Biomedical subjects
L Cardozo
Publications and source records attributed to L Cardozo.
Genetic analysis of Triatoma infestans following insecticidal control interventions in central Bolivia.
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The Burch colposuspension for women with and without detrusor overactivity.
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Imaging in urogynaecology.
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Interstitial cystitis--still an enigma after 80 years.
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Care in a midwife managed delivery unit. Pregnancy and delivery require a joint midwifery and medical approach.
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A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound.
A new technique of measuring bladder wall thickness using transvaginal ultrasound is described. Measurement of the bladder wall using ultrasound was found to have a good intra- and interobserver reproducibility. Measurements of the bladder wall thickness were altered if more than 50 ml of fluid was within the bladder. Forty-five women with urinary symptoms were recruited from the urodynamic clinic; those with urodynamically diagnosed detrusor instability were found to have significantly thicker bladder walls than women with urodynamically diagnosed genuine stress incontinence. Application of this technique may be useful in the diagnosis of detrusor instability.
Estrogen therapy in the management of urinary incontinence in postmenopausal women: a meta-analysis. First report of the Hormones and Urogenital Therapy Committee.
OBJECTIVE: To apply a meta-analysis to available data to evaluate the efficacy of estrogen therapy in the management of postmenopausal women with urinary incontinence. METHODS: The literature review incorporated English language articles based on a search of EXCERPTA MEDICA, BIOSIS, and MEDLINE from January 1969 to June 1992. Criteria included: peer-reviewed original article, confirmed diagnosis of urinary incontinence, an estrogen-treated group, and outcome data on subjective improvement, quantitation of fluid loss, or maximum urethral closure pressure. In addition, the data had to allow comparison between treated and control groups in controlled trials or an estimated change in uncontrolled series. meta-analytic methods were applied only to studies considered to be controlled clinical trials. RESULTS: Of 166 articles reviewed, 143 did not meet the entry criteria; six were considered controlled clinical trials and 17 were uncontrolled series. Meta-analysis found an overall significant effect of estrogen therapy on subjective improvement for all subjects (P < .01) and for subjects with genuine stress incontinence alone (P < .05). The results showed no significant effect on quantity of fluid loss but a significant effect (P < .05) on maximum urethral closure pressure. However, the latter result was influenced by only one study showing a large effect. CONCLUSION: It appears from this analysis that estrogen subjectively improves urinary incontinence in postmenopausal women. However, the studies included nonhomogeneous groups, and the diagnostic criteria, therapeutic interventions, and outcome assessments varied considerably.
Is routine induction of labour at term ever justified?
Balancing the risks of prolonged gestation against those of induced labour is difficult. Risks to the fetus increase slightly after 42 weeks' gestation but women having labour induced are more likely to have instrumental deliveries or babies with low Apgar scores. Since many women are now expressing a preference for minimal interference in childbirth the most acceptable management of post-term pregnancy seems to be increased fetal surveillance. Each case needs to be considered individually and it is important that the woman is involved in the decision to induce.
Evaluation of the pharmacokinetic and pharmacodynamic interaction between quinidine and nifedipine.
Quinidine and nifedipine appear to be subject to metabolism by the same isozyme of cytochrome P-450. In addition, both drugs have been reported to alter the pharmacokinetics of other compounds. To investigate a potential interaction, 10 healthy subjects (five male, five female) received quinidine sulfate (200 mg orally), nifedipine (20 mg orally), or the combination of both drugs every 8 hours for 4 doses using a randomized, cross-over study design with a 2-week washout period between treatments. Drug concentration, heart rate, and mean arterial pressure were measured at frequent intervals after the final dose. Quinidine concentrations were unchanged by the co-administration of nifedipine. Nifedipine area under the curve (AUC0-8) increased 36.6% from 333 to 455 micrograms.hr/L (P < .05) after quinidine administration. Heart rate was significantly higher in the nifedipine-quinidine treatment at 0.5, 1.0, 1.5, and 2.0 hours when compared with either drug alone. The maximum increase in heart rate (17.9 beats/minute) occurred at 0.5 hours after nifedipine administration and was significantly correlated with serum concentrations at that time (r = .78). These results suggest that quinidine inhibits nifedipine metabolism, and this pharmacokinetic interaction results in enhanced pharmacologic response.
Oestriol in the treatment of postmenopausal urgency: a multicentre study.
UNLABELLED: Oestrogen deficiency in postmenopausal women is thought to be important in the genesis of lower urinary tract symptoms, in particular the 'urge syndrome'. Evidence to support the use of oestrogen therapy in symptomatic postmenopausal women is, however, limited. Oestriol is a weak, naturally occurring oestrogen that may be beneficial to the urogenital tissues without stimulating the endometrium. We have investigated the use of oestriol in the treatment of postmenopausal sensory and motor urge incontinence. MATERIALS AND METHODS: A double-blind, placebo-controlled, randomised, multicentre study of 3 mg oral oestriol/day for 3 months in the treatment of women with urge incontinence was undertaken. RESULTS AND CONCLUSIONS: Sixty-four women were recruited into the study. Although oestriol produced both subjective and objective improvement in lower urinary tract function, it was not significantly better than placebo. Some of the difficulties of running a multicentre study were encountered.
Teaching vaginal examination.
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The assessment of bladder neck movement in postpartum women using perineal ultrasonography.
Twenty-three postpartum women underwent perineal ultrasonography to determine bladder neck position at rest, on Valsalva and during pelvic floor contraction. On Valsalva, significant descent of the bladder neck and apposition to the symphysis pubis occurred. During pelvic floor contraction, there was significant elevation of the bladder neck; however, in approximately one-third of cases no movement was demonstrated. The bladder neck was shown to move through the arc of a circle whose center is the inferior border of the symphysis pubis. Perineal ultrasound provides a simple, objective way of measuring bladder neck elevation during pelvic floor contraction. This may be a more appropriate means of determining treatment outcome, in women undergoing conservative treatment for genuine stress incontinence, than measures of vaginal squeeze pressure.
Growth of the normal human lower urinary tract from 12 to 21 weeks gestation.
Normal development of the human lower urinary tract was studied between the 14th and 20th week of gestation using 3 modes of fixation. Fixation by direct distension provides a high degree of reproducibility of parameters used to study the growth of the fetal bladder. Using this method, fetuses ranging from 12 to 21 weeks gestation were studied. Results obtained demonstrate that the length of the bladder, the inter-ureteric distance, and the distance between the apex of the trigone and the distal tip of the urethra occur in a linear mode. Furthermore, the rate of growth of the male urethra was evidently higher when compared to that of the female from the 12th week of gestation. Data from this work can be used for a more accurate assessment of cases with abnormal lower urinary tract development.
Endoscopically guided bladder neck suspension for continence in paraplegic women with implant driven micturition.
Two paraplegic women who had undergone implantation of a sacral anterior nerve root stimulator to treat their voiding difficulties and recurrent urinary tract infections subsequently suffered from stress incontinence. After urodynamic evaluation they were treated with a Stamey operation which rendered them dry without hindering their implant driven micturition.
Urinary incontinence in women: have we anything new to offer?
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Racial differences in drug response: isoproterenol effects before and after propranolol.
The aim of this study was to determine in young, healthy men the relative contribution of pharmacodynamic factors inherent between two groups known to respond differently to hypertensive therapy. Black (n = 10) and white (n = 10) men received an isoproterenol sensitivity test before and after propranolol (0.1 mg/kg, then 50 micrograms/min). There were greater increases (twofold) in systolic BP following the 1.0- and 1.5-microgram isoproterenol dose (P less than 0.05) in the black group. During propranolol there were no differences in free (1)-propranolol concentrations between the groups; however, propranolol decreased resting heart rate in the white group more than in the black group (P less than 0.05). Cardiac index decreased less in the black group compared to the white group (P less than 0.05). Following the second isoproterenol challenge, there again were greater increases in systolic BP in the black group at both the 10- and the 20-micrograms isoproterenol dose (P less than 0.05). Our study has highlighted the importance of cross-racial studies in evaluating drug effects.
Urethral pressures: analysis of transmission pressure ratios.
Transmission pressure ratio (TPR) analysis of urethral pressure profilometry data has been advocated for the diagnosis of genuine stress incontinence (GSI). However, the clinical usefulness of the technique has not been adequately evaluated. Using videourodynamics as the gold standard, the TPR results of 150 continent women and 153 with GSI have been compared. The mean TPR for each quartile of the functional urethral length was computed, as was the maximum TPR value (TPR-max) and the position on the urethra where it occurred (TPR-mode). There was a statistically significant difference between the 2 groups for TPR values in the distal 2 quartiles of the urethra and for TPR-max and TPR-mode. With the use of the Kappa statistic it was found that the TPR-mode was the most discriminatory of the TPR parameters. Even using this measure, the overlap between normal and GSI was so great as to make accurate diagnosis impossible. It was therefore concluded that TPR analysis is useless for the diagnosis of GSI. However, such an analysis is helpful for the understanding of the pathophysiology of GSI and its treatment.