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Biomedical subjects

G Ralph

Publications and source records attributed to G Ralph.

At least 37 records · Page 2Linked to original sources
PubMed1992

Treatment of unruptured tubal pregnancy by laparoscopic instillation of hyperosmolar glucose solution.

Sixty patients with unruptured tubal pregnancy were treated with local laparoscopic instillation of 50% glucose solution. This treatment was successful in 49 (98%) of 50 patients with an initial serum human chorionic gonadotropin level of less than or equal to 2500 mU/ml and in six (60%) of 10 with an initial level greater than 2500 mU/ml. No side effects were seen. The average hospital stay of patients who did not require a second intervention was 5.2 days (range 3 to 10). The average time between glucose instillation and the decline of serum human chorionic gonadotropin levels below the level of detectability was 21.3 (+/- 14.3) and 30.2 (+/- 10.9) days in patients with serum levels less than or equal to 2500 mIU/ml and greater than 2500 mIU/ml, respectively. Five patients (8%) underwent a second laparoscopy (n = 4) or laparotomy (n = 1) because of stable or increasing human chorionic gonadotropin levels and progressing clinical symptoms. We conclude that laparoscopic instillation of hyperosmolar glucose solution is safe, technically simple, and effective in the treatment of unruptured tubal pregnancies associated with a serum human chronic gonadotropin level less than or equal to 2500 mIU/ml.

Chorionic Gonadotropin↗
PubMed1991

[Endoscopic bladder neck suspension--clinical, urodynamic and radiologic results].

70 women were evaluated clinically and urodynamically both before and, on average 16 (12-48) months after undergoing endoscopic suspension of the bladder neck, following Stamey, for genuine stress urinary incontinence. The average age of the patients at surgery was 52 (35-85) years; the average parity was 3 (0-10). Preoperative and postoperative lateral colpocystograms were performed on 48 patients. 40 patients had marked descent of the pelvic organs; 30 patients had previously undergone vaginal hysterectomy and anterior colporrhaphia. Overall, 70% of the patients were postoperatively clinically and urodynamically continent at follow-up; however, only 44% of the patients with a preoperative urethra closure pressure (UCP) less than 20 cm H2O were continent. The functional urethral length was unchanged but the point of maximum closure pressure was shifted to the proximal third of the urethra. The UCP at rest decreased significantly (p = 0.0277). Radiologically, the bladder neck was elevated further and the angle beta decreased more in the patients continent after surgery, than in those who remained incontinent. These data suggest that the Stamey operation is effective in selected patients with stress incontinence, but not in patients with a low UCP at rest.

Adult↗
PubMed1991

Interactions between insulin and insulin-like growth factor I in the pathogenesis of polycystic ovarian disease.

Concentrations of growth factors were examined in 28 patients with clinical and endocrinologic signs of polycystic ovarian disease (PCOD). Elevated levels of total insulin-like growth factor I (IGF-I) and decreased levels of the human growth hormone (HGH) were found. Studies of carbohydrate metabolism and of insulin receptors on erythrocytes indicated insulin resistance in all PCOD patients. Elevated insulin and IGF-I levels seem to play a pathogenetic role in PCOD by influencing the development and steroid production of ovarian follicles. Interactions between insulin and IGF-I could be shown at different levels. A positive correlation between elevated insulin and IGF-I concentrations was demonstrated in patients with different classes of gestational diabetes. Hyperinsulinemia seems to be the trigger mechanism and therefore the key to the pathogenetic loop of polycystic ovarian disease.

Adult↗
PubMed1991

[Effect of various operations for incontinence on the dynamics and topography of the bladder and bladder neck].

245 women who underwent surgery for stress urinary incontinence between 1982 and 1989 were tested urodynamically before and after surgery; lateral colpocystograms were obtained in 118 patients. 116 women underwent colpoperineoplasty, 59 Burch colposuspension, and 70 Stamey/Raz endoscopic suspension of the bladder neck. 72% of the patients were continent after the Burch operation, 70% after the Stamey/Raz procedure, and 54% after colpoperineoplasty. In patients with severe stress incontinence, the Burch and Stamey/Raz procedures were effective significantly more often than colpoperineoplasty (73% and 66% vs 37%). In patients with a hypotonic urethra, the Burch procedure was successful significantly more often than the other two operations (88% v. 62% and 47%). Colpoperineoplasty and the Stamey/Raz procedure both significantly decreased the urethral closure pressure (UCP) at rest while significantly improving the UCP under stress, the depression quotient, the pressure transmission factor. Urodynamic criteria of the urethral stress profiles differed significantly between continent and incontinent women. Colpocystography showed that the Burch and Stamey/Raz operations moved the vesicourethral junction well above the lower margin of the symphysis while colpoperineoplasty moved it to the lower margin. The angle beta was significantly smaller after Burch and Stamey/Raz operations than after colpoperineoplasty. There was no difference in any of the parameters between women with or without micturition complaints.

Adult↗
PubMed1991

Radicality of parametrial resection and dysfunction of the lower urinary tract after radical hysterectomy.

Sixty-six patients who underwent radical abdominal hysterectomy between 1971 and 1985 for stage Ib-IIb cervical cancer underwent urodynamic studies 1-15 years after surgery. None of the patients had received radiotherapy. Surgical specimens were processed as serial giant sections permitting measurement of the resected parametrial and paravaginal tissue. In 1984 parametrial resection was extended to the pelvic wall by the use of hemoclips. Impaired bladder sensation, bacteriuria, and residual urine were significantly more common among the patients who had more radical surgery, as were reduced flow rates and abnormal bladder compliance.

Female↗
PubMed1990

Urological complications after radical hysterectomy with or without radiotherapy for cervical cancer.

We reviewed urologic complications in 320 patients who underwent radical abdominal hysterectomy for stage Ib-IIb cervical cancer. 145 patients received adjuvant radiotherapy, and 116 were available for urodynamic testing 1-14 years later. The overall incidence of fistulas was 4.4%. Three of eight fistulas following surgery alone healed spontaneously; all fistulas following adjuvant radiotherapy required surgical correction. Nocturia and urgency were reported more often after adjuvant radiotherapy than after surgery alone. We conclude that urologic complications after radical hysterectomy can be made more intractable by adjuvant radiotherapy.

Adult↗
PubMed1990

[Surgery of prolapse and incontinence in Austria--current status and prospects].

In early 1989, we sent a questionnaire to all 89 Departments of Gynaecology in Austria. Questions covered the number and type of gynaecological operations performed, perioperative management, and diagnosis and treatment of descent and urinary incontinence. 90% of questionnaires were returned. We found that currently 2/3 of all hysterectomies and 9/10 operations for descent and incontinence are done vaginally, irrespective of the size of the department. There was no relationship between the frequency of vaginal hysterectomies and the percentage of vaginal operations for descent and incontinence. Suprapubic bladder drainage is used in over 50%, in 85% postoperative screening for urinary tract infection is done routinely, and 53% of departments use prophylactic antibiotics. We conclude, that vaginal hysterectomy is still the method of choice in Austria, and that there is extreme emphasis on vaginal operations for urinary incontinence.

Adult↗