Search PubMed⌕ Search

Biomedical subjects

G Rydén

Publications and source records attributed to G Rydén.

At least 19 recordsLinked to original sources
PubMed2000

Abdominal urethrocystopexy using fibrin sealant. A prospective study of long-term efficacy.

Over the past decade efforts have been made to develop less invasive surgical treatment for female stress urinary incontinence (SUI). Abdominal urethrocystopexy with fibrin sealant combined with a couple of absorbable sutures has previously been reported as a promising method. This prospective observational study was aimed at evaluating the efficacy and safety of abdominal urethrocystopexy through a minilaparotomy using solely fibrin sealant (Tisseel) as the fixation glue. Forty-three women with objectively proven SUI were operated upon with this method. The subjective cure rates at 1 and 3 years' follow-up were 72% and 55%, respectively. The corresponding objective cure rates were 64% and 60%. No serious major operative complications occurred. One patient had transient urinary retention for 3 months. Otherwise, micturition was established within a median 1 day (range 1-3 days) after the operation. The result of this pilot study indicates a cure rate lower than that obtained with the conventional abdominal Burch colposuspension. Thus the method cannot be recommended as a standard procedure for treatment of SUI.

Adult↗
PubMed1997

Clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension.

OBJECTIVE: The purpose of this study was to determine the clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension. MATERIAL: Fifty women subjectively complaining of recurrent urinary incontinence (RUI) median 6 years after Burch colposuspension and 52 women with primary stress urinary incontinence were examined during 1991-93. METHODS: The participants were assessed with medical history, uro-gynecological examination and urodynamic investigation consisting of pad-test, urethrocystoscopy, cough provocation test, cystometry, urethra profilometry and flowmetry. RESULTS: Women with RUI demonstrated significantly increased incidences of recurrent lower urinary tract infection (24% vs. 8%), lumbago and sciatica (66% vs. 38%), rectocele (80% vs. 21%), and enterocele (24% vs. 0%) compared to women with primary stress urinary incontinence. Hypermobility of the bladder neck and urethra and palpable contraction of the levator ani muscles was observed significantly more often among the women with primary stress incontinence (90% vs. 42% and 83% vs. 56%, respectively). The leakage in women with RUI was significantly less pronounced than among women with primary stress incontinence. Detrusor instability was found significantly more often in women with RUI (47.51% vs. 23%). Low urethra pressure was found in five women with RUI. CONCLUSION: Women with RUI after Burch colposuspension seem to have a more pronounced pelvic floor weakness than women with primary stress urinary incontinence, whereas the urinary leakage is less pronounced. Recurrent lower urinary tract infection, lumbago and sciatica as well as detrusor instability are commonly observed whereas low urethral closure pressure is rare in women with RUI after Burch colposuspension.

Adult↗
PubMed1997

Anorectal manometry in women with urinary stress incontinence.

OBJECTIVE: The aims of this prospective study were to determine the bowel function and the anal sphincter function in women with urinary stress incontinence by means of anorectal manometry and to look for manometric variables which could predict the development of surgery demanding genital prolapse after Burch colposuspension. SUBJECTS: During 1991-1992 twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated upon with the Burch colposuspension. No concomitant prolapse repair surgery was performed. Forty-four healthy subjects without anorectal disorders were used as controls. METHODS: All subjects were investigated with anorectal manometry using a microtransducer catheter. A standardized questionnaire concerning bowel function was answered at interview. The manometry and interview were performed preoperatively and one year after the Burch colposuspension. RESULTS: According to the preoperative questionnaire, fecal incontinence was found in 62%, constipation in 38% and straining at defecation in 71%. There were no significant differences in any of the manometric parameters between the preoperative and the one-year postoperative assessment. The patients with prolapse operations after the colposuspension (n = 6) had a significantly lower anal squeeze pressure area (p = 0.029) preoperatively compared to the control subjects. The patients without prolapse surgery (n = 15) did not differ in manometric parameters from the control subjects. CONCLUSION: Bowel dysfunction is common in women with stress urinary incontinence. The women with low anal squeeze pressure area preoperatively are at risk for the development of genital prolapse after Burch colposuspension.

Adult↗
PubMed1996

Prediction of genital prolapse after Burch colposuspension.

OBJECTIVE: The aim of this prospective observational study was to investigate the gynecological and defecographic features in women with stress urinary incontinence operated with Burch colposuspension in order to analyze if the findings could predict subsequent development of genital prolapse. SUBJECT: Twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated with the Burch colposuspension during 1991-1992. No concomitant prolapse repair surgery was performed. METHODS: All were carefully examined in the lithotomy position at rest and with the Valsalva maneuver. The pelvic floor laxity was graded semiquantitatively. The defecography and the clinical examination were done preoperatively and repeated one year postoperatively. RESULTS: The clinical examination revealed a significant progression of rectoceles (p = 0.003) after the colposuspension. The colposuspension cured a significant number of cystoceles (p = 0.035). Six women (29%) had subsequent corrective prolapse surgery median 2 years after the colposuspension. The defecographic measurements showed a significant increase of the recto-vaginal distance (RVD) following the operation (p = 0.020). At the postoperative measurement the group with subsequent prolapse surgery had a significantly larger RVD as compared to the group without further surgery (p = 0.004). The kappa reliability test showed poor agreement between the defecographic and clinical assessment of the rectoceles. CONCLUSION: We failed to find any clinical or defecographic characteristic which could predict the development of surgery-demanding genital prolapse following colposuspension. The colposuspension seemed to accelerate the deterioration of the pelvic floor. However, only a minority of the patients developed symptomatic genital prolapse demanding corrective surgery. We suggest that only women with symptomatic prolapse should be considered for concomitant corrective surgery at the time of the colposuspension.

Defecation↗
PubMed1995

Vulvitis granulomatosa: a cryptogenic chronic inflammatory hypertrophy of vulvar labia related to cheilitis granulomatosa and Crohn's disease.

We report the cases of two patients with vulvitis granulomatosa, a chronic inflammatory hypertrophy of the vulvar labia thought to represent the vulvar variant of cheilitis granulomatosa. One of the women later experienced recurring cheilitis granulomatosa, while the other developed intestinal Crohn's disease 6 years later. The interrelationships of vulvitis granulomatosa, cheilitis granulomatosa, and Crohn's disease are discussed.

Adult↗
PubMed1994

Prognostic factors and long-term results of the Burch colposuspension. A retrospective study.

The purpose of this retrospective study was to evaluate the importance of different preoperative estimates and postoperative complications on the outcome of the Burch colposuspension with respect to urinary continence. During the period 1980-1988 243 women were operated upon with the Burch colposuspension for stress incontinence or mixed incontinence. The patient records have been analysed with respect to preoperative assessments and postoperative complications. 236 patients were alive at the follow-up, median 6 years after operation, and 232 (98%) answered a postal questionnaire about their present urinary symptoms. According to the postal questionnaire the overall cure-rate was 63 per cent, another 27 per cent were improved. Prognostic factors for an unsuccessful outcome of the operation were previous urinary incontinence surgery, postoperative febrile morbidity, and immediate voiding difficulties (stranguria and difficulties emptying the urinary bladder). At the follow-up the voiding difficulties were still significantly more often seen in patients not cured from incontinence than among women cured by the colposuspension. Among the patients with recurrent incontinence we also found a significantly higher rate of lower urinary tract infections ( > 3 UTI per year). The continence rate was found to be almost constant between the second and tenth year postoperatively. No significant differences in preoperatively measured maximal urethral closure pressure and functional urethral length were found between cured and not cured patients. Although not significant, the cure-rate showed a tendency to decrease with age at the operation, both in the short-term result as well as the long-term result.

Adult↗
PubMed1994

An open prospective randomized study of dinoproston and gemeprost in second trimester legal abortions.

The aim of this open prospective randomized study was to compare two non-invasive methods for second trimester abortion using gemeprost pessaries (Cervagem) and dinoproston gel (Cerviprost) concerning effectiveness, time for abortion, consumption of analgesics, infection-rate and side-effects. Forty women admitted for second trimester legal abortion were allocated to treatment with either gemeprost (20) intravaginally or dinoproston (20) intracervically. All patients were pre-treated with a 3 mm in diameter Lamicel tent applied intracervically for about four hours. The success-rate was 95% for gemeprost and 75% for dinoproston within approximately 48 hours. The median abortion time calculated from the insertion of the Lamicel tent for the successful cases was 22 h 0 min for gemeprost and 24 h 5 min for dinoproston (not significant). The shortest abortion time was found among parous women in the Cervagem group. The difference between Cerviprost and Cervagem in parous women was statistically significant. For nonparous women there were no significant differences in abortion time between the two regimes. No significant difference was found in the demand of Pethidin and the infection-rate between the two groups. No major side effects of the treatment were found. Even if no significant difference in successful abortions was found, probably due to the small patient material, Cervagem seems to be the most appropriate of the two non-invasive methods, because of a 95 per cent success-rate within 48 hours, but also due to its simplicity in design.

Abortifacient Agents, Nonsteroidal↗
PubMed1993

Alpha-adrenergic receptors in human myometrium: changes during pregnancy.

Myometrial biopsies from 80 women, delivered by cesarean section in 26-42 completed weeks of pregnancy, were analyzed using radiolabeled alpha 1-antagonist [3H]-prazosin and alpha 2-antagonist [3H]-rauwolscine. Statistical analysis was performed using Student's t test (two-tailed), where p < 0.05 was considered significant. The number of alpha 2-adrenergic receptors did not vary (mean value weeks 37-39 = 17.2 +/- 1.3 fmol/mg protein), while the dissociation constant (Kd) for alpha 2-receptors tended to increase with increasing gestational age, implying reduced affinity near term (p < 0.05, mean values 3.4 +/- 0.2 nM). alpha 1-Receptors, however, increased significantly (p < 0.01) in the pregnancy weeks 37-39 (mean value 29.2 +/- 2.9 fmol/mg prot) while Kd was unaltered. Increased number of alpha 1-receptors, along with a decreased affinity of alpha 2-receptors, could, in combination with other factors, play a role in the initiation of labor.

Analysis of Variance↗
PubMed1990

Binding of four oxytocin analogues to myometrial oxytocin and arginine-vasopressin binding sites in pregnant women.

The binding of 3H-oxytocin (3H-OT) and 3H-arginine-vasopressin (3H-AVP) and the displacement from binding sites by four oxytocin analogues were studied in myometrial membrane preparations from full-term pregnant women. Specific 3H-OT binding was saturable with a maximal binding capacity of 76.1 fmol/mg DNA, and a dissociation constant of 0.5 pM. Corresponding values regarding 3H-AVP was 148.6 fmol/mg DNA and 0.7 pM. The oxytocin analogues tested demonstrated a high specific binding to the OT and AVP receptor sites; in fact, the affinity of the analogues to the 3H-AVP binding sites was higher than to the 3H-OT binding sites. The order of potency between the analogues was CAU greater than CAM greater than CAP greater than CAO and CAP greater than CAU greater than CAO greater than CAM for the OT and AVP binding sites, respectively. The displacement of oxytocin and arginine-vasopressin, respectively, from the myometrial receptor sites indicate partly separate binding sites for oxytocin and AVP and might implicate that AVP can be of importance in regulating myometrial activity in pregnancy. The results on oxytocin analogues imply that other pharmacological tests must be performed for quantification of the relaxing effects on the uterus and to determine the optimal analogue for clinical trials in preterm labor and dysmenorrhoea.

Arginine Vasopressin↗
PubMed1988

Neurological condition of large-for-gestational-age infants during the newborn period.

Thirty-two large-for-gestational-age (LGA) infants and 46 appropriate-for-gestational-age (AGA) infants used as controls, were investigated. LGA and AGA infants did not differ regarding instrumental deliveries or asphyxia. The infants were examined on the 1st and 5th days after birth with a standardized neurological assessment. The LGA infants showed a significantly delayed neurological adaptation with fewer optimal responses on day one as compared to the AGA infants. These differences were not observed on day five. There were no neurological differences between prenatally and postnatally detected LGA infants. No significant differences were observed regarding parity on maternal complications, neonatal course, and neurological scores of the LGA infants.

Fetal Macrosomia↗
PubMed1987

Effects of enprofylline, a new xanthine derivate, on human pregnant myometrium.

The recently developed xanthine derivate, enprofylline, was studied in an in vitro system with human pregnant myometrium, in particular its effect on spontaneous myometrial contraction, cyclic adenosine monophosphate content, cyclic adenosine monophosphate protein kinase, and cyclic adenosine monophosphate-and cyclic guanosine monophosphate-dependent phosphodiesterase activity. Enprofylline was shown to be a rather potent smooth muscle relaxant [inhibitory concentration that decreases response by 50% (IC50) = 3 X 10(-5) mol/L] and an almost equally potent cyclic adenosine monophosphate-dependent phosphodiesterase inhibitor (IC50 = 10(-4) mol/L), whereas it was a less potent cyclic guanosine monophosphate-dependent phosphodiesterase inhibitor. Enzyme kinetic studies revealed that enprofylline is a competitive cyclic adenosine monophosphate phosphodiesterase inhibitor. Enprofylline increased the cyclic adenosine monophosphate content in a dose-dependent way with subsequent increased activity of cyclic adenosine monophosphate-dependent protein kinase. It is suggested that enprofylline relaxes myometrial smooth muscles and that this is at least partly the result of interference with the cyclic adenosine monophosphate system.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1986

Forceps or vacuum extraction? A comparison of effects on the newborn infant.

Sixteen women delivered by forceps and 20 women delivered by vacuum extraction (VE) owing to secondary uterine inertia were compared with a control group of 11 women who gave birth spontaneously. The cord arterial pH was lower in the VE group than in the forceps and control groups. Base deficit in both arterial and venous cord blood was greater in the VE group than in the forceps group, probably owing to the longer application and extraction times in VE than in forceps delivery. The incidence of retinal hemorrhage did not differ between the forceps and VE groups. The incidence of cephalhematomata was greater among VE infants than in the forceps and control groups. All infants were examined on the 1st and 5th day by standardized neurological and behavioural examination. There were no significant differences in neurological status between the forceps and VE groups. Thus, in low extraction with no signs of fetal asphyxia, either method can be used with safety if the obstetrician is familiar with both methods of operative vaginal delivery.

Adult↗
PubMed1986

Blood pressure and renal function during normal pregnancy.

In order to obtain reference values during normal pregnancy 24 women with strict criteria for health and normal pregnancy were studied. Greatest interest was focused on blood pressure (BP) measurements and renal function tests. Investigations were made in early second trimester and in the 30th, 33rd and 36th gestational weeks. Gestational age was estimated by ultrasound measurement of crown-rump length before the 14th gestational week. Both systolic and diastolic BP measured in the right arm were about 10 mmHg lower in the left lateral position than when supine or standing. The difference is suggested to be dependent on hydrostatic factors. Diastolic BP should be defined at the fourth phase of the Korotkoff sounds in order to be reliable because of the common phenomenon of late or non-disappearance of the sounds during pregnancy. Diastolic BP in phase IV increased in up to 25% of the cases with 15 mmHg or more from early second trimester to the 36th gestational week in all three positions. Serum creatinine concentration was low in early second trimester and did not change during pregnancy, while serum urea decreased and serum urate increased during pregnancy. The results emphasize the importance of using reference values from a normal pregnant population obtained at different gestational weeks for comparison in studies on certain pathological conditions during pregnancy, especially pre-eclampsia.

Adult↗
PubMed1985

Beta-adrenergic receptors in human myometrium during pregnancy: changes in the number of receptors after beta-mimetic treatment.

The concentration of available beta-adrenoceptors has been studied in the myometrium of women treated with terbutaline for premature uterine contractions and in an untreated control group. Myometrial strips were taken at cesarean section from the lower uterine segment and the uterine fundus. The concentration of beta-adrenoceptors was determined with a radioligand binding assay. In untreated women we found no difference in the concentration of beta-adrenoceptors in the uterine fundus compared to that in the lower uterine segment. The cyclic adenosine monophosphate production after beta-adrenoceptor agonist stimulation in vitro was equal in both locations. In the terbutaline-treated women, the binding site concentrations in both the fundus and lower uterine segment were lower compared to those in the control group. The decrease was most pronounced in the fundus where receptor concentration was only half that found in the control group. The results suggest that treatment with beta-mimetics causes a desensitization in the beta-adrenoceptor system of human myometrium during pregnancy. This desensitization may partly explain the limited duration of the relaxant effect of beta-mimetics often seen in the treatment of preterm labor.

Cyclic AMP↗
PubMed1984

Screening for detection of intra-uterine growth retardation by means of ultrasound.

In a two-stage ultrasound screening program the gestational age was assessed by measurement of the fetal crown-rump length in early pregnancy. At an adjusted gestational age between 32 and 35 completed weeks the biparietal diameter, the abdominal circumference, the abdominal area and the ratio between fetal head area and abdominal area were estimated by means of ultrasound measurement. 'Acute' fetal weight was estimated by calculations from biparietal diameter and abdominal diameters. Percentile curves were constructed for these parameters and cut-off limits were tested for the predictability of intra-uterine growth retardation of the fetus. The abdominal circumference and area estimations were equally good for the detection of intra-uterine growth retardation. The biparietal diameter alone is of limited value for the detection of intra-uterine growth retardation but the combination with abdominal diameters in 'acute' fetal weight estimation can well be used. The ratio between the skull and abdominal areas seems to be of little use for the detection of intra-uterine growth retardation of two reasons: difficulty in measurement and low sensitivity. We consider that the assessment of gestational age in early pregnancy is a necessity both for the identification of suspected IUGR by means of ultrasound and the diagnosis of IUGR by measurement of fetal weight at birth. It is concluded that if the gestational age has been assessed by crown-rump length measurement in early pregnancy, a single estimation of the fetal abdominal circumference between 32 and 35 completed gestational weeks and a cut-off limit at the 15th percentile offers a detection rate of about 90% of the growth retarded infants.

Abdomen↗
PubMed1984

Beta-adrenoceptor function of leukocytes in pregnant women treated with terbutaline for preterm labor.

The correlation between cyclic AMP (cAMP) production in myometrial tissue and that in leukocytes was studied in 21 women delivered by cesarean section for obstetrical reasons. After in vitro beta-adrenoceptor stimulation, cAMP production in myometrial tissue was found to be closely correlated with that in leukocytes (r = 0.96). Using cAMP production in leukocytes as an indicator of the state of the beta receptor function in myometrium, 18 women treated with terbutaline for preterm labor were studied. Repeat analyses of cAMP production were made in leukocytes before, during and after treatment. The results showed a significant reduction in cAMP production 3-5 hours and 1-2 days after terbutaline infusion. The cAMP values remained low during infusion. In women orally treated with terbutaline, a slight reduction in cAMP production was found after the first dose, but there was no significant reduction after 1-14 days of treatment. After cessation of terbutaline treatment, cAMP production remained low during the following 3 days, but after 5-8 days an increase was found in 7 out of 9 patients. It is suggested that a desensitization of the beta-adrenoceptor system in leukocytes appears after beta-adrenoceptor agonist treatment in high doses and that measurement of cAMP production reflects the state of desensitization of the beta-adrenoceptors in myometrial cells too.

Administration, Oral↗