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Biomedical subjects

N Kadar

Publications and source records attributed to N Kadar.

86 records · Page 5Linked to original sources
PubMed1984

Treatment of urinary incontinence after radical hysterectomy.

The results of therapy of eight previously untreated women without urinary fistulas who had been severely incontinent for three to eight years after radical hysterectomy are presented and the principles of management discussed. Radiologic and urodynamic studies are required to assess the bladder pressure response to filling, proximal urethral pressures, bladder neck closure at rest, and mobility of the bladder neck, to determine the mechanism responsible for the urine loss and to select appropriate therapy. Augmentation of proximal urethral pressures by medical or surgical means is required if the bladder neck is open at rest. All such patients improved dramatically on ephedrine, but tachyphylaxis developed in cases of total sphincter failure. Retropubic urethropexy did not relieve the incontinence in these cases, whereas a sling operation restored complete continence. If an incremental bladder pressure response to filling is present, operations to increase bladder outlet resistance are contraindicated. Treatment with anticholinergic medications was unsuccessful in these cases.

Adenocarcinoma↗
PubMed1983

Pharmacokinetics of intravenous theophylline in pregnant patients at term.

The pharmacokinetics of theophylline was determined in six pregnant, nonsmoking women in labor at term following a single bolus infusion of 5.6 mg/kg of aminophylline over 20 minutes. Cord blood levels were obtained from three babies at delivery. Compared to values reported in the literature for nonpregnant adult nonsmokers, the volume distribution (mean 573 +/- 53 ml/kg) and clearance rate (mean .88 +/- .24 ml/kg/min) of theophylline is increased in pregnant women, but the half-life (mean 7.95 +/- 2 hrs) remains unaltered. Similar doses of aminophylline can therefore be used in pregnant and nonpregnant adults who do not smoke cigarettes, but the infusion rate required to maintain a mean serum concentration of 10 micrograms/ml (0.5 mg/kg/hr) is almost half that initially reported in the literature. The serum theophylline concentrations in maternal venous and mixed cord blood at delivery were almost identical, which implies that theophylline crosses the placenta rapidly and that the fetus represents a "shallow" drug compartment.

Adolescent↗
PubMed1983

The frequency, causes and prevention of severe urinary dysfunction after radical hysterectomy.

Urinary dysfunction that developed in 58 patients treated by radical hysterectomy, with or without total vaginectomy and whole pelvic irradiation over a 10-year period, was studied retrospectively by case record review and telephone enquiry. Seven of the 58 (12%) were found to be severely handicapped, six by incontinence and enuresis, and one by the complete inability to void. Twenty-one (36%) patients had absent bladder sensation or urine loss that caused only minor inconvenience. Advancing age, the menopause, whole pelvic irradiation, and total vaginectomy did not increase the likelihood of developing long-term urinary problems. The determining factor was whether the most lateral portions of the cardinal and uterosacral ligaments had been resected or spared at the time of surgery. It is concluded that serious disability may be avoided by conserving the lateral portions of the pelvic ligaments while obtaining adequate surgical margins during radical hysterectomy.

Female↗
PubMed1983

Combined use of serum HCG and sonography in the diagnosis of ectopic pregnancy.

During an 18 month period, 320 patients were referred with clinical suspicion of an ectopic pregnancy. This study is based on 19 patients with ectopic pregnancy who had both a sonographic examination of the pelvis and determination of serum beta human chorionic gonadotropin (HCG) before surgery. Emphasis is focused on the spectrum of sonographic appearances that may occur in ectopic gestation. These are illustrated, and the sonographic criteria that have been used both for a positive diagnosis and for the exclusion of ectopic pregnancy in the past are analyzed. It is suggested that the accuracy of sonography can be increased by determining the serum HCG level on the day of the scan and by interpreting the findings with reference to the discriminatory HCG zone.

Adult↗
PubMed1983

Prognosis for future childbearing after midcavity instrumental deliveries in primigravidas.

The frequency of subsequent childbearing and the method of subsequent delivery among 149 primigravidas who required instrumental delivery for midcavity arrest of the fetal head in the second stage of labor and 1258 primigravidas who delivered spontaneously were compared. The frequency of subsequent childbearing was similar in the two groups, but operative delivery for cephalopelvic disproportion (CPD) in a second pregnancy was six times greater in the instrumentally delivered group (11.2 versus 2%; P less than .005). Nevertheless, more than 75% of instrumentally delivered primigravidas who delivered heavier infants in their second pregnancy did so spontaneously. It is concluded that relative CPD is not a common factor necessitating midcavity deliveries, even if cases in which peridural anesthesia is used and deliveries for fetal bradycardia are excluded from consideration. This probably accounts for the fact that over 97% of instrumentally delivered infants suffered no birth trauma or birth asphyxia.

Birth Weight↗
PubMed1982

Receiver operating characteristic (ROC) curve analysis of the relative efficacy of single and serial chorionic gonadotropin determinations in the early diagnosis of ectopic pregnancy.

A study was undertaken of 36 patients with viable intrauterine pregnancies who presented in the first trimester with abdominal pain and/or vaginal bleeding, and of 15 patients with ectopic pregnancies, all of whom had at least two human chorionic gonadotropin (hCG) determinations in the same gestation. The mean and lower 25%, 20%, 15%, 5%, and 1% limits of the rate of hCG increase in serum and of the serum hCG at different periods of gestation were determined for intrauterine pregnancy with the use of linear regression analysis, and each was used as a basis for identifying ectopic gestation. It was found that for any given false-positive rate, subnormal rates of hCG increase were more sensitive in identifying ectopic gestations than single "low for date" hCG values. It is suggested that the explanation for this may be that hCG production in many patients with ectopic pregnancies is normal until symptoms develop and falls thereafter as the functional trophoblastic mass is reduced by the shearing off the trophoblast from the tubal wall, which takes place with the development of the pregnancy and of symptoms.

Chorionic Gonadotropin↗
PubMed1981

A method of screening for ectopic pregnancy and its indications.

The possibility of distinguishing between normal intrauterine and ectopic pregnancies by determining the lower limit of the rate of human chorionic gonadotropin (hCG) increased in early pregnancy was investigated. This can be expressed as the slope of the log hCG-time curve or as the percent increase in hCG over a given sampling interval. For practical purposes, the rate is most easily determined from 2 samples drawn 48 hours apart. The differences between the 2 hCG values obtained is expressed as a percentage of the initial value, and should be 66% or greater for this sampling interval. Approximately 15% of normal intrauterine pregnancies screened in this way will appear abnormal, and the diagnosis in 13% of ectopic pregnancies will be delayed beyond 48 hours.

Chorionic Gonadotropin↗
PubMed1981

Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy.

The most reliable ultrasonographic criteria for diagnosing ectopic pregnancy are based on the appearance of the uterus in the presence of a positive urine pregnancy test. The absence of an intrauterine sac signifies ectopic pregnancy, whereas its presence indicates intrauterine gestation. These criteria cannot be applied when serum pregnancy tests are used unless the serum human chorionic gonadotropin (hCG) level at which the sac of an intrauterine pregnancy becomes visible on ultrasound is known, because these tests are far more sensitive and identify pregnancy at an earlier stage than does sonar. In this study, the hCG level that distinguishes patients with intrauterine pregnancies in whom a gestational sac can be seen from those in whom it cannot be seen was determined and designated the discriminatory hCG zone. This zone lies between 6000 and 65000 mIU/ml. The absence of an intrauterine sac in conjunction with hCG values above this level signifies ectopic pregnancy; however, the absence of an intrauterine sac has no diagnostic significance when associated with hCG values below the discriminatory zone. An intrauterine sac associated with hCG levels above the discriminatory zone reliably indicates an intrauterine pregnancy, but at hCG values below the zone, it is suggestive of an abnormal pregnancy-either a missed abortion or an ectopic gestation.

Chorionic Gonadotropin↗
PubMedDate not supplied

The timing of a repeat ultrasound examination in the evaluation for ectopic pregnancy.

A method is described for timing a repeat ultrasound examination in patients evaluated for ectopic pregnancy in whom the findings are initially non-diagnostic. This method is based on measuring the serum hCG at the time of the initial ultrasound examination, which allows the time interval required for the serum hCG to exceed 6500 mIU/ml to be calculated. When the serum hCG is above this level, the gestational sac of an intrauterine pregnancy can be reliably identified, and failure to do so signifies ectopic gestation. Seven patients referred for ultrasound to rule out ectopic pregnancy had initially nondiagnostic findings. In each case, a correctly-timed repeat examination, demonstrating a gestational sac, enabled the diagnosis to be excluded.

Chorionic Gonadotropin↗