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Biomedical subjects

W G Hurt

Publications and source records attributed to W G Hurt.

At least 19 recordsLinked to original sources
PubMed1991

Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction.

Forty-seven women had urethral pressure profile determinations performed at rest and during a Kegel pelvic muscle contraction, after brief standardized verbal instruction. Twenty-three (49%) had an ideal Kegel effort--a significant increase in the force of urethral closure without an appreciable Valsalva effort. Twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence. Age, parity, weight, estrogen deprivation, prior continence surgery or hysterectomy, and passive urethral function did not predict a successful effort. We concluded that simple verbal or written instruction does not represent adequate preparation for a patient who is about to start a Kegel exercise program.

Adult↗
PubMed1991

Outpatient gynecologic procedures.

The majority of gynecologic surgical procedures can be performed on an outpatient basis. Utilization of outpatient surgical centers helps reduce the cost of health care, lessens the disruption of patients' personal lives, and promotes their recovery through early ambulation and a lower incidence of postoperative nosocomial complications. Patient education and improvements in anesthetic and surgical techniques will allow additional and more complicated gynecologic procedures to be performed in outpatient surgical centers. In doing so, the surgeon must not increase the overall risk of the procedure or compromise the surgical technique in a way that may produce a result that is not as good or as durable as the same procedure performed on an inpatient basis.

Abortion, Induced↗
PubMed1991

Ectopic pregnancy in an urban teaching hospital: can tubal rupture be predicted?

We evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadotropin (hCG-beta subunit) were significantly higher in patients with ruptured versus unruptured ectopic pregnancies (16,612 mIU/mL vs 6406 mIU/mL), no breakpoint excluded the possibility of tubal rupture. In fact, one third of ectopic pregnancies in patients with a serum beta-hCG level below 100 mIU/mL were ruptured. We conclude that clinical symptoms and signs are poor predictors of tubal rupture. In addition, absolute values of serum beta-hCG are not helpful in excluding the possibility of rupture.

Adult↗
PubMed1990

Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy.

To assess the relationship between either bacterial vaginosis or trichomoniasis vaginitis and posthysterectomy infection, preoperative evaluation of the vaginal secretions was performed in 161 women undergoing abdominal hysterectomy. Thirty-two patients (19.9%) and 27 patients (16.8%), respectively, met the diagnostic criteria for bacterial vaginosis and trichomoniasis vaginitis. Patients with either bacterial vaginosis or trichomoniasis vaginitis were more likely than control subjects to have cuff cellulitis, cuff abscess, or both (relative risk 3.2, 95% confidence interval 1.5 to 6.7 for bacterial vaginosis; relative risk 3.4, 95% confidence interval 1.6 to 7.1 for trichomoniasis vaginitis). Preoperative vaginitis had no effect with respect to the incidence of postoperative wound infection, urinary tract infection, or intravenous line phlebitis. Bacteroides sp., Peptostreptococcus sp., and/or Gardnerella vaginalis ("bacterial vaginosis organisms") were isolated from the vaginal cuff in the majority of patients with postoperative cuff cellulitis. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for the development of posthysterectomy cuff cellulitis.

Adult↗
PubMed1989

Seminoma in pubertal patient with androgen insensitivity syndrome.

The case of a 14-year-old girl with complete androgen insensitivity syndrome and metastatic seminoma is reported. She was treated by bilateral adnexectomy, removal of paraaortic lymph nodes, postoperative radiation, and estrogen replacement therapy. She represents the fourth case of gonadal malignancy to be reported in a teenage patient with androgen insensitivity syndrome.

Adolescent↗
PubMed1988

Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Adult↗
PubMed1988

Dynamic urethral pressure profilometry pressure transmission ratio determinations after continence surgery: understanding the mechanism of success, failure, and complications.

Twenty-two women who had previously undergone continence surgery for the correction of stress urinary incontinence were evaluated with dynamic urethral pressure profilometry and had bladder-to-urethra pressure transmission ratios calculated. Eight of the subjects had recurrent or persistent genuine stress incontinence (group 1), seven had detrusor instability (group 2), and seven had normal continence and detrusor function (group 3). In addition, we evaluated ten subjects with detrusor instability but no previous surgery (group 4). There were clear and significant differences in pressure transmission ratios between the four groups. These differences suggest that subjects in group 1 have the same basic mechanisms of incontinence (ie, inefficient pressure transmission to the urethra as reflected by pressure transmission ratios less than 90%) as do never-operated women with genuine stress incontinence. Subjects in group 2 had pressure transmission ratios that were significantly higher than those in either group 3 or 4. This supports the hypothesis that obstruction may play a role in post-continence surgery detrusor instability, but not in idiopathic detrusor instability. Group 2 subjects had pressure transmission ratios very close to the ideal of 100%. We postulate that continence procedures that consistently result in pressure transmission ratios close to 100% should have the greatest chance for success without inducing complications.

Adult↗
PubMed1988

Lichen planus of the vulva.

Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.

Atrophy↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗
PubMed1987

Positive endocervical curettage in patients with satisfactory and unsatisfactory colposcopy: clinical implications.

We studied a total of 177 patients with cervical intraepithelial neoplasia or invasive carcinoma to evaluate the clinical implications of a positive endocervical curettage. All patients underwent cervical conization. One hundred and ten women had unsatisfactory colposcopy; 67 had satisfactory colposcopy. Patients with unsatisfactory colposcopy had a higher frequency of invasive lesions in the endocervix (9 versus 1.5%, P less than .05) and involvement of internal cone margins (12 versus 0%, P less than .01); they were also more likely to require additional, frequent treatment for persistent or recurrent disease (9 versus 1%, P less than .05) than patients with satisfactory colposcopy. Histologic review of the cone specimens in patients with satisfactory colposcopy revealed no lesion deeper in the endocervical canal than was predicted by colposcopic examination. These observations suggest that selected patients with positive endocervical curettage may be managed without diagnostic conization, if they had a satisfactory colposcopic examination.

Biopsy↗
PubMed1986

Urethral axis and sphincteric function.

Position and mobility of the urethral axis are considered factors influencing urethral competence. Specific correlation between the urethral axis and its sphincteric function is lacking. Eighty-four patients with the symptom of stress urinary incontinence and 31 patients with sensory symptomatology but not urinary incontinence underwent clinical and urodynamic evaluation. This included objective assessment of urethral axial positions and mobility with use of a specially designed protractor. Comparative analysis of urethral axial data was done between 70 incontinent women with objective evidence of sphincteric incompetence and 24 continent women without it. The urethral axis at rest, during bearing down, and in its total excursion were found to be not significantly different and distributed similarly between both groups. Assessment of the urethral axis was found to be not predictive of urethral function.

Cough↗
PubMed1986

A technique for surgical correction of fallopian tube prolapse.

Prolapse of the fallopian tube is a rare complication of gynecologic surgery. Five cases were operated upon in the authors' hospital within the past year. A summary of these cases is given. One of the cases, which required a second operative procedure, is discussed. The surgical technique for complete excision of the prolapsed fallopian tube via the vagina is described.

Adult↗
PubMed1986

Genital condylomas in immunosuppressed women: a therapeutic challenge.

Of 30 immunosuppressed women with genital condylomas, 20 (67%) had associated neoplasia of the lower genital tract. We retrospectively studied 11 patients with flat condylomas confined to the cervix; all lesions were eradicated by conventional therapy. Three patients studied retrospectively and 16 studied prospectively had condylomatous lesions involving several sites within the lower genital tract. These lesions were unusually resistant to various treatment methods. Maintenance therapy with 5-fluorouracil (5-FU) cream resulted in a significantly higher control rate (6/7 patients, 86%) than could be achieved otherwise (2/9 patients, 22%; P less than .025). We conclude that ablative therapy by surgery or topical chemical agents followed by maintenance therapy with 5-FU cream may be the treatment of choice for condylomas and other human papillomavirus-associated lesions of the lower genital tract in immunosuppressed women.

Adult↗
PubMed1979

Behçet's syndrome associated with pregnancy.

A case of Behçet's syndrome diagnosed during pregnancy is reported. It is believed that this condition is more common in the United States than previously thought. It should be considered in the differential diagnosis of genital ulceration.

Adult↗
PubMed1979

Cryotherapy of the cervix.

Cryotherapy is most useful in treating mild and moderate dysplasia of the ectocervix and symptomatic benign chronic cervicitis. It has almost replaced electrocauterization of the cervix and has reduced the need for conization. Cytology and colposcopy are essential in the selection of patients for this procedure and in evaluating their response to therapy.

Colposcopy↗
PubMed1978

Direct electronic urethrocystometry.

Direct electronic urethrocystometry simultaneously records pressures in the bladder, proximal urethra, and abdomen in a patient at rest and under stress while the bladder fills with urine. It documents the presence or absence of detrusor contractions and is an essential part of the evaluation of patients with detrusor dysfunction and urinary incontinence.

Female↗
PubMed1978

Laparoscopic tubal occlusion with silicone rubber bands.

Application of the silastic ring to the Fallopian tubes through the laparoscope seems to be a simple, safe and acceptable method of tubal sterilization. The technique and results in 337 patients are described. In the majority of cases, the procedure was effected in the outpatient department under local anaesthesia. Transsection of the tube (with or without bleeding), tearing of the mesosalpinx, and avulsion of the tube at the uterotubal junction were the most common complications; with experience and adherence to the proper technique of ring application, the above can be minimized. The pregnancy rate following this procedure seems to be acceptable, but long-term follow-up is necessary for definitive conclusions.

Adolescent↗