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Biomedical subjects

D Lamm

Publications and source records attributed to D Lamm.

At least 19 recordsLinked to original sources
PubMed2001

[Unplanned pregnancies in a developed society--a study on a maternity ward in Berlin].

OBJECTIVE: Unplanned pregnancies are still common in developed societies. Although the medical-technical methods are mainly in use for family planning, other methods - not provided by the medical care system - have an important impact on the occurrence of unplanned pregnancies. Moreover the frequency of their use is not accurately recorded in usual study-protocols. The spread of methods based on the knowledge of physiologic infertility in woman's cycle (further: fertility awareness) and their relation to unplanned pregnancies is to be investigated. METHODS: A survey by way of self-administered questionnaire was conducted between September 1997 and March 1998 on women in a maternity ward in a hospital in Berlin (former East-Berlin, n = 220). The use of family planning methods (with a special focus on fertility awareness) and the planning state of pregnancies were recorded. RESULTS: 33 % of delivered pregnancies were unplanned. In the last year before conception occurred the part of the use of fertility awareness grew from 12 % to 30 % and correspondingly 25 % to 32 % of unplanned pregnancies were connected with these methods. CONCLUSIONS: The blanking-out of fertility awareness in the framework of medical care system leads to a constellation where a considerable part of unplanned pregnancies occurs beyond its range. The adequate solution for this problem should be an incorporation of fertility awareness into the mainstream of family planning.

Abortion, Induced↗
PubMed1995

Optimal treatment of superficial bladder cancer in 1994.

Bladder cancer, one of the first cancers associated with industrialization, is not unexpectedly increasing in incidence throughout the world. Despite the increasing incidence of bladder cancer, mortality has actually decreased in recent years. In advanced and metastatic bladder cancer, the platinum/methotrexate-based combination of chemotherapy may be responsible for this improved survival. However, chemotherapy appears not to have influenced survival in patients with superficial disease. Increasing evidence suggests that bacillus calmette-Guérin immunotherapy can reduce both disease progression and mortality.

Journal Article↗
PubMed1991

Long-term complete remission in bladder carcinoma in situ with intravesical TICE bacillus Calmette Guerin. Overview analysis of six phase II clinical trials.

Carcinoma in situ is a form of superficial transitional cell carcinoma, which is characterized by a lateral spread along the bladder epithelium, with high-grade malignancy and poor prognosis. Early radical cystectomy is considered the definitive treatment even in the absence of associated invasive cancer. In six prospective phase II studies, 123 carcinoma in situ patients were administered intravesical TICE bacillus Calmette-Guerin (BCG). Treatment consisted of at least six weekly instillations (induction) followed by twelve monthly instillations (maintenance) of BCG (50 mg: 1 to 8 x 10(8) colony-forming units). Of 119 evaluable patients, 90 (76%) achieved complete remission including 45 of 63 (71%) patients who received prior intravesical chemotherapy. Forty-five responders (50%) remain in complete remission with negative urine cytology with a median duration of response projected to be greater than or equal to forty-eight months. There is no difference in survival between BCG responders and nonresponders, but there is a significant difference in cystectomy rates: 10 of 90 (11%) responders vs. 16 of 29 (55%) nonresponders (P less than 0.0001, Fisher's exact test) and time to cystectomy (31 vs. 74 mos.) (P less than 0.001, log-rank test). Delaying cystectomy does not seem to affect survival and improves quality of life. Treatment was well tolerated with some major adverse effects. Intravesical TICE BCG is an effective treatment for bladder carcinoma in situ patients with or without prior chemotherapy.

Administration, Intravesical↗
PubMed1989

Intravesical bacillus Calmette-Guérin and second primary malignancies.

In an effort to answer the question, "Does intravesical bacillus Calmette-Guérin (BCG) therapy increase the incidence of second primary malignancies," the records of 153 patients treated with BCG for carcinoma in situ of the urinary bladder were reviewed. The weight of the available evidence suggests that intravesical BCG does not increase the incidence of second primary malignancies. While this question should be investigated, at the present time it appears that the advantage of intravesical BCG for high-risk patients with superficial bladder cancer outweighs the known disadvantages.

BCG Vaccine↗
PubMed1986

[Sexuality and urinary incontinence].

In an attempt to investigate correlations between sexuality and urinary incontinence (UI), fifty-one women with stress incontinence (18), urge incontinence (12), or combined stress/urge incontinence (21) were interviewed on their sexual behaviours, prior to and after development of UI. The results were compared with data on the average female population in the GDR. Women with subsequent UI were found to have perceived cohabitarche as extremely beautiful or disgusting or anorgastic with significantly higher frequency, as compared to the general female population. The average number of sexual partners and frequency of cohabitations had been higher with women in whom UI was to develop later on. Their sexual behaviours did not come closer to those of the general female population until UI was growing manifest. While marital problems were quoted as causes of UI by 39 per cent of the interviewers, only 14 per cent gave a negative assessment of their present partnerships. Reduced sexual relationships were often (47 per cent) offset by vicarious sexual activities. These women were more often than others suspected of trying to find a pretext for evading sexual intercourse on grounds of marital problems. Yet, one third of women with UI said that during orgasm they would strongly press downward, which might result in additional strain on the pelvic floor. In other words, sexual disorders and UI appeared to favour each other. Hence, psychosomatic and sexological investigations on interhuman relations should be adopted as part of comprehensive therapeutic planning to cope with urinary incontinence.

Adult↗
PubMed1984

[Indications and methods for kidney sonography and isotope renography in pregnancy].

Ultrasonographic determination of the renal parenchyma/pyelon index (PPI) and semi-quantitative ING evaluation with complementary consideration of the passage value, following re-positioning, were applied to 114 pregnant women, among them 57 without and another 57 with diseases, as well as to twelve puerperae and 14 gynaecological patients (control group) for the purpose of objectivating urinary stasis in pregnancy. No significant differences were found to exist with regard to PPI and ING parameters in normal early pregnancy between the pregnant probands, on the one hand, and the non-pregnant control group, on the other. However, a significant delay occurred to the activity maximum on the right side in the second trimenon and also on the left side in the third trimenon, yet, without ultrasonographically recordable adequate enlargement of the renal pelvis. Additional delays in maximum activity and half-life of curve decline as well as drop in PPI parameters were recorded (but not statistically secured), primarily on the right side, from pathologically affected pregnant patients (acute pyelonephritis, asymptomatic bacteriuria, gestosis). Pyelon enlargement (PPI decline) in pathologically affected pregnant patients differed from that in clinically intact patients in the third trimenon only in cases of acute pyelonephritis (22 patients). A correlation was established between PPI decline and ING passage data above 70 per cent in 50 per cent of these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriuria↗
PubMed1981

[Indication for and methods of sling operations (author's transl)].

Sling operations are considered to be highly dependable approaches to stress incontinence. While they used to reserved primarily for recurrent incontinence, in the past, today, they often are applied as primary approach, either alone or in conjunction with uterus extirpation. The reasons underlying such change are explained by the present and past distributions of operations for incontinence at the Gyneacological Hospital of Humboldt-Universität zu Berlin. Indications can now be established with higher accuracy due to the availability of urometry. Urge incontinence or combined stress-urge incontinence with predominance of the urge component as well as assisted detrusor micturation are contra-indications. Useful information sometimes, may be derived from the presence of uninhibited detrusor contractions provoked by means of a Foley catheter. If at least some improvement is to be achieved of predominant stress incontinence, synthetic sling material should not be used. In the context of surgical peculiarities, neck is underlined for removing cystoceles and adjusting the sling to the bladder neck region. Diazepam, alpha-receptor blocker and/or cholinergics should be used to handle postoperative disorders of micturition. Postoperative urine flow studies are of limited value. Successful micturition without residual urine is the decisive criterion by which to measure the result of a sling approach. Sling operations should be confined to large well equipped and properly staffed hospitals for the diagnostic input involved, surgical peculiarities, and risk of postoperative disorders of micturition.

Female↗
PubMed1980

Pediatric urolithiases: a ten-year review.

Sixty-one children who presented with urinary calculi between 1967 and 1977 were reviewed. The overall incidence of calculus disease in our patients was higher than reported previously from other centers in this country. Because presenting symptoms varied, a high index of suspicion was often required for diagnosis. Stones of infection were the most common type identified. Inasmuch as the revurrence rate of calculi in children was low (6.5%), careful consideration of time and cost is warrented before extensive evaluation for metabolic causes of stone formation is undertaken. Immobilization was an important factor in the etiology of stone disease. Most stones less than 5 mm in size passed without surgery.

Adolescent↗
PubMed1979

[Psychodiagnostic examination of patients with functional urinary incontinence (author's transl)].

Psychometric personality questionnaires were used to test 100 patients with symptoms of urinary incontinence. The following findings were recorded: Accumulation with significance of increased psychasthenic values in patients with normal urogynaecological status was higher than that recordable from patients in pathological conditions. The group of patients with mere stress incontinence differed from the group with urge or combined urge-stress incontinence by statistically secured differentiated between means values recordable from neurosis-relevant, test scales, including psychosomatic disorders, depression, neuroticism, social introversion, and phobic disorders. Reference is made to psychogenic factors and their role within a set of multifactorial conditions conducive to functional urinary incontinence of women. Consequences regarding diagnosis and therapy are discussed.

Female↗
PubMed1979

[Progress in prevention and control of urological complications associated with carcinoma of the cervix. Third communication: Renographic representation of functional disorders of the upper urinary tract (author's transl)].

Reported in this paper is the use of isotope nephrography in longitudinal examinations of 151 patients with cervix carcinoma who had undergone radical abdominal or vaginal surgery in the Gynaecological Hospital of Charité Berlin, between 1971 and 1973. Also included were 140 patients whose carcinoma treatment dated back nine to 15 years. While functional disturbances of the upper urinary tract within the five-year follow-up period dropped continuously from about 29 to five per cent in recent time, persisting disorders of secretion and/or ureteral dynamics recorded in ING checks from 16.4 per cent of earlier carcinoma treatments. The number of pathological isotope nephrograms recorded presurgically from patients who eventually died of recurrent carcinoma had been five times as high (49 per cent) as that recorded from cured patients. Only to some extent had those findings been attributable to the given carcinoma stage. Routine ING (isotope nephrography) also helped to identify nine cases of carcinoma recurrence, and its systematic use facilitated just as many decisions on fistulation of the functionally better kidney in cases of imminent anuria (uraemia). Yet, as a whole voiding disorders of the upper urinary tracts have decreased in the authors' hospital, as compared to records in the past. That improved situations is attributed to progress in carcinoma therapy but even more to energetic early action against urinary tract infections and postsurgical impairment of bladder voiding as well as to high-continuity monitoring of renal and ureteral functions. ING, today, deserves a firm position in all after-care programmes following treatment of cervical carcinoma.

Female↗
PubMed1978

[Experiences gained from the establishment of a complex physical therapy program for the management of female urinary incontinence].

Reported in this paper are preliminary experiences so far obtained from a complex physiotherapeutic programme for conservative and pre-operative treatment of functional urinary incontinence in women. Included in this pilot study were 82 patients of whom 23 (28 per cent) were continent on termination of the therapy, while another 38 (46 per cent) had improved to an extent where they abandoned their original intention to undergo surgery for incontinence. Complex physiotherapy may add favourably to the spectrum of possible therapeutic approaches, provided its proper and differentiated coordination with the generally known surgical approaches.

Electric Stimulation Therapy↗
PubMed1978

[Advances in the prevention and control of urologic complications of cervix cancer. 2. Bladder-function disorders].

By means of 386 comparative cystometries hypertensive reactions were recorded from the urinary bladder both following total and radical vaginal hysterectomy. Hypertension was most strongly pronounced over the first two weeks after operation and receded spontaneously during the third and fourth weeks. That increased intravesical pressure, therefore, was attributed primarily to the surgical trauma and its inevitably accompanying irritation of the bladder. Predominant parasympathetic denervation of the bladder by radical surgery was found to be relevant, first of all, during micturation. Reduced sense of emptying the bladder and sympathetically induced disturbances in the correlations between detrusor and the urethrovesical region favoured the formation of residual urine. Its early therapy, using cholinergics, is becoming increasingly problematic. Intensive control of infections and persistent continuation of catheterisation, until the autonomously functioning bladder has got adjusted to its changed conditions, so far remain to be the most dependable approaches to prophylaxis and therapy of micturation disorders following radical surgery. In severe cases more recent pharmacological and neurohistochemical findings regarding selective effectiveness of alpha-receptor blockers and beta-stimulators in neurogenic bladder may open new therapeutic ways.

Female↗
PubMed1978

[Urologic complications in genital prolapse in women].

With the help of a large number of patients of the gynaecological hospital of Berlin University is demonstrated that with increasing genital descent incontinences of urine more infrequently appear, infections and cases of urinary stasis, however, more frequently. The causes of this are shown. In urinary incontinence must always be thought of the fact that apart from the urethral occlusion insufficiency also a pseudostress incontinence, urge-incontinence or overflow incontinence are possible. - infections of the urinary tract demand prophylactic as well as aimed therapeutic consequences. - Functional disturbances of the kidneys and of the upper urinary tract can nowadays be demonstrated early and carefully by means of the isotope nephrography. The indication to chromocytoscopy and urography is thus further restricted in descent and prolapse. Symptoms of renals insufficiency were observed in 15% of the prolapse diseases. Gynaecologists should more frequently consult nephrologists. On the other hand, in renal insufficiency of older women nephrologists should always think of the genital prolapse as a possible cause.

Female↗
PubMed1977

[Experiences with bladder-uterus fistulae].

The present summary reports 5 cases of vesicocervical fistula, 9 cases of vesicocervico-vaginal fistula and 1 of vesicocervicocorporeal fistula seen over the last 20 years. When compared with the period between 1941 and 1955 the number of such fistula cases has increased fourfold. All thses fistulas, with just one exception, arose as a consequence of obstetric treatment. Conservative therapie was successful only in one case while all the other fistulas had to been operated upon. The preferred operating technique was that of vaginal metroplasty (Wolkowitsch-Küstner's technique). Hysterectomy or stump exstirpation with cystorraphy were performed in 4 cases. The combined vesicocervico-corporeal fistula required a vaginoabdominal treatment. 14 patients were brought to recovery. Increases in the number of vesicouterine fistulas as observed over recent years are considered to be related to a more concentrated therapy and to a higher frequency of cesarean sections. The vaginal route is all the more justified for fistula operations the nearer the fistula is located to the vagina. Operations of that kind require adequate skill in urinary bladder-ureteral- and uterosurgery.

Abortion, Spontaneous↗
PubMed1977

[Isotope nephrographic studies in benign gynecologic diseases].

1014 patients with benigne gynaecological diseases (functional incontinence of urine with and without displacement, myoma of uterus, ovarian tumors, chronic salpingoophoritis) were examined by means of isotope nephrogram before gynaecological treatment was begun. A group of 156 patients was parallely examined by means of chromocystoscopy and intravenous urography. For judgement of the ING-curves we applicated an extra parameter--the drain value "A"--, through which it was possible to differenciate between emptying disturbances and functional urinary transport disorders. To obtain this value it is necessary to change the position of the patients during examination. Under these conditions approximately 95% of ING-findings conformed with those vaised by intravenous urography. Giving weight to these conditions, we recommend the application of ING in gynaecology as a screening method. Criteria for optimal usage of this method are mentioned.

Chronic Disease↗