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Biomedical subjects

A Cutner

Publications and source records attributed to A Cutner.

At least 19 recordsLinked to original sources
PubMed2005

Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women.

To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

Adult↗
PubMed2004

Intrapartum ultrasound estimation of total bladder volume.

OBJECTIVE: To determine whether real-time ultrasound measurement of multiple linear dimensions of the bladder could be used to estimate total bladder volumes of women in labour. AIM: To create a simple reproducible formula using ultrasound techniques to help estimate total bladder volumes of women in labour. This may prevent unnecessary catheterisation and conversely, avoid failure to catheterise when indicated, thereby reducing the complications associated with catheterisation and bladder overdistension. DESIGN: Prospective, observational study of women in labour. SETTING: Delivery Suite, Obstetric Hospital, University College London Hospitals. POPULATION: Forty-nine women in labour recommended for catheterisation by their attending midwives. METHOD: A real-time ultrasound scanner was used to measure bladder diameters in two planes: transverse width and height, and sagittal width and height. A Foley's catheter was inserted and the bladder drained into a graduated bowl under sterile conditions. These values and urine volumes were recorded and a formula for detecting bladder volumes above 300 mL was developed using linear regression methods and the Bland-Altman limits of agreement. MAIN OUTCOME MEASURE: Sensitivity and specificity of derived formulae in predicting bladder volume from ultrasound measurements. Correctly predicted volumes greater than 300 mL. RESULTS: Among the 49 women, 36 were nulliparous and 13 were multiparous. All had full-term pregnancies with cephalic presentation and were in active labour with cervical dilatations ranging from 3 to 10 cm. There were no previous caesarean sections among the multiparous women. Thirty-nine women had epidural analgesia. Indications for catheterisation included a palpable bladder per abdomen, or the interval from last urine voided. The catheterised volumes ranged from 30 to 720 mL with a median of 150 mL. The new equation (0.68 x h x d x w) had a sensitivity of 77% (95% CI 46-95%) and specificity of 86% (95% CI 71-95%) for detecting bladder volumes greater than 300 mL. In order to ensure that about 95% of women in need of catheterisation are detected, the above equation was improved using the Bland-Altman limits of agreement. The sensitivity of this final equation (1.74 x h x d x w) was 100% (95% CI 75-100%) and the specificity dropped to 36% (95% CI 21-54%). CONCLUSION: It is possible to use real-time ultrasound in estimation of total bladder volumes of women in labour. The implications are that all of those normally selected as being in need of catheterisation could be detected, while about a quarter of those women would avoid unnecessary catheterisation.

Catheterization↗
PubMed2001

Laparoscopic colposuspension.

Laparoscopic urogynaecology started to develop following the first report of a laparoscopic colposuspension in 1991. The place of laparoscopic treatment of urinary incontinence has yet to be established and, as for all new techniques, case reports, case series and small randomized studies have been reported. Larger randomized studies with adequate power have yet to be reported. Current opinion is divided as to the success of these new operations. Assessment of outcome is further clouded by large variations in technique, such that like is not always compared with like. The present review assesses the recent literature and the place of the traditional colposuspension performed via the laparoscopic route.

Female↗
PubMed2000

The effect of local anaesthetic spray on the pain associated with local anaesthetic injection, prior to biopsy or loop diathermy to the cervix in the outpatient colposcopy clinic.

We evaluated the effectiveness of local anaesthetic spray prior to injection of local anaesthetic before biopsy or large loop excision of the transformation zone of the cervix at colposcopy. This was a prospective, randomised, double-blind placebo-controlled study involving 51 women. Pain or discomfort was measured using a four-point categorical scale and a visual analogue score. Our results show that the use of local anaesthetic spray has no effect on the pain or discomfort experienced by patients having local anaesthetic injections to the cervix, and cannot be recommended.

Adult↗
PubMed1997

Lower urinary tract symptoms in pregnancy.

Lower urinary tract symptoms are almost universal in the antenatal period and in most cases are transient. Retention of urine is one of the few conditions which must be treated as there may be long-term consequences. The symptoms of frequency and stress incontinence are those which have been most examined in pregnancy. It would appear that the former have no long-term sequelae but the latter may be an indicator of potential sphincter damage during delivery. The recent documentation of detrusor instability antenatally further confuses the picture and demonstrates the need for functional studies to determine the exact significance of these lower urinary tract symptoms.

Female↗
PubMed1993

Management of the third stage of labour in women at low risk of postpartum haemorrhage.

OBJECTIVE: To compare active management with physiological management of the third stage of labour in women at low risk of postpartum haemorrhage. DESIGN: Randomised allocation of women in labour at low risk of postpartum haemorrhage to either physiological or active management of the third stage. SETTING: Labour ward in a district general hospital. PATIENTS: 193 Women with spontaneous vaginal delivery at term completed the study. Exclusion criteria were induction or augmentation of labour, antepartum or previous postpartum haemorrhage, premature rupture of membranes, previous caesarean section, raised blood pressure, cervical lacerations and third degree tears. INTERVENTIONS: Active management with syntometrine and controlled cord traction; or physiological management, where the cord was not clamped and the placenta was delivered by maternal effort. MEASUREMENTS: Blood loss was measured subjectively at delivery and estimated objectively by comparing the haemoglobin in labour with that on the third postpartum day. The duration of the third stage was also measured as was the incidence of retained placenta and blood transfusion. RESULTS: There was no significant difference in the estimated blood loss or haemoglobin drop between the two groups (P > 0.5). In addition the duration of the third stage was significantly longer in the physiological group (P < 0.001). Out of 90 women having physiological management, 7 received oxytocics for presumed postpartum haemorrhage. Only one case in the active group required further oxytocics and one other case in this group required a manual removal of placenta. CONCLUSIONS: This preliminary study confirms that active management results in a reduction in the length of the third stage of labour. However, it suggests that active management does not reduce blood loss when compared to physiological management in the woman at low risk of postpartum haemorrhage.

Delivery, Obstetric↗
PubMed1993

Prevalence and significance of urethral instability in women with detrusor instability.

The phenomenon of urethral instability has been poorly defined and its significance is disputed. The aim of this study was to investigate the prevalence and significance of urethral instability in a group of women with idiopathic detrusor instability. Urethral instability was defined as a spontaneous fall in maximum urethral pressure of one-third or more, in the absence of detrusor activity, over a 2-min period. Urethral instability occurred in 42% of patients with detrusor instability and was strongly associated with the sequence of relaxation of the urethra prior to unprovoked detrusor contraction. Women with detrusor instability and a stable urethra exhibited primary contraction of the detrusor. The symptom of stress incontinence was more common in women with urethral instability. Women with detrusor instability may be subdivided into 2 groups on the basis of urethral instability, the presence of which suggests a primary dysfunction of the urethra. Such patients may derive more benefit from treatment with an alpha adrenoceptor agonist in addition to (or instead of) standard anticholinergic therapy.

Female↗
PubMed1992

The assessment of bladder neck movement in postpartum women using perineal ultrasonography.

Twenty-three postpartum women underwent perineal ultrasonography to determine bladder neck position at rest, on Valsalva and during pelvic floor contraction. On Valsalva, significant descent of the bladder neck and apposition to the symphysis pubis occurred. During pelvic floor contraction, there was significant elevation of the bladder neck; however, in approximately one-third of cases no movement was demonstrated. The bladder neck was shown to move through the arc of a circle whose center is the inferior border of the symphysis pubis. Perineal ultrasound provides a simple, objective way of measuring bladder neck elevation during pelvic floor contraction. This may be a more appropriate means of determining treatment outcome, in women undergoing conservative treatment for genuine stress incontinence, than measures of vaginal squeeze pressure.

Journal Article↗
PubMed1992

Growth of the normal human lower urinary tract from 12 to 21 weeks gestation.

Normal development of the human lower urinary tract was studied between the 14th and 20th week of gestation using 3 modes of fixation. Fixation by direct distension provides a high degree of reproducibility of parameters used to study the growth of the fetal bladder. Using this method, fetuses ranging from 12 to 21 weeks gestation were studied. Results obtained demonstrate that the length of the bladder, the inter-ureteric distance, and the distance between the apex of the trigone and the distal tip of the urethra occur in a linear mode. Furthermore, the rate of growth of the male urethra was evidently higher when compared to that of the female from the 12th week of gestation. Data from this work can be used for a more accurate assessment of cases with abnormal lower urinary tract development.

Female↗
PubMed1992

Effect of vaginal ultrasound probe on lower urinary tract function.

Vaginal ultrasonography has been advocated as an alternative to videocystourethrography. Ultrasound avoids the potential risks of X-rays and reduces the cost of equipment. We have investigated the effect of the vaginal probe on the physiology of the bladder and urethra. A series of 24 women underwent urethral pressure profilometry, with and without a vaginal probe in situ. There was a significant increase in maximum urethral pressure, functional urethral length and area under the profile curve both at rest and during stress in the presence of the device. This was due to stretching and compression of the urethra by the probe. Transmission pressure ratios were significantly increased for the first 3 quartiles of the urethra. Twenty women underwent lateral bead chain urethrocystography with and without a vaginal probe. At rest, the probe resulted in elevation of the bladder neck and apposition to the symphysis pubis, and during a Valsalva manoeuvre the descent of the bladder neck was restricted by the presence of the probe. These results indicate that a vaginal probe alters the position and function of the lower urinary tract. We postulate that incontinence is reduced as a result of the probe. The use of vaginal ultrasonography in the assessment of women with urinary incontinence is therefore not recommended.

Female↗
PubMed1991

Assessment of urinary symptoms in early pregnancy.

OBJECTIVES: To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy. SETTING: The termination clinic and gynaecology ward at King's College Hospital. DESIGN: Observational study. SUBJECTS: 47 women before termination of pregnancy at between 6 and 15 weeks. INTERVENTIONS: Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry. MAIN OUTCOME MEASURES: The occurrence of lower urinary tract symptoms and their association with urodynamic findings. RESULTS: Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings. CONCLUSIONS: The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.

Adolescent↗