Biomedical subjects

Georgia Panagopoulos

Publications and source records attributed to Georgia Panagopoulos.

21 records · Page 2Linked to original sources

PubMed2003

Effective treatment for mixed urinary incontinence with a pubovaginal sling.

PURPOSE: We assessed the results of autologous fascia pubovaginal sling (PVS) in women with mixed incontinence using a validated outcome score and identified risk factors for failure. MATERIALS AND METHODS: A total of 131 women who received a PVS for sphincteric incontinence (SUI) confirmed by history, physical examination and/or videourodynamic study (VUDS) were identified from a database during the accrual dates 1995 to 2001. Patients with a urethral diverticulum, neoplasm or urinary fistula were excluded. Patients with SUI who also complained of urinary urge incontinence (UUI) and/or had detrusor instability that reproduced incontinence symptoms during VUDS were diagnosed with mixed incontinence (MUI). Patients completed a urological questionnaire, 24-hour voiding diary, pad test, VUDS and cystoscopy preoperatively. The diagnosis of SUI and UUI was further confirmed by physician interview. In patients with MUI detrusor overactivity was classified according to urodynamic criteria. At least 1 year postoperatively the validated Urinary Incontinence Outcome Score (UIOS) was calculated from a 24-hour diary, pad test and questionnaire, and outcomes in patients with SUI and those with MUI were compared. The study was powered a priori to detect a 20% difference in outcome score. Cured patients (UIOS 0) were compared with those who were not cured (UIOS 1 or greater) and univariate analysis was applied to identify the correlates of failed PVS. RESULTS: Of the 131 patients evaluated 33 with a diverticulum or fistula were excluded and 98 underwent PVS. Patient age was 45 to 84 years (median 66). Followup was 1 to 7 years (median 3). A total of 46 patients (48.5%) had simple SUI and 52 (51.5%) had MUI. Two patients were lost to followup (2%) and the procedure was presumed to have failed. There were no differences in age, hormone status, previous surgery or pelvic organ prolapse between patients with SUI and MUI. The cure/improved rate was 97% in 44 SUI cases and 93% in 47 MUI cases, which was a nonsignificant difference (p = 0.33). Analysis of the MUI group showed that patients who were cured and not cured had similar age, parity, urethral angle, bladder capacity, leak point pressure and pad tests. Patients with MUI who were cured had a higher number of voids in 24 hours on preoperative voiding diary (12 vs 8, p = 0.01), while those who were improved or in whom treatment failed had a greater number of urgency (5.6 vs 4.1, p <0.05) and UUI (5.1 vs 3.0, p <0.01) episodes. Univariate analysis of MUI cases showed that an increasing number of preoperative urgency and urge incontinence episodes correlated directly with PVS failure (r = 0.33, p = 0.038 and r = 0.35, p = 0.048, respectively). In contrast, an increasing number of voids correlated with successful PVS (r = 0.4, p = 0.01). CONCLUSIONS: Women with SUI and concurrent urge incontinence or detrusor instability have a successful PVS outcome at a rate comparable to that in women with simple SUI, in contrast to our previous findings. Increasing episodes of urgency and urge incontinence on the preoperative voiding diary correlated directly with surgical failure, while voiding frequently was associated with cure.

Aged↗

PubMed2002

A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument.

STUDY DESIGN: A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). OBJECTIVE: To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. METHODS: Using the SRS 24 questionnaire, seven scoliosis centers agreed to prospectively assess outcome for surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. RESULTS: A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P < 0. 001). Overall, patients were highly satisfied with the results of surgery. CONCLUSION: Preoperative pain exists in our adolescent scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with adolescent idiopathic scoliosis.

Adolescent↗

PubMed2002

Failure of intravenous fluid therapies to decrease serum sodium levels in elderly hospitalized patients.

Elderly patients may have a tendency to develop hyponatremia due to sensitivity to stimuli that release ADH as well as an impaired ability to excrete a water load. We evaluated changes in serum sodium in elderly hospitalized patients who received various forms of intravenous fluid therapies. All patients were required to have a baseline serum sodium of 136-145 meq/L. Fourteen patients were enrolled in the study. The mean age was 82.9 +/- 6.8 years (mean +/- SEM). Thirty-six % were nursing home residents. Seventy-nine % were females. Seventy-two % received half normal saline and the remainder received normal saline as intravenous fluid therapy. The patients received a mean of 1098 +/- 145 mL of intravenous fluid per day, in addition to oral fluids. Mean follow up period was 5.9 days (3-10 days). Mean baseline serum sodium was 140.2 +/- 0.7 meq/L andmean follow up serum sodium was 141.4 +/- 0.9 meq/L. The m ean baseline BUN was 25 +/- 3.6 mg/dL and mean follow u BUN was 19.6 +/- 3.4 mg/dL. The mean baseline serum creatinine was 0.9 +/- 0.1 mg/dL and mean follow up creatinine was 0.9 +/- 0.1 mg/dL. The postintravenous fluid therapy serum sodium in the group receiving half normal saline was 141.7 +/- 0.7 meq/L and 140.8 +/- 3 meq/L in the normal saline group. No significant difference was observed between the pre and post fluid therapy for any of these paramenters (p > 0.05). Mean baseline plasma renin activity was 1.6 +/- 0.7 ng/ml/hour and fifty-seven % had PRA of less than 1 ng/ml/hour. Mean plasma aldosterone was 8.5 +/- 1.8 ng/mL and forty-two % were less than 5.5 ng/mL. Plasma ADH and ANP was 5.7 +/- 3.4 pg/mL and 83.6 +/- 26.9 pg/mL, respectively. Mean serum and urine osmolalities were 290 +/- 3.1 mOsm/kg and 471 +/- 57.7 mOsm/kg, respectively. No patient developed hyponatremia and 7 of the 14 patients experienced an increase in serum sodium during the follow up period. We conclude that many elderly patients hospitalized for acute medical illnesses either maintain a stable serum sodium or experience an increase in serum sodium. This occurs because total fluids administered to these patients are generally insufficient.

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