Biomedical subjects
Publications and source records attributed to L Cardozo.
Following the last menstrual period, a woman's "genital organs are sealed with the signet of sterility" (De L'Isère, 1850) and the ensuing hypo-oestrogenism, a consequence of ovarian failure, results in major metabolic disturbances. These include osteoporosis, thin skin, and an increased propensity for myocardial ischaemia. In association with these changes, lower urinary tract dysfunction occurs, also related to lower levels of circulating oestrogen.
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Climacteric symptoms in 120 women were treated with a total of 469 hormone implants (oestradiol 50 mg and testosterone 100 mg) over a period of four years. All patients with a uterus were given an oral progestogen to prevent endometrial hyperplasia. There was a marked response to treatment, hot flushes being improved in all patients, depression in 99% and loss of libido in 92%. Patient acceptability of this type of treatment was good and there were few side effects or complications. After therapy, the serum oestradiol exceeded the serum oestrone but remained within normal limits. When climacteric symptoms returned and re-implantation occurred the serum levels of oestrone, oestradiol, luteinising hormone (LH), follicle stimulating hormone (FSH) and testosterone were within the normal range for the reproductive age. This indicates that the return of symptoms is due to a change in the hormone levels rather than absolute hypo- oestrogenism .
The urodynamic changes produced by sacral anterior root stimulators have been assessed in 13 patients with spinal injuries. Before surgery all of the eleven men and two women had poor or absent bladder control with large residual volumes. Videocysto-urethrography with pressure and flow studies was performed pre-operatively and repeated once post-operatively, at intervals of 6 months to 5 years. In all cases the residual volume was reduced to less than 50 ml and the functional bladder capacity increased to within the normal range. All the patients were able to void voluntarily by activating their implants in bursts. This produced an interrupted stream at normal voiding pressures and acceptable flow rates. There was definite improvement in vesico-ureteric reflux and decrease in bladder trabeculation following implantation of the stimulator. Use of the stimulator has enabled nine of the patients to be continent at night. Eight of them are also dry during the day.
The clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy were studied in 73 patients, of whom 29 had incontinence due to urethral sphincter incompetence. Pre-and post-operative urodynamic assessment was made and follow-up continued for 2 years. Symptoms of urge incontinence, stress incontinence and prolapse were significantly reduced following surgery. Urodynamic data showed no significant change. The incidence of detrusor instability and voiding difficulties was not increased.
Sixty women with urinary incontinence were treated by the Burch colposuspension operation and bladder neck plication. The pre- and postoperative clinical and urodynamic features of the 15 patients with recurrent incontinence were compared and contrasted with 45 women who were cured. Factors which were associated with failed surgery included increaseing age, previous continence surgery, the presence of detrusor instability, and a postoperative rise of intrinsic bladder pressure either on filling of standing up.
Detrusor instability has remained resistant to conventional forms of treatment. An attempt to use biofeedback methods in its management is described. Six female patients with symptoms of frequency, urgency and urge incontinence due to detrusor instability were conditioned to auditory and visual stimuli for 6 to 8 1 h sessions. They were assessed clinically and urodynamically. The results are presented as well as detailed case studies of 3 patients. Subjectively, 3 were cured, 2 improved and 1 remained the same; objectively, 3 were cured, 1 improved and 2 remained the same. No significant side effects were encountered.
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Eighty patients with urinary incontinence were treated by colposuspension and bladder neck plication. Fourteen patients had difficulty in establishing normal micturition postoperatively. Of these, 10 patients took longer than 21 days to void and had reduced peak urine flow rates after surgery; the other four patients voided within ten days of surgery but had reduced peak urine flow rates before and after surgery and all had residual urines in excess of 100 ml following surgery. The value of the preoperative diagnosis of pre-existent bladder dysfunction by symptomatology and the peak urine flow rate is discussed.
Continuous recordings of maternal and fetal heart rate were made in 30 antenatal patients during simulated abdominal radiography in late pregnancy. Transient changes in fetal heart rate occurred in 43 per cent of patients in the supine position compared with 27 per cent in the prone position. Transient increase of maternal heart rate occurred in 37 per cent of patients. There was no evidence of revealed or concealed caval occlusion.
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The role of Triatoma sordida in the domestic transmission of Trypanosoma cruzi was assessed in 7 rural localities in Velasco Province, Department of Santa Cruz, Bolivia. Tri. sordida, the only triatomine species identified in these localities, was found inside 58.0% of houses but not in large numbers (3.1 bugs per infested house on average). A total of 220 faecal samples from domiciliary bugs was examined microscopically and by the polymerase chain reaction for the presence of trypanosomes: 21.4% were infected. Analysis of blood meals of domiciliary Tri. sordida showed that humans were the commonest host (70.4%), followed by chickens and dogs. Four of 418 persons tested were seropositive for Tryp. cruzi. Only 2 of a second group of 62 persons living in dwellings infested by Tri. sordida were seropositive. Tryp. cruzi infection was demonstrated in dogs and domestic rats. Three other species of small mammals were found to be infected with trypanosomes. In our study area, domestic Tri. sordida are mainly incriminated in the transmission of Tryp. cruzi to synanthropic animals, whereas transmission to humans is very rare. The presence in houses of small populations of Tri. sordida infected with Tryp. cruzi is therefore currently insufficient for this insect to constitute a major epidemiological risk factor.
Congestive heart failure (CHF) is the most common cause for hospitalization in older patients, and the prevalence of this condition is expected to rise as the population ages. The high cost of care has resulted in an increased emphasis on cost-effective approaches in patient management. One way to achieve this is the use of clinical pathways. This article compares outcomes in a group of older hospitalized patients managed on a CHF pathway with those of a historical cohort managed in the traditional manner. The patients on the pathway had significant reductions in length of stay and cost of care as well as more effective delivery of processes of care. Mortality rates were unchanged, at 3.5%. However, readmission rates showed a significant increase, from 9.25% to 13.5%, for patients on the pathway.
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