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Biomedical subjects

M D Walters

Publications and source records attributed to M D Walters.

At least 55 records · Page 3Linked to original sources
PubMed1996

Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction.

OBJECTIVE: Our purpose was to evaluate the efficacy and consequences of sacrospinous ligament suspension and pelvic reconstruction. STUDY DESIGN: Patients who underwent sacrospinous ligament suspension between 1978 and 1991 were evaluated from follow-up visits, telephone interviews, questionnaires, and chart reviews. Before and after operation, vaginal support was graded in three segments. Postoperative visceral and sexual function was evaluated. RESULTS: Mean length of follow-up for 243 patients was 73.6 months. Of these, 102 (42.0%) had a support defect in at least one segment; anterior, posterior, and apical defects were found in 91 (37.4%), 33 (13.6%), and 20 (8.2%) patients, respectively. A clinically significant defect was defined as a symptomatic first-degree or any second-or third-degree prolapse. Defect-free survival rates at 1, 5, and 10 years were 88.3%, 79.7%, and 51.9%, respectively. Eleven patients (4.5%) underwent subsequent pelvic reconstruction. CONCLUSION: Sacrospinous ligament suspension and pelvic reconstruction are effective for vaginal apex support, but vaginal prolapse recurs with time, most commonly in the anterior segment.

Adult↗
PubMed1996

Worker exposure to endotoxin, phenolic compounds, and formaldehyde in a fiberglass insulation manufacturing plant.

Worker exposures in a fiberglass wool insulation manufacturing plant were studied. The plant used a continuous process and operated at full production during a six-week study. Area samples were used to characterize spatial variability of contaminant levels. Repeated personal samples were used to characterize the distribution and to explore within- and between-worker variability of exposures. The greatest potential for exposure to each of the contaminants was restricted to specific areas of the plant. Area geometric mean concentrations were 1 to 390 ng/m3 for endotoxin and 22 to 414 micrograms/m3 for formaldehyde. There was considerable within-area variation of endotoxin (geometric standard deviation [GSD] 2.6 to 5.5) and formaldehyde (GSD 2.0 to 4.5). Concentrations of phenolic compounds were correlated with endotoxin and were influenced by a relatively high limit of detection. The ranges of personal GM exposures across homogeneous groupings were smaller than the range for the corresponding areas (endotoxin 5.8 to 36.4 ng/m3; formaldehyde 18.1 to 67.4 micrograms/m3). Variability in personal exposure was high. Individual GSDs ranged up to 10, with the mean individual GSD of 3.4 for endotoxin, and up to 12 with mean 3.7 for formaldehyde. Suggested thresholds for acute respiratory effects of endotoxin exposure were frequently exceeded (46% of 8-hr personal samples > 10 ng/m3, 7% > 100 ng/m3). No personal samples exceeded the Occupational Safety and Health Administration permissible exposure level or the American Conference of Government Industrial Hygienists' threshold limit value for formaldehyde; however, 34% were greater than 60 micrograms/m3 and 11% were greater than 120 micrograms/m3. Thus, exposures fell in a range where important exposure-response relationship could be examined.

Air Pollutants, Occupational↗
PubMed1995

Sexual function in women with uterovaginal prolapse and urinary incontinence.

OBJECTIVE: To compare sexual function in women with and without uterovaginal prolapse and urinary incontinence. METHODS: Eighty women with prolapse and with or without incontinence and 30 continent women without prolapse completed questionnaires assessing sexual function and underwent a physical examination. RESULTS: Women with prolapse were older than those without prolapse (mean age +/- standard deviation 58.2 +/- 13.0 versus 49.2 +/- 8.4 years, respectively; P < .001). The proportions of sexually active women were similar in both groups (56 and 57% for those with and those without prolapse, respectively). Measures of sexual function were not significantly different between the two groups. The mean global sexual function score was 0.58 +/- 0.15 in the prolapse group and 0.55 +/- 0.14 in the comparison group, a nonsignificant difference. The proportion of women with vaginal dryness or dyspareunia did not differ significantly between the two groups. Interest in sexual activity was unchanged in 70% of sexually active women with prolapse and incontinence, and 84% reported satisfaction with their sexual relationship. Twenty of 45 (44%) sexually active women with prolapse reported incontinence during sexual activity, and 14 (31%) reported that incontinence or prolapse interfered with sexual activity. After multivariate analysis, increasing age was the only significant factor predictive of a higher global sexual function score (P = .02), indicating worse sexual function. Increasing grade of prolapse predicted interference with sexual activity (P = .05), although this did not affect frequency of intercourse or description of satisfaction with the sexual relationship. CONCLUSION: Women with prolapse and urinary incontinence do not differ from continent women without prolapse in measures of sexual function; age is the most important predictor of sexual function.

Adult↗
PubMed1995

Vaginal anatomy and sexual function.

OBJECTIVE: To describe vaginal anatomy related to sexual function in women. METHODS: One hundred four women presenting for gynecologic care (mean age 55.8 years) completed questionnaires assessing sexual function and underwent measurements of vaginal caliber and length, and grading of vulvovaginal atrophy. RESULTS: Women who were not currently sexually active had a higher mean body mass index. Current sexual activity was not associated with differences in vaginal length or introital caliber. Among 73 sexually active women, 30 had one or both symptoms of dyspareunia and vaginal dryness, and 43 had neither symptom. Menopausal status, current use of estrogen, introital caliber, and vaginal length were not different in women with dyspareunia, vaginal dryness, or both when compared to women having neither symptom. Premenopausal women with dyspareunia, vaginal dryness, or both had significantly higher global sexual function scores, reflecting worse sexual function, when compared with premenopausal women without these symptoms (0.61 +/- 0.16 versus 0.46 +/- 0.15, respectively; P = .02); however, there was no significant difference in postmenopausal women (0.60 +/- 0.12 versus 0.61 +/- 0.12). CONCLUSION: Vaginal anatomy, measured by introital caliber, length, and vulvovaginal atrophy, does not correlate well with sexual function, particularly symptoms of dyspareunia and vaginal dryness.

Adult↗
PubMed1994

Estrogen and urinary incontinence in women.

OBJECTIVE: The purpose of this study was to review the efficacy of estrogen therapy for urinary incontinence by examining published trials and to review the epidemiologic and physiologic evidence for its action. DATA SOURCES: Controlled and uncontrolled trials of estrogen therapy in the English literature were collected. Eight controlled and 14 uncontrolled trials were identified. METHODS OF STUDY SELECTION: Trials were selected if they were prospective. All types of estrogen treatment were included. All types of outcome measurements were included. DATA EXTRACTION AND SYNTHESIS: Trials were categorized by type of estrogen used; outcome variables (subjective improvement vs objective urodynamic data); and cure/improvement rates. CONCLUSIONS: Published trials do not support estrogen replacement as efficacious therapy for stress urinary incontinence. It may be useful for incontinence associated with urgency and frequency. Adequately large controlled trials that evaluate estrogen replacement regimens used in the USA remain to be done.

Clinical Trials as Topic↗
PubMed1993

Atypical (non-diarrhea-associated) hemolytic-uremic syndrome in childhood.

We describe the clinical and laboratory features of 20 children who were seen during the past 20 years with idiopathic nondiarrhea-associated hemolytic-uremic syndrome. There was no seasonal variation in time of onset; a genetic pre-disposition seemed likely in two of the cases. The prodromal illness was nonspecific and by definition did not include diarrhea. Hypertension was a major problem in the majority of the patients. Five died, three during the initial illness; four are in end-stage renal failure, and all but two of the survivors have residual nephropathy. Eleven patients had a "relapsing" course; up to eight additional documented episodes of hemolytic-uremic syndrome occurred in individual patients. Of the nine children treated before 1980, three died shortly after onset, two never recovered function after the initial illness, one had a relapsing course and died later, and one had residual nephropathy. Plasma exchange was introduced for the management of non-diarrhea-associated hemolytic-uremic syndrome in 1980; since then, all of the 11 patients have recovered function after the initial episode, but 10 of them had relapses. It appears that with the introduction of plasma exchange there has been an improved outcome in the initial phase, but the survivors tend to have relapses. Atypical (non-diarrhea-associated) hemolytic-uremic syndrome is a heterogeneous yet distinct subgroup of hemolytic-uremic syndrome that differs from diarrhea-associated hemolytic-uremic syndrome on epidemiologic, clinical, laboratory, histologic, and prognostic grounds.

Blood Transfusion↗
PubMed1992

Toxic shock-like syndrome caused by adenovirus infection.

Adenovirus infections commonly occur in childhood and produce a wide range of clinical disease. The most common sites of infection are the respiratory and gastrointestinal tracts but involvement of cardiovascular, neurological, cutaneous, ophthalmic, renal, and hepatic systems can also occur. A case of toxic shock-like syndrome with symptoms of multiorgan involvement resulting from adenovirus infection is reported.

Adenovirus Infections, Human↗
PubMed1992

Nonsurgical treatment of urinary incontinence.

Genuine stress urinary incontinence can be treated by surgical or nonsurgical methods. Conservative treatments include pelvic muscle exercises, hormonal and nonhormonal pharmacologic therapy, and functional electrical stimulation with vaginal or anal electrodes. All of these methods improve or cure stress incontinence in a significant proportion of selected women, with less cost and morbidity. Patients with genuine stress incontinence generally should have a trial of conservative therapy before corrective surgery is offered. Behavioral and pharmacologic methods, alone and in combination, are used for women with detrusor instability. Behavioral regimens, including bladder retraining and biofeedback, are particularly effective for urge and stress incontinence, but are dependent on compliance and motivation of both patient and caregiver. Drug therapy is effective, but with potential morbidity. As with genuine stress incontinence, surgical methods should only be employed for patients with detrusor instability who do not respond to nonsurgical treatment.

Adrenergic alpha-Agonists↗
PubMed1990

A randomized comparison of gentamicin-clindamycin and cefoxitin-doxycycline in the treatment of acute pelvic inflammatory disease.

In this prospective trial, 130 hospitalized patients with acute pelvic inflammatory disease based on clinical criteria were randomly treated with intravenous gentamicin plus clindamycin (N = 63) or cefoxitin plus doxycycline (N = 67) for at least 4 days, followed by oral clindamycin or doxycycline, respectively, for a total of 14 days. Pre-treatment cultures were obtained for endocervical Neisseria gonorrhoeae and Chlamydia trachomatis, and for endometrial C trachomatis and aerobic and anaerobic bacteria. Overall, 46 subjects (35%) had endocervical cultures positive for N gonorrhoeae. Endocervical and endometrial cultures were positive for C trachomatis in 16 and 6%, respectively. Ninety-five percent of patients had at least one aerobic bacterium, 38% had at least one anaerobic bacterium, and only 2% had no organisms isolated from their endometrium. Fifty-seven subjects taking gentamicin-clindamycin (90.5%) and 64 subjects taking cefoxitin-doxycycline (95.5%) were clinically cured, a nonsignificant difference. Three subjects treated with gentamicin-clindamycin and one treated with cefoxitin-doxycycline required hysterectomy or salpingectomy for cure. Follow-up examinations and cultures were performed in 84% of the subjects. Post-treatment cultures for N gonorrhoeae were negative in all cases tested. Post-treatment endocervical and endometrial C trachomatis cultures were negative in ten of 11 subjects treated with gentamicin-clindamycin and in eight of nine treated with cefoxitin-doxycycline, a nonsignificant difference. We conclude that gentamicin-clindamycin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease and are equivalent in eradicating genital N gonorrhoeae and C trachomatis.

Acute Disease↗
PubMed1990

Urethral mobility and its relationship to stress incontinence in women.

Multiple physiologic factors, only one of which is urethral support, make up the female continence mechanism. Abnormal urethral support leads to deficient transmission of abdominal pressure to the urethra, which results in genuine stress incontinence in some women. Many techniques are available for measuring urethral mobility. The determination of urethral mobility is not useful in the diagnosis of urinary incontinence. However, it provides some information about which surgical procedure is most appropriate for the correction of genuine stress incontinence.

Female↗
PubMed1990

Reclosure of disrupted abdominal incisions.

We evaluated prospectively a technique of delayed reclosure of disrupted abdominal incisions. Forty-one consecutive postoperative obstetric and gynecologic patients with abdominal incisions that had opened because of infection, hematoma, or seroma and had intact fascia participated in the study. All wounds were first managed identically, with surgical drainage and debridement, for a minimum of 4 days. The patients then were randomized to either wound reclosure by a standardized en bloc technique (35) or healing by second intention (six). Reclosure was successful in 30 of 35 cases (85.7%). The mean time to complete healing was 15.8 days in successful cases, 67.2 days in failed cases, and 23.2 days for all patients who were reclosed. Failure to heal after reclosure was due to subcutaneous infection in two patients and seroma in three; these women were significantly heavier than those in whom reclosure was successful. There were no other major complications of wound reclosure. Patients randomized to healing by second intention required a mean of 71.8 days of wound care. The time to complete healing in the wound-reclosure group was significantly shorter compared with the group that healed by second intention (P = .002, log rank test). We conclude that en bloc reclosure of disrupted surgical incisions, compared with nonsurgical treatment, significantly decreases the time required for wound healing and has minimal morbidity.

Adult↗
PubMed1990

Psychosexual study of women with detrusor instability.

Clinical impression suggests that many cases of detrusor instability are psychosomatic. We evaluated 63 women with urinary incontinence and 27 continent controls using the Minnesota Multiphasic Personality Inventory, Uplift and Hassle Scales, and a structured questionnaire screening sexual dysfunction. All incontinent women underwent diagnostic urodynamic studies including uroflowmetry, subtracted water cystometry with provocation, and urethral closure pressure profilometry. Thirty-five women had genuine stress incontinence and 28 had detrusor instability, including nine with mixed incontinence. No differences in psychological test results were noted between the detrusor-instability and genuine-stress-incontinence groups. On the Minnesota Multiphasic Personality Inventory, subjects with detrusor instability scored significantly higher than controls on the hypochondriasis (P = .006), depression (P = .01), and hysteria (P = .0009) scales. Compared with continent controls, the detrusor-instability group reported a lower frequency of uplifts (P less than .05) and a greater intensity of hassles (P less than .05). Both incontinent groups reported more sexual dysfunction than did controls. We conclude that many women with urinary incontinence have abnormal psychological and sexual test results reflecting moodiness, feelings of helplessness and sadness, pessimism, general hypochondriasis/somatization, and sexual dysfunction. These abnormalities appear to be associated with urinary incontinence in general rather than with specific diseases of the urinary tract.

Adult↗
PubMed1990

Postabortal hemorrhage due to placenta increta: a case report.

Placenta accreta is defined as a condition involving an abnormal adherence of the placenta to the myometrium. It is rare for placenta accreta to present before 20 weeks' gestation; only eight cases have been previously reported. This case report describes a first-trimester placenta accreta which presented during suction curettage for missed abortion. The major risk factors for placenta accreta are related to previous uterine trauma. Considering the rising rate of operative births in the United States, it is possible that the incidence of placenta accreta in early gestation will increase.

Abortion, Missed↗
PubMed1989

The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome.

Review of data from 79 children with the haemolytic uraemic syndrome (HUS) showed that the polymorphonuclear leucocyte (PMN) count at presentation in childhood HUS predicts outcome. Logistic regression analysis of several features at presentation identified only the PMN count and the presence of a diarrhoeal prodrome as having a significant effect on the outcome (P less than 0.01 and P less than 0.001 respectively). The geometric mean PMN count was significantly raised in 70 children who had typical HUS following a diarrhoeal prodrome (D+ cases) compared with that of 9 children who had atypical disease without diarrhoea (D- cases) (t-test on log-transformed data, P less than 0.005). Fifty-seven children with D+ HUS who recovered completely had a significantly lower geometric mean PMN count than D+ cases with a bad outcome (P less than 0.001). Four of these patients, who died in the acute stage of the disease, had a significantly higher mean count than the rest of the D+ patients (P less than 0.001). Multiple regression analysis demonstrated that the PMN count in D+ cases was not significantly influenced by haemoglobin concentration, platelet count, length of the prodrome, or the administration of antibiotics in the prodromal period. A high PMN count at presentation in D+ HUS indicates a poor prognosis. The data emphasise the heterogeneity of HUS and suggest that PMN participate in the pathogenesis of the disorder in typical D+ cases but not in atypical D- cases.

Child↗
PubMed1989

Hemolytic uremic syndrome.

HUS has now emerged as a common clinical and pathologic syndrome that may result from a variety of disease processes. On the basis of clinical and epidemiologic criteria, several distinct subgroups of the disorder have been distinguished, the most common of which are the result of infectious processes, whereas the rarer forms may be genetically determined or acquired defects in vascular homeostasis. A related group of bacterial toxins, verotoxins, and Shiga toxin, produced by a variety of species of enteric pathogens, have been implicated in the pathogenesis of typical childhood HUS. In the few years since verotoxin-producing organisms were first incriminated as the possible etiologic agents of HUS, there has been a remarkable growth in knowledge of the biology of verotoxin and its role, not only in HUS but in hemorrhagic colitis and childhood diarrhea. The availability of purified toxin and new tools for detection of verotoxin and verotoxin-producing organisms, such as monoclonal antibodies and probes for DNA hybridization, should enable definitive studies of the epidemiology and pathogenesis of verotoxin-associated HUS to be undertaken. The growing understanding of HUS should eventually lead to improved treatment and ultimately to prevention of this serious childhood disorder.

Child↗