Search PubMed⌕ Search

Biomedical subjects

P Riss

Publications and source records attributed to P Riss.

At least 37 records · Page 2Linked to original sources
PubMed1990

[The value of curettage in the assessment of abnormal uterine bleeding].

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.

Adult↗
PubMed1989

[Classification and documentation of vulvar changes: organization of a data bank by personal computer].

We developed a simple menu driven database on a personal computer for classification and documentation of vulvar lesions (IBM-PC, dBaseII). Vulvar lesions were classified according to morphological appearance: red, white, dark, ulcer, small tumor (less than 1 cm), large tumor. The data for each category were entered in multiple choice form or as free text and stored in a separate database file. Overlap between categories was observed in vulvar intraepithelial neoplasia, invasive carcinoma and between large and small tumors. For each category an automated table of the frequencies of the different diagnoses is provided, individual patients and variables can easily be accessed through the database query language. We used the database system in the gynecological outpatient clinic of our department during 6 months and were able to document 117 patients with vulvar lesions. In our experience, the database system permits complete documentation according to clinical criteria of all vulvar lesions seen in gynecological practice.

Diagnosis, Differential↗
PubMed1989

[Hypophyseal suppression and subsequent cycle stimulation: experiences in an in vitro fertilization program].

Gonadotropin releasing hormone (GnRH) agonists can induce a hypogonadotropic state. We studied the effect of a long acting GnRH agonist on pituitary gonadotropin levels, the pattern of serum steroid levels in subsequent cycle stimulation, and whether such a protocol can improve the results of an in-vitro fertilization (IVF) program. 29 patients with tubal factor from our IVF program received 4 mg Decapeptyl CR intramuscularly and were subsequently stimulated with FSH/HMG/HCG (Group I). 35 patients were stimulated according to our standard protocol with HMG/HCG (Group II). After a single injection of Decapeptyl CR, serum levels of LH, FSH and E2 fell to more than half of pretreatment levels. In the subsequent cycle stimulation the gonadotropin dosage was increased threefold compared with the control group. In group I, progesterone levels were significantly higher. Though more oocytes were retrieved in group I, fertilization rates were significantly lower. After Decapeptyl and the subsequent stimulation, we observed short rises in urinary LH in 22/29 patients. In our experience, a single intramuscular injection of Decapeptyl resulted in sufficient pituitary suppression, however, we could not see an improvement in the results after IVF.

Estradiol↗
PubMed1989

[Construction of a decision tree for preoperative diagnosis in urinary incontinence].

In order to analyse the decisions used in non-urodynamic preoperative diagnosis of female urinary incontinence we constructed a decision tree, consisting of decision nodes and probability nodes. Each branch of the decision tree leads to an end point (terminal node), to which an utility must be assigned. We describe the different steps in the construction of the decision tree: 1. listing of all possible decisions (questionnaire, clinical stress test, both, no preoperative tests), 2. assignment of probabilities to the different events (e.g. cure, failure, operation in the absence of genuine stress incontinence), and 3. assignment of utility factors to the end points. We used previously published probabilities from our clinic, utility was assigned arbitrarily using a score from -10 to +90. The decision tress allows not only the calculation of the strategy with the highest expected utility, but also threshold analysis, sensitivity analysis and cost-benefit analysis. We feel that decision trees are valuable tools for analysing how medical decisions are reached and are particularly useful in teaching situations.

Adult↗
PubMed1988

[The urethral pressure profile at rest and in stress following diaphragmplasty].

56 women underwent vaginal repair because of primary genuine stress incontinence. Urodynamic investigation was carried out preoperatively and 10.9 (7-13) months after surgery. At follow-up continence was demonstrable in 44/56 patients (79%). Detrusor instability following surgery for stress incontinence was found in 2/56 patients (4%). Vaginal repair failed to rectify stress incontinence in 21% of the patients. In cured patients the postoperative urethral pressure profile at rest remained unchanged, while the postoperative urethral closure pressure profile during stress significantly increased in these patients. In incontinent patients following surgery the urodynamic parameters of both pressure profiles correlated well with the severity of the incontinence.

Adult↗
PubMed1988

Wertheim radical hysterectomy 1921-1986: changes in urologic complications.

In order to assess the incidence and type of urologic complications associated with Wertheim's radical hysterectomy we studied all 154 patients undergoing radical hysterectomy at our department between 1980 and 1986. More than 2/3 of patients had stage I carcinoma of the cervix, the mean age was 46.9 years (range 27-73 years). Various intraoperative reconstructive procedures were required in 5%. A comparison with the experience of Wertheim (before 1919) and that of a subsequent time period (1952-1967) showed that while the incidence of intraoperative injury to the lower urinary tract remained stable, the incidence of postoperative fistula formation decreased significantly (from 6.4% to 0.6%), possibly due to changes in the operative technique. We conclude that Wertheim's radical hysterectomy now involves only a very low risk of injury to the bladder or to the ureter.

Adult↗
PubMed1988

[Impulse galvanization in postoperative urination disorders].

In this study we examined the therapeutic effect of impulse-galvanization in patients with voiding difficulties after anterior vaginal repair. Patients (n = 56/79) revealing residual urine until the sixth postoperative day were studied. Considering the onset of the first spontaneous micturition and the lack of residual urine no significant difference was found in the group undergoing impulse-galvanization (n = 19) compared to a group without therapy (n = 37). By adjuvant treatment with alpha-sympathicolytics, spasmolytics or tranquilizers patients with impulse-galvanization and the comparative group were found to be without residual urine 11.2 and 13 days after surgery, respectively (p less than 0.001).

Electric Stimulation Therapy↗
PubMed1988

Obesity and stress urinary incontinence: significance of indices of relative weight.

We analyzed the significance of weight and various indices of relative weight in the assessment of genuine stress incontinence (GSI) in 193 female patients. Body mass index [BMI = weight/(height2)] and the other indices of relative weight [weight/height - weight/(height3)] were not markedly different between patients with GSI and a control group of 43 females without demonstrable incontinence. A markedly increased BMI was found to be correlated with a positive clinical stress test. In addition BMI was significantly higher in patients with a higher maximum urethral pressure. We conclude that although obese women tend to have higher maximum urethral pressures, this advantage disappears in regard to the maximum urethral closure pressure, resulting in a higher prevalence of positive clinical stress test.

Adult↗
PubMed1987

[Comparison of vaginosonographic, transabdominal sonographic and laparoscopic follicle puncture for the retrieval of oocytes within the scope of an in vitro fertilization program].

For follicular aspiration and oocyte retrieval for in-vitro-fertilization (IVF) laparoscopy, laparotomy and different ultrasound guided methods like transvesical and transvaginal puncture can be used. Sonographically guided follicular aspiration has become more important because this procedure is less invasive. In this study we compared the results of 28 laparoscopical, 35 transabdominal and 21 transvaginal follicle puncture after successful cycle stimulation. Performing transvaginal puncture 4.7, using laparoscopy 3.4 and performing transvesical puncture 2.0 oocytes per attempt were retrieved. The advantages of transvaginal follicle aspiration were a shorter operation time, a superficial anesthesia and compared to laparoscopy a less invasive and simple technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Female↗
PubMed1987

[Sex behavior and vaginal flora in climacteric and postmenopausal females].

515 menopausal or postmenopausal women visiting the gynecologic clinic of a university hospital and having received no hormonal replacement therapy were screened for frequency of sexual intercourse and clinical symptoms typical for this period in life by a questionnaire. We found that a high percentage of women are still sexually active even with advanced age. It appeared that sex life is more intensive right after the menopause. A decrease of sexual intercourse after an age of 66 years and older seems to be secondary to the lack of a partner. Older women who remained sexually active had significantly more often a pathologic vaginal smear. We conclude that even in older women, when seen for consultation, it remains important to take into account possible sexual activity in regard to the diagnosis and therapy of vulvovaginitis.

Aged↗
PubMed1987

Comparison of the results of vaginal and abdominal follicle scans.

The hormonal profile and sonographical assessing of the number and size of the follicles are important in hyperstimulated cycles. Follicular imaging obtained by abdominal scanning may be distorted by echoes from the intestine or by unfavourable location of the ovaries and patients must have a full bladder. We compared the number and size of the follicles at abdominal sonography with the results obtained by vaginal sonography in 37 patients. Vaginal sonography showed more follicles than abdominal sonography because of improved imaging of small follicles on early days of cycle. This might help one to tailor the hyperstimulation to an individual's endocrine response.

Adult↗
PubMed1987

Relationship between the steroid and prolactin concentration in follicular fluid and the maturation and fertilization of human oocytes.

Seventy-eight follicles and their follicular fluid were aspirated from 46 women undergoing in vitro fertilization (IVF) procedures after stimulation of the ovaries with a low-dose human menopausal gonadotropin/human chorionic gonadotropin stimulation regimen. The concentrations of estradiol (E2), progesterone (P), testosterone (T), and prolactin (PRL) were measured in follicular fluid and related to the maturation of the oocyte-corona-cumulus complex (OCCC) and the fertilization of oocytes. Follicles containing mature oocytes had significantly higher follicular fluid E2 and P levels than follicles with intermediate and immature oocytes. A constant decrease in PRL and T values with advancing follicular maturation was observed. Similar results were obtained when the fertilizing ability of the oocytes was examined. The gradual decline in follicular fluid PRL and T levels during follicular development was connected with increasing E2 and P biosynthesis and therefore seems to be an important precondition for normal follicular and oocyte maturation.

Adult↗