiology is complex and includes: 1) disturbance of the balance between the sympathetic/parasympathetic influence on bladder and urethral function, 2) drugs which inhibit the miction reflex, 3) anaesthesia and sedation which cloud the awareness of bladder filling, 4) rapid filling of the bladder with subsequent overdistension, 5) lesion of the nerve fibres to the lower urinary tract, 6) mechanical obstruction and 7) difficult positions and/or situations for miction. Preoperative information about difficulty in emptying the bladder constitutes a predisposing factor and may require preoperative elucidation and treatment. Postoperative retention of urine may be countered by informative and practical measures and restriction of fluid intake. In selected cases, prophylactic treatment with alpha-blockers and prostaglandin may reduce the frequency. Therapeutically, oral parasympathomimetica do not appear to be effective while alpha-blockers may be employed. In cases where catheter treatment is employed and which is anticipated to be required for more than 48 hours, suprapubic drainage is recommended as this results in fewer cases of urinary infection than transurethral indwelling catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1991

[Assessment of micturition cystourethrography. Intra- and inter-observer variation].

The reliability of any method of investigation depends upon the accuracy and reproducibility of the results of the investigation. The accuracy of voiding cystoureterography (VCU) which is greatly dependent on the radiographic assessment cannot be assessed because no standard answers exist. The reliability of the method may be assessed in the form of intra- and inter-observer variations. VCU investigations from 24 women with incontinence were assessed by two independent radiologists. Fifteen of the radiological examinations had previously been described by one of the radiologists so that intra-observer variation could be assessed by these. Inter-observer variation was 70% (95% confidence limits 51-89%), calculated from the diagnoses anterior and posterior suspension defects, combined defects and normal conditions. The corresponding intra-observer variation was 53% (95% confidence limits 27-78%). The radiographic criteria for subdivision of suspension defects into anterior and posterior defects are, theoretically, very simple but appear to be difficult to attain in practice. The indications for employing a form of examination where assessment of the result of examination is so obscure should be very weighty.

Adult↗
PubMed1991

How to measure urethral elastance in a simple way. Elastance: definition, determination and implications.

The elastance of a biological tube describes the resistance of the latter to dilatation. It is defined as dP/dV, where dP is the pressure increase caused by the volume increase dV. Elastance is the reciprocal of compliance. Elastance in the female urethra can be estimated from the slope of the regression line of related values of pressure and cross-sectional area. In the present study, urethral elastance was calculated by measurement of the related pressures and cross-sectional areas during stepwise dilatation by a balloon and by determination of the pressure at which inflow through side holes in catheters with increasing diameters began. There was no difference between the elastance values obtained by the two methods. Due to the linear correlation found between pressure and cross-sectional area we conclude that urethral elastance can be estimated from measurements of urethral pressure at two or more related cross-sectional areas by a simple technique using e.g., 8F, 14F, and 20F catheters.

Adult↗
PubMed1991

Method for evaluation of the urethral closure mechanism in women during standardised changes of cross-sectional area.

A method for evaluation of the closure mechanism in the female urethra during forced opening has been developed and tested. The cross-sectional area (CA) of the tube and the intraluminal pressure were measured simultaneously by a specially designed balloon catheter. The method enables induction of standardised changes of CA at different rates. Applied in the female urethra the induction results in a distinct pressure response which increases with increasing rate of change of CA as well as size of the induction. The inflation of the balloon simulates a forced opening of the urethra and hence leakage. Obviously, urinary incontinence takes place at forced opening of the urethra. Accordingly, this novel method can give important information on the pathophysiology of stress urinary incontinence in particular and the physiology of sphincter functions in general.

Catheterization↗
PubMed1991

Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in healthy females.

A probe which permits continuous measurement of the related values of pressure and cross-sectional area in the female urethra was used to provide a quantitative description of the adjunctive occlusive forces in terms of pressure and power (mWatt) generation. Measurements were carried out at the bladder neck, midurethrally and distally in the urethra in 30 healthy women during coughing and squeezing. Statistically significant variations were found in pressure and power generation between the 3 sites of measurement both during coughing and squeezing. Power generation and the pressure increase were significantly greater during coughing than during squeezing along the entire length of the urethra. The presence of a dynamic active closure mechanism was demonstrated at the bladder neck in addition to that located midurethrally. This bladder neck mechanism is thought to be due to the vagino-levator sling system (the urethral supports).

Adult↗
PubMed1991

Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in females with genuine stress incontinence.

A probe which permits continuous measurement of the related values of pressure and cross-sectional area in the female urethra was used for a quantitative description of the adjunctive closure forces in terms of pressure and power generation during coughing and squeezing in 30 females with genuine stress incontinence (GSI). Measurements were performed at the bladder neck, midurethrally and distally in the urethra. A statistically significant decrease in power generation was found at the bladder neck and midurethrally during squeezing compared with the values in healthy females. During coughing the power generation was significantly decreased midurethrally and measurement of pressure generation revealed similar results. These findings indicate that the active closure mechanisms at the bladder neck and midurethra are significantly weakened in females with GSI. The results do not support the concept that impaired passive pressure transmission to the urethra is an important pathophysiological factor in GSI.

Adult↗
PubMed1991

Acute effect of norfenefrine on the urethral pressure profile in females with genuine stress incontinence.

To study the acute effect of norfenefrine, given orally in aqueous solution, on the urethral closure function, profilometry was performed before and after administration of placebo and increasing doses of norfenefrine in 6 females with genuine stress incontinence. A weak increase in urethral pressure was observed after administration of 90 mg of norfenefrine. No changes in heart rate and blood pressure occurred. The results indicate that the direct sympathomimetic effect of norfenefrine is weak. It is suggested that norfenefrine mainly acts via indirect mechanisms.

Female↗
PubMed1990

[Use of micturition cystourethrography in evaluation of urinary incontinence in women].

Miction cystourethrography (MCU) is an investigation of the conditions of suspension of the bladder. Assessment of the conditions of suspension has been employed by som urologists for 1) diagnosis of genuine stress incontinence (SI), 2) choice of operative procedure for SI and 3) assessment of the surgical result after operation for SI. It is generally agreed that MCU, as a routine method, does not contribute any important diagnostic information on account of the very low predictive values. Whether MCU can contribute information of significance in the choice of operative procedure for SI is still controversial. Recent investigations suggest that the suprapubic approach is more effective than vaginal procedures and that this should be preferred for SI, regardless of the type of possible suspension defect and the presence of slight to moderate cystocele. This reduces the significance of a meticulous radiological diagnosis. Whether large cystoceles should be operated upon vaginally and/or suprapubically is not yet elucidated but these are not indications for MCU as they can be diagnosed by gynaecological examination. Postoperative MCU has revealed poor correlation between cure and relief of a possible suspension defect. As MCU is a resource-demanding examination which may be difficult to interpret, it cannot be recommended as a routine in assessment of urinary incontinence in women.

Female↗
PubMed1990

A technique for the dynamic assessment of anal sphincter function.

A technique which renders continuous measurement of the cross-sectional area and pressure of the anal canal possible during distension and contraction of the anal sphincter has been developed. Electromyography of the external sphincter is measured simultaneously. With this technique a more detailed assessment of anal sphincter function is possible, including the opening and closing pressures of the sphincter at rest, anal compliance, anal hysteresis and the maximal closing pressure during squeeze. The results of in vitro measurements, measurements on 16 healthy subjects and 6 patients with faecal incontinence are presented.

Anal Canal↗
PubMed1990

Pressure/cross-sectional area probe in the assessment of urethral closure function. Reproducibility of measurement.

A probe, which enables measurement of related values of pressure and cross-sectional area, was used for in vitro studies and in vivo measurements in the female urethra. Six healthy females underwent two successive investigations. Measurements were performed at the bladder neck, in the high-pressure zone and distally in the urethra. The in vitro study showed that cross sectional areas of 13-79 mm2 were determined with a SD of 1.4 mm2. In vivo measurements revealed that the urethral parameters: elastance, hysteresis, pressure and power of contraction during coughing and squeezing were fairly reproducible. However, a certain interindividual variation of the parameters was found.

Adult↗
PubMed1990

Mechanical properties of the urethra in healthy and stress incontinent females: dynamic measurements in the resting urethra.

The relationship between pressure and cross-sectional area in the resting urethra during its inflation and deflation was examined in 30 healthy females and in 30 patients with genuine stress incontinence (GSI). Measurements were performed at the bladder neck, in the high-pressure zone and distally in the urethra. The mechanical properties of the urethra were found to vary significantly as a function of time after induction of a cross-sectional area (stress episode) in both groups of women. The pattern of response of the urethra showed significant differences between normals and GSI particularly during dynamic conditions. Our results indicate that mechanical laxity of the urethra at the bladder neck and midurethrally especially at dynamic events (stress episodes) is of pathophysiological importance in GSI.

Adult↗
PubMed1990

Variations in urethral and bladder pressure during stress episodes in healthy women.

Pressure variations in the urethra and bladder during stress episodes and their time separations were investigated in 30 healthy female volunteers. The pressure was measured by means of a double microtip transducer catheter with the distal sensor in the bladder and the proximal sensor at the bladder neck, the mid-urethra and the distal urethra. In advance of the pressure spike during cough a pressure rise was demonstrated in the bladder and at all 3 sites of measurement in the urethra. The urethral pressure increments preceding and following the pressure spike were statistically significantly higher in the mid-urethra than the corresponding bladder pressures. This active urethral pressure generation in the mid-urethra and distal urethra was initiated 200 ms before the bladder pressure began to rise. The pressure in the urethral high pressure zone was higher than the bladder pressure in all cases. Passive pressure transmission to the urethral high pressure zone can take place only insignificantly due to a continuous higher pressure inside the urethra than in the bladder and due to the location of the high pressure zone in the demarcation of the abdominal cavity. It was concluded that the urethral pressure rise in the high pressure zone during stress episodes is mainly generated actively by intra- and/or peri-urethral structures.

Adult↗
PubMed1990

Medical treatment of female urge incontinence.

Urge incontinence is a common symptom in women. The etiology is multifactorial. In most patients, however, the underlying cause remains unclear. Symptomatic treatment with detrusor inhibiting drugs constitutes the mainstay of therapy in these idiopathic cases. Many drugs have been proposed although the documentary proof of their efficacy varies. Limited efficacy and systemic side effects are frequent problems using available drugs. Rational pharmacotherapy requires an up to date knowledge of the physiology, pathophysiology and the clinical pharmacology of the lower urinary tract. The principles of drug therapy should be based on: 1) meticulous assessment of the patient; 2) precise classification of the bladder dysfunction; 3) individual drug selection and dose adjustment; and 4) current control with critical assessment of the indications for continued therapy.

Adult↗
PubMed1989

Eosinophil cationic protein in urine in patients with urinary bladder tumors.

Measurement of eosinophil cationic protein (ECP) in urine constitutes a new biochemical method for assessment of local eosinophil activity in the bladder. ECP in urine was measured in 18 patients previously treated for various types of urinary bladder tumors and a comparable control group of 18 normals. The median concentration of ECP in urine from the patients was 46.5 arb. U/l versus 24.5 arb. U/l from normals. This difference was statistically highly significant (p less than 0.01). This study suggests that eosinophils are involved in the host tumor relationship in patients with urothelial neoplasia. Measurement of ECP in urine may imply a new concept for assessment of urothelial tumors.

Aged↗
PubMed1989

Doxepin in the treatment of female detrusor overactivity: a randomized double-blind crossover study.

A total of 19 women with detrusor overactivity and associated symptoms completed a double-blind placebo-controlled crossover study of doxepin. All patients had previously failed to respond to conventional pharmacotherapy. Doxepin was given at bedtime in a single 50 mg. dose for the first 2 weeks and, if needed, the dose was increased with 25 mg. in the morning for the last week of the 3-week treatment period, which was followed by 2 weeks of washout before crossover. The preference for doxepin to placebo was statistically significant (p less than 0.01). Doxepin caused a significant decrease in the nighttime micturition frequency and the nighttime incontinence episodes (p less than 0.05). Urine loss at the standardized 1-hour pad weighing test decreased significantly during treatment with doxepin although statistical significance (p equals 0.07) was not obtained. Cystometric parameters (first sensation and maximum cystometric capacity) improved significantly during treatment with doxepin (p less than 0.06 and less than 0.04, respectively). Side effects were frequent but mild. Suggestions for use of this tricyclic antidepressant in women with detrusor overactivity and possible mechanisms of action are discussed.

Adult↗