[Physical diagnostics--bimanual vaginal examination].
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Female↗
Biomedical subjects
G Gerretsen
Publications and source records attributed to G Gerretsen.
[Inventory and follow-up of patients with surgery for (uterine) vaginal prolapse, combined with or without, (masked) stress incontinence].
OBJECTIVE: Evaluation of the development or persistence of urinary stress incontinence in patients operated on because of prolapsed uterus, with cooperation between gynaecologists and urologists. DESIGN: Retrospective. SETTING: Department of Gynaecology and Obstetrics, Leyenburg Hospital, The Hague, the Netherlands. METHODS: In 178 patients subjected to prolapse correction in the period 1992-1996, presence of urinary incontinence was analysed by means of a written enquiry after an average of 22 months. The 91 patients who had visited the gynaecological outpatient clinic and were seen together with a urologist, were subjected to urodynamic examination in the absence of symptoms of stress incontinence and were operated in cooperation with the urologist. Four groups were distinguished on the basis of preoperative features: group I (n = 37) with manifest stress incontinence, group II (n = 22) with masked stress incontinence, group III (n = 32) in whom no (masked) stress incontinence could be demonstrated and group IV (n = 87) not subjected to urodynamic examination. The patients of groups I and II, in addition to prolapse correction, were also subjected to urethral suspension. RESULTS: Twenty-five (68%) of the group with manifest stress incontinence were free of stress incontinence after the operation, while eight patients (22%) reported improvement (a total of 89%). In 22 of the 54 patients (41%) who preoperatively had no incontinence symptoms, urodynamic examination revealed a masked stress incontinence. Sixteen of them (73%) did not develop symptoms of stress incontinence after the operation, while eight (15%) did develop such symptoms. Thirty of the 32 patients (94%) who preoperatively had no (masked) stress incontinence remained symptom-free. Out of 64 patients without preoperative incontinence, who were operated without urological cooperation, 12 (19%) developed stress incontinence.
Aged↗
The electroencephalogram during normal third trimester pregnancy and six months postpartum.
In 1942 Gibbs and Reid described a slowing of the electroencephalogram (EEG) at the end of a normal pregnancy. To the best of our knowledge this is the only report that addresses the modification of the EEG in normal pregnancy. We performed a spectral multichannel EEG analysis and revealed no differences during third trimester pregnancy and six months postpartum. Therefore EEG changes seen during pregnancy, which were previously regarded as 'subtle changes of pregnancy', may turn out to be clinically relevant changes which indicate either pre-existing EEG dysfunction or EEG abnormalities in the context of a pregnancy-related disorder.
Analysis of Variance↗
Cerebral vasospasm and vasodilatation in pre-eclampsia.
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Adult↗
[Diagnosis and treatment of extrauterine pregnancy in The Netherlands].
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Chorionic Gonadotropin↗
The effect of estriol on the cytology of urethra and vagina in postmenopausal women with genito-urinary symptoms.
In a double-blind, randomised trial, 62 postmenopausal women with genito-urinary symptoms were treated with oestriol or matching placebo for 4 weeks. Estriol (Synapause-E3, Nourypharma Nederland) was given orally for 4 weeks in a single daily dose (8 mg/day first week, 4 mg/day second and third week, 2 mg/day fourth week). The influence of estriol on the vaginal and urethral epithelium was assessed by using the karyopycnotic index and the maturation value. As we expected, it was confirmed that estriol has a remarkably beneficial effect on the vaginal epithelium. This also applies to the epithelium of the urethra, although the effect is much less obvious.
Aged↗
Abnormal cerebral hemodynamics in pregnancy-related hypertensive encephalopathy.
A patient with an imminent pregnancy-related hypertensive encephalopathy is presented in whom transcranial Doppler ultrasound studies revealed increased middle cerebral artery blood flow velocities before and up to 7 days after cesarean section. These increased velocities are normally caused by cerebral vasospasm and subsequent hypoperfusion in pregnancy-related hypertensive encephalopathy. Additional duplex volume flow studies of the common carotid artery were in favor of cerebral hyperperfusion as a cause of the increased blood flow velocities. The clinical implications of these findings are discussed.
Adult↗
Endodermal sinus tumor of the vagina: radiation therapy and progeny.
BACKGROUND: Extraovarian endodermal sinus tumor generally originates in the vagina or cervix of young girls. Some 50 cases are known, all younger than 3 years of age. Many were treated with outdated regimens, and there are 5-year survival data on only nine of them. We describe a curative outcome of primary radiation only. CASE: A 40-year-old woman had a history of localized endodermal sinus tumor of the vagina, stage I, treated by brachytherapy at the age of 6 months. Radiation had a severe impact upon the later functioning of her pelvic organs, with marked deformity of the pelvic floor, vagina, urethra, and bones of the pelvic outlet. She conceived by homologous insemination at the age of 34. Delivery was by cesarean at 31.5 weeks' gestation. CONCLUSION: Current forms of management give preference to limited excisional surgery and multi-agent chemotherapy, analogous to that used for the treatment of endodermal sinus tumor of the ovary. This is the first report of a patient treated by radium needles and the only known patient who had a subsequent pregnancy.
Adult↗
[No increase in the incidence of breast carcinoma with subcutaneous administration of estradiol].
Between 1972 and mid-1990 the frequency of breast cancer was studied in a group of 261 mostly premenopausal women of the gynaecological department of the Municipal Hospital in The Hague, the Netherlands. All the patients had had a total hystero-adnexectomy after which they were substituted with estradiol implants. On the basis of a stratified lifetable giving the cumulative incidence of breast cancer in the Netherlands, an expected incidence of 2 per 1000 person-years was estimated for the observed group (mean observation period: 8.25 years). There were three cases of breast cancer in the observed group. This means an incidence density of 1.4 per 1000 person-years. It is concluded that this form of oestrogen substitution does not increase the risk of breast cancer.
Breast Neoplasms↗
A new method for diagnostic curettage.
A new device ('Abradul') for policlinical curettage was tested for reliability. The histology of the curettage obtained prior to hysterectomy was compared blindly to that of the surgical specimens in 61 patients. As a correlation of almost 100% was found, the results for this convenient and economical outpatient procedure are very promising. Routine screening for the patient at risk is now within reach.
Adenocarcinoma↗
Acute abdomen due to placenta percreta.
Placenta percreta is a rare but serious complication of pregnancy, usually presenting itself in the third trimester. The incidence of fetal death and maternal mortality is high. We report a case presenting as an acute abdomen, due to haemoperitoneum at 33 weeks of pregnancy. Incidence, etiology, diagnosis and treatment are discussed, and the literature is reviewed.
Abdomen, Acute↗
A rare cause of lumbosacral plexus neuropathy.
This is the second report of a case in which a uterine myoma, one of the most common benign tumours of women, was the cause of a lumbosacral plexus neuropathy. The possibility of uterine myoma should be considered in the differential diagnosis of neuropathy of the lumbosacral plexus in women.
Aged↗
Fixed fetal heart rate pattern after intrauterine accidental decerebration.
A fixed fetal heart rate (FHR) pattern, with a normal frequency without accelerations and decelerations can be observed in early pregnancy during the inactive episodes of the rest-activity cycle, in association with certain drugs administered to the mother and in some cases of anencephaly. In the present case report a fetus is described in which a persistent fixed FHR pattern was indicative of decerebration in utero. The latter occurred after a serious maternal respiratory and cardiovascular collapse. The discrepancy between maternal and fetal outcome and the pathophysiologic backgrounds underlying the FHR changes are discussed.
Adult↗
The factor VIII ratio in normal and pathological pregnancies.
The factor VIII ratio was measured in 102 pregnant women (43 uncomplicated pregnancies, 19 with pre-eclampsia without fetal growth retardation, 8 pre-eclampsia complicated by fetal growth retardation, 12 with only fetal growth retardation and 20 with gestational diabetes). The pathological pregnancies showed a statistically significant elevation of the factor VIII ratio compared to the normal pregnancies. The group of pre-eclampsia complicated by fetal growth retardation showed the most marked increase of the factor VIII ratio. The results are discussed in relation to the hypothesis that the elevated factor VIII ratio is mainly due to the release of factor VIII antigen by various forms of vascular stress.
Antigens↗
Trophoblast alterations in the placental bed in relation to physiological changes in spiral arteries.
Ninety-three placental bed biopsies containing a segment of a spiral artery at the level of the decidual-myometrial junction (53 with and 40 without physiological changes) were histologically investigated for depth of trophoblastic penetration of the uterine wall, formation of trophoblastic multinucleated giant cells and the enzyme histochemical characteristics of the interstitial (stromal) and vascular (intramural) trophoblast. The depth of trophoblastic penetration was not related to the presence or absence of the physiological changes. Conversely, in the absence of physiological changes, a significant accumulation of multinucleated giant cells at the decidual-myometrial junction was found before 36 weeks of gestation. The enzyme histochemical characteristics of the placental bed trophoblast suggest a stromal migration of trophoblast to the proximal (decidual-myometrial) part of the spiral artery whereas the distal part might be invaded by intraluminal (upstream) invasion. The hypothesis is put forward that in the absence of physiological changes a disturbed stromal migration is caused by intrinsic (trophoblastic) or extrinsic (interstitial of vascular) factors expressed by the augmentation of the multinucleated cells at the decidual-myometrial junction.
Female↗
Rapid regression of a suprasellar extending prolactinoma after bromocriptine treatment during pregnancy.
A patient is described with hyperprolactinemia, post-pill amenorrhea, galactorrhea, and a normal pituitary fossa. Pregnancy occurred after induction of ovulation with bromocriptine. During pregnancy rapidly increasing visual field defects due to suprasellar extension of a pituitary tumor were observed. Operation was advised but refused. The patient was treated with bromocriptine in a dose of 15 mg daily, which resulted in normalization of the bitemporal hemianopia within 2 weeks.
Adult↗
Morphological changes of the spiral arteries in the placental bed in relation to pre-eclampsia and fetal growth retardation.
The spiral arteries at the level of the decidual-myometrial junction in the placental bed were examined histologically in 93 biopsies. Of these, 23 originated from normal uncomplicated pregnancies, 30 from pre-eclamptic and 40 from otherwise complicated pregnancies. The association of the "physiological changes' of the spiral artery with uncomplicated pregnancy and their absence in pre-eclampsia, as noted by Brosens and others, has been confirmed. In addition, in pregnancies without pre-eclampsia, these changes were significantly more often absent with fetal growth retardation. The hypothesis is put forward that hypertension of pregnancy is a compensatory mechanism to ensure an adequate blood supply to the placenta when the "physiological changes' fail to occur.
Arteries↗
Immune reactivity of women on hormonal contraceptives. Phytohemagglutinin and concanavalin-A induced lymphocyte response.
To investigate the influence of sex-steroids on the in vitro correlate of cell-mediated immunity (CMI), blood samples from 49 women on hormonal contraceptives were tested on the lymphocyte response to the mitogens phytohemagglutinin (PHA) and concanavalin A (Con-A). Sixteen women were taking oral contraceptives of combined oestrogen/progestogen of the same brand (low oestrogenic and middle range progestogenic activity); 15 had received intramuscular injections of medroxyprogesterone acetate and 18 women were using a sequential pill. The results were compared with those of 18 women not taking contraceptive steroids and matched for age. No significant changes were observed between the different groups. Considering the previously found alterations in dinitrochlorobenzene (DNCB) skin test reactivity by sex steroids, it is hypothesized that sex-steroids have little or no influence on the central proliferative phase of the immune response, but have a profound effect on the efferent phase.
Adolescent↗