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M D Walters

Publications and source records attributed to M D Walters.

71 records · Page 4Linked to original sources
PubMed1989

Mechanisms of continence and voiding, with international continence society classification of dysfunction.

The two functions of the lower urinary tract are storage of urine within the bladder and timely expulsion of urine from the urethra. Bladder filling occurs with little or no increase in intravesical pressure, despite large increases in urine volume. This process, called accommodation, results from viscoelastic properties of the bladder wall and reflex inhibition of detrusor contractility. Urinary continence is maintained at rest by outflow resistance generated by the urethral sphincteric mechanism. With increases in intra-abdominal pressure, urethral resistance is augmented by passive pressure transmission to the bladder neck and proximal urethra and possibly by reflex muscular activity within the urogenital diaphragm. Normal voiding is a reflex act under voluntary control that involves relaxation of the urethra and sustained contraction of the bladder until emptying is complete. The ICS has classified lower urinary tract dysfunction as disorders of the filling or storage phase and as disorders of the emptying phase. Although urodynamic testing is not always necessary, some evaluation of both bladder and urethral function in each phase is required for accurate diagnosis.

Female↗
PubMed1988

The diagnostic value of history, physical examination, and the Q-tip cotton swab test in women with urinary incontinence.

One hundred six consecutive women who came to our clinic complaining of urinary incontinence underwent complete urodynamic evaluation. Urologic questions, pelvic examination findings, and the Q-tip cotton swab test results were examined to determine their ability to predict genuine stress incontinence (N = 59) versus other urologic disorders (N = 47). The symptom of stress incontinence, moderate to severe cystocele, and Q-tip cotton swab test result greater than or equal to 30 degrees were more common in women with genuine stress incontinence. Of the other urologic symptoms, only sensory urgency and enuresis were significantly associated with overactive detrusor function and voiding disorders. The combined findings of stress incontinence, cystocele, and no sensory urgency correctly identified 22% of women with genuine stress incontinence and eliminated 96% of women with other urologic disorders. Stress incontinence, moderate to severe cystocele, and no sensory urgency had a positive predictive value of 100%, but a sensitivity of only 10%. When used in series, the Q-tip cotton swab test contributed no additional information to that found by history taking and physical examination.

Aged↗
PubMed1988

Antibodies to Chlamydia trachomatis and risk for tubal pregnancy.

We performed a case-control study of the effect of exposure to Chlamydia trachomatis on the risk for tubal pregnancy. Sixty women with tubal pregnancies and 60 matched control women with normal second-trimester intrauterine pregnancies were studied. Cases were more likely than controls to have detectable antichlamydial IgG antibodies (82% versus 58%, p less than 0.01) and their mean titers were higher. The prevalence of IgM antibody seropositivity was not different between cases and controls (20% versus 12%, not significant). Compared with women with IgG antibody titers of less than or equal to 1:8 the relative risk for tubal pregnancy for women with titers greater than or equal to 1:128 was 6.6 (95% confidence interval, 2.0 to 21.6). Among women with tubal pregnancies, antichlamydial antibody titers of greater than or equal to 1:128 were significantly associated with pelvic adhesions and inflammatory tubal mucosal damage. Only 17.6% of women with detectable antichlamydial antibody or inflammatory tubal damage reported a history of pelvic inflammatory disease or gonorrhea.

Adult↗
PubMed1988

Intravascular platelet activation in the hemolytic uremic syndrome.

We studied intravascular platelet activation in patients with typical (epidemic) and atypical (sporadic) HUS and found defective aggregation, decreased platelet and increased plasma serotonin in both groups. The findings were present not only on admission during the thrombocytopenic stage of the disease, but persisted for several weeks after recovery of the platelet count. Reduced endothelial PGI2 production was significantly more common in plasma from atypical than typical cases. Plasma from both typical and atypical HUS patients induced aggregation of normal platelets, but this phenomenon was unrelated to both the presence of thrombocytopenia or the stage of the disease. Serum platelet aggregating activity was higher in the atypical HUS patients, and was not associated with immune complexes detectable by polyethylene glycol precipitation. The data indicate that intravascular platelet activation is a feature of both forms of HUS, and may be initiated by different mechanisms in the two subgroups. While abnormal PGI2 synthesis appears to be important in the atypical cases, neither defective PGI2 production nor platelet aggregation by plasma factors adequately accounts for platelet activation in the majority of typical cases.

Adolescent↗
PubMed1988

Antineutrophil cytoplasm antibody in crescentic glomerulonephritis.

Antineutrophil cytoplasm antibody (ANCA) has been reported in the sera of adults with Wegener's granulomatosis and microscopic polyarteritis, but this phenomenon has not so far been described in children. We report three children with crescentic glomerulonephritis in whom ANCA concentrations were raised at presentation. Two cases were idiopathic, and the other later developed features of Wegener's granulomatosis. In all three, plasma exchange and immunosuppression removed ANCA, but in only one case was there clinical improvement. This child later developed classical nasal lesions of Wegener's granulomatosis associated with a decline in renal function and a rise in ANCA. Plasma exchange and immunosuppression again produced a good clinical response and removed ANCA. This suggests that ANCA is either a marker of disease activity, or is involved in the pathogenesis of disease.

Autoantibodies↗
PubMed1987

Q-tip test: a study of continent and incontinent women.

Urethral axis position and mobility, as determined by the "Q-tip test," were measured in subjectively continent women (N = 26), women with genuine stress incontinence (N = 28), and women with other types of urinary incontinence and voiding dysfunction (N = 20). Diagnostic urodynamic evaluation in symptomatic women included standard history, physical examination, urine culture, Q-tip test, uroflowmetry, standing "stress test," resting and stress urethral pressure profiles, and subtracted medium-fill water cystometry with provocation. Multiple regression analysis was used to determine the existence of significant clinical predictors of the dependent variables (stress angle, urethral mobility). These factors were used as covariates to identify differences between the adjusted group means. The results indicate a wide range of values for each Q-tip test measurement in all groups. Age, parity, resting Q-tip angle, and the presence of anterior vaginal relaxation were associated with maximum stress Q-tip measurement. Significant differences in maximum stress Q-tip angle and urethral mobility were noted only between the continent controls and women with genuine stress incontinence. No differences were found between the two incontinent study groups. We conclude that urethral position and mobility as measured by the Q-tip test are related to defects in anterior vaginal support, but not to specific urologic diagnosis.

Adult↗
PubMed1987

The contralateral corpus luteum and tubal pregnancy.

One hundred fourteen cases of tubal pregnancy were examined for evidence of active or chronic salpingitis, other anatomic and functional etiologies, and the side of the corpus luteum relative to the pregnancy. A corpus luteum was found ipsilateral to the tubal pregnancy in 80 cases (70%) and contralateral in 18 (16%). In 16 cases (14%), the position of the corpus luteum could not be identified by inspection. No differences were noted among the groups in days from last normal menstrual period or the incidence of irregular bleeding. Of the 98 cases in which a corpus luteum was identified, 53 women (54%) had at least one condition that could be considered etiologic for tubal pregnancy, including 38 (39%) who had microscopic evidence of chronic salpingitis. No association was found between the laterality of the corpus luteum and the presence of risk factors, including mechanical factors. Possible explanations for absent corpora lutea in association with tubal pregnancies are discussed.

Adult↗
PubMed1986

Platelet-derived growth factors as possible mediators of vascular proliferation in the sporadic haemolytic uraemic syndrome.

Mitogenic activity was measured in matched plasma and serum samples from 17 children with typical epidemic haemolytic uraemic syndrome (HUS), 13 with atypical sporadic HUS, 7 with other renal diseases, and 8 normal children. The serum mitogenic activity of the normal children (median 18.35, range 15-35 U/ml) greatly exceeded that of plasma (median 5.4, range 1.04-11.9 U/ml). Patients with atypical sporadic HUS had raised plasma mitogenic activity (median 9.35, range 0-35 U/ml, p less than 0.01). Both plasma and serum from children with the typical epidemic form of HUS had low or undetectable mitogenic activity (median for plasma 1.0, range 0-5.9 U/ml, p less than 0.001; median for serum 1.85, range 0-23.8 U/ml, p less than 0.005). These low concentrations in typical epidemic HUS were associated with the presence of an inhibitor of cell growth. The results suggest that there is intravascular release of platelet mitogens in atypical sporadic HUS and that these mitogens may therefore be mediators of the vascular proliferative lesions.

Adolescent↗
PubMed1986

Obstructive endocarditis in an immunodeficient infant.

We report the case of 5-week-old male infant who presented as a 'near miss cot death'. He had the immunodeficient syndrome of defective neutrophil mobility and delayed umbilical cord separation. He was shown to have staphylococcal endocarditis with a large vegetation on the mitral valve, and acute obstruction of the mitral valve flow may have accounted for the suddenness of his presentation. Death resulted from overwhelming sepsis with widely disseminated micro-abscesses.

Cell Movement↗
PubMed1986

Anatomy and pathology of tubal pregnancy.

The prevalence of tubal pregnancy has increased markedly during the past decade. The reasons for this are obscure. A systematic gross and histopathologic study of 25 consecutive ectopic pregnancies has been performed using a clearing method not used previously for this purpose. In addition, the presence of the corpus luteum and its location in reference to the tubal pregnancy are documented. Results indicate that trophoblastic spread was predominantly intraluminal in 67% of cases. Intratubal hemorrhage, generally in parallel to trophoblastic spread, often led to marked tubal destruction. Histologic evidence of salpingitis was noted in only seven of 24 specimens (29%). The corpus luteum was contralateral to the ectopic pregnancy in five of 21 cases (23.8%). Clinical correlates and areas of future research are discussed. Results indicate that segmental resection of the tubal pregnancy is appropriate in selected cases.

Adolescent↗
PubMed1985

Steroid-responsive nephrotic syndrome: a generalised disorder of membrane negative charge.

A simple chemical test, based on the binding of the cationic dye alcian-blue 8GX (AB), has been devised to measure negative charge on cell membranes. The test has demonstrated that AB binding to red blood cells and platelets is significantly less in children with steroid-responsive nephrotic syndrome (SRNS) or nephrotic syndrome associated with focal segmental glomerulosclerosis than in normal controls. However, the sialic acid content of the nephrotic cell membrane is normal. This suggests that a generalised loss of membrane negative charge occurs in SRNS and that this is due to neutralisation rather than absence of anionic groups.

Adolescent↗
PubMed1984

Malignant transformation of vaginal endometriosis.

A well-documented case of extraovarian endometriosis undergoing malignant transformation is presented. A vaginal focus of endometriosis was biopsied over a 13-year interval during which time progression from benign to malignant disease was observed. Exogenous estrogen replacement was administered throughout the interval of transformation. The pathology, pertinent literature, and implications of the present case are discussed.

Adenocarcinoma↗
PubMedDate not supplied

The evaluation and treatment of urinary incontinence in women: a primary care approach.

BACKGROUND: Urinary incontinence, the involuntary loss of urine severe enough to have adverse social or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. At least 10 million adults in the US suffer from urinary incontinence, including an estimated 15 to 30 percent of community-dwelling older persons. In spite of its high rate of occurrence, fewer than one-half of women with regular urinary incontinence seek medical help for their problem, either because of embarrassment or the perception that their symptoms are normal. METHODS: MEDLINE files were searched from 1970 to 1990 using the key words "incontinence," "prevalence," and "diagnosis" and for specific nonsurgical treatments. Only articles pertaining to adult women were chosen. RESULTS AND CONCLUSIONS: Urinary incontinence frequently can be diagnosed accurately by family physicians using basic tests in the office. Many women experience improvement of incontinence with properly employed behavioral and pharmacologic therapy. Other women benefit from referral for specialized evaluation and consideration for surgical therapy.

Adult↗
PubMedDate not supplied

Pelvic floor disorders in women: an overview.

Urinary incontinence affects 10% to 58% of community-dwelling women and up to 50% of nursing home residents. Prevalence of incontinence appears gradually to increase during young adult life, has a broad peak around middle age, and then a steady increase in the elderly. It has been shown to affect a person's social, clinical, and psychological well-being. The majority of women with incontinence do not seek medical help. The estimated annual direct cost of urinary incontinence alone in women in the United States (in U.S. dollars) is 12.4 billion. The proportion of the United States population over age 75 was 22% in the year 1999 and is expected to grow substantially during the coming decades. Pelvic floor disorders such as urinary incontinence, fecal incontinence, and pelvic organ prolapse affect older women disproportionately. Because of this relationship, it is estimated that the growth in demand for services to care for female pelvic floor disorders will increase at twice the rate of growth of the population over the next 30 years. Approximately 10% of women have surgery for pelvic organ prolapse or urinary incontinence in their lifetime and nearly 30% of these operations are for recurrent disease. This fact suggests that failure rates after surgery for pelvic floor disorders are high, in spite of the introduction of many new surgical diagnostic techniques, tools and operations. Numerous techniques have been developed to evaluate the type and extent of urinary and fecal incontinence and prolapse. A number of treatment options exist, ranging from behavioral to medical and surgical approaches. This document will discuss some of the general issues related to pelvic floor disorders and suggest areas for future research.

Female↗
PubMedDate not supplied

Vaginal diaphragm rings in the treatment of stress urinary incontinence.

To assess the effectiveness of wearing vaginal diaphragm rings in the treatment of stress urinary incontinence, 10 women with genuine stress incontinence were studied. Patients underwent urodynamic evaluation and perineal pad testing before and after fitted diaphragm rings were in place. Patients kept symptom diaries for 1 week without the ring and then for 1 week with the ring. They also gave an overall subjective evaluation of their experience. Urodynamic findings were essentially unchanged by wearing diaphragm rings. Trends toward improvement were observed in the results of pad tests and symptom diaries. Four of the 10 women experienced clinically significant improvement in amount of urine lost during pad tests, number of leaks per week, and overall assessment of response. Vaginal diaphragm rings may be an effective treatment for some women with stress urinary incontinence.

Adult↗