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Biomedical subjects

R L Summitt

Publications and source records attributed to R L Summitt.

At least 37 records · Page 2Linked to original sources
PubMed1993

Urogynecologic causes of chronic pelvic pain.

Many women with CPP undergo lengthy evaluations and sometimes empiric operative procedures only to continue to have pain for which no clear source can be found. Occasionally, a review of urinary symptoms may be the key to initiating a diagnostic and therapeutic course that reveals a urologic cause for their pain. Appropriate treatment directed to the urinary disorder may lead to improvement and potentially obviate gynecologic surgery.

Chronic Disease↗
PubMed1992

Cervical cytology: a randomized comparison of four sampling methods.

OBJECTIVE: The purpose of this study was to compare smear quality and endocervical cell recovery of four cervical smear sampling devices. STUDY DESIGN: Two thousand fifteen patients undergoing routine cervical smears at the University of Tennessee Obstetrics and Gynecology clinics were randomly assigned to a cotton swab-spatula, Cytobrush-spatula, Cervex-Brush, or Bayne Pap Brush. The cytopathology laboratory, blind to method, used specific criteria to grade smears as being optimal, adequate, marginal, or inadequate. Statistical analysis was by the chi 2 and analysis of variance tests. RESULTS: No statistical differences occurred among the groups for nonpregnant patients. For pregnant patients smear quality was improved with both Cytobrush-spatula and Bayne Pap Brush versus cotton swab-spatula (p = 0.0301 and 0.0004, respectively); cotton swab-spatula had fewer endocervical cells than the Cytobrush-spatula (p = 0.0001), Cervex-Brush (p = 0.0288), and Bayne Pap Brush (p = 0.0081). CONCLUSIONS: The cotton swab-spatula and Cytobrush-spatula appear to be the most effective screening methods for nonpregnant and pregnant patients, respectively.

Biopsy↗
PubMed1992

Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing.

OBJECTIVE: Patients' histories of urinary incontinence and the results of several standard clinical tests were correlated with final diagnoses obtained by multichannel urodynamic testing. We used a combination of clinical test results to predict the final diagnoses. STUDY DESIGN: Ninety consecutive women with a primary complaint of urinary incontinence completed a standardized questionnaire and underwent a structured clinical examination consisting of several standard clinical tests. Each patient later underwent multichannel urodynamic testing to obtain a final diagnosis. RESULTS: Although the symptoms of stress incontinence were significantly associated with genuine stress incontinence and mixed incontinence, overlap in patients with detrusor instability did not allow the histories to be useful diagnostically. The only clinical tests showing significant association with the final diagnoses of incontinence were the cough stress test and single-channel medium-fill cystometry. Reliable prediction of the urodynamic diagnosis of incontinence could not be achieved with either of these two tests or with a combination of variables obtained by discriminant analysis. CONCLUSIONS: Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation when it is available.

Adult↗
PubMed1992

Urethral diverticula: evaluation by urethral pressure profilometry, cystourethroscopy, and the voiding cystourethrogram.

OBJECTIVE: To compare the value of urethral pressure profilometry with that of cystourethroscopy and the voiding cystourethrogram in the evaluation and management of urethral diverticula. METHODS: Twelve women with signs or symptoms of a urethral diverticulum were referred. The initial evaluation included cystourethroscopy and a voiding cystourethrogram. All then underwent urethral pressure profilometry. RESULTS: Nine of 12 patients had urethral diverticula, two had Skene duct cysts, and one had genuine stress incontinence. Both cystourethroscopy and voiding cystourethrography demonstrated diverticula in all patients who had them. Excision was the preliminary surgical plan in these women. Urethral pressure profilometry demonstrated a pressure depression or biphasic curve in all nine cases with diverticula. Stress incontinence was noted in one of these nine women. A biphasic curve was also noted in one woman with a Skene duct cyst and in the one who had genuine stress incontinence only. According to preset criteria for profilometry, excision was the planned operative procedure for all. CONCLUSIONS: Cystourethroscopy and voiding cystourethrography were satisfactory techniques for diagnosing urethral diverticula and planning appropriate surgical treatment. The urethral pressure profile confirmed the presence of a diverticulum, but noted pressure depressions in cases other than diverticula. Profilometry did not change the surgical plan for treating diverticula, but allowed the planning of additional incontinence surgery in one patient.

Adult↗
PubMed1992

Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.

OBJECTIVE: To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomy. METHODS: Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy-assisted vaginal hysterectomy with endoscopic staples (N = 29) or a standard vaginal hysterectomy (N = 27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operations. RESULTS: Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy-assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891. CONCLUSION: Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

Adult↗
PubMed1992

Investigative techniques, assessment of incontinence, and urodynamics.

The past year's literature reflects a continued interest in studying and refining standard investigative techniques, both urodynamic and radiographic, that have long been used to evaluate patients with lower urinary tract dysfunction. In addition, new, simple, and inexpensive technologies that allow relatively accurate diagnosis and that minimize medical costs have been introduced. These continued efforts to understand the pathophysiology of the lower urinary tract better bring both the practicing physician and the urogynecologist closer to making correct diagnoses and appropriate therapeutic decisions.

Cystoscopy↗
PubMed1992

Outpatient vaginal hysterectomy: a pilot study.

To determine the feasibility and safety of outpatient vaginal hysterectomy, we conducted a prospective study of 35 patients. Inclusion criteria required that the patient: 1) had no medical problems requiring hospitalization, 2) had a working telephone and a support person during the first 48 postoperative hours, 3) signed an informed consent document and understood the postoperative instructions, 4) required no concomitant surgical procedure such as anterior or posterior colporrhaphy, 5) required no additional antibiotic therapy for valvular heart disease, and 6) sustained no intraoperative injury requiring hospital monitoring. A physician contacted the patient by telephone on the evening of surgery and on postoperative days 1 and 2, and a nurse saw each patient in her home on postoperative days 1 and 2. Total hospital stay from admission to discharge from the ambulatory surgery unit was 9.4 +/- 0.81 hours (range 7.8-10.6). The mean preoperative hematocrit was 37.0 +/- 3.5% (range 29.3-43.5), with a mean discharge hematocrit of 32.5 +/- 4.2% (range 27-39). Follow-up hematocrit measurements at 24 hours, 48 hours, and 1 week were unchanged (P greater than .05) from that at hospital discharge. Two patients required hospital readmission, one on postoperative day 7 for a vaginal cuff abscess and another on postoperative day 3 for a spinal headache. On a 13-item questionnaire, most subjects rated the entire outpatient experience positively. These data suggest that outpatient vaginal hysterectomy can be a safe procedure and is well-accepted by selected patients. Based on these preliminary findings, an expanded clinical trial is warranted.

Adult↗
PubMed1991

Vaginal cuff closure at abdominal hysterectomy: comparing sutures with absorbable staples.

To compare two methods of vaginal cuff closure during abdominal hysterectomy, 60 patients were randomized to one of two cuff-closure methods. The vaginal cuff was closed with three interrupted 0-Dexon sutures in 30 and with absorbable staples in 30. Both groups were similar with respect to age, gravidity, parity, preoperative indication, hemoglobin, and hematocrit. The operative technique and quantity of irrigation used was standardized. Operative blood loss was calculated by the weight method and an unactivated, medium flat Jackson-Pratt drain was left in place for collecting postoperative cuff cultures at 24 and 48 hours. The mean operative times in the suture group (97.4 minutes) and staple group (93.4 minutes) were not significantly different (P greater than .05). Cuff-closure time was more rapid (P = .0001) in the staple group (5.8 minutes) than in the suture group (9.3 minutes). Intraoperative cultures were positive in eight of 30 suture patients (26.7%) and eight of 30 staple patients (26.7%). Postoperative cultures at either 24 or 48 hours were positive in four women (13.3%) in the suture group and six (20%) in the staple group. Febrile morbidity occurred in six (20%) in each group. Three staple and two suture subjects developed a vaginal cuff abscess or hematoma, one of whom was readmitted to the hospital for intravenous antibiotics and draining of the vaginal cuff abscess. The presence of a positive vaginal cuff culture did not predict clinical outcome. Based on these observations and the increased cost of the stapling device, we conclude that there is no significant clinical advantage of surgical staples over traditional sutures for vaginal cuff closure at abdominal hysterectomy.

Adult↗
PubMed1991

Discrepancy of cervical cytology and colposcopic biopsy: is cervical conization necessary?

The purpose of this study was to determine whether diagnostic cervical conization is necessary in the patient with a discrepancy between the Papanicolaou smear and the colposcopically directed biopsy(s). Patients eligible for the study had at least a two-degree discrepancy, eg, CIN III cytology and CIN I or less on colposcopic biopsies, or CIN II cytology with biopsies showing no dysplasia. Of the 786 records reviewed, 87 (11.1%) had such a discrepancy. Twelve of 87 patients (13.8%) were pregnant and ten of 87 (11.5%) failed to return after their initial colposcopic evaluation, leaving 65 patients in the study group. Of these, 20 of 65 (30.8%) were treated medically, nine (13.8%) had cryotherapy, and 36 (55.4%) underwent diagnostic cervical conization. Of patients undergoing cervical conization, three had microinvasive carcinoma of the cervix. Following medical therapy, only two of 20 patients (10%) had negative cytology, two (10%) had CIN I, five (25%) received additional therapy, and 11 (55%) were lost to follow-up. Seven patients did not return for follow-up Papanicolaou smear after medical treatment, and four did not return after their initial posttreatment Papanicolaou smear revealed persistent dysplasia. Of the nine patients treated with cryotherapy, six (66.7%) had a negative Papanicolaou smear at the time of their initial follow-up. The results of this study emphasize the importance of proceeding with diagnostic or therapeutic conization if a two-stage or greater discrepancy exists between the colposcopically directed biopsies and the cervical cytology. The risk of not diagnosing a microinvasive or invasive cervical carcinoma far outweighs the risk of conization.

Biopsy↗
PubMed1990

Stress incontinence and low urethral closure pressure. Correlation of preoperative urethral hypermobility with successful suburethral sling procedures.

Forty-eight women with genuine stress incontinence and low urethral closure pressure were treated with a suburethral sling procedure using polytetrafluoroethylene. All patients underwent a preoperative clinical evaluation and multichannel urodynamic testing. The clinical examination included a "Q-tip" test to determine the presence or absence of urethral hypermobility. Urethral hypermobility was defined as a maximal angle change of greater than or equal to 30 degrees from the horizontal, measured during straining or coughing in the lithotomy position. Thirty-four patients underwent repeat multichannel urodynamic testing three months postoperatively to determine the objective surgical success. Ninety-three percent of patients (27/29) with a positive preoperative Q-tip test were cured. Of patients with a negative preoperative Q-tip test, only 20% (1/5) were cured. Preoperative urethral hypermobility was a good prognostic indicator of operative success when a suburethral sling procedure was used to treat genuine stress incontinence and low urethral closure pressure.

Adult↗
PubMed1985

Genetic amniocentesis: a twelve years' experience.

The first 2,013 fetuses in 2,000 patients undergoing genetic amniocentesis at our institution were analyzed for the incidence of abnormal findings and for the safety and accuracy of the procedure. One percent of the patients were found to have aneuploid fetuses and another 1% were found to have elevated amniotic fluid concentrations of alpha-fetoprotein. Advanced maternal age was the indication for amniocentesis in 84% of the women with aneuploid fetuses. Thirty-two (1.6%) of the pregnancies ended in spontaneous abortion and 35 (1.7%) were terminated because of abnormal results of the prenatal diagnostic procedure. Our error rate was 0.15%, and tissue culture was successful in 97.7% of the procedures. During the latter part of our experience concurrent ultrasonography was utilized with the amniocentesis, resulting in a reduction in blood-tinged specimens from 15.0% to 5.2%. In experienced hands, midtrimester amniocentesis for the purpose of prenatal diagnosis of genetically determined defects is a safe, accurate, and valuable procedure for the identification of fetal abnormalities.

Adult↗
PubMed1983

High-resolution chromosome analysis of phenotypically abnormal patients with apparently balanced structural rearrangements.

Thirteen phenotypically abnormal patients with previously identified de novo or familial, apparently balanced, chromosome rearrangements were reexamined with high-resolution techniques. No definite imbalance could be demonstrated in any of the cases. However, some breakpoints were reassigned to more specific sub-bands and others to totally different bands. The study confirmed translocation reciprocity in some cases in which metaphase banding techniques failed to allow such determination. In one patient an apparent extra dark band was observed which could be explained by limited uncoiling, intraband exchange or small band duplication. In two patients limited uncoiling was observed in one derivative chromosome. Tissue-limited mosaicism was discovered in cultured fibroblasts from one of the seven patients evaluated.

Child↗
PubMed1983

Diploid-triploid mosaicism: delineation of the syndrome.

Two unrelated infants with multiple anomalies and diploid-triploid mosaicism are reported. A comparison of their clinical features with those of twelve published reports with 2n/3n karyotype is provided. The data reveal that 2n/3n mosaicism is a clinically recognizable syndrome.

Abnormalities, Multiple↗
PubMed1982

Incidence of nickel-induced sister-chromatid exchange.

Nickel is a recognized carcinogen to which the general population is being increasingly exposed. A nickel-induced alteration in the incidence of sister-chromatid exchanges in cultured lymphocytes has been investigated. Human lymphocytes from a single donor were cultured in media containing various concentrations of nickelous chloride from 10(-6) to 10(-3) M and a control culture containing no added nickel. A significantly increased incidence of exchanges over background was induced at 1.19 x 10(-4) M as indicated by a Student's t-test. A concentration/response curve was generated up to 5 x 10(-4) M where the nickel concentration was lethal to the cells. The nickel response was analyzed by a chi-square test for any variation in location of activity across the karyotype and no differences were detected. The background incidence did vary from a uniform distribution across the karyotype with increasing incidences in chromosomes 1 and 2 and those of the B group, and decreased incidences in the E, F, and G groups.

Cells, Cultured↗
PubMed1979

Duplication 6q syndrome.

Duplication (partial trisomy) of the long arm of chromosome 6 has been described in 5 children [Robertson et al, 1975, Chen et al, 1976, Clark, 1977]. We wish to report here an additional case due to a familial translocation in which the proband's karyotype is 46,XX,der(3),rcp(3;6)(p25;q21)mat. The phenotypes of the 6 children with duplication 6q are strikingly similar. Each child has duplication involving approximately the distal 1/3 to 1/2 of the long arm of chromosome 6. Distinctive features present in all 6 children include microcephaly, acrocephaly, prominent forehead, flat facial profile, depressed nasal bridge, flat malar areas, "carp" mouth, micrognathia and mental retardation. The phenotype of the duplication 6q syndrome is distinctive enough to be clinically recognizable.

Abnormalities, Multiple↗