Biomedical subjects
Publications and source records attributed to C S Iosif.
Porcine dermis was used for abdomino-vaginal urethroplasty in 53 women with urinary stress incontinence. The patients have been followed for periods ranging from 1.5 to 4 years; 47 of them were continent of urine both subjectively and on urodynamic testing. The postoperative complications were minimal and there has been no instance of foreign body reaction.
When female estrogenized rabbits were injected i.v. with 3H-progesterone, the tritium concentration determined after one hour was about two to three times higher in urethra, urinary bladder and vagina than in the heart. High affinity progesterone receptors (KD = 1-2 nM) could be demonstrated in both cytoplasmic and nuclear fractions prepared from estrogenized rabbit urethra, bladder and vagina. The cytosolic receptor concentration in both urethra and bladder was about half of that in the vagina. The concentration of nuclear receptors in urethra was not significantly different from that in the vagina, but in the bladder the concentration was only about one fourth of that in the vagina or urethra. The mean KD of cytosolic receptors from bladder was significantly higher than the corresponding values in urethra and vagina. Progesterone binding sites in the bladder had a broader hormonal specificity than those in the urethra or vagina. The present demonstration of specific progesterone receptors in the female urethra might provide a possible link between estrogen progesterone interaction and the appearance of urinary incontinence during pregnancy in women.
After 150 ml of physiologic saline solution had been infused into the extra-amniotic space before first-trimester vacuum aspiration abortion, intrauterine pressure ranged between 16 and 23 mm Hg, thus not more than during Braxton Hicks contractions. At chorionic villi sampling during continuous saline solution infusion, fetal heart activity (beats per 15 seconds) decreased temporarily from about 36 to about 33.
105 women with urinary stress incontinence were treated over an 8-year period. The operations carried out were: 44 Zoedler slings using mersilene and 61 slings using lyodura. Follow-up lasting from 3 to 11 years showed complete failure in 17 patients (16%). The plastic slings of the Zoedler type led to an increased risk of complications such as retropubic infections, rejection of the mersilene, and chronic urinary retention. The lyodura sling was considered good prosthetic material. Our experience shows that a sling operation, as a primary method, may be selected for patients with stress urinary incontinence and a large degree of descent of the anterior vaginal wall and/or uterus.
Colpo-urethrocystopexy was performed on 195 women. The patients had been observed for a period ranging from 1 to 7 years. One hundred and eighty-seven of them are continent, while there were 8 relapses (5 patients a complete relapse and 3 patients partial relapse). The postoperative complications were minimal: incisional infections (4.1%), acute urinary tract infections (8.7%). The abdominal colpo-urethrocystopexy was combined with other primary gynecologic operations in 44 patients. This operating technique is uncomplicated and successful in correcting stress urinary incontinence in women.
Wet weight of the vagina increased by more than two-fold following treatment of the ovariectomized rabbits daily for 7 days with 100 micrograms/kg estradiol-17 beta or estriol. The concentration of estrogen receptors expressed on the basis of milligrams of protein in both the cytosolic and nuclear fractions decreased significantly after treatment with estradiol or estriol. The data reinforce the view that estriol given in low doses over a long period of time has as good an effect as estradiol on the vagina, and its use might be safer with respect to the effect on endometrial proliferation.
One thousand two hundred women, aged 61, randomly selected from a defined geographical area in South Sweden, were interviewed by an anonymous questionnaire about their urogenital symptoms. Seventy-five percent co-operated, of whom 29.2% admitted to some degree of urinary incontinence and 48.8% some degree of lower genital tract disorder. Stress incontinence symptoms were reported by 11.8% of the women, urge incontinence by 7.9% and both types combined--"mixed" by 9.5%. Four percent of all women (18% of stress incontinence) experienced a loss sufficient to necessitate the wearing of a sanitary napkin or change of under clothing several times a day. Thirteen percent had repeated urinary tract infections. Itch, discharge and smarting pain was reported by 15%. Thirty-eight percent had vaginal dryness and dyspareunia. Only 4% of the women were undergoing estrogen therapy.
Four hundred and eleven women with urinary incontinence were studied and treated over a 12-year period. The surgical procedures undertaken included 45 colporrahies with Kelly stitches, 12 interposition operations, 49 fascial slings, 49 Zoedler slings using Mersilene, 66 slings using dura, 136 retropubic colpourethrocystopexies, and 54 other operations. Retropubic operations, such as colpourethrocystopexy, should be considered the primary operation for stress incontinence, for if correctly executed, they give the best long-term cure rate (97%).
It is not uncommon to use estrogen therapy in patients with urinary stress incontinence. The possibility of a selective action of estrogen in the lower urinary tract was examined. Wet weight of the uterus, vagina and urethra increased significantly, and that of the urinary bladder insignificantly after estradiol treatment of ovariectomized rabbits. When ovariectomized rabbits were injected i.v. with 3H-estradiol, the tritium concentration, determined after 1 hour, was 3 to 4 times higher in urethra, urinary bladder and vagina than that in the muscle. High affinity estradiol receptors (KD approximately 1 X 10(-9) M) could be demonstrated in both the cytoplasmic and nuclear fractions prepared from the female rabbit urethra and bladder. The concentrations of estradiol receptors in the urethra and bladder were about 10 and 20 times lower respectively than those in the uterus. The present evidence for estradiol receptors in the lower urinary tract supports the case for estradiol therapy in urinary incontinence.
48 women with genuine primary stress urinary incontinence and prolapse were studied and treated over a 6-year period. The surgical procedures undertaken included urethroplasty with lyodura sling and prolapse plasty (45 patients), urethroplasty with lyodura sling and vaginal hysterectomy (3 patients). A follow-up from 2 years to 6 years showed in 2 patients a complete failure. The complications were: acute urinary tract infections (5 patients), incisional hernia (1 patient), prolonged urinary retention (3 patients). The results suggest that this technique is successful in correcting stress urinary incontinence and prolapse in women.
Eighty-two gynecological patients with clinical signs of a lower urinary tract infection (UTI) were randomized to 10 days' treatment with either a fixed combination of pivampicillin-pivmecillinam (PAPM) or trimethoprim-sulphamethoxazole (TMPS). The effect of treatment could be evaluated in 25 patients on PAPM and in 19 on TMPS, who had bacteriologically verified UTI and who completed treatment and check-ups. All strains were sensitive in vitro to the respective antibiotic combination used. Treatment eradicated the original pathogen in 75-80% of the cases, 64% of the patients on PAPM and 47% on TMPS having sterile urine 3 weeks after end of treatment. Side effects could be evaluated in 76 patients. Two patients on PAPM and 8 on TMPS had to discontinue treatment due to side effects. Including abnormal values for hematology, liver and renal parameters, significantly fewer side effects (p = 0.038) were noted on PAPM (7/40) than on TMPS (15/36).
Intra-uterine pressure was recorded with a triple-channelled microtransducer catheter in women with fibromyomas prior to hysterectomy or myomectomy and in women due to undergo hysterectomy because of other gynecological disorders. In most of the patients with myomas the uterine activity differed from that in the women without myomas and from findings in previous studies on uterine activity in healthy subjects. Thus, small and irregular contractions were frequently seen in the pressure recordings from the receptors placed in the vicinity of myomas. In women with dysmenorrhea secondary to the development of myomas, increased uterine activity was registered. It is concluded that myomas may have a clinically significant effect on uterine activity.
The effect of abdomino-vaginal sling urethro-plasty according to lyodura slings on the intravesical and intraurethral pressure was evaluated in 25 women with prolapse and stress incontinence. The investigations including a gynecological examination, urine and simultaneous urethro-cystometry. Prior to the operation, all incontinent women had a negative urethral closure pressure at stress. After surgery all 25 patients reported continence, which was confirmed by positive urethral closure pressures. The urethral pressure at rest was significantly decreased in all patients 2 weeks after operation but returned to the same value 1 year after surgery as before surgery. The functional and the absolute urethral lengths increased minimally after the operation.
A retrospective investigation into the prevalence of stress incontinence in women delivered by elective cesarian section (without experience of labor) in Lund from 1974 to 1979, was carried out in 1980. Of 264 women whose replies were solicited, 204 responded. The others had moved about and could not be reached. Permanent stress incontinence was reported by a significant number of patients without experience of labor. This supports our earlier findings which indicated that pregnancy and hereditary factors are more decisive in bringing about stress incontinence than the delivery itself.
A retropubic colpourethrocystopexy method was performed on 120 patients. A follow-up from 8 months to 4 years showed in 2 patients a complete failure and in 1 patient partial failure. The complications were: acute urinary tract infections (14 patients), incisional infections (7 patients) and prolonged urinary retention (2 patients). The results suggest that this technique is simple and successful in correcting stress urinary incontinence in women. Cystourethrocele grade I was corrected by this procedure.
Cytosolic and nuclear fractions prepared from the urethra, urinary bladder, and trigonum of the bladder obtained at urethrocystectomy from four female patients were analyzed for the presence of estrogen receptors. High-affinity estradiol receptors (KD 0.7 x 10(-9)M) could be detected in both cytosolic and nuclear fractions of the urethra from all four patients. Estradiol receptors could be detected in only the nuclear fractions of the urinary bladder in two of the four preparations. In the trigonum, cytosolic and nuclear receptors could be measured in one and three preparations, respectively. The receptor concentrations in both trigonum and the bladder were lower than those in the urethra. By providing experimental evidence for the presence of estradiol receptors in the lower uninary tract, the present data advance the case for estradiol therapy in incontinent patients.
Since elevated concentrations of peripheral benzodiazepine (PBZr) have been reported in some tumors it was of interest to study the distribution PBZr in the endometrium and endometrial carcinoma. A specific ligand or PK 11195 was used to measure PBZr in the mitochondria (m-fraction) and the microsomal fraction (p-fraction). Density of binding sites and binding affinity (KD) was computed from Scatchard analysis. Binding in both m- and p-fractions from endometrium and endometrial carcinoma were saturable and of high affinity. The PBZr density in p-fraction from endometrium was slightly higher than in m-fraction, whereas the binding in m-fraction in endometrial carcinoma was more than 2-fold higher than in p-fraction. The difference between the densities in m-fraction from endometrial cancer and endometrium was highly significant (p < 0.005). There was no significant difference in the binding affinities (KD values) for PK 11195 in the various fractions. The selective increase in the density of PBZr in mitochondria of tumors suggests an association with energy demand and utilization and could be of diagnostic and/or therapeutic value in endometrial cancer. The role of a relatively high density of PBZr in microsomal fractions remains to be elucidated.