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Biomedical subjects

G A Bachmann

Publications and source records attributed to G A Bachmann.

At least 19 recordsLinked to original sources
PubMed1998

The clinical platform for the 17beta-estradiol vaginal releasing ring.

All women, regardless of race, culture, or socioeconomic background, experience urogenital atrophy as a result of hypoestrogenism from the menopause. As women go through the aging cycle, their vaginal and urethral epithelium become progressively deprived of estrogen and the tissue loses epithelial thickness, rugation, moisture, vasculature, and elasticity. The pH increases to above 5, infections in the urinary tract and vagina become more prevalent and cytologic study reflects loss of estrogen by a decrease in superficial cells and an increase in basal and parabasal cells. Replacement of estrogen to reverse these changes is the standard of care, with recent attention focused on the local delivery of estrogen by the vaginal route. The first vaginal ring delivery system of estrogen to the urogenital tract recently has been introduced, with the data confirming efficacy and safety of this delivery method for the treatment of urogenital atrophy. In addition, data on the 17beta-estradiol-releasing ring also support excellent patient acceptance of this local vaginal delivery system of estrogen therapy.

Administration, Intravaginal↗
PubMed1998

Operational improvement of gynecologic laparoscopic operating room services: an internal review.

BACKGROUND: To reorganize reusable laparoscopic instrumentation to promote instrument accessibility, minimize instrument breakage, eliminate infrequently used instruments on permanent trays, and help control maintenance costs. TECHNIQUE: The Robert Wood Johnson University Hospital Gynecologic Steering Committee evaluated during a 5-month period the storage, use, and maintenance of gynecologic laparoscopic instrument sets used in the surgical suite. Acting on this data, the committee oversaw the following changes. Infrequently used instruments were removed from permanent trays and separately packaged. Two types of gynecologic laparoscopy trays were prepared: one for laparoscopic bilateral tubal ligations and one for both diagnostic and operative laparoscopy. A double-decker compartmentalized tray in which instruments were sterilized and stored replaced the extant single-layer ones in which instruments were stacked on each other. To facilitate instrument identification and function, a surgical manual was compiled with photographs of each instrument and a description of its use. EXPERIENCE: After implementation of these changes, maintenance and sterilization costs for a 10-month period were compared with those for the previous 10 months. There was a savings of $13,889. The ratio of total costs divided by number of cases performed during the two study periods was also compared. There was a savings of $31 per case. CONCLUSION: Savings were achieved by reorganizing this operating room's handling of reusable gynecologic laparoscopy equipment. By eliminating infrequently used instruments from the permanent trays and by using a double decker compartmentalized tray that was used during surgery, sterilization, and storage, both sterilization costs and maintenance costs were reduced.

Costs and Cost Analysis↗
PubMed1997

Peripheral progesterone (P) levels and endometrial response to various dosages of vaginally administered P in estrogen-primed women.

OBJECTIVE: To compare the pharmacokinetics and pharmacodynamics of 100 mg/d, 200 mg/d, and 400 mg/d (200 mg two times per day) of P administered vaginally for 14 days to estrogen-primed postmenopausal women. DESIGN: Randomized, open-label, three-way crossover study. SETTING: Two university-based investigative sites. PATIENT(S): Twenty healthy postmenopausal women with histologically normal endometria. INTERVENTION(S): Oral 17 beta-E2 was given each day of a 28-day cycle; a P vaginal suppository was inserted daily according to the randomization schedule during days 15-28 of each cycle; blood samples were collected; an endometrial biopsy was obtained on day 25; and patients were crossed over to the next treatment cycle after a washout period of at least 30 days. MAIN OUTCOME MEASURE(S): Mean P blood levels, endometrial dating/conversion. RESULT(S): There was good vaginal absorption of P for all dosages. Endometrial conversion occurred in all 200- and 400-mg/d P-dosed cycles, whereas the 100-mg/d dosage failed to convert primed endometria consistently. There also was a significantly increased tendency for earlier bleeding and spotting with the 100-mg/d dosage. CONCLUSION(S): Both the 200- and 400-mg/d dosage regimens consistently convert an estrogen-primed endometrium, and yield appropriate endometrial dating and bleeding patterns. However, the 400-mg/d dosage attains the highest sustained blood levels and may be the best dosage regimen for further study.

Administration, Intravaginal↗
PubMed1997

Evaluation of a vaginal moisturizer in baboons with decreasing ovarian function.

Decrease of estrogen concentrations in postmenopausal women leads to many urogenital problems including vaginal dryness, atrophy, stenosis, itching, and irritation, along with sexual dysfunction. Systemic estrogen replacement is effective in many women but may not be effective in others because estrogen therapy may be contraindicated for medical reasons. The reproductive tract in nonhuman female primates has been used successfully as a model for a variety of research including, but not limited to, anatomy and physiology, reproduction, cancer, infectious disease, and menopause. The baboon is especially valuable because of the similarity of its menstrual cycle to women's, prior research with this animal, and its adaptability to captivity. A nonhormonal, nonsystemic, bio-adhesive vaginal moisturizer was evaluated in baboons as a possible alternative to hormonal therapy for vaginal symptoms due to a decrease in estrogen concentrations. Eight baboons with decreasing ovarian function were used in a two-part study to evaluate vaginal health with pliability, elasticity, mucosal secretion, pH, and histologic features as criteria. The first study involved a single intravaginally administered dose of test product, with evaluation at 20 min and 24 h later. The second study consisted of five doses given at 24-h intervals, with daily evaluations for 9 consecutive days. There was marked improvement in vaginal pliability, elasticity, and secretions, with decreased pH and thickness of the vaginal epithelium. These effects appeared 1 or 2 days after drug administration, reached the maximum on day 4, and mostly decreased by day 8. However, increased secretions, vaginal elasticity, and vacuolization of the epithelium in biopsy specimens persisted to the last day of observation. The study results indicate the efficacy of the test product and the value of the baboon as a model to study decreasing ovarian function and vaginal health.

Animals↗
PubMed1995

Psychosexual gynecology.

The psychosexual health of the female patient not only is affected by her overall gynecologic well-being but also may be greatly influenced by cultural myths and attitudes, psychological health, and social support. For primary care physicians to incorporate the psychosexual issues of a woman into her overall medical care, there must exist a sensitivity to the patient's needs, an atmosphere for open discussion regarding sexual and psychological concerns, an office staff to provide appropriate medical support, and the availability of experienced specialists in cases in which referral is necessary. The quality of the physician-patient interaction as well as the degree of empathy shown to women with gynecologic problems may exacerbate or improve psychosexual outcomes.

Female↗
PubMed1995

Influence of menopause on sexuality.

Menopause is associated with anatomical, physiological and psychological changes that often influence sexuality in the aging female. The decreased estrogen levels have a multitude of effects on sexual function, including decreased support of female pelvis, loss of ability to adequately lubricate the urogenital tissue, and changes in body configuration. This situation is aggravated by the alterations in the skin, breasts, muscles and skeleton caused by estrogen loss. For many women, these changes translate into a poorer self-image, diminution of self-esteem and, eventually, a loss of sexual desire. Societal expectations also have a negative impact on sexuality, as most cultures still believe that older women become sexually retired. Although this attitude is changing, cross-sectional studies still show that there are negative sexuality changes associated with menopause and that postmenopausal women note a loss of sexual desire. Age and relationship status are also important correlates of sexual activity and sexual satisfaction. With increasing age, the frequency of most types of sexual activity decreases and sexual dysfunctions increase. Urogenital atrophy due to loss of estrogen is one of the most important contributors to the decline in sexual activity with the menopause. Partner availability and partner function are important contributors as well to the decline of sexual activity, since older men, like older women, often have sexual dysfunctions. Overall, decreased sexual desire and loss of vaginal lubrication in the female and erectile difficulties in the male, or absence of a partner, are commonly reported causes of increasing sexual difficulties for the older female. Hormone replacement therapy not only ameliorates the local anatomic and physiologic changes, but also may have positive psychological benefits.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1994

Irregular bleeding, body mass index and coital frequency in Norplant contraceptive users.

Seventy-five women with a mean age of 27.5 years who requested Norplant implants for contraception were studied over a five-year period. The patients kept daily diaries of their vaginal bleeding and coital frequency, and were seen at least every six months at which time their weight was measured. This study examines the impact of Norplant implants use on menstrual regularity, body mass index and coital frequency. Irregular bleeding was most prevalent during the first two years of Norplant implants use and accounted for the primary reason for discontinuation of this method. No increase in Body Mass Index (BMI) was noted in Norplant implants users over the five-year study period. Women with irregular bleeding did not have a higher or lower BMI compared to women with regular bleeding and irregular bleeding patterns did not impact on coital frequency. Over five years, four pregnancies occurred during Norplant implant use. Norplant implants are a highly effective contraceptive method and women using this method should not expect an increase in body weight. Irregular bleeding is most frequent during the first two years of use and menstrual cyclicity resumes in the majority of women by the third year of use and continues to the fifth year of use.

Adult↗
PubMed1994

Nonhormonal alternatives for the management of early menopause in younger women with breast cancer.

Current medical practice recommends the use of alternatives to estrogen-replacement therapy for the treatment of menopausal sequelae in younger women with breast cancer, although this clinical recommendation is undergoing reappraisal. Until prospective randomized studies addressing hormone use in this population are available, estrogen use in breast cancer patients will remain controversial. Because estrogen-replacement therapy is not the standard of practice and there is limited information available on nonestrogen therapies, women with breast cancer who are menopausal may not be prescribed or counseled about nonestrogen options. The efficacy, safety, and extent of use of most nonestrogen treatment modalities (other hormonal preparations, nonhormonal drugs, homeopathic preparations, and non-drug treatments) are not well documented and, unlike estrogen, many are selective in their benefit and do not share estrogen's universal impact. The use of several nonestrogen approaches for the prevention and treatment of osteoporosis has been promising. Traditional recommendations to maintain skeletal integrity, such as weight-bearing exercise; a diet rich in calcium and limited in caffeine, alcohol, and protein; avoidance of smoking; and measures to minimize trauma have been expanded to include the use or investigation of drugs (either alone or in combination). These drugs include progestins, vitamin D metabolites, injectable and intranasal synthetic salmon calcitonin, bisphosphonates, sodium fluoride, parathyroid hormone, growth factors, tamoxifen, etc. Strict control of the known risk factors, such as smoking, dyslipidemia, and hypertension as well as exercise, weight control, and the use of tamoxifen, are employed for the prevention and treatment of cardiovascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The changes before 'the change'. Strategies for the transition to the menopause.

As women enter their fifth decade, the gradual depletion of their ovarian follicles as they make the transition to the menopause can have medically important adverse consequences. Their physicians need to review with them the changes that can occur during this period (including irregular bleeding, sexual dysfunction, and other perimenopausal symptoms) and inform them about available treatments. Patients considering pregnancy should be offered fertility testing, and those who wish to avoid pregnancy should be made aware of the benefits and risks of oral contraceptive therapy. Preventive health measures should be discussed.

Adult↗
PubMed1993

Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic.

Few studies have investigated the prevalence of sexual dysfunction in nonclinical samples. In the present study, a standardized sexual function questionnaire was administered to 329 healthy women, aged 18-73 years, all of whom were enrolled in a Women's Wellness Center. About two-thirds of the sample were married or living with a partner, and most women were employed outside of the home. A broad range of sexual behavior frequencies were observed, with 48.5% reporting at least weekly intercourse, compared to 28.4% who were not sexually active at the time of study. Among the most common sexual problems reported were anxiety or inhibition during sexual activity (38.1%), lack of sexual pleasure (16.3%), and difficulty in achieving orgasm (15.4%). Other common problems were lack of lubrication (13.6%) and painful intercourse (11.3%), each of which was significantly more prevalent in the postmenopausal group. Despite these difficulties, 68.6% of the sample rated their overall sexual relationship as satisfactory. Age and relationship status were significant predictors of sexual satisfaction, with older women and singles reporting a higher incidence of sexual problems. Educational level, religious affiliation, and employment status were not predictive of sexual dysfunction in the present study.

Adolescent↗
PubMed1993

Sexual function in the perimenopause.

Proper medical supervision and care, especially the prescribing of appropriate pharmacologic therapy, combined with factual information, supportive guidance, and sympathetic counseling will ameliorate or enhance sexual function in most perimenopausal women. The preventive steps taken during the midlife years will help build a solid foundation to ensure continued sexual activity and enjoyment for couples that extends into the menopausal, postmenopausal, and geriatric years.

Female↗
PubMed1992

Hysterectomy: is there a need for a clinical trial?

Hysterectomy, the second most common operation today, with the majority of cases done in perimenopausal women usually performed for symptomatic relief. Consequently controversy exists on the appropriateness of indications. A clinical trial is proposed to study this question.

Clinical Trials as Topic↗
PubMed1991

Sexuality in sexagenarian women.

Sexual behavior was examined in 59 healthy, post-menopausal women between 60 and 70 years of age. Subjects were interviewed by a psychologist, completed medical and sexual questionnaires and had a gynecologic exam and blood drawn for determination of estradiol, luteinizing hormone and total and free testosterone. Partners filled out a mail-back sexual questionnaire. Thirty-nine (66%) of the group were coitally active and twenty (34%) were abstinent. The coitally active group reported higher levels of sexual desire (P less than 0.03), greater sexual satisfaction (P less than 0.007), more comfort in expressing sexual preferences (P less than 0.009) and greater pre-menopausal sexual satisfaction (P less than 0.01) and on pelvic examination were noted to have less genital atrophy (P less than 0.0005) than the abstinent group. For the entire sample sexual complaints such as decreased desire and vaginal lubrication in the female and erectile difficulties in the male were reported frequently. Of the hormones studied, higher serum levels of free testosterone were associated with reports of increased sexual desire.

Aged↗
PubMed1990

Sexual issues at menopause.

Although the desire for sexual encounters and the frequency of coitus decrease with menopause, sex in the elderly is no longer considered taboo and continues to be an important and acceptable activity for most older persons. Couples in their 50s or older expect continued sexual involvement, but most consider intercourse the only legitimate form of sexual exchange and reject other forms of sexual activity. Sexual dysfunctions which impair coital ability, especially ejaculatory difficulties in the male and genital atrophy and loss of vaginal lubrication in the female, are frequent. Menopausal couples are often not knowledgeable about physiologic aging changes that affect sexual performance and are reluctant to communicate sexual difficulties to their partner. Without professional counseling and/or pharmacologic intervention, these conditions may lead to sexual frustration and abstinence. The identification and treatment of problems, as well as patient education, are imperative in caring for the menopausal patient.

Aging↗
PubMed1990

Hysterectomy. A critical review.

Hysterectomy is of interest to the practicing obstetrician-gynecologist not only from the medical and surgical points of view but also because of the societal interest that the procedure attracts. The operation was first described in the third century A.D. writings of Soranus and before the turn of this century carried a very high surgical morbidity and mortality rate. With the technologic advances made during this century in both medical and surgical specialties, the operation has become quite safe, with a mortality rate of approximately 12/10,000 procedures. However, although it is possible to objectively measure the improved quality and increased quantity of life when hysterectomy is done for cancer treatment or other life-threatening conditions, it is difficult to so measure those parameters when hysterectomy is done solely to improve the quality of life. Today the physician's medical judgment and patient's understanding of the procedure are no longer the only criteria that have to be considered before surgery. Input by third-party payers, hospital administrators, quality assurance programs, second opinion programs and standards of practice in the geographic region also play a role. Also, alternatives to hysterectomy are being evaluated; in many circumstances they are being utilized today when hysterectomy would have been the treatment of choice before this decade.

Adult↗