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Biomedical subjects

G Ralph

Publications and source records attributed to G Ralph.

At least 19 recordsLinked to original sources
PubMed2003

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients.

The sentinel lymph node biopsy (SLNB) represents a minimal invasive surgical method for axillary staging in patients with primary breast cancer. In a prospective study, evaluation of quality of life (QOL) and arm morbidity was performed before surgery on a total of 56 breast cancer patients. The EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires were used for QOL assessment. Assessment of pain was additionally observed using the McGill Pain Questionnaire. Arm mobility was observed by goniometric measurement of arm movement. Data were collected before surgery (t1), 1 week after discharge (t2) and 9-12 months after surgery (t3). The type of axillary surgery does not seem to affect global QOL at a short-time follow-up, but patients recover sooner after SLNB. Body image and sexual functioning remain stable in both types of axillary surgery. Arm/shoulder pain was reported in 36% of patients after SLNB in comparison to 68% receiving axillary lymph node dissection (ALND), and 'numbness' was reported only in 4% of patients in the SLNB group vs 19.3% after ALND. Abduction, flexion and horizontal adduction of the affected arm show significant impairment after ALND. Breast cancer patients should be counselled about the benefits of SLNB over ALND concerning QOL and postsurgery side effects in a short-term follow-up.

Adolescent↗
PubMed2003

Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability.

Our objectives were to ascertain the tolerability and efficacy of trospium chloride in doses of 20 mg twice daily for long-term therapy (52 weeks) in patients with urge syndrome. The trial comprised a total of 358 patients with urge syndrome or urge incontinence. After randomisation in the ratio of 3:1, participants were treated continuously for 52 weeks with either trospium chloride (20 mg twice daily) or oxybutynin (5 mg twice daily). At intervals of 4-8 weeks, patients were physically examined with measurements of blood pressure and pulse rate, were questioned about any adverse events, checked for compliance and underwent relevant laboratory tests. As an additional safety measure, an ECG was made at 26 and 52 weeks. Urodynamic measurements were performed at the beginning, and at 26 and 52 weeks to determine the maximal cystometric bladder capacity. Among others things, the frequencies of micturition, incontinence and number of urgency events were recorded in patient diary protocols in weeks 0, 2, 26 and 52. The evaluation of vital parameters, laboratory results and ECGs did not show any relevant changes attributable to the action of the anticholinergics. Analysis of the micturition diary clearly indicated a reduction of the micturition frequency, incontinence frequency, and a reduction of the number of urgencies in both treatment groups. Mean maximum cystometric bladder capacity increased during treatment with trospium chloride by 92 ml after 26 weeks and 115 ml after 52 weeks (P=0.001). Further comparison with oxybutynin did not reveal any statistically significant differences in urodynamic variables between the drugs. Adverse events occurred in 64.8% of the patients treated with trospium chloride and 76.7% of those treated with oxybutynin. The main symptom encountered in both treatment group was dryness of the mouth. For patients on trospium chloride, the estimated risk of an unexpected adverse event was 0.027 per patient per week for all adverse events and 0.009 for dryness of the mouth, resulting in a considerably lower risk during treatment given with trospium chloride than with oxybutynin (0.045 and 0.021, respectively). An overall assessment for each of the drugs reveals a comparable efficacy level and a better benefit-risk ratio for trospium chloride than for oxybutynin due to better tolerability.

Adult↗
PubMed2001

The driving license examination as a stress model: effects on blood picture, serum cortisol and the production of interleukins in man.

We have studied the following stress model: the tension caused by sitting for the theoretical part of the driving license examination. Volunteers were investigated twice, after their driving license examination and after a (stress-free) control session. The effects of the stress were investigated by studying the blood picture (differential counts), serum concentration of cortisol, and cytokine production in stimulated blood cells. Relationships between the subjective perception of stress and the physiological reaction were also investigated. This stress induced significant increase in the concentrations of cortisol and hemoglobin, and in the values of hematocrit and MCV, and in the lipopolysaccharide-induced release of IL-1beta and -6. The subjective feelings of irritability and wakefulness were also significantly higher after the exam. A significant relationship was found between the changes in the stimulated production of IL-1beta and irritability. The responsiveness to psychological stress might be influenced by the temporary mood of the subjects.

Adolescent↗
PubMed2001

The Austrian tension-free vaginal tape registry.

In Austria a central registry for all TVT operations has been established in which more than 800 cases have so far been registered. The registry contains information on pertinent data on the operated patients and intra- and postoperative outcomes of the TVT surgery. No serious complications and no mortality have been registered until now.

Austria↗
PubMed2001

Tension-free vaginal tape operation: results of the Austrian registry.

OBJECTIVE: To assess the use of and perioperative complications associated with the tension-free vaginal tape operation with a central registry. METHODS: Fifty-five gynecology units completed questionnaires on patients undergoing the tension-free vaginal tape operation. Information was collected on patient, surgical, and postoperative data. RESULTS: A total of 2795 patients were entered. Overall, 773 patients (28%) had undergone previous surgery for incontinence or prolapse; 1640 (59%) tension-free vaginal tapes were performed as isolated operations, and 1155 (41%) were done in combination with other procedures. The median operating time for tension-free vaginal tapes alone was 30 minutes (range 10-120). Of the isolated tension-free vaginal tapes, 727 (44%) were performed with local, 711 (43%) with regional, and 193 (12%) with general anesthesia. In patients undergoing tension-free vaginal tape only, postoperative bladder drainage was obtained with intermittent catheterization in 389 (24%) patients, an indwelling urethral catheter in 1032 (63%), and a suprapubic catheter in 143 (9%). The bladder perforation rate was 2.7% overall (n = 75) and higher in patients with than in those without previous surgery (4.4% compared with 2.0%, P =.01). There were four bladder perforations (3.3%) among the 120 patients with previous colposuspension. Most patients undergoing tension-free vaginal tape only were able to void the next day (range 0 to over 64). A total of 68 patients (2.4%) required reoperation for reasons related to the tape (39 to loosen, remove, or cut the tape, or to place a suprapubic catheter, 19 for hematoma, one for bowel injury). CONCLUSION: The tension-free vaginal tape has become a frequently performed operation in Austria. There are considerable variations in clinical practice. The risk of bladder perforation was increased in patients with previous surgery. Severe complications were rare.

Austria↗
PubMed1999

Five-year results after anti-incontinence operations.

OBJECTIVE: This study was undertaken to evaluate continence rates 5 years after anterior colporrhaphy, anterior colporrhaphy with needle suspension of the bladder neck, and Burch colposuspension. STUDY DESIGN: Among 544 women with stress incontinence who were operated on between 1989 and 1993, 327 women (60%) underwent clinical and urodynamic reevaluation 5 years after the operation. Choice of surgical procedure was made on the basis of clinical and urodynamic findings and of physician preference. Continence was defined as no loss of urine during cystometry or during coughing with the bladder filled to 300 mL. RESULTS: The 327 patients underwent a total of 334 operations. The objective overall continence rates at 5 years were 61% (65/107) after anterior repair, 49% (59/121) after anterior repair with needle suspension, and 79% (84/106) after Burch colposuspension. Continence rates after anterior colporrhaphy were 82% (32/39) among patients with mild stress incontinence but 49% (33/68) among those with moderate or severe incontinence (P <.02). Continence rates among patients with moderate or severe incontinence were 49% (59/121) after anterior repair with needle suspension and 79% (84/106) after the Burch operation (P <.02). CONCLUSION: Anterior colporrhaphy can cure mild stress incontinence but is inadequate to correct severe incontinence. Additional needle suspension may be of benefit for patients with moderate to severe incontinence. Abdominal colposuspension is superior to the vaginal operations for long-term cure of stress incontinence.

Adult↗
PubMed1998

[Needle suspension methods in the treatment of urinary stress incontinence].

In 1959 A.J. Pereyra published a simple transvaginal surgical method to elevate and fixate the bladder neck and proximal urethra with a specially designed needle in women with stress urinary incontinence. This method was repeatedly modified during the last 35 years. Mild to moderate stress incontinence with or without pelvic floor relaxation is regarded as an indication for needle bladder neck suspension. Contraindications include severe stress incontinence, low-pressure urethra, urge incontinence and recurrent stress incontinence. Postoperative continence rates range from 40% to 91% depending on inclusion criteria, preoperative diagnostics, criteria for success or failure, and duration of follow-up. There are no controlled clinical studies comparing different needle suspension techniques.

Female↗
PubMed1996

Long-term effects of vaginal dissection on the innervation of the striated urethral sphincter.

OBJECTIVE: To study the long-term effects of vaginal dissection on the innervation of the striated urethral sphincter. METHODS: Perineal nerve terminal motor latency was measured before and 8 weeks and 1 year after anterior colporrhaphy, colpoperineoplasty, and vaginal hysterectomy in 33 women, 19 of whom also underwent endoscopic suspension of the bladder neck. RESULTS: In the entire series, the mean perineal nerve terminal motor latency was prolonged before surgery over that in normal continent women and further prolonged 8 weeks and 1 year postoperatively. In the subjects who underwent vaginal hysterectomy and anterior colporrhaphy, perineal motor latencies were not significantly prolonged at the 8-week postoperative follow-up and had almost returned to preoperative values 1 year later. However, in those who underwent additional endoscopic bladder neck suspension, perineal motor latencies were prolonged at both postoperative follow-up examinations. Perineal motor latencies were unchanged 1 year postoperatively in continent patients (N = 19) but were prolonged in incontinent patients (N = 14). CONCLUSION: Vaginal dissection, especially during endoscopic bladder neck suspension, can worsen preexisting perineal neuropathy in patients with pelvic relaxation and stress incontinence.

Adult↗
PubMed1995

[5 years results of incontinence operations].

OBJECTIVE: To evaluate results 5 years after anterior colporrhaphy with or without needle suspension of the bladder neck and after Burch colposuspension. METHODS: 186/291 women (64%) operated on between 1989 and 1990 underwent clinical and urodynamic reevaluation. RESULTS: Objective continence rates after anterior colporrhaphy were 80% (20/25), 46% (22/47) and 12.5% (1/8) in patients with first-, second- and third-degree stress incontinence according to Ingelman-Sundberg. Continence rates in patients with second- and third-degree stress incontinence were 59% (29/49) after additional needle suspension and 86% (50/58) after the Burch procedure. CONCLUSIONS: Anterior colporrhaphy can cure mild stress incontinence but is not indicated for severe incontinence. The Burch procedure provides the best continence rates in patients with severe stress incontinence.

Female↗
PubMed1994

[Abdominal colposuspension--the gold standard in incontinence therapy?].

Abdominal colposuspension has become the operation of choice in moderate and severe urinary incontinence in the female. The operation involves an elevation of the bladder neck and approximation to the back of the symphysis pubis, resulting in an improved pressure transmission to the proximal urethra. These operative techniques have become standardised, while the various modifications differ in the exact location of the sutures in the vaginal fascia and connective tissue in the small pelvis. Most commonly, the sutures are placed lateral of the bladder neck and passed through the ileo-pectineal ligament (Cooper ligament). Even in unfavourable cases, success-rate lies between 70% and 90%.

Abdomen↗
PubMed1994

[Neuro-urodynamic sequelae of vaginal continence surgery].

This study aimed to investigate the influence of anterior repair on pudendal nerve terminal motor latency. Neurourodynamic investigation (urethral profilometry, measurement of pudendal nerve terminal motor latency according to the method of Snooks and Swash) was performed before and 8 weeks after anterior repair (n = 14) and before and after additional endoscopic bladder neck suspension (n = 23). Stress incontinence and pudendal neuropathy were found preoperatively in all patients. In 17/37 (48%) of patients who were incontinent postoperatively the pudendal nerve latency was significantly prolonged.

Electric Stimulation↗
PubMed1993

[Surgical therapy of recurrent stress incontinence].

We reviewed 245 patients, who underwent surgical treatment of stress urinary incontinence between 1982 and 1989. All patients underwent clinical and urodynamic assessment before and an average of 23 months after surgery (range 12-28). 159 patients had not undergone a previous incontinence operation and 86 one or more previous procedures. 42 patients with recurrent stress incontinence underwent a Burch colposuspension, 20 an anterior colporrhaphy and colpoperineoplasty, and 24 a Stamey endoscopic bladder neck suspension. All operations were successful, more frequently in patients undergoing the first surgical attempt at correction of incontinence than in those undergoing surgery for recurrent incontinence (Burch colposuspension 88% vs 69%; anterior and posterior repair 62% vs 20%; Stamey bladder neck suspension 80% vs 52%). In patients with severe stress incontinence both the Burch and Stamey procedures yielded significantly better results than anterior and posterior repair (73% and 66% vs 37%). The urethral closure pressure at rest was unchanged in patients continent after surgery, but significantly reduced in the surgical failures. Stress profile values differed significantly between patients continent after surgery and surgical failures. Also, the vesicourethral junction was elevated further in the continent than in the incontinent women.

Adult↗
PubMed1993

[Treatment of stress incontinence with total prolapse of the uterus].

40 women (average age 65 years) who underwent vaginal hysterectomy and colpoperineoplasty for total prolapse of the uterus with (26) or without Stamey's procedure (14), were tested urodynamically before and 14 months after surgery. 6/14 (43%) women were clinically and urodynamically continent after vaginal hysterectomy and anterior and posterior repair, compared to 20/24 (83%) after an additional Stamey's procedure. The pressure transmission ratio was significantly improved after both procedures (p = 0.05). These results indicate that anatomic correction does not suffice to correct latent stress urinary incontinence in patients with uterovaginal prolapse. Endoscopic suspension of the bladder neck seems to be a successful method in these cases. The transmission ratio was improved by both operative procedures. The results show, that colpoperineoplasty alone cannot correct stress incontinence in patients with total prolapse of the uterus. In such cases Stamey's procedure is a successful method.

Aged↗