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Biomedical subjects

C A Ballard

Publications and source records attributed to C A Ballard.

At least 37 records · Page 2Linked to original sources
PubMed1988

Combined detrusor instability and stress urinary incontinence: where is the primary pathology?

Thirty-nine patients (from a total of 307 women) with clinical and urodynamic diagnosis of stress urinary incontinence had cystometric findings consistent with detrusor instability. Detailed multichannel urethrocystometry of these 39 patients revealed that urethral relaxation preceded the bladder contraction by 2-5 s. These patients were randomly allocated to either medical treatment (n = 21) by Ditropan 5 mg t.i.d. for 6 weeks prior to the surgical procedure, or to surgical treatment (n = 18) with no attempt to treat the bladder instability prior to surgery. All patients had repeat clinical and urodynamic evaluation at 3-12 months postoperatively. Six of the 39 patients (15%) still had urethral relaxation and bladder contractions on postoperative urethrocystometry. Four of these 6 patients still had stress urinary incontinence and urethral funneling. These 4 were considered surgical failures. Two of the 39 (5%) had postoperative detrusor instability in spite of good surgical results. This series suggests that in women with combined stress urinary incontinence and bladder instability, where bladder contraction is preceded by urethral relaxation, there is a more than 90% chance that bladder instability will disappear after successful operation for stress urinary incontinence.

Adult↗
PubMed1988

Role of cystourethrography in the preoperative evaluation of stress urinary incontinence in women.

Thirty-two women with stress urinary incontinence and 27 control continent patients with pelvic relaxation underwent a detailed clinical and urodynamic evaluation of the lower urinary tract. All patients underwent a standard chain urethrocystographic evaluation to detect anatomic pathology of the lower urinary tract. Urethrocystographic study included an evaluation of the posterior and anterior urethral angle, funneling of the proximal urethra on straining, the position of the urethrovesical junction and flattening of the bladder base. No differences were seen in the incidence of radiographic findings in women with pelvic relaxation with or without stress urinary incontinence. All five cystographic criteria were similar in the continent and stress incontinence patients. Static urethrocystography cannot differentiate women with and without stress urinary incontinence from among those with pelvic relaxation and thus should not be relied upon in the evaluation of women with urinary incontinence.

Adult↗
PubMed1988

Use of fetal cardiotocographic monitor in the evaluation of urinary incontinence.

Thirty-five women (mean age 52 years, mean parity 3) were evaluated consecutively for urinary incontinence. Stability of the bladder was evaluated by standing provocative water urethrocystometry, using a microtip pressure transducer and a multichannel electrophysiologic recorder. Cystometry was repeated immediately after emptying of the bladder. Second cystometry (standing provocative) was performed using a fetal cardiotocographic monitor for pressure recording. The simple cystometry (using the cardiotocograph technique) was very sensitive when evaluating women with a stable bladder (n = 25) and less sensitive when detecting bladder instability (n = 10). We conclude that the use of this simple technique is a viable option if urodynamic equipment is unavailable. There is no need for further evaluation in patients with findings of a stable bladder, but if bladder instability is detected, further in-depth evaluation is required.

Adult↗
PubMed1987

Role of the Q-tip test in evaluating stress urinary incontinence.

The Q-tip test was applied on 105 patients. Fifty-one had stress urinary incontinency (SUI), 28 had bladder instability by clinical and urodynamic criteria, and 36 had mild or moderate pelvic relaxation without urinary pathology. More than 90% of the patients with SUI and no previous surgery had a positive Q-tip test, with 90% test sensitivity in this group. More than one-third of the patients with bladder instability and almost one-half of the patients with pelvic relaxation and no urinary incontinence had a positive Q-tip test, for low test specificity. The Q-tip test is a simple clinical tool for diagnosing pelvic relaxation, which at times leads to SUI. Almost all patients with primary SUI have pelvic relaxation. The Q-tip test alone does not stand as a diagnostic test. When it is positive, the diagnosis of genuine stress incontinence is possible although not absolute. A negative test should cause one to question the diagnosis of genuine stress incontinence, and sophisticated and more expensive tests should be ordered before establishing a final diagnosis.

Adult↗
PubMed1987

The use of vascular clips to minimize blood loss in colpourethropexy.

A serious intraoperative and postoperative complication associated with colpourethropexy as described by Burch and Tanagho and others is hemorrhage. We performed the Tanagho modification of the Burch procedure in 13 patients, as the sole procedure in the treatment of genuine stress incontinence. Vascular clips were used to circumscribe the fat overlying the anterior part of the vaginal wall, thereby allowing en bloc resection of the vascular fat pad. Suspensory sutures of 1-0 Vicryl (polyglactin 910) were placed; no retroperitoneal drains were used. The blood loss was estimated to be less than 50 milliliters in ten instances and less than 75 milliliters in three. The average hospital stay was 4.2 days. All of the patients were given antibiotic prophylaxis and were discharged home with suprapubic drainage of the bladder. There were no intraoperative or postoperative complications. Thus, one of the serious complications of colpourethropexy can be avoided by using vascular clips to facilitate the removal of the periurethral and paravesical fat from the anterior part of the vaginal wall.

Adipose Tissue↗
PubMed1987

Bladder training after surgery for stress urinary incontinence: is it necessary?

Eighty-nine consecutive patients with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence entered this study. Forty women had a revised Pereyra procedure and 49 had a Burch retropubic urethropexy. All had a suprapubic Bonnano catheter for postoperative bladder drainage. Postoperatively, patients were randomly allocated to "bladder training" (N = 44) or "nonbladder training" (N = 45) protocols. "Bladder training" consisted of scheduled clamping and unclamping of the catheter, whereas the "nonbladder training" patients had continuous bladder drainage throughout their postoperative period. Postvoiding residual urine volume was measured twice daily after the patient had voided with a symptomatically full bladder. The catheter was removed once residual volume was 50 mL or less. The bladder training protocol had no effect on resumption of spontaneous voiding after surgery. There was no significant change in length of postoperative bladder catheterization or in urinary tract infection rate among women with or without bladder training.

Adult↗
PubMed1987

Suprapubic versus transurethral bladder drainage after surgery for stress urinary incontinence.

Fifty-one patients with clinical and urodynamic diagnoses of stress urinary incontinence were randomly allocated to either suprapubic (N = 24) or transurethral (N = 27) bladder drainage after vaginal surgery for stress incontinence (revised Pereyra procedure). Postoperative use of suprapubic bladder drainage significantly reduced febrile morbidity (calculated as fever index; P less than .01) and length of hospitalization (P less than .05). Postoperative normal bladder functions resumed more quickly when suprapubic drainage was used (P less than .05), so that most patients did not need bladder catheterization upon discharge, as opposed to more than half of those with Foley catheters, who left the hospital with a catheter in place (P less than .05). We conclude that it is both beneficial and cost-effective to use suprapubic bladder drainage after a Pereyra operation for stress urinary incontinence.

Adult↗
PubMed1984

Ovarian tumors associated with pregnancy termination patients.

One hundred adnexal masses were discovered at the time of pregnancy termination among a total of 55,278 pregnancy terminations performed at the Los Angeles County/University of Southern California Medical Center between 1970 and 1982. Seven patients were found to be not pregnant, and 93 masses were associated with pregnancy, for an incidence of one adnexal mass for every 594 (0.17%) terminations. Benign cystic teratoma was the most common lesion found (46;50%). There were two (2.2%) ovarian malignancies, 15 masses were bilateral, 11 masses were associated with pain, and torsion of the adnexa had occurred in seven cases. The preoperative diagnosis was made more commonly in the first trimester (86%) than in the second trimester (29%). Since many ovarian tumors are small, the true incidence is unknown. In a series of 998 abortion hysterectomies, 13 ovarian tumors were found, for an incidence of 1.3%.

Abortion, Spontaneous↗
PubMed1981

First and midtrimester abortion with intramuscular injections of sulprostone.

An intramuscular injection of a newer PGE2 analogue (Sulprostone) was given to fifty-seven patients for a late first or second trimester abortion. The drug was injected in doses of 500 microgram every 6 hours for a maximum of 24 hours. Fifty-two patients aborted. The incidence of gastrointestinal side effects was similar to patients receiving intramuscular 15-methyl PGF2 alpha and there were no serious complications.

Abortifacient Agents↗
PubMed1981

The vaginal administration of 9-deoxo-16,16-dimethyl-9-methylene PGE2 for second trimester abortion.

9-Deoxo-16,16-dimethyl 9-methylene PGE2 was given as a vaginal suppository at 0 and 8 hours to 37 patients. Two different doses were given, a 75-mg and 60-mg dose. The larger dose achieved an 86% abortion rate at 24 hours and for the smaller dose it was 53%. When an intramuscular injection of 15-methyl PGF2 alpha Tham was added at 24 hours, the success rate was 91% and 80% at 36 hours. The incidence of gastrointestinal side effects were significantly reduced when compared to vaginal administration of either PGE2 or 15-methyl PGF2 alpha methyl ester. The incidence of temperature elevation was similar to that achieved with the use of vaginal PGE2 but higher than with the use of vaginal 15-methyl PGF2 alpha methyl ester.

16,16-Dimethylprostaglandin E2↗
PubMed1980

Abdominal hysterectomy for abortion-sterilization. A report of 500 consecutive cases.

This report is a retrospective study of 500 consecutive abdominal hysterectomies performed on the Therapeutic Abortion Service at the Los Angeles County-University of Southern California Medical Center from 1968 to 1974. The cases have been examined as to the patient's profile of age, religion, ethnic group, marital status, gravidity, parity, and abortion history; the coexisting medical problems; the types of associated surgeries performed; complications and morbidity, including blood loss, febrile episodes, and length of hospitalization. This patient population was predominantly 26 to 35 years of age, Catholic, Spanish-surname, married, and in their third to eighth pregnancy. Over 30% of our patients had some relatively severe medical or social problem contributing to their selection of this procedure. In over 80% of patients, hysterectomy was the only surgical procedure performed. Average blood loss was less than 400 cc, and 6.8% of patients had transfusion. In about 32% of patients a significant febrile episode was recorded. The average postoperative stay in hospital was about 5 days. No death was encountered. In view of these findings and the apparent benefits of a combined procedure, it is suggested that this surgical approach is a safe and effective method of simultaneous termination of unwanted pregnancy and childbearing capacity in selected cases in which hysterectomy would be medically indicated.

Abortion, Therapeutic↗
PubMed1977

Maternal-fetal pharmacological activity of amikacin.

Thirty healthy gravid patients of six to 20 weeks' gestation each received a single dose of 7.5 mg of amikacin/kg within 24 hr prior to elective hysterectomy. The half-life (t1/2) of amikacin in maternal serum was 2.07 hr. The mean peak concentration of amikacin in the sera of these patients was slightly lower than that in nonpregnant adults. Two-thirds of the placental samples had amikacin concentrations of greater than or equal to 8 microng/g during the 20-hr interval between drug injection and delivery time. In fetal kidney the concentration of amikacin peaked at a level of 22.4 microng/g at 12 hr after administration. The peak concentration of amikacin in fetal urine was 24 microng/ml, and the t1/2 was 3.2 hr. High levels of the drug in fetal urine and low levels in fetal serum (less than 4 microng/ml) and amniotic fluid (less than 3 microng/ml) were unrelated to high levels found in fetal kidney. Levels of amikacin in fetal lung were 1.4-8.0 microng/g during intervals of 1-16 hr between administration of the drug and time of delivery. With the increasing number of drugs available for use, both potential benefits and risks for the fetus must be considered when prescribing an antibiotic to treat the infected gravid patient, and it should be kept in mind that low levels in body fluid may not be equated with safety.

Amikacin↗
PubMed1977

Maternal-fetal transfer of cefazolin in the first twenty weeks of pregnancy.

Maternal-fetal transfer of cefazolin was investigated with use of a single 14-mg/kg intramuscular dose administered to 40 gravidas before elective hysterectomy. The half-life of cefazolin in maternal serum was 1.5 hr with mean concentrations at 2 and 4 hr of 39 and 16 microgram/ml, respectively. By microbiological assay, cefazolin was not detected in brain, cerebrospinal fluid, lung, liver, or kidney of the fetus but was present in concentrations of 1-11 microgram/ml in 12 of 27 individual samples of fetal serum from 0.75 to 10.66 hr. Cefazolin appeared in fetal urine from 2.17 to 19.5 hr at levels of less than 5 microgram/ml with a half-life of 5.4 hr. Cefazolin was present in the amniotic fluid of fetuses older than 14 weeks in concentrations of less than 1 microgram/ml from 9 to 21.75 hr. After administration of a single dose to the mother early in pregnancy, the fetal distribution of cefazolin is limited to the body fluids.

Amniotic Fluid↗
PubMed1977

Tobramycin: maternal-fetal pharmacology.

To investigate the maternal-fetal transfer of tobramycin (TBM) and its distribution in the fetus, a single dose of 2 mg/kg was administered intramuscularly to 35 pregnant patients (13 first trimester, 22 second trimester) 0.5 to 34 h before hysterectomy. TBM concentration was assayed microbiologically in maternal serum, fetal tissues (placenta, brain, lung, liver, and kidney), and fluids (amniotic, cerebrospinal fluid [CSF], urine, and serum). Mean maternal serum half-life (1.54 h) and mean peak serum concentration of TBM were within ranges reported for nonpregnant adults. In fetal serum, half-life was 5.2 h, and TBM levels did not exceed 0.58 mug/ml. For intervals up to 34 h, the mean TBM concentration in placental tissues was 1.4 mug/g. Concentration differences related to fetal maturation were found for fetal CSF, amniotic fluid, and fetal kidney. No antimicrobial activity was found in the fetal CSF of >16 weeks' gestation. TBM was present predominantly in the second trimester amniotic fluid specimens. Fetal kidney concentrations reached 7.2 mug/g at 34 h after maternal drug administration. Higher TBM concentrations were related to advanced maturation of the fetal kidney. Second trimester fetal urine concentrations for TBM ranged from 0.1 to 3.4 mug/ml, and the fetal urinary half-life was 3.7 h. Knowledge of fetal pharmacology is essential for weighing the fetal benefits or risks of antimicrobial therapy for the infected gravid patient.

Anti-Bacterial Agents↗
PubMed1977

Maternal-fetal pharmacology of cefatrizine in the first 20 weeks of pregnancy.

To evaluate maternal-fetal pharmacology of cefatrizine (BL-S 640), a new oral cephalosporin, a single oral 1,000-mg dose was administered to 33 gravidas (8 to 20 weeks' gestation) at varying intervals within 46 h of an elective therapeutic abortion by hysterectomy or intra-amniotic prostaglandin F(2a) induction. Mean maternal serum concentrations at 1, 2, 4, and 8 h were 3.7, 7.9, 6.5, and 1.6 mug/ml; beyond a 3-h peak, a half-life of 2.4 h was determined. Cefatrizine placental half-life was 4.4 h. None of the 11 fetuses from a prostaglandin F(2a) abortion revealed cefatrizine activity; in contrast, 17 of 22 fetuses from a surgical abortion demonstrated cefatrizine concentrations in two or more samples. Fetal cefatrizine levels were less than 3 mug/g or mug/ml in kidney and urine, less than 2 mug/ml in serum and bile, and less than 2.5 mug/g in lung. After a single maternal dose, cefatrizine has a wide distribution in the fetus in the first half of gestation.

Amniotic Fluid↗