Biomedical subjects
Publications and source records attributed to W G Hurt.
Bilateral selective embolization of the internal iliac arteries was utilized to control late recurrent post-partum hemorrhage. Angiographic embolization appears to be safe and effective, and giving consideration to its use in patients in similar situations is recommended.
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.
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.
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.
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.
Lesions of the vulva are common and are often associated with unnecessary and sometimes harmful delays in diagnosis and definitive therapy. Simple office biopsies, performed prior to treatment, permit histologic classification of the lesion and provide a basis for therapeutic recommendations.
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This study evaluates fluid weight uroflowmetry as a screening technique for urogynecologic conditions. Sixty women with no known pathologic condition volunteered for the evaluation of normal uroflowmetric parameters and curve patterns. Forty were menstruating cyclically, and 20 were postmenopausal. The parameters studied included: (1) total voided volume, (2) flow time, (3) peak flow rate, and (4) time to peak flow rate. In addition, uroflowmetric tracings were classified according to their patterns of configuration into: (1) normal, (2) multiple peak, and (3) interrupted. The parameters studied showed no difference in the two normal groups. A wide range of values was observed. Neither age, parity, weight, height, nor menstrual cycle phase affected the data. Values obtained from patients with idiopathic instability of the detrusor muscle, sensory urgency, and stress urinary incontinence did not show differences or trends. Seventeen percent of the tracings of the normal population group showed either multiple peak or interrupted patterns. Patients with sensory urgency (p less than 0.001) had a higher incidence of multiple peak and interrupted flow rate patterns.
Four cases of benign cystic mesothelioma are described. The disease affects young white women (mean age, 30 years), and they present with chronic pelvic pain. At laparoscopy or laparotomy, multiple cysts ranging in size from 0.5 to 4 cm in diameter and containing clear fluid are seen. The disease commonly affects the pelvic organs and/or omentum. With the electron microscope, the cell of origin of this proliferative process is shown to be the mesothelial cell. The disease has been previously described under a variety of terms. There seems to be a tendency for recurrence, but no malignant potential is apparent. Treatment may be conservative with preservation of pelvic organs. Benign cystic mesothelioma should be considered in the differential diagnosis of cystic lesions of the female genital tract.
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Accurate diagnosis of the adnexal mass requires knowledge of embryology, anatomy, and physiology. Bimanual pelvic examination remains the primary and most practical means of detecting and evaluating adnexal pathology. Selective use of diagnostic techniques will help determine the nature and extent of involvement. Prompt and specific diagnoses facilitate therapy and improve results.
Ninety-two (24.6%) of 374 patients referred to our gynecologic urology unit were found to have instability of the detrusor muscle with no recognizable associated pathologic conditions: idiopathic detrusor instability. Thirty-nine (42.4%) of these 92 patients demonstrated the instability only after detrusor activation maneuvers such as coughing, heel bouncing, or positional changes. The cure rate among patients with both "spontaneous" and "provoked" contractions of the detrusor muscle was comparable to the cure rate among those whose bladder contractions were apparent only after detrusor activation maneuvers (p greater than 0.9). The success rate of bladder retraining drills (BRD) as the sole mode of therapy was not significantly different from that observed with BRD combined with anticholinergics (p greater than 0.6).
The role of cystourethrography in the evaluation of urinary incontinence is controversial. This study evaluates the significance of 5 radiologic landmarks described in the literature as characteristic of stress urinary incontinence. It was expected to determine how often these landmarks were read similarly by independent observers and whether these radiologic findings in patients with stress urinary incontinence differ from those in patients with idiopathic detrusor instability. Eight-three cystourethrograms of patients having either stress urinary incontinence of idiopathic detrusor instability were reviewed. Three radiologists interpreted 5 radiologic landmarks on each study. Lack of identification and of agreement in interpretation by all 3 investigators varied from 19.3 to 54.2%. There were no statistically significant difference in the distribution of radiographic characteristics between patients with stress urinary incontinence and those with idiopathic detrusor instability.
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Endometrial sampling is an easily performed, economical, and accurate outpatient diagnostic procedure with wide application in gynecology. It is readily accepted by patients as an alternative to inpatient dilatation and curettage. The information which it provides relative to endometrial histology enables the physician to detect premalignant and malignant processes, to be precise in making diagnoses, and to document the results of therapy.
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.
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.