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Biomedical subjects

W Lichtenegger

Publications and source records attributed to W Lichtenegger.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Urodynamic results following surgery of incontinence].

184 women who underwent surgery because of stress incontinence during the years 1982-1986 were examined both before and after surgery. The interval between operation and post operational control was from 12 to 60 months. After colporrhaphy anterior and colcoperineoplasty 69% of the women were continent; 14% showed a stress incontinence of first degree, 17% a stress incontinence of second degree. After Marshall-Marchetti 75% of the patients were continent; 16% were stress incontinent to degree I. The best result was achieved by lifting the neck of the bladder (Stamey-method): 82% of the women were continent, 18% stress incontinent. The urethral closure pressure at rest went down significantly after colporrhaphia anterior; it rose slightly after Marshall-Marchetti and the endoscopic lifting of the bladder neck (Stamey-method). All postoperatively continent women showed an improval of pressure transmission, the best result having been achieved after the endoscopic lifting of the bladder neck (Stamey-method). Contrary to colporrhaphia anterior and colpoperineoplasty the miction was impaired after abdominal operational methods. The results will be shown and discussed.

Female↗
PubMed1988

Urodynamics following radical abdominal hysterectomy for cervical cancer.

We performed urologic evaluations and urodynamic studies on 40 patients before and 2 weeks, 6 months and 1 year after radical abdominal hysterectomy for cervical cancer. Preoperative findings were mostly within normal limits. Fourteen days after surgery, all patients had small, spastic bladders and 68% had residual urine. Bladder sensation was impaired in all patients at 2 weeks and in 63% after 1 year. The average bladder capacity was 400 ml before surgery, 180 ml at 2 weeks, 350 ml at 6 months, and 460 ml at 1 year. One year postoperatively, no patient had residual urine, but 17.5% had asymptomatic bacteriuria, 17.5% had bladder trabeculation, 62.5% had abnormal compliance, and 85% used abdominal straining to void. Three patients developed overflow incontinence and 8 women developed urodynamic stress incontinence. Most patients were tolerant of the observed dysfunction.

Female↗
PubMed1988

Operative anatomy and technique of radical parametrial resection in the surgical treatment of cervical cancer.

Wertheim's radical operation aimed, by removing the parametrial tissue far from the tumour, to achieve margins free of disease. The paratissues contain the lymphatic channels draining the cervix. They run to the pelvic wall and are interspersed by lymph nodes scattered throughout the parametrium. If lymphadenectomy is to be curative then the entire parametrium must be removed. To this end the resection of the cardinal ligament was pushed to its limit by dissection directly at the pelvic wall. The surgical technique is guided by the anatomy of the pelvic fascia. The gaine hypogastrique lies just beneath the peritoneum and facilitates the opening of the paravesical space. The following are discussed: the condensations of the pelvic fascia; the composition of the cardinal ligament; the division into a venous, an arterial, and a neurovegetative root; and the anatomy of the connective tissue planes. The order in which the surgical steps are carried out is important. The paraspaces are opened first. The ureter is identified, and lymphadenectomy is performed. The rectum is dissected off the vagina, and the uterosacral ligaments are identified and removed. Only then is the vesico-uterine fold opened. The bladder is dissected off the vagina, and the anterior parametrium is clamped and divided. Now the cardinal ligament is completely exposed. The bladder, rectum and ureter have been mobilized so that the parametrium can be divided sharply directly at the pelvic wall, clipping the vessels step-by-step. The paracolpium is clamped and divided according to the proposed vaginal cuff. Thus, the entire lymphatic drainage can be removed. The value of this extension of radical abdominal hysterectomy lies especially in the treatment of large, voluminous tumours.

Broad Ligament↗
PubMed1988

Urological complications after radical abdominal hysterectomy for cervical cancer.

Radical abdominal hysterectomy for cervical cancer is naturally associated with a number of urological complications. In a review of 320 hospital records we found a 6.6% incidence of intraoperative injury to the bladder or ureters; in all cases the tumour had encroached on the organ. The incidence of postoperative fistula formation was 4.4%. Postoperative urodynamic studies of 116 patients after radical hysterectomy, with or without adjuvant radiotherapy, quantified lower urinary tract dysfunction. A prospective study of 40 patients showed that 20% developed urinary stress-incontinence after surgery. Patients who had had surgery only showed an improvement in most urodynamic parameters over the years, while patients who had also had radiotherapy did not. Seventy-eight per cent of the patients after surgery only were satisfied with their condition and, years later, reported no complaints. They may just have become used to them, but half the patients who had also had radiotherapy reported complaints, mainly impaired bladder sensation, frequency and nocturia. Urinary tract dysfunction after radical hysterectomy is inevitable, but meticulous peri-operative management, regular follow-up examinations and psychological support can keep it to a minimum and help the patient to cope.

Adult↗
PubMed1988

[Disorders of bladder emptying following abdominal radical operation of cervix cancer].

Radical abdominal hysterectomy causes functional disorders of the lower urinary tract. We prospectively evaluated urinary dysfunction in 72 women before 2 weeks, 6 months and 1 year after surgery. The results were compared to those of 10 women who underwent simple abdominal hysterectomy. After radical abdominal hysterectomy 63% of our patients had impaired or absent bladder sensibility at 6 months. Bladder compliance was abnormal in 79% patients at 14 days and in 60% after 6 months and 1 year. Preoperative urethral stress profiles were performed in 58 patients. 69% of the stress profiles showed continence, 31% stress incontinence. 11 initially continent women (22%) developed stress incontinence. We attribute post-operative stress incontinence to surgical trauma, edema, haematoma, scartissue that restricts mobility of the bladder neck.

Adult↗
PubMed1987

[Labor induction at term: amniotomy versus intravaginal administration of prostaglandin E2 tablets].

This study compares the conventional method for induction of labour, amniotomy (A) with or without oxytocin infusion, with induction by means of intravaginal prostaglandin (PG)-E2 tablets. We reviewed the records of 266 women (A group: 155 women, PG group: 111 women), who had no risk factors at the time of induction. Both methods were effective. However, induction by PGE2 tablets presented less risk and was more comfortable than early amniotomy. We conclude that A should no longer be the method of choice for the induction of labour at term; the application of intravaginal PGE2 tablets is an efficacious, easy, and low-risk alternative.

Administration, Intravaginal↗
PubMed1987

[Labor induction by intravaginal administration of prostaglandin E2 tablets].

Between 1982 and 1984, at Graz University Obstetric and Gynaecological Clinic, labour was induced in 307 women (146 primiparae and 161 multiparae) by intravaginal administration of 3 mg prostaglandin (PG) E2 tablets, because birth was overdue or because labour was irregular. No risk factors were present when PG was administered: signs of deficiency or postmaturity, or twisted cord, were ruled out. The following complications were evaluated: birth rate and induction-birth interval in relation to cervical maturity and parity. The number of complications was low. It was unrelated to cervical maturity and only partially to parity. Birth was induced successfully with a single dose of 3 mg PG E2 in over 80% of the primiparae and over 90% of the multiparae. The majority of the primiparae and all the remaining multiparae were successfully delivered with a second dose; no relationship between birth rate and cervical maturity was established. Among the primiparae with a low degree of cervical maturity the child was born within 12 hours in over 50% of the cases, among primiparae with more mature cervices in almost 90%. Among the multiparae, the child was born within 12 hours in 90% of the cases regardless of the state of cervical maturity. It is concluded from these results that with appropriate monitoring of birth, intravaginal administration of PG E2 tablets is an efficient and easily managed method of inducing birth at term, involving little risk.

Administration, Intravaginal↗
PubMed1987

[Functional disorders of the lower urinary tract following radical abdominal and vaginal surgery of cervix cancer].

To establish the prevalence and extent of lower urinary tract dysfunction after radical surgery for cervical cancer, we evaluated 121 patients who underwent surgery between 1978 and 1984. 91 women underwent radical abdominal hysterectomy for disease in stage Ib or IIb; 30 patients underwent radical vaginal hysterectomy for stage Ib disease. Evaluation, at 12-72 months postoperatively, included pelvic examination, urinary history (explored via a specially designed questionnaire), measurement of residual urine, urine culture, and urodynamic studies. All patients underwent urethrocystoscopy and intravenous urography. Results showed 36 patients completely free of complaints, namely, 17 (18.7%) after radical abdominal hysterectomy and 19 (64%) after the vaginal produce. 85 patients (70%) had complaints, most commonly difficult spontaneous micturition (81.4% after abdominal, 17% after vaginal surgery). Other pathologic conditions were identified as follows: stress incontinence in 52.8% of patients after abdominal and 24% after vaginal surgery; impaired bladder sensation in 48.4% after the abdominal procedure but in only 13% after the vaginal; residual urine volume exceeding 10% of maximum bladder capacity in 13.2% after abdominal surgery (range: 40-220 ml) and 24.2% after vaginal surgery (range: 30-200 ml); significant bacteriuria in 21 patients (23%) after abdominal hysterectomy and 3 patients (9%) after vaginal. Urodynamic studies showed that, after abdominal surgery, bladder compliance was normal in 41.8% of patients, high in 39.6%, and low in 18.7%. After vaginal surgery, bladder compliance was normal in 66% of patients and abnormal in 34%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Heart function in infants and small children, whose mothers required tocolysis with hexoprenaline sulfate (Gynipral)].

Cardiac function was investigated in 23 retrospectively selected children (mean age 15 months, range 2/12-3 4/12), whose mothers had undergone a successful course of tocolysis around the 31st week of pregnancy. Hexoprenaline sulfate (Gynipral) had been given at a mean cumulative dose of 51,103 micrograms over an average period of 13.8 days. The infants were born at term; cases with marked birth asphyxia, low birth weight or other perinatal problems possibly influencing cardiac performance were not included. The examination included a chest X-ray, ECG (all standard leads) and ultrasonography. There was no evidence of myocardial dysfunction which might have been the late result of untoward effects of the beta 2-mimetics given during the last trimester of pregnancy. All probands were normally developed: on cardiological examination an incidental systolic murmur was found in 2 infants and border-line cardiomegaly in another proband. ECG revealed a wandering pace-maker and occasional ventricular extrasystoles in one 3 month-old boy, which is not necessarily abnormal at this age. Two-dimensional echocardiography showed normal cardiac anatomy in all 23 probands. One-dimensional M-mode showed normal left ventricular function parameters. The slightly elevated myocardial contractility demonstrated by means of the M-mode was attributed to increased sympathetic tone in the non-sedated children.

Child, Preschool↗
PubMed1986

Diagnosis and treatment of gestational diabetes according to amniotic fluid insulin levels.

In spite of dietary treatment, the infants of pregnant patients with abnormal glucose tolerance have hyperinsulinism and diabetogenic fetopathy in 10 to 36% of cases. Those patients, who require insulin to prevent from fetopathy cannot be reliably selected by maternal parameters such as blood glucose and glycosylated hemoglobin values. We recommend the measurement of amniotic fluid insulin between the 28 and 32 weeks of pregnancy to differentiate whether the fetus is compromised or not. Subjects with values above the 97th centile require insulin therapy. Inadequate insulin dosage or delayed fetal hyperinsulinism can be discovered by checking the amniotic fluid insulin level at 33 to 36 weeks. In a total of 88 gestational diabetic patients 19 had raised amniotic fluid insulin levels indicating the onset of diabetic fetopathy at an early stage. Diabetic patients with raised amniotic fluid insulin levels needed large doses of insulin, namely 64.6 +/- 29.5 (Mean +/- SD) U/24 h. This treatment reduced mean blood glucose levels from 98 +/- 9 (Mean +/- SD) mg/dl to 82 +/- 10 mg/dl and was sufficient to prevent from diabetic fetopathy.

Adult↗
PubMed1985

Amniotic fluid glucose values in normal and abnormal pregnancies.

Glucose values were determined in 102 urine samples of newborn infants and in 2295 amniotic fluid (AF) samples of women between the 14th and 42nd week of pregnancy. One thousand, six hundred fifty-five of the AF samples derived from normal pregnancies, 50 from pregnancies with fetal malformations, 115 from cases of hydramnios, 246 from pregnant women with an abnormal oral glucose tolerance test, and 230 from insulin-dependent diabetics. Mean AF glucose concentration rises slightly between the 14th and 17th week of pregnancy, decreasing from 46 to about 16 mg% at the end of pregnancy. In cases of fetal malformations, 68% of the glucose levels was below the tenth percentile of normal values. Hydramnios showed no deviation from normal values. In patients with abnormal glucose tolerance, AF glucose increased by a total of 42% and by 67% in fetal hyperinsulinism. Insulin-dependent diabetics had glucose values elevated by a total of 77% and by 106% in fetal hyperinsulinism. The AF glucose profile reflects the level of maternal blood glucose that is transported to the fetus and excreted in the fetal urine as a major source of glucose in AF.

Amniotic Fluid↗
PubMed1984

[16-Phenoxy-prostaglandin-E2 for inducing abortion in intact and complicated pregnancy].

The prostaglandins used so far in early pregnancy exercise distressingly strong side effects (Table 5). These side effects are closely correlated with the effectiveness of the prostaglandins. 16-phenoxy-prostaglandin-E2 (SHB 286) was employed in 476 women for inducing abortion in intact and disturbed pregnancy and for priming before performing a planned abruptio. During the priming of 64 women before inducing abortion, this was induced in 59% of the women already by a single intramuscular application of 500 micrograms SHB 286-depending on parity, whereas in the remaining cases it was possible to avoid dilatation of the cervix or to substantially facilitate dilatation technique. For inducing abortion during the second trimenon, SHB 286 was applied extra-amnially in 15 cases, intra-amnially in 24, intravenously in 56 and intramuscularly in 99 cases. The dosage was lowest on extra-amnial administration (50 micrograms on the average), and highest on intramuscular application with a mean of 1760 micrograms. The time until induced abortion set in was between 16 hours (intra-amnial application) and 12 hours (intravenous application). The rate of abortions was more than 90% on intra-amnial, intravenous and intramuscular application, and 80% on extra-amnial application. In case of missed abortion and hydatid mole, SHB 286 was applied systemically only. In missed abortion the mean dosage up to expulsion was 1700 micrograms on intravenous administration, whereas it was 1126 micrograms only if given intramuscularly. The dosage for inducing abortion was 8 hours by the IV route and 10 hours by the IM route.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortifacient Agents↗
PubMed1984

Insulin levels in amniotic fluid of normal and abnormal pregnancies.

The normal level of insulin in amniotic fluid between the 13th and 42nd weeks of pregnancy was determined by means of 988 single analyses in individual healthy women. Insulin passes into the amniotic fluid via the fetal urine, and its level does not depend on fetal gender. Between the 13th and 25th weeks of gestation, the insulin level increases by an average of 1.3 to 5.1 microU/ml. From the 27th to the 42nd weeks, an increase of 6 to 9.1 microU/ml is observed. In the same period, the 97th percentile rises from 11.2 to 18 microU/ml. In 543 patients with pregnancy disorders, lower levels of insulin in amniotic fluid were observed in intrauterine fetal death, placental insufficiency, fetal growth retardation, and malformations. Elevated levels of insulin were observed in rhesus disease. In the treatment of pregnant women with betamimetics and glucocorticoids, the mean amniotic fluid insulin level rose to more than double the normal values.

Adrenergic beta-Agonists↗
PubMed1984

Gestational diabetes and screening during pregnancy.

The oral glucose tolerance test is an unreliable test in screening for diabetogenic fetal disease. In diabetogenic fetopathy due to gestational diabetes (White class A diabetes), the insulin content in the umbilical cord blood as well as in the fetal urine is considerably raised. As increased amounts of insulin pass into the amniotic fluid via the fetal urine, the fetal disease can be diagnosed from the amniotic fluid insulin content. In 75 pregnant women with potential diabetes, the blood sugar value was below 160 mg/dL at maximum under glucose loading in 28 patients; it was over 200 mg/dL in 25 patients. However, diabetogenic fetopathy was present in only 14 patients. The endangered and the healthy fetus could be distinguished in each case by amniotic fluid insulin content. The mean amniotic fluid insulin values in diabetogenic fetopathy were about seven times the normal.

Amniotic Fluid↗