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Biomedical subjects

J T Benson

Publications and source records attributed to J T Benson.

53 records · Page 3Linked to original sources
PubMed1992

Histology and fertility effects of polydioxanone on rat reproductive tissue.

This prospective study compares the histology and fertility effects of the microsuture polydioxanone to nylon and polyglactin-910. Twelve rats underwent uterine horn microroeanatomoses with nylon (6 right horns), polyglactin-910 (6 right horns), and polydioxanone (12 left horns). After mating, there were no significant differences in gestational implantations or adhesions per uterine horn. Postoperative histologic evaluation of nylon showed persistent histiocytic reaction and fibrosis, occasional giant cells, and suture persistence at 100 days. Polyglactin-910 had initial histiocytic responses, no giant cells or fibrosis, and was resorbed by 60 days. Polydioxanone had initial histiocytic reaction and giant cells, no fibrosis, and was resorbed by 100 days. Our findings, and a review of the literature, confirmed mixed histologic reactions but no difference in fertility with these three microsutures. Because of its low reactivity and great strength, polydioxanone may be a good alternative suture material in reproductive microsurgery.

Animals↗
PubMed1992

Pelvic prolapse: assessment with evacuation proctography (defecography)

The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.

Adult↗
PubMed1992

Idiopathic fecal incontinence.

Pelvic floor dysfunction is related to neuropathic injury to the pelvic floor musculature. Clinically, the patient may present with genital prolapse or urinary or fecal incontinence. For a successful outcome, the physician must consider all pelvic compartments in the evaluation and treatment of patients with these disorders. Disorders of the posterior compartment are the least familiar to the gynecologist. Idiopathic fecal incontinence, a posterior compartment defect, is defined as a progressive deterioration of anal sphincter function in patients with no history of sphincter damage. This review discusses the latest findings about idiopathic fecal incontinence within the context of pelvic floor dysfunction and neuropathy.

Electromyography↗
PubMed1991

Definition of normal female pelvic floor anatomy using ultrasonographic techniques.

Urogynecology deals with anatomic and physiologic defects of the female pelvic floor, including urinary and anal incontinence. Ultrasonographic investigation of the female pelvic floor may be helpful in diagnosis and management of both symptom complexes. To interpret pelvic floor ultrasound studies, normal parameters are necessary. Ten asymptomatic control subjects were studied for internal and external anal closing pressures, anal-rectal angles, puborectalis muscle movement, position of urethral egress, and amount and direction of urethrovesical junction mobility. Means and standard deviations for each parameter were obtained. Comparison to studies performed during the same time interval on patients symptomatic for urinary or anal incontinence is discussed.

Adolescent↗
PubMed1990

Physiologic evaluation of the anorectum. A new ultrasound technique.

Pelvic floor physiology is a complex area of clinical study. Continence and voiding functions are not completely understood. Incontinence is an especially underrated problem. With the use of manometry and ultrasound, anorectal physiology is evaluated and correlated with clinical dysfunction. A description of a previously undescribed ultrasound technique to evaluate anorectal angles and puborectalis function is presented. The results in 10 controls and 53 symptomatic patients with different degrees of continence dysfunction are discussed. The controls showed anal pressures and anorectal angles of 29 cm H2O and 114 degrees at rest and 67 cm H2O and 95 degrees with contraction. Six of the symptomatic patients had complete incontinence to solid stools. The results of their pressures and angles were 14 cm H2O and 151 degrees at rest and 32 cm H2O and 124 degrees with contraction. The values of this group compared with controls is significantly different (P less than 0.05). Ultrasound is helpful in assessing the pelvic floor, both subjectively and objectively. It has the advantages of avoiding radiation and allowing a longer viewing time. It is less expensive compared with radiographic proctography and the data are complementary. Ultrasound and manometry may be useful for long-term follow-up of anorectal physiology.

Aged↗
PubMed1990

Evaluation of a minimal-incision pubovaginal suspension as an adjunct to other pelvic-floor surgery.

In September 1987, Gittes and Loughlin first described a minimal-incision pubovaginal suspension as a modification of the Pereyra needle suspension urethropexy. Thirty-four women who underwent the minimal-incision urethropexy procedure were studied for up to 13 months postoperatively. Although 21 patients also had the anterior vaginal wall opened to perform concomitant pelvic-floor surgery, the principles of minimal suprapubic incision, full-thickness vaginal sutures, and no dissection of endopelvic fascia were followed strictly in all 34 cases. With a mean follow-up of 9.5 months, the objective cure rate was 91% and subjectively, 97% of the patients were either cured or improved. This technically simpler procedure is effective for treating genuine stress urinary incontinence in women who also require surgical repair of other pelvic-floor defects.

Adult↗
PubMed1989

Comparative costs of a cooperative care program versus hospital inpatient care for gynecology patients.

The cost of gynecologic care delivered in a cooperative care (co-op) unit was compared with the cost for similar patients treated in a traditional hospital inpatient unit. No significant differences were found. This finding was in direct contrast to our earlier study of obstetric patients where overall savings were achieved. The authors did, however, find cost savings (approximately $450) for those co-op patients cared for by physicians who were frequent users of the unit. Most of the savings for this group was achieved through a reduction in the cost of routine services, which includes nursing care. If the current nursing shortage leads to an increase in co-op units, nursing administrators need to be aware that potential cost savings may depend on physician familiarity with the co-op concept. A major role of nursing therefore, is to provide information on the benefits of cooperative care both to physicians and to potential patients.

Adult↗
PubMed1989

Neurophysiologic control of lower urinary tract.

Current concepts in neurophysiology are discussed, with emphasis on neurotransmitters and electrodiagnosis. Specific neuronal mechanisms governing urine storage and expulsion are presented followed by clinical considerations of various neuronal dysfunctions.

Electrophysiology↗
PubMed1988

Comparative costs of a cooperative care program versus inpatient hospital care for obstetric patients.

The cost of obstetric care delivered in a cooperative care unit was compared with the cost for similar patients treated in a traditional inpatient maternity unit. The study sample contained 1,683 consecutive patients representing 23 diagnosis categories. The analysis indicates that cooperative care patients had significantly lower total hospital costs. This cost savings persisted even when we controlled for case severity. The only exception was for the obstetric patient requiring intra-abdominal surgery. For fiscal year 1986, hospital cost savings for the 576 patients who used the cooperative care unit was +80,640 or approximately +105,000 in total patient charges. The majority of the savings came from a reduction in routine nursing services that are directly attributable to the cooperative care unit. We conclude that cooperative care can be an economically feasible alternative for most obstetric patients.

Adult↗
PubMed1985

Gynecologic and urodynamic evaluation of women with urinary incontinence.

One hundred women with urinary incontinence were evaluated at the urodynamic investigation unit. Sixty-seven percent of the patients in this series were found to have significant gynecologic disease underscoring the importance of simultaneous gynecologic and urologic investigation. Incontinence surgery was determined to be indicated in 44 of the 87 patients who had the symptom of stress urinary incontinence, suggesting that accurate evaluation of the lower urinary tract in women complaining of incontinence does allow a careful selection of patients for surgical therapy. Discussion is given regarding the determination of the amount of patient evaluation necessary before instituting therapy.

Adult↗
PubMedDate not supplied

Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980-1990.

Therapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985-1990) and was not (1980-1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy-five patients had surgery alone during 1980-1984 and 38 during 1985-1990. TE was initially performed on 134 patients during 1985-1990. Bleeding (n = 30) and perforation (n = 1) prompted emergent operation in 23% of cases following TE. Thus 69 (38 + 31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p < 0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p < 0.0001). Sixty-one percent of incompletely visualized TE-treated lesions required operation, and 18% of well visualized ulcers underwent operation (p < 0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p = 0.7). Mean follow-up was 540 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Physeal fractures: Part 1. Epidemiology in Olmsted County, Minnesota, 1979-1988.

All children in Olmsted County, Minnesota, who had a physeal fracture in the 10-year period 1979 through 1988 were identified in this population based study. Children with acute fractures from surrounding areas of Olmsted County and children with subacute, chronic fractures or complications of fractures among referral patients were not included. Eight-hundred fifty children sustained 951 physeal fractures; 561 boys (66%) sustained 637 fractures, and 289 girls (34%) experienced 314 fractures. The male:female ratio was 2:1 and incidence rates were greatest among 11-12 year-old girls and 14-year-old boys. The overall age- and sex-adjusted incidence of physeal fractures was 279.2 per 100,000 person-years (95% confidence interval, 261.4-296.9). The most common site was the phalanges of fingers, which accounted for 37% of all physeal fractures. Salter-Harris type II was the most common type of fracture (54%), but 149 fractures (16%) did not fit into this classification. Therefore, two new, previously unclassified fracture types were added and are reported in detail (see Physeal Fractures: Part 2. Two Previously Unclassified Types, pp. 431-38). This led to a review of existing classifications and creation of a new one (see Physeal Fractures: Part 3. Classification, pp. 439-48).

Adolescent↗