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Biomedical subjects

S Raz

Publications and source records attributed to S Raz.

At least 91 records · Page 5Linked to original sources
PubMed1989

Prospective evaluation of an assessment strategy for geriatric urinary incontinence.

The objectives of this study were to design and prospectively evaluate a strategy to assess geriatric urinary incontinence in primary care settings. A management plan for urinary incontinence was determined for 264 elderly incontinent patients (205 females and 59 males) based on a clinical evaluation, simple tests of lower urinary tract function, and several criteria for referral for further evaluation derived from the literature on incontinence. Of the 264 patients, 168 (64%) also consented to undergo a urologic and formal urodynamic evaluation. Half of these 168 patients met at least one criterion for referral for further evaluation. At least one-quarter of the patients who met one or more of the criteria were found not to require surgical intervention, and probably did not benefit from the urologic and urodynamic evaluation. Among 84 patients who did not meet any of the criteria for referral, the urologic and urodynamic evaluation changed the initial treatment plan in only 10 (12%). The risks associated with the treatment plan based on the clinical assessment in these patients were, however, relatively small. While further refinement and testing in larger numbers of incontinent patients are needed, the data presented document that a substantial proportion of elderly patients with a treatable and often ignored problem can be appropriately managed based on a relatively simple and inexpensive assessment, which can easily be carried out in primary care settings.

Aged↗
PubMed1989

Inverted schneiderian papilloma of the sinonasal tract in children.

Inverted schneiderian papilloma of the sinonasal tract is an uncommon lesion in adults and is even less common in children. Nine cases occurring in the pediatric age group have been reported in the literature. We describe two more childhood cases of inverted schneiderian papilloma, one occurring in a 15-year-old girl and the other in a 10-year-old boy. This lesion in children behaves similarly to that in adults. When treated by intranasal surgery, it usually recurs. With this report we would like to illustrate the diagnostic and differential diagnostic elements of this lesion and increase the awareness of this entity in the pediatric age group.

Adolescent↗
PubMed1988

Female urinary incontinence. Therapeutic approaches.

Urinary incontinence results from bladder or sphincter dysfunction. Bladder-related incontinence due to a reduced-capacity, unstable, or noncompliant bladder can often be remedied by augmentation techniques. For anatomic incontinence, excellent results are achieved with use of any of the retropubic or transvaginal suspension techniques that restore the bladder neck and proximal urethra to a high, fixed retropubic position. However, when the urethral sphincter is intrinsically damaged, mere restoration of position will fail to cure the problem. Such damage warrants use of a compression procedure that increases urethral resistance, such as one of the many sling techniques, implantation of an artificial urinary sphincter, or periurethral Teflon injection.

Female↗
PubMed1988

Ventriculomegaly in schizophrenia: is the choice of controls important?

The issue of adequate controls for the study of ventriculomegaly in schizophrenia has been explored initially by Andreasen et al. (1982), who proposed that healthy volunteers, a group with presumably smaller ventricles than medical controls, be considered the optimal comparison group in this area of research. Recently, Smith and Iacono (1986) suggested that group differences may appear to be greater when controls who are patients are used, as a result of the systematic exclusion of medical patients with large though normal ventricles. We conducted a meta-analysis of 37 studies of lateral ventriculomegaly in schizophrenia to clarify this issue. The results indicate that the average effect size in studies with healthy controls does not differ significantly from that obtained in studies employing medical, neurological, or psychiatric (nonpsychotic) controls. Thus, any group without gross neurological damage or severe psychopathology may be used for establishing ventriculomegaly in schizophrenia.

Cerebral Ventricles↗
PubMed1988

Simple versus multichannel cystometry in the evaluation of bladder function in an incontinent geriatric population.

Bladder capacity and stability were determined among 171 incontinent geriatric patients (mean age 80 years) with 2 techniques: a simple procedure for cystometry involving incremental bladder filling by gravity and a continuous water filling multichannel cystometrogram. Bladder capacities measured by both methods in 164 patients were correlated significantly by simple linear regression (r equals 0.75, p equals 0.0001) and they were not significantly different by paired t tests (t equals 1.20, p equals 0.23). Of the patients 110 (64 per cent) had detrusor motor instability or hyperreflexia on the multichannel cystometrogram, and simple cystometry had a sensitivity of 75 per cent, specificity of 79 per cent and positive predictive value of 85 per cent for this finding. The simple procedure was practical, well tolerated and helped to provide information for management decisions that would have been difficult to obtain from many of these geriatric patients without a formal and more complex urodynamic evaluation. When performed with other simple tests of lower urinary tract function and interpreted in conjunction with a few straightforward clinical criteria, simple cystometry can be helpful to assess bladder function among incontinent geriatric patients in settings in which formal urodynamics are either unavailable or impractical.

Aged↗
PubMed1988

Surgical treatment of the incontinent female patient with myelomeningocele.

Surgical therapy was required for 42 incontinent female patients with myelomeningocele who had urodynamically documented high pressure bladders. Conservative treatment consisting of cholinolytic and alpha-adrenergic agents, and intermittent self-catheterization had failed. The surgical approach consisted of perivesical denervation (for hyperreflexia), Burch bladder neck suspension, enlargement cystoplasty and ureteral reimplantation when required. Among 33 patients (79 per cent) there was no incontinence on intermittent self-catheterization and 6 (14 per cent) had improvement with rare urgency or stress incontinence. In 3 patients (7 per cent) sphincteric incompetence required a transvaginal sling procedure.

Adolescent↗
PubMed1988

Fascial sling to correct male neurogenic sphincter incompetence: the McGuire/Raz approach.

We report the surgical approach used in 4 male myelomeningocele patients suffering from severe urinary incontinence owing to poor bladder compliance and sphincter incompetence. While bladder compliance was corrected by enlargement cystoplasty the sphincteric incompetence was treated by an autologous fascial sling around the bladder neck with excellent results. We consider this operation as an alternative to the artificial urinary sphincter in cases of male neurogenic sphincter incontinence.

Adolescent↗
PubMed1988

[Surgical treatment possibilities of severe urinary incontinence in women].

Severe female urinary incontinence type 3 is a most difficult challenge to a urologic surgeon. In 40 of more than 800 patients evaluated for stress incontinence, type 3 urinary incontinence was diagnosed by clinical, urodynamic, and radiographic examination. The etiology was neurogenic or non-neurogenic. The first step of treatment in all patients was a modified pubovaginal sling to increase urethral resistance; this procedure was successful in 65%. Severely damaged periurethral tissues resulting from earlier multiple pelvic surgery (111 operations in 28 patients with non-neurogenic etiology), radiation, or prior local infections were responsible for failures. Patients whose incontinence was not corrected by this initial treatment required further surgical procedures, such as suburothelial Teflon injection, urethral reconstruction, and continent urinary diversion. This additional surgery resulted in an overall 92% success rate after a minimum follow-up of 18 months. In view of the severe nature of the incontinence of these individually problematic patients, this is a satisfactory results.

Adolescent↗
PubMed1987

Morphological brain abnormalities in schizophrenia determined by computed tomography: a problem of measurement?

The size of the cerebral ventricles was estimated from computed tomographic (CT) scans of 14 young patients with schizophrenia and 12 medical controls. The subjects were a representative subsample from a larger sample studied by Boronow et al. (1985). Although no CT abnormalities were detected in the psychiatric patients using traditional measures (mechanical planimetry for the lateral ventricles and a linear measure for the third ventricle), a volumetric analysis of the same 26 scans revealed enlargement of the lateral and third ventricles in the schizophrenics. The effect revealed by volumetric measures of the lateral ventricles was 58% greater than that obtained with digital planimetry and 96% greater than the effect found using mechanical planimetry. No differences were found between volumetric and digital planimetric measures of the third ventricle, but the effect revealed by the latter measure was 114% greater than that obtained by a linear index. It is suggested that volumetric measures of lateral ventricles based on information from several CT slices may be more sensitive to group differences in ventricular size than planimetry. Likewise, area measures of the third ventricle may be more sensitive to group differences than linear measures.

Adolescent↗
PubMed1987

Female urethral obstruction after Marshall-Marchetti-Krantz operation.

During the last 5 years 13 neurologically normal women were seen with urodynamically proved urethral obstruction after a Marshall-Marchetti-Krantz operation. These obstructed patients were treated by a simple transvaginal procedure consisting of complete urethrolysis followed by a needle urethrovesical resuspension procedure. Postoperatively, 12 patients experienced complete disappearance of the presenting symptoms, return to a normal voiding pattern and decreased residuals of urine to less than 50 cc. The remaining patient, although urodynamically unobstructed, had to remain on intermittent catheterization. The pathophysiology, diagnosis and treatment of this iatrogenic type of female urethral obstruction are discussed.

Female↗
PubMed1987

The impact of detubularization on ileal reservoirs.

For many years, parts of the large or small bowel have been used for bladder augmentation and substitution. Recent controversy over the advantages and disadvantages of continent urinary diversion using detubularized ileum (the Kock pouch) and tubular ileum (the Camey procedure) focussed on how a highly compliant urinary reservoir should be formed. We compared the compliance of isolated intact ileal segments and ileal pouches constructed after transection of the antimesenteric border. Hydrodynamic data was obtained at four different points in time: acute (immediately after pouch construction), and after two, six and twelve weeks. Over the first six weeks the reservoirs were connected to the bladder for drainage. At six weeks, subtotal cystectomy and separate anastomosis of the tubular ileal loop and the detubularized ileal pouch to the trigone was performed to study the influence of cyclic reservoir distention. Statistical analysis of the pressure-volume curves revealed significantly better compliance of the detubularized ileal pouch as compared to the intact ileal segments. The area under the pressure curve values (AUC) were p less than 0.025, p less than 0.02, p less than 0.005 and p less than 0.02 for the acute experiment, after two weeks, after six weeks, and after 12 weeks respectively. Our findings suggest that transection of the circular intestinal wall is an important step in the creation of a good-compliant urinary reservoir.

Animals↗
PubMed1987

Clinical versus urodynamic diagnosis in an incontinent geriatric female population.

The clinical presentation of incontinence was compared to diagnoses based on urological and urodynamic evaluation in 135 elderly women assessed consecutively in an outpatient clinic. Most patients (64 per cent) presented with mixed symptoms: 16 per cent presented with pure stress and 16 per cent with pure urge incontinence. After evaluation 46 per cent of the patients had stress incontinence with a stable bladder, 27 per cent had detrusor instability or hyperreflexia without sphincter weakness and 19 per cent had mixed urodynamic abnormalities. Presenting symptoms were predictive of urodynamic diagnosis in 64 per cent of the patients with pure stress incontinence and 55 per cent with pure urge incontinence. In general, symptoms in our patient population were less predictive of urodynamic findings than in previously reported series of younger incontinent women but they were more predictive than in other series of elderly women. Predictive values for some urodynamic findings were enhanced by combining a symptom with certain physical findings. Implications of these data for the evaluation and treatment of incontinence in the geriatric population are discussed.

Aged↗
PubMed1987

Tubovaginal leakage: an unusual cause of incontinence.

Incontinence after hysterectomy may be caused by an abnormal fallopian tube draining into the vaginal cuff. We report 2 cases of this condition, which generally is known as hydrops tubae profluens. One patient also had genuine stress urinary incontinence and the other suffered persistent disease after 2 failed suspension procedures. This rare condition should be considered in the differential diagnosis of unusual causes of incontinence.

Fallopian Tubes↗
PubMed1987

Urodynamic use of fiberoptic microtipped catheter.

Solid state microtransducers are used widely in urodynamics to record bladder and intraluminal urethral pressures. They are sensitive and capable of giving high quality, reproducible pressure recordings. They do not require the determination of a reference point but they are expensive and fragile, and calibration may be difficult to perform. We describe our experience with a new catheter for pressure recording based on fiberoptic technology. In addition to the advantages of the conventional microtipped catheters, the new catheter is thinner (4F), easier to calibrate and less expensive. Controlled testing of the new catheter was performed in an experimental setting and in clinical trials during urodynamic evaluation. The catheter provides reliable pressure recordings compared to standard microtipped catheters.

Animals↗