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Biomedical subjects

I N Ramsay

Publications and source records attributed to I N Ramsay.

8 recordsLinked to original sources
PubMed1996

A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female.

Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the inpatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.

Adult↗
PubMed1993

Time-series analysis of urethral electrical conductance measurements in the assessment of unstable urethral pressure: results in normal patients and in those with genuine stress incontinence.

It is well established that urethral pressure variations occur in patients with or without urinary incontinence, but to what extent they contribute to a patient's symptoms remains unclear. Previous work has suggested that in stress incontinent patients, a rise in bladder neck electrical conductance (BNEC) occurs simultaneously with a fall in urethral pressure, and that this represents bladder neck opening. Six patients with genuine stress incontinence (gsi), and six normal controls underwent simultaneous urethral pressure and BNEC measurements, the results being subjected to time-series analysis, to determine whether the previous finding could be confirmed statistically, and to establish whether a similar association was present in normal women. All six patients with gsi and five of the normal patients had unstable urethral pressure. Estimated cross-correlation of differenced data for the two parameters showed a significant negative correlation at zero time lag in three patients with gsi and two of the control group. There was no significant correlation between the two parameters in the other seven patients. We conclude that the previous finding of a correlation between urethral pressure variation and BNEC, suggesting bladder neck opening occurs as urethral pressure falls in patients with gsi is confirmed, but appeared to be present in only 50% of patients; the finding is just as likely in normal patients, and therefore whilst it may be of relevance to the severity of symptoms, could not be held to have any aetiological significance.

Adult↗
PubMed1993

Uroflowmetry in the puerperium.

One hundred women underwent uroflowmetry once per day for the first 3 days after delivery, and the results compared to those of 53 nonpregnant controls in an effort to determine 1) whether urinary flow in the puerperium is different to that found without pregnancy, 2) whether uroflow parameters change as the puerperium progresses, and 3) which characteristics of a patient or her labour bear most influence upon the results of uroflowmetry. Urinary flow in the puerperium was seen to be different from that of the nonpregnant female in that mean flow rates were lower. In addition to this, voided volume, total flow time, and time to peak flow were all significantly increased on day 1, but were comparable on days 2 and 3. Other than for falling voided volumes, uroflow parameters did not alter significantly as the puerperium progressed. Correlation of the variables age, parity, baby weight, length of first and second stage, use of epidural and perineal suturing with the parameters of urinary flow failed to show any significant relationship.

Adult↗
PubMed1993

Incidence of abnormal voiding parameters in the immediate postpartum period.

One hundred eighty-four patients were assessed prospectively by uroflowmetry and postmicturition ultrasonography on a daily basis in the immediate postpartum period to assess the incidence of abnormal voiding parameters, their predisposing factors, and whether the combination of two screening tests was more helpful than either alone as a screening test of abnormal voiding in the puerperium. The incidence of abnormal voiding parameters was 43%. The majority of these were asymptomatic. Of those patients who had an abnormality, 68% had normal voiding parameters by the time they went home, and all of those who returned for follow-up had normal parameters. Operative delivery, perineal trauma, and epidural anaesthesia all increased the incidence of abnormal voiding parameters. Residual urine was a feature in 70 of the 79 patients found to be abnormal, and the incidence of an abnormal flow rate was not significantly greater than in the nonpregnant population. This suggests that the addition of uroflowmetry does not confer any benefit over postmicturition assessment of residual urine by ultrasonography in the detection of patients with postpartum voiding dysfunction.

Anesthesia, Epidural↗
PubMed1992

Subtrigonal phenol injections in the treatment of idiopathic detrusor instability in the female--a long-term urodynamic follow-up.

A total of 36 subtrigonal phenol injections were performed on 29 patients with detrusor instability. Long-term follow-up (mean 13.7 months) showed a subjective response rate of only 14%, and objectively there was no significant change in any urodynamic parameter in the group as a whole. There was, however, a significant improvement in cystometric capacity and volume at first contraction, in those under 55 years of age. One patient developed a vesicovaginal fistula following repeat injections. This suggests that subtrigonal phenol injections have little place in the treatment of detrusor instability, especially in the over 55s, and repeat injections should be abandoned because of the risk of major complications.

Adult↗
PubMed1991

Who requests reversal of female sterilisation? A retrospective study from a Scottish unit.

The characteristics and circumstances of 55 women who underwent reversal of sterilisation were compared with those of 55 women who had a sterilisation performed at the same time, but who did not subsequently undergo reversal. Patients who underwent reversal were sterilised at a significantly younger age, and were more likely to have been sterilised at the time of therapeutic abortion or miscarriage. The parity at the time of sterilisation was the same for both groups. The reason for requesting reversal was a change of partner in the vast majority of cases. From this and other studies we conclude that alternative contraception should be sought in patients who are young or whose relationships appear unsteady at the time of sterilisation request, and that sterilisation at the time of therapeutic abortion should be abandoned in favour of an interval procedure. By so doing we may stem the rising tide of patients who subsequently seek a reversal of their sterilisation.

Adult↗
PubMed1988

Poor maternal weight gain between 28 and 32 weeks gestation may predict small-for-gestational-age infants.

In a retrospective analysis of 158 women considered to have had normal, low-risk pregnancies, 30 gave birth to infants with a birthweight less than the 10th centile for gestation. These 30 women had a significantly poorer mean increase in weight (0.99 kg) between 28 and 32 weeks gestation than the other 128 women (1.95 kg) who gave birth to infants with birthweights above the 10th centile for gestation. There was no statistically significant difference in booking weight, overall weight gain or other variables associated with low birthweight between the two groups of women which suggests that poor maternal weight gain specifically between 28 and 32 weeks gestation may predict small-for-gestational-age infants.

Adult↗