摘要:

Q-tip tests were carried out on 63 women to determine optimal placement and the effects of bladder fullness and significant anterior vaginal wall relaxation. Significantly higher maximum straining angles were observed when the tip of the Q-tip was placed at the urethrovesical junction or the proximal urethra, compared with placement in the bladder (P< .05), midurethra (P< .01), or distal urethra (P< .01). Bladder fullness did not alter the results significantly. There were no significant differences in resting or maximum straining angles when patients with significant anterior vaginal wall relaxation and genuine stress incontinence were compared with continent women who had significant anterior vaginal wall relaxation. However, in the absence of significant anterior vaginal wall relaxation, women with genuine stress incontinence had significantly higher maximum straining angles than those with bladder instability (P< .05) or control subjects (P< .05). The Q-tip test, if performed correctly, is an easy, inexpensive, and reliable method of quantifying mobility of the bladder neck and proximal urethra in continent or incontinent women with or without pelvic relaxation.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study investigated the use of a one-week urinary diary in the evaluation of incontinent women. The sample consisted of 50 community-dwelling women, ages 55 years and older, ambulatory, and mentally intact, who were volunteers in a clinical trial on behavioral management for urinary incontinence. All subjects kept a urinary diary for two consecutive weeks. An analysis of the immediate (one-week) test-retest variability and correlations on weekly diurnal micturition frequency, nocturnal micturition frequency, and urinary incontinent episodes were performed in subjects with sphincteric incompetence alone (N= 34) and in those with detrusor instability with or without concomitant sphincteric incompetence (N= 16). In addition, information obtained on history was compared with that obtained from the diary. Diurnal micturition frequency, nocturnal micturition frequency, and number of incontinent episodes were highly reproducible and did not differ by urodynamic diagnosis. Test-retest correlations were highest with diurnal micturition frequency and incontinent episodes. Lower correlations were observed with nocturnal micturition frequency, with a significant difference observed between diagnostic groups. Although modest, significant relationships between data collected by history and diary were observed in the overall sample, but there were significant differences between diagnostic groups. The results indicate that a one-week diary is a reliable method for assessing the frequency of voluntary micturitions and involuntary episodes of urine loss.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A group of 86 women with genuine stress incontinence who underwent retropubic urethropexy were evaluated with both pre-and postoperative urodynamics. Twenty of these 86 women (23.3%) also had unstable detrusors preoperatively. Eleven of these 20 women (55%) had stable detrusors after retropubic urethropexy. Five of the 66 patients (7.6%) who had stable detrusors preoperatively were found to have unstable detrusors on postoperative urethrocystometry. The overall cure rate for women with detrusor instability and genuine stress incontinence was only 30%. Analysis of symptoms, previous anti-incontinence procedures, age, parity, and cystometric parameters revealed no differences between those women who had stable detrusors after retropubic urethropexy and those who remained unstable. Similarly, patients whose bladders became unstable after retropubic urethropexy could not be distinguished from those who remained stable. Patients undergoing retropubic urethropexy should understand the possibility that the operation may cause urinary incontinence due to detrusor instability even if it cures their genuine stress incontinence, and that if they have both genuine stress incontinence and detrusor instability, their chances for an operative cure of both conditions are low.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Clinical and urodynamic variables of 49 non-estrogen-supplemented and 23 estrogen-supplemented postmenopausal women with urinary incontinence were compared. We ascertained their estrogenic status via plasma estradiol and estrone levels, as well as from parabasal and superficial cell counts from both the urethra and vagina. The effect of estrogen supplementation, in conjunction with the effect of age and urodynamic diagnosis, was studied in relation to filling-phase urodynamic data and incontinence severity and outcome variables. Analysis of covariance was used. No direct effect of estrogen supplementation was noted on parameters of urethral function. In patients with detrusor instability, a borderline direct positive effect (P= .06) was noted in the volume needed to reach maximal cystometric capacity from the first sensation to void. For these patients, the magnitude of fluid loss was greater without estrogen supplementation. However, this difference did not reach statistical significance. Nocturia was significantly less frequent in the estrogen-supplemented groups (P= .04). Estrogen-supplemented patients had a higher incidence of positive bulbocavernosus reflex (P= .01). These observations suggest that hypoestrogenism may affect the sensory threshold of the lower urinary tract of incontinent postmenopausal women.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Endometriosis was detected in 42 cases out of 566 patients undergoing laparoscopic tubal sterilization. The presence of endometriosis was then correlated with previous contraception. Those patients using no contraception, or barrier contraception alone, were regarded as controls. Previous oral contraceptive use was associated with a lower incidence of endometriosis, although the difference was not significant. A significantly higher incidence (P< .05) of endometriosis was present in former intrauterine device users, possibly because of retrograde flow of increased menses.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A principal cause of desquamative vaginitis is erosive lichen planus. We report five cases to illustrate the classic oral and vaginal findings, describe the histology, and relate the therapeutic response of the disease. Early recognition of the disorder and prompt use of corticosteroids and vaginal dilators may prevent the common sequelae of adhesion formation and vaginal stenosis.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Glassy cell carcinoma of the cervix has been classically regarded as a poorly differentiated adenosquamous carcinoma, infrequently diagnosed and associated with a poor outcome regardless of the modality of therapy. The histologic characteristics associated with this lesion are also frequently encountered among undifferentiated large-cell, nonkeratinizing cervical carcinomas. In a review of all undifferentiated large-cell carcinomas of the cervix encountered at the University Hospital in Seattle, Washington, over an eight-year period, 29 cases appeared to display the characteristic histologic criteria described as typical for glassy cell carcinoma. All cases were stage Ib lesions, and 28 were treated by radical hysterectomy. The mean age was ten years younger than that of the usual patient treated at this institution with stage I carcinoma. Fourteen of these patients (45%) have developed recurrent carcinoma, and in all but one, the interval to recurrence was less than eight months. Only two have survived after second-line salvage therapy. The current survival rate among the 29 women is 55%. These observations suggest that the poor prognosis ascribed to the classically defined glassy cell carcinoma also holds true for this extended group of large-cell, undifferentiated cervical cancers that display similar histologic features and pursue a similarly aggressive clinical course.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cervical adenocarcinoma in situ is a rare disease. Eighteen patients with this disease seen at the University of Michigan Medical Center are reported, with a review of their clinical characteristics and pathologic data. These patients represented 9.2% of all endocervical adenocarcinomas seen during the study period. Their median age was 37 years, compared with a median age of 47 years in those women with invasive disease. Sixty percent presented with abnormal bleeding. Cone biopsy margins were examined in 12 patients, and accurately predicted the presence or absence of disease in ten of 12 hysterectomy specimens. One patient developed recurrent adenocarcinoma, and died of disease 16 years after initial diagnosis. Based on these data, it is suggested that hysterectomy and pelvic lymph node evaluation be used to treat these patients.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We reviewed 46 cases treated at the Gynecology Service of Memorial Sloan-Kettering Cancer Center from 1970–1984 to evaluate the impact of modern multimodal therapy on survival of patients with uterine leiomyosarcoma. Eighteen patients had their primary treatment at Memorial Hospital, whereas the remaining 28 patients were referred either after primary surgery (ten) or after the development of recurrent disease (18). Thirty-four patients initially had disease confined to the uterus. Twelve of these patients received various adjuvant treatment regimens after hysterectomy, and 83.3% developed recurrent disease; 68.2% of 22 patients who received no adjuvant therapy developed recurrent disease. Twelve patients who presented with extrauterine disease all died within two years of initial treatment. Thirty-seven patients were treated for persistent or recurrent disease after primary treatment. No objective responses to radiation therapy were seen in these patients. Doxorubicin used alone or in combination produced a 16.7% response rate (average duration four months), whereas there were no responses to chemotherapeutic regimens not containing doxorubicin. The disease-free survival rate for all patients in this study was 22%; those patients who presented with stage I and II disease had a 29% survival rate.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cytologic assessment of peritoneal washings or ascites in ovarian cancer patients has been suggested as a method of evaluating response to therapy or disease status, although the accuracy of this technique has not been clearly established. Ascitic fluid or peritoneal washings were obtained during 96 reassessment laparotomies that were biopsy-positive for residual intraperitoneal ovarian cancer. Cytologic studies done on these samples failed to detect malignant cells in 66% of the cases with gross residual disease and 78% of the cases with only microscopic residual disease on biopsy. The accuracy of peritoneal cytology in detecting residual ovarian cancer was unrelated to residual tumor size, original clinical stage, histologic tumor grade, and tumor cell type. Examination of ascitic fluid found at the time of surgery was somewhat more reliable than assessment of peritoneal washings, although this difference was of borderline statistical significance. Peritoneal cytology cannot reliably detect residual ovarian cancer after initial treatment with surgery and chemotherapy. Negative peritoneal cytology is frequently seen in the presence of gross residual tumor.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID