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Biomedical subjects

L Cardozo

Publications and source records attributed to L Cardozo.

At least 73 records · Page 4Linked to original sources
PubMed1998

Efficacy and safety of tolterodine in patients with detrusor instability: a dose-ranging study.

OBJECTIVE: To investigate the efficacy and safety of tolterodine, a new antimuscarinic agent, and define the optimum dosage in patients with symptoms of detrusor instability (urgency, increased frequency of micturition and/or urge incontinence). PATIENTS AND METHODS: A double-blind, placebo-controlled, multicentre study was carried out; after a 1-week run-in period to establish baseline values, 81 patients were randomized to receive placebo or tolterodine 0.5, 1, 2 or 4 mg twice daily for 2 weeks. Micturition (diary) variables, urodynamics and subjective urinary symptoms were assessed after 2 weeks' treatment. RESULTS: A per-protocol analysis of efficacy in 64 patients showed dose-related improvements in recorded micturition and urodynamic variables, e.g. at a dosage of 2 mg twice daily, the frequency of micturition, episodes of incontinence and pad use were reduced by 20%, 46% and 29%, respectively, while the volume at first contraction increased by 89 mL. The 4 mg dosage was associated with a large increase in residual urinary volume and an increased incidence of dry mouth. The incidence of adverse events (mainly mild or moderate antimuscarinic effects) was comparable with placebo at tolterodine dosages of < or = 2 mg. No serious adverse events were observed and tolterodine had no clinically significant impact on electrocardiographic or laboratory findings. CONCLUSION: The results indicate that tolterodine offers an effective treatment for the symptoms of detrusor instability. The optimum dosage appears to be 1-2 mg twice daily.

Adult↗
PubMed1998

Incontinence in the elderly.

This year has seen many advances in the treatment of incontinence in the elderly, particularly the use of devices to control genuine stress incontinence and new drug treatments for detrusor instability to reduce side-effects and improve compliance. The results of existing surgical treatments for genuine stress incontinence have been evaluated more closely and newer techniques, which are less invasive and produce less morbidity, have been applied and evaluated in the elderly.

Aged↗
PubMed1998

Implementing a clinical pathway for congestive heart failure: experiences at a teaching hospital.

Clinical pathways are processes of care that use a multidisciplinary team effort to move patients toward a designed outcome. This article details the challenges of a Quality Enhancement and Clinical Resource Management Team in designing and implementing a successful congestive heart failure pathway at a teaching hospital. Academic institutions have the resources as part of their research mission, to enhance the development of clinical pathways and assess their outcomes.

Aged↗
PubMed1998

Prevalence of faecal incontinence among women with urinary incontinence.

Four hundred and sixty-five women attending a urodynamic clinic were interviewed, and completed a detailed bowel questionnaire, about their urinary and bowel symptoms. All the women underwent video-cystourethrography with pressure and flow studies. The reported incidence of faecal incontinence was 15.3% (n = 71) on direct questioning and 26% (n = 121) on the postal questionnaire. Faecal incontinence was more common in women with a urodynamic diagnosis of detrusor instability (30% (n = 26)) than among women diagnosed as having genuine stress incontinence (21% (n = 38)). Denervation and myogenic injuries sustained during childbirth have been suggested as a common cause for genuine stress and faecal incontinence, but there may be an alternative mechanism to explain why women with detrusor instability suffer from faecal incontinence.

Adult↗
PubMed1998

Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women.

OBJECTIVE: To assess the efficacy of oral oestriol in the prevention of recurrent urinary tract infections in elderly women. DESIGN: Double-blind, randomised, parallel group, placebo controlled trial SETTING: Urogynaecology Unit at King's College Hospital with some women recruited from the geriatric units of St. Pancras Hospital and Dulwich Hospital, London (UK). PARTICIPANTS: Seventy-two postmenopausal women older than 60 years of age (mean 73.2 years) suffering from recurrent urinary tract infections. INTERVENTION: Oral oestriol (3 mg per day) or placebo for six months. MAIN: outcome measures Urinary tract infection rates. RESULTS: The study was difficult to conduct because of its design and the age of the participants. Oral oestriol (3 mg per day) was not shown to be superior to placebo in the prevention of recurrent urinary tract infections, but both oestriol and placebo improved urinary symptoms during the trial. CONCLUSION: The power of the study might have been too low to detect a significant difference between the groups, or oral oestriol (3 mg per day) may have been either the wrong dose or the wrong route of administration for this indication.

Administration, Oral↗
PubMed1998

The urethra (UPP, MUPP, instability, LPP).

Urethral function can be assessed using many different techniques and this is very important when applied to women with neurological abnormalities. Urethral pressure profilometry, although not diagnostic for urethral sphincter incompetence, can be used to detect strictures and the ostia leading to urethral diverticula. Urethral instability may be recorded using urethral pressure catheters. The significance of this finding is uncertain but it has been suggested that women with urethral instability and detrusor instability are less responsive to therapy with anticholinergic drugs than those with a stable urethra. Micturition pressure profilometry is useful for determining obstruction during voiding and enables the site of obstruction to be determined. Leak point pressures (LPP) can be classified as detrusor or abdominal. Detrusor LPP are useful in patients with neurological disease. Abdominal LPP are subdivided according to the method used to increase intra-abdominal pressure either the Valsalva manoeuvre or coughing. The technique used to obtain an LPP can alter the measurement obtained and a standardized technique is essential for consistent results. LPP correlate with the urinary incontinence of women with genuine stress incontinence undergoing a pad test but is of no value if the woman does not leak! Tests of urethral function during bladder filling, stress and voiding phases help in assessing lower urinary tract dysfunction in neurourology.

Female↗
PubMed1997

Managing postmenopausal cystitis.

Cystitis caused by prolonged estrogen deprivation may be grossly underreported. This may be why many advocates of hormone replacement therapy focus on its cardiovascular and skeletal benefits while ignoring the bladder and urethra.

Atrophy↗
PubMed1997

Early voiding difficulty after colposuspension.

OBJECTIVE: To determine the incidence of post-operative voiding dysfunction (POVD) after colposuspension and to identify pre-operative risk factors. PATIENTS AND METHODS: A retrospective study of 100 women having colposuspension to determine the preoperative clinical assessment (history, physical examination, symptom-specific questionnaire and visual analogue score assessment of urological symptoms), pre-operative urodynamic investigations (uroflowmetry, twin-channel subtracted cystometry and video-cystourethrography), information on post-operative catheter management and the presence and management of any POVD. RESULTS: Twenty-one women experienced significant POVD attributable to their colposuspension. This resolved within 6 months in 19, but persisted beyond 6 months in two. Women experiencing POVD were significantly older and were more likely to have previously undergone a hysterectomy. The risk of POVD was 12% for those aged < 50 years, 25% at age 50-64, and 50% for those over 65 years. The duration of post-operative catheterization was related to the presence of symptoms of voiding difficulty. CONCLUSIONS: The risk of POVD after colposuspension increases with age. In women over 65 years old, consideration should be given to an elective temporary discharge home with a suprapubic catheter in situ for 7-10 days before initiating a catheter-clamping regimen.

Adult↗
PubMed1997

An assessment of residents' competence in the delivery of bad news to patients.

PURPOSE: To assess the level of residents' competence in delivering bad news to patients. METHOD: In June 1995, 25 residents (of 116) in the Wayne State University general internal medicine residency program volunteered to participate in the study, which consisted of videotaped interviews of a simulated patient whose profile had been developed to highlight the delivery of a diagnosis of lung cancer. The residents were evaluated using an instrument based on a review of the current literature regarding the skills considered necessary for giving bad news in a caring and informative manner. The instrument contained 16 items, seven in the informative category and nine in the affective category. Each item was rated on a five-point Likert scale (from 1 = "doesn't do this" to 5 = "does this very well"). A rating of > or = 4 on any item indicated competence in the skill area measured by that item. All interviews included in the study were rated by all six of the authors. Interrater reliability was calculated to be .91. RESULTS: In all, 22 interviews (three by women, 19 by men) were included in the study. The residents' ages ranged from 26 to 35 years; the numbers of years since graduation from medical school ranged from two to six. Twenty were third- or fourth-year residents ready to graduate; the other two were completing their first year. Mean ratings in the informative category ranged from 1.51 to 4.51; for three items, mean ratings were > or = 4. The total mean rating for all the items in this category was 3.42. Mean ratings in the affective category ranged from 1.15 to 4.75; for three items, mean ratings were > or = 4. The total mean rating for all the items in this category was 3.45. CONCLUSION: The residents showed a general lack of competence in delivering bad news. The skill items with the lowest ratings were primarily related to eliciting the patient's perspective, which may represent a weakness on the part of the residency program in teaching the residents to use a "patient-centered" interviewing style. The results of this study will form the basis of a curriculum to improve residents' comfort with and skills for delivering bad news to patients.

Adult↗
PubMed1997

Lower urinary tract symptoms in pregnancy.

Lower urinary tract symptoms are almost universal in the antenatal period and in most cases are transient. Retention of urine is one of the few conditions which must be treated as there may be long-term consequences. The symptoms of frequency and stress incontinence are those which have been most examined in pregnancy. It would appear that the former have no long-term sequelae but the latter may be an indicator of potential sphincter damage during delivery. The recent documentation of detrusor instability antenatally further confuses the picture and demonstrates the need for functional studies to determine the exact significance of these lower urinary tract symptoms.

Female↗