Biomedical subjects

D M Holmes

Publications and source records attributed to D M Holmes.

9 recordsLinked to original sources

PubMed1990

How frequently need vaginal smears be taken after hysterectomy for cervical intraepithelial neoplasia?

A retrospective longitudinal review identified 341 women who had had a hysterectomy in association with CIN 3, in Tayside Region, during the years 1967-1977; 219 (64%) had completed 10 years of cytology follow-up and of 140 women eligible for 15-year smears 79 (56%) completed the 15-year follow-up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial neoplasia (VAIN) was diagnosed. Only one patient completing 15-year follow-up had an abnormal smear and VAIN later diagnosed. No patient over this 15-year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957-1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CIN 3 at hysterectomy. With such data we would propose screening 6-monthly during the first post-operative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme.

Adult↗

PubMed1989

Oxybutinin versus propantheline in the management of detrusor instability. A patient-regulated variable dose trial.

Two of the principal drugs used to treat detrusor instability, oxybutinin hydrochloride and propantheline bromide, were compared using clinical and urodynamic outcome measures in a randomized crossover trial with a patient-regulated variable dose regimen. Of the 23 women in the trial, 14 reported subjective improvement during treatment with oxybutinin hydrochloride compared with 11 during treatment with propantheline bromide. Apart from a greater increase in the maximum cystometric capacity with oxybutinin, there were no other objective differences between the two drugs. Oxybutinin significantly delayed the first desire to void, increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Propantheline significantly increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Three patients stopped treatment due to side-effects.

Adult↗

PubMed1989

Bladder neck electrical conductivity in female urinary urgency and urge incontinence.

Thirty-nine consecutive women, referred because of lower urinary tract symptoms of stress incontinence, urgency and urge incontinence, were interviewed and their symptoms were graded using a standardized questionnaire. They were investigated with conventional, fast-fill cystometry and with a new bladder neck electrical conductivity (BNEC) test which measures bladder neck activity. A highly significant correlation between the symptoms of urgency and urge incontinence and the maximum amplitude of bladder neck activity was found with the new test. The correlation of the maximum deflection at rest with the symptom of urgency was significantly better than the best correlation found with the cystometric measurements. The values for sensitivity and specificity of cystometry for the detection of an abnormality associated with urgency were 58% and 92% respectively, and the corresponding values for a positive BNEC test (as defined by a maximum deflection at rest greater than 13 microA) were 100% and 77%.

Adult↗

PubMed1989

Bladder neck electrical conductivity in the treatment of detrusor instability with biofeedback.

A new method for controlling the symptoms and objective signs of detrusor instability was investigated in a pilot study. The method uses the activity of the bladder neck, monitored by a conductivity catheter, as a biofeedback signal. Voluntary closure of the bladder neck mechanism abolishes abnormal detrusor activity. Ten severely symptomatic women with detrusor instability were assessed clinically and urodynamically before and after a course of biofeedback. Statistically significant improvements in the symptoms of urgency and urge incontinence were found. Five of the seven women who agreed to have repeat cystometry had stable cystometrograms. There was a statistically significant fall in the mean maximum deflection at rest from 41.5 to 16.5 microA (P less than 0.05) measured during bladder neck electrical conductivity tests before and after treatment.

Biofeedback, Psychology↗

PubMed1987

Micturition and the mind: psychological factors in the aetiology and treatment of urinary symptoms in women.

The mental state of 211 women attending a urodynamic clinic was assessed using questionnaires. Patients with genuine stress incontinence had scores comparable with other patients with longstanding physical complaints. Patients with sensory urgency were more anxious than those with genuine stress incontinence. Patients with detrusor instability were as anxious as patients with sensory urgency and in addition had higher scores on the hysteria scale. A subset of patients (roughly a quarter of the total) was identified, comprising members of all three diagnostic groups, for whom urinary symptoms rendered life intolerable. These patients were as anxious, depressed, and phobic as psychiatric inpatients, emphasising the serious psychological morbidity experienced by patients with urinary symptoms. Fifty patients with detrusor instability or sensory urgency entered a randomised trial comparing psychotherapy, bladder drill, and propantheline. The psychotherapy group significantly improved on measures of urgency, incontinence, and nocturia, though not on frequency. Bladder training was an effective treatment for frequency and patients became less anxious and depressed. There was a modest improvement in frequency of micturition in patients given propantheline. Frequency may be a learnt disorder which responds to the direct symptom oriented approach of bladder training. Patients with urgency and nocturia predominating might derive more benefit from psychotherapy.

Anxiety↗

PubMed1985

Silastic sling for urethral sphincter incompetence in women.

Conventional sling materials have numerous disadvantages. A reinforced Silastic sling is described and its use reported in 30 patients. There was an 83% symptomatic and objective cure of stress incontinence. The advantages of this material include its consistent strength, adjustability and ease of removal.

Female↗

PubMed1983

Bladder training--3 years on.

Fifty-six patients with the "urge syndrome" were reviewed between 1 and 5 years after in-patient treatment by bladder training. There was an overall initial cure/improvement rate of 85%. The best long-term results were obtained in those with objectively stable bladders before treatment. Forty-three per cent of patients with reduced detrusor compliance and idiopathic instability relapsed after initial improvement. Those with primary instability or with associated degenerative disease responded poorly to treatment.

Adolescent↗

PubMed1982

Assessment for and results of urinary undiversion.

Twenty-five patients with surface diversions have been assessed for undiversion over the past 3 years. Fourteen of these have been reconstructed of which half are in the more difficult myelodysplastic group. In 7 patients renal deterioration or renal failure was the indication for undiversion. The critical factors for success are good urethral mechanism function and adequate ureteric function. All but one are subjectively pleased, and all but one have stable renal function and are continent. Infection, especially Pseudomonas, must be eliminated and careful follow-up is mandatory.

Adult↗

PubMedDate not supplied

The person and diabetes in psychosocial context.

This review spans life with diabetes from the first year through the succeeding period of relatively good health, into the phase when the patient needs to accommodate for more symptoms and impaired functioning. Focusing on autonomy, vulnerability to fears, and vocational choices, this article compares effects of diabetes on children and youths with effects on those with onset in later life. A concept of biopsychosocial homeostasis helps to explain: (1) why patients turn to a physician when they do; (2) how the physician may often save the patient time and money by helping that patient to change psychological and social components of well-being and functioning--and highlights the importance of these; (3) how to treat depressive disorder; (4) how to discuss worst fears and encourage patients to play with their unpleasant imaginings; and (5) how to reduce hypoglycemia. Repeated hypoglycemic episodes have the cumulative deleterious effect of undercutting the patient's and others' sense that the patient is dependable, with impaired performance and even serious occupational and marital repercussions. Educational tactics are suggested for the patient with IDDM who finds it harder to identify early levels of hypoglycemia; that patient must learn to respond to specific clues of mild hypoglycemia, stemming from defective thinking and emotional and sexual functioning. There is no substitute for a full history and an empathic understanding of the patient's imaginings, relationships, and circumstances.

Adaptation, Psychological↗