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K Haadem

Publications and source records attributed to K Haadem.

14 recordsLinked to original sources
PubMed1998

[Review of the literature on advantages and disadvantages: episiotomy: only limited protection against ruptures--time for a revision?].

A review of the literature on the pros and cons of episiotomy suggests that it should be used restrictively. Although there is a general agreement that episiotomy is protective against anterior perineal tears, no evidence has been found to support the belief that it is protective against anal sphincter muscle tears, pelvic muscle damage or urinary incontinence in the parturient or intracranial haemorrhage or intrapartum asphyxia in the newborn. Women undergoing episiotomy are characterised by greater blood loss in conjunction with delivery, and there is a risk of improper wound healing and increased pain during the early puerperium. The prevalence of episiotomy in Sweden has been declining over the past 20 years, and is now approximately five per cent among multiparae and fifteen per cent among primiparae.

Anal Canal↗
PubMed1998

Frequency of anal sphincter rupture at delivery in Sweden and Finland--result of difference in manual help to the baby's head.

BACKGROUND: Anal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmö in Sweden and Turku in Finland, and analyze the potential determinants. METHODS: Retrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994. RESULTS: The incidence of anal sphincter ruptures in Malmö, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the baby's head when crowning through the vaginal introitus between Malmö and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmö than in Turku. CONCLUSIONS: The difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the baby's head when crowning.

Anal Canal↗
PubMed1997

HPV 16 DNA and mRNA in cervical brush samples quantified by PCR and microwell hybridization.

To quantitate HPV 16 DNA and mRNA, biotinylated amplicons from PCR and reverse transcription PCR were captured on streptavidin-coated microtitre plates. The amount of amplicon was determined by colorimetric detection after hybridization with an alkaline phosphatase-labelled probe. Dynamic ranges of between 4 and 6 log10, sufficient to cover the amounts of viral DNA and mRNA prepared from cervical samples were achieved. The reproducibility of the colorimetric detection step was reflected in coefficients of variation (C.V.) below 8%, considerably better than that of chemiluminescence detection. In a series of 89 HPV 16 DNA positive cervical samples, as compared with a CIN I/normal diagnosis subgroup, the number of HPV 16 genome copies per assay was significantly greater in a CIN II subgroup (P = 0.014), and a high-grade neoplasia subgroup (P = 0.040), and the content of HPV 16 mRNA significantly greater in the high-grade neoplasia subgroup (P = 0.0021). The number of mRNA equivalents per copy of viral DNA was higher for E5 than for the other three mRNA species analyzed (P < 0.001), and the concentration of E6*I mRNA was higher than those of the E6 full-length (P < 0.001) and E6*II (P < 0.001) transcripts. Despite these differences, no correlation was found between histological/cytological diagnosis and the amount of viral mRNA relative to the viral load.

Cervix Uteri↗
PubMed1997

Can women with intrapartum rupture of anal sphincter still suffer after-effects two decades later?

BACKGROUND: Recent research has revealed that women who suffer anal sphincter rupture (ASR) during delivery can experience persisting complaints some time afterwards. Examinations have been made some years postpartum, but it would be of interest to know if women with anal sphincter rupture might still have complaints attributable to the tear, two decades later. METHODS AND MATERIAL: A questionnaire was mailed to women with recorded intrapartum anal sphincter rupture (n = 66) and to matched controls without anal sphincter rupture (n = 66), two decades after the event. RESULTS: Forty-one of the anal sphincter rupture women and 38 controls replied. Anal problems were more often experienced by the anal sphincter rupture subjects (n = 18) than by the controls (n = 7) (P < 0.01). Complaints such as anal fissures, gas incontinence and leakage into lingerie were significantly more common in the sphincter rupture group. Four claimed the physic trauma had deterred them from further pregnancy; two had nevertheless given birth later on. Five (12%) of the women were unaware that they had sustained a sphincter tear. CONCLUSIONS: Women with intrapartum anal sphincter rupture can still suffer problems 20 years afterwards. In the follow-up of these women, information and support are essential and active tracing of such women is to be recommended.

Anal Canal↗
PubMed1994

The effects of parturition on female pelvic floor anatomy and function.

Our knowledge of the immediate effects of parturition on pelvic floor anatomy and physiology has been sparse. However, with the introduction of computed tomography, ultrasonography, and magnetic resonance imaging, new tools have become available for visualizing dynamic antenatal and postpartum changes in the pelvic musculature. Although few studies have been performed, there is evidence of a pregnancy-related increase in the frequency of urinary stress incontinence, and of an increased frequency of persistent anal incontinence in cases of sphincter tears.

Female↗
PubMed1992

Maximum anal sphincter strength measured by the solid sphere test and anal pressure profiles.

OBJECTIVE: To evaluate two methods of quantifying external anal sphincter function. DESIGN: Open study. SETTING: Helsingborg Hospital, Sweden. SUBJECTS: 73 patients (63 women and 10 men), of whom 25 were incontinent of gas and liquid or solid stool. INTERVENTIONS: Anal pressure profiles and the "solid sphere" test. OUTCOME MEASURE: Correlation between results of tests and presence of incontinence. RESULTS: Continent patients were younger than incontinent ones. The correlation between the maximum force the patient could retain and the maximum anal squeeze pressure was good (r = 0.67, p < 0.001). Younger continent patients (n = 48) and significantly higher pressures than incontinent patients (n = 25), but the range and overlap were wide. The reproducibility of both methods was good. CONCLUSIONS: Although the solid sphere test is easier and quicker to do, anal pressure profiles yield more information that is important in the evaluation of incontinence.

Adult↗
PubMed1991

Estrogen receptors in the external anal sphincter.

Inasmuch as anal competence in women is reduced after the age of 50 years, it may be dependent on effects of estrogens. In this study, samples of the external anal sphincter were analyzed for the presence of estrogen receptors and were found to be present at a median concentration of 5.0 fmol per milligram of protein (range, 1.9 to 13) in women (n = 7), and 1.1 fmol per milligram of protein (range, 0 to 3.2) in men (n = 7). These findings are of interest with regard to the treatment of idiopathic anal incontinence.

Adult↗
PubMed1991

Anal sphincter competence in healthy women: clinical implications of age and other factors.

Normal variation in anal sphincter competence was examined with anal pressure profilometry, using a low compliant recording system and a perfused catheter, in 49 healthy women with a mean age of 51 years (range 20-79). Maximum resting anal pressure and maximum squeeze pressure declined with age (r = -0.61; P less than .001 for both), more rapidly so after menopause. Rectal pressure increased with body mass index (r = 0.60, P less than .001). Closing pressure (ie, the difference between maximum resting anal pressure and rectal pressure), an important determinant of anal continence, was more markedly reduced with age (r = -0.69, P less than .001) than was maximum resting anal pressure. Age-related changes were found for the length of the anal canal (r = -0.36, P less than .05). Parity and anal pressures were unrelated. Women are more frequently affected by anal incontinence than are men. Anal pressure profilometry is a useful diagnostic aid, though age-related changes must be taken into consideration when evaluating the results. The more rapid decline of anal pressures after menopause might imply that anal sphincter tissue is a target for estrogen.

Adult↗
PubMed1990

Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls.

Twenty-one consecutive women with anal sphincter muscle rupture during delivery (0.79%) and 15 controls were examined. The anal sphincter was immediately repaired in the study group and the function determined with anal profilometry at 3 days and 3 months after delivery, and in ten of the patients after 12 months. Anal sphincter strength was reduced soon after delivery in the controls but regained normal strength within 3 months. In the anal sphincter rupture group, an improvement was found over the first 3 months after delivery, but afterwards no further change occurred. The anal sphincter strength was significantly reduced compared to the control group, both soon after delivery and after 3 months. Their voluntary anal pressure increased from 1.7 kPa immediately after delivery to 3.2 kPa at 3 months in the study group and the corresponding values in the control group were 4.0 and 6.5 kPa, respectively. For the closing pressure, that is the resting pressure minus the rectal pressure, the values in the study group were 4.2 and 6.7 kPa, and in the control group 7.2 and 9.4 kPa, respectively. In the women with anal sphincter rupture, however, a significantly increased frequency of gas incontinence was found.

Adult↗
PubMed1988

Long-term ailments due to anal sphincter rupture caused by delivery--a hidden problem.

Questionnaires concerning ailments were sent postpartum (mean two years) to 62 women with anal sphincter ruptures (ASR), who were compared with a matched control population. The frequency of anal sphincter rupture at the hospital during delivery in the period, 1978-82, was 0.7% (n = 63). Primiparity, instrumental deliveries, abnormal presentation, large babies and oxytocin stimulation were all risk factors. Of 59 women answering the questionnaire 37 (63%) stated that they had had ailments three months postpartum, mainly with pain and involuntary passage of flatus but also with dyspareunia and occasional incontinence of faeces. Long-term symptoms were noted by 28 (48%) of the women, mainly with involuntary passage of flatus but also perineal pain, dyspareunia and occasional incontinence of faeces. Long-term symptoms occurred in 7 (88%) of women with ASR also involving the anal mucosa, but only in 21 (39%) of those with ASR only. Three of the patients subsequently underwent reconstructive surgery, and three complained of psychological problems.

Adult↗
PubMed1987

Anal sphincter function after delivery rupture.

Questionnaires were sent to 63 women with anal sphincter rupture that occurred during vaginal delivery two to seven years earlier. Half of them had significant trouble, such as incontinence for gas, dyspareunia, and pain. We performed anal pressure profilometry in 14 of these women and in ten controls for comparison, and found a significant reduced strength in the external anal sphincters of the studied group. When anal sphincter rupture extended through the rectal mucosa, the internal sphincter strength was also reduced. The persisting signs and symptoms of anal dysfunction indicate that women with anal sphincter rupture need more attention and follow-up.

Adult↗
PubMed1986

Doxorubicin-cisplatin combination chemotherapy for recurrent carcinoma of the cervix.

A total of 31 patients with recurring or metastasizing squamous cell carcinoma of the cervix were treated with doxorubicin and cisplatin. Sixteen patients (Group 1) had previously been treated with external irradiation and two intracavitary radium applications, and 15 patients (Group 2) had been treated with radiotherapy plus chemotherapy with bleomycin plus mitomycin, peplomycin, or melphalan. The overall frequency of response was approximately 16% (five of 31 patients). In Group 1, two of 16 patients had complete remission for 14+ and 28 months, and survival for 36+ and 45+ months. One of 16 patients had partial remission for 8 months, and survival for 16+ months. In Group 2, two of 15 patients achieved partial remission for 16 and 18 months, and survival for 28 and 35 months. No serious side effects were noted in the two groups.

Adult↗