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Biomedical subjects

A Hextall

Publications and source records attributed to A Hextall.

15 recordsLinked to original sources
PubMed2001

The role of estrogen supplementation in lower urinary tract dysfunction.

The female lower urinary and genital tracts both arise from the primitive urogenital sinus and develop in close anatomical proximity. Sex hormones have a substantial influence on the female lower urinary tract throughout adult life, with fluctuations in their level leading to macroscopic, histological and functional changes. Urinary symptoms may therefore develop during the menstrual cycle, in pregnancy and following the menopause. Estrogen deficiency, particularly when prolonged, is associated with a wide range of urogenital complaints, including frequency, nocturia, incontinence, urinary tract infections and the 'urge syndrome'. Estrogen supplementation subjectively improves urinary stress incontinence but there is no objective benefit when given alone; however, estrogen given in combination with phenylpropanolamine may be clinically more useful. Hormone replacement therapy does appear to treat postmenopausal irritative urinary symptoms such as frequency and urgency, possibly by reversing urogenital atrophy, and there is also evidence to suggest that estrogens can provide prophylaxis against recurrent urinary tract infections. However, the 'best' type of estrogen, route of administration and duration of therapy are at present unknown.

Adult↗
PubMed2000

Oestrogens and lower urinary tract function.

There is increasing evidence from animal and human studies that sex steroids have an important effect on the female lower urinary tract during adult life. Oestrogen receptors have been identified throughout the brain, pontine micturition centre and in the bladder, urethra and pelvic floor. Fluctuations in the circulating level of oestrogens and progesterone occurring during the menstrual cycle and in pregnancy influence the prevalence of urinary symptoms and the results of urodynamic investigation. In addition, the menopause and subsequent oestrogen deficiency have been implicated in the aetiology of a number of urogenital complaints including incontinence, urgency and recurrent urinary tract infection (UTI). However, the use of hormone replacement therapy for these conditions has given conflicting and largely disappointing results. The aim of this paper is to discuss the role of oestrogen in the pathogenesis and treatment of lower urinary tract dysfunction.

Estrogens↗
PubMed1999

Colposuspension after previous failed incontinence surgery: a prospective observational study.

OBJECTIVE: To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery. DESIGN: Prospective observational study. SETTING: Tertiary referral urogynaecology unit. PARTICIPANTS: Fifty-two consecutive women with recurrent genuine stress incontinence operated on by one surgeon. MAIN OUTCOME MEASURES: Subjective and objective cure of stress incontinence. Complications of surgery. RESULTS: The mean age of the women was 51 years (range 28-72) and weight 72.7 kg (range 53-112). Sixty-five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post-operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear which required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self-catheterisation, but only one needed to continue this for six months. None of the women developed detrusor instability. CONCLUSIONS: In this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.

Adult↗
PubMed1999

Lower urinary tract symptoms and their impact on women with anorexia nervosa.

Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo-oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life.

Adolescent↗
PubMed1998

Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse?

The aim of the study was to evaluate the use of a vaginal pessary in the detection of genuine stress incontinence (GSI) in women with urogenital prolapse undergoing urodynamic investigation. Continent women with urogenital prolapse, with or without associated urinary symptoms, were studied. All underwent videocystourethrography using a standardized protocol. None had evidence of incontinence on provocative testing in the upright position. A well-fitting vaginal ring pessary was inserted to reduce the prolapse and mimic a vaginal repair. The provocative tests were then repeated while the bladder was screened. Seventy women with a mean age 59.0 years (range 34-83) were recruited over a 21-month period: 15 women complained of prolapse alone and 55 had concurrent urinary symptoms; 19 women (27%) developed GSI only following the insertion of a vaginal pessary. The women who became incontinent were significantly older (mean age 63.9 years) than those who remained continent (mean age 56.8 years) (P < 0.020). The use of a vaginal pessary increases the detection rate of GSI in continent women with urogenital prolapse undergoing videocystourethrography. These findings are important because women with prolapse and coexisting incontinence should be offered a continence procedure rather than a simple vaginal repair.

Female↗
PubMed1997

Managing postmenopausal cystitis.

Cystitis caused by prolonged estrogen deprivation may be grossly underreported. This may be why many advocates of hormone replacement therapy focus on its cardiovascular and skeletal benefits while ignoring the bladder and urethra.

Atrophy↗
PubMed1996

Pregnancy following a single lung transplant.

Successful pregnancy in a single lung transplant recipient has not been reported previously. The long term effect of pregnancy on graft function and management of deteriorating pulmonary function is not defined. This case describes the management, outcome, and problems encountered when a single lung transplant recipient developed a progressive deterioration in pulmonary function during pregnancy, attributed to accelerated obliterative bronchiolitis.

Adult↗
PubMed1994

Mucosal concentration and excretion of clindamycin by the human stomach.

Each of 12 patients undergoing routine diagnostic upper gastrointestinal endoscopy received a single iv infusion of clindamycin phosphate 300 mg over 10 min. During the endoscopy, mucosal biopsies of the gastric antrum and fundus were obtained at varying times following the infusion. The clindamycin concentrations in the biopsies and in serum samples also taken after the infusion were determined. In addition, six healthy volunteers participated in a cross-over study on two different days. On both days, each subject received a single iv infusion of clindamycin phosphate 300 mg, immediately after which, gastric secretion was stimulated by iv pentagastrin (2 micrograms/kg/h) which was infused continuously over 150 min. On one of the study days, acid secretion by the stomach was inhibited by a slow iv infusion of ranitidine 50 mg. Clindamycin concentrations in gastric aspirates and serum samples collected after the infusion were determined. Concentrations of clindamycin in the fundal mucosa were significantly higher than the simultaneous serum concentrations (median ratio of tissue concentration to serum concentration, 2.0; P < 0.005) while concentrations in the antral mucosa were similar to those in serum (median ratio, 1.2; P = 0.65). Ranitidine significantly inhibited pentagastrin-stimulated acid secretion as demonstrated by a decrease in the volume of gastric aspirate when ranitidine was administered compared with when it was not administered (P < 0.01). Clindamycin concentrations in gastric juice were approximately one and one-half times higher than those in serum samples obtained simultaneously, both during stimulation of gastric acid secretion with pentagastrin and during inhibition of pentagastrin-stimulated acid secretion with ranitidine. Gastric juice concentrations of clindamycin were significantly higher following administration of ranitidine than after stimulation of gastric secretion by pentagastrin alone. Fundal mucosal and gastric juice concentrations of clindamycin exceeded the hypothetical maximum serum concentrations, indicating that accumulation in the stomach occurred against a concentration gradient.

Adult↗