PubMed Health⌕ Search

Biomedical subjects

J C Winters

Publications and source records attributed to J C Winters.

At least 19 recordsLinked to original sources
PubMed2003

Neck mobility measurement by means of the 'Flock of Birds' electromagnetic tracking system.

OBJECTIVE: To establish the accuracy and reliability of a six-degrees-of-freedom electromagnetic tracking device, the "Flock of Birds", for measuring neck rotations and to identify the main sources of error. DESIGN: Ten human subjects made the same types of maximal neck rotation, both actively and passively: axial rotation in neutral position, from a flexed position and from an extended position, flexion/extension and lateral flexion. The same movements were mimicked in a 'dummy head' set-up. METHODS: One Flock of Birds receiver was mounted on the thorax, one on the head. By means of a third receiver, mounted on a stylus, bony landmarks on head and thorax were palpated. These served to define two anatomically based local coordinate systems, to which the rotations were referred. RESULTS: Measurements were accurate with a maximal measurement error of 2.5 degrees. No significant difference between active and passive rotation was seen. The intra-subject variation was low within the same session, SD between 2 degrees and 4 degrees. Between sessions the variability was considerable, SD between 5 degrees and 16 degrees. CONCLUSION: The Flock of Birds method is reliable and sufficiently precise. The variability in measured range of motion between sessions is a point of concern in interpreting follow-up studies in patients. RELEVANCE: A reduced range of neck motion is a major complaint in pathologies of the cervical spine or the shoulder. A method is described in which neck rotations are related to well-defined bony landmarks. In combined rotations, e.g. flexion combined with axial rotation, the measured range of motion can sometimes fluctuate strongly (up to 30 degrees ) between measurements, without apparent pathology.

Adult↗
PubMed2001

Transabdominal approach to repair of vaginal vault prolapse.

PURPOSE: To review the preoperative evaluation of women with vaginal vault prolapse and describe the surgical methods of treatment using a transabdominal approach. METHODS: Abdominal sacral colpopexy is the most widely performed method of transabdominal correction of vaginal vault prolapse. The procedure is completed by securing the apex to the vagina to the periosteum of the sacrum with mesh. This procedure is demonstrated in great detail. Successful repair can be achieved by other transabdominal approaches and by laparoscopic approaches. RESULTS: Twenty women (mean age 67.9 years) were evaluated for complex pelvic floor prolapse. Six (30.0%) patients had failed transvaginal sacrospinus ligament fixation. Abdominal sacrocolpopexy utilizing Marlex mesh, Halban culdeplasty, and paravaginal repair was performed on all patients. Five posterior repairs and one anterior repair was done. The average operating time for the colpopexy and enterocele repair alone is approximately 90 minutes. The average blood loss was 284 cc. The average hospital stay was 3.7 days. The mean follow-up is 11.3 months (6-27 months). The vaginal vault is well supported in all patients with no recurrent enterocele or vault prolapse. Three patients have asymptomatic grade II cystoceles, and three patients have asymptomatic grade II rectoceles. There were few complications. No mesh complications have been encountered. CONCLUSIONS: Vaginal vault prolapse can be a difficult problem to diagnose and treat. Successful treatment requires thorough knowledge of the anatomy, methods of diagnosis, and treatment options. The abdominal sacrocolpopexy achieves excellent correction of vaginal vault prolapse with minimal morbidity.

Abdomen↗
PubMed2001

Colpocleisis for the treatment of vaginal vault prolapse.

Most females with total vault prolapse undergo reconstructive procedures to restore normal anatomy and function; however, elderly patients who no longer desire sexual intercourse or are medically unstable can be treated effectively with a vaginal closure or colpocleisis. The traditional approach to colpocleisis has been to simply invert the vagina using pursestring sutures after removing the vaginal mucosa. Although simple to perform, after repairing referred treatment failures who used this approach, we began to use a different approach that emphasizes the strength of an anterior repair and extensive posterior repair that then is sutured together. This vaginal closure is reinforced with a strong perineorrhaphy. This multicompartment colpocleisis was performed in 38 elderly females (mean age 77, range 68 to 88) with total vault prolapse. No treatment failures were noted with a mean follow-up of 24 months (range 3 to 52 months), and all patients were satisfied with the results of the procedure. No significant complications occurred, and no patient has regretted the loss of sexual function. The aim of this article is to discuss the indications, procedural aspects, and results of performing a multicompartment colpocleisis and partial colpocleisis for total vault prolapse in elderly females.

Aged↗
PubMed2000

Abdominal sacral colpopexy and abdominal enterocele repair in the management of vaginal vault prolapse.

Vaginal vault prolapse and enterocele represent challenging forms of female pelvic organ relaxation. These conditions are most commonly associated with other pelvic organ defects. Proper diagnosis and management is essential to achieve long-term successful outcomes. Physical examination should be carried out in the lithotomy and standing positions (if necessary) in order to detect a loss of vaginal vault support. With proper identification of the vaginal cuff, one should assess the degree of mobility of the vaginal cuff with a Valsalva maneuver. If there is significant descent of the vaginal cuff, vaginal vault prolapse is present, and correction should be considered. The abdominal sacral colpopexy is an excellent means to provide vaginal vault suspension. This procedure entails suspension of the vaginal cuff to the sacrum with fascia or synthetic mesh. This procedure should always be accompanied by an abdominal enterocele repair and cul-de-sac obliteration. In addition, many patients require surgical procedures to correct stress urinary incontinence, which is either symptomatic or latent (occurs postoperatively after prolapse correction). Complications include: mesh infection, mesh erosion, bowel obstruction, ileus, and bleeding from the presacral venous complex. If the procedure is carried out using meticulous technique, few complications occur and excellent long-term reduction of vaginal vault prolapse and enterocele are achieved. The purpose of this article is to review the preoperative evaluation of women with pelvic organ prolapse, and provide a detailed description of the surgical technique of an abdominal sacral colpopexy.

Aged↗
PubMed2000

Use of bone anchors in female urology.

Stress urinary incontinence remains one of the most prevalent conditions encountered by urologists. In many cases, surgical correction of this condition is carried out using a pubovaginal sling procedure. Bone anchors were initially used in transvaginal needle suspension procedures to improve stabilization of the bladder neck. This technology has been extended to sling procedures, allowing completion of these procedures by an entirely transvaginal approach. Early results of these procedures are encouraging, and overall morbidity appears much less when compared with conventional pubovaginal sling procedures. In this article, the application of bone anchors in female urology is reviewed. Techniques of pubovaginal sling and abdominal sacrocolpopexy using bone anchors and potential complications of bone anchor implantation are discussed. Surgeons performing procedures for the treatment of stress incontinence should be aware of the benefits and potential risks of bone anchor implantation.

Bone Nails↗
PubMed2000

Comparison of biomechanical properties of periosteal suture fixation and bone anchor fixation to the pubic bone.

OBJECTIVES: To compare the relative strength of fixation using bone anchors (BAs) compared with direct suture placement into the periosteum. METHODS: The anterior bony pelvis was harvested from 21 female cadavers. In each pelvis, BA suture fixation was performed using Cinch anchors on one side of the pubic bone and direct periosteal suture fixation (PSF) on the contralateral side of the same pelvis. We used No. 1 polyproprolene suture for all cases. Using a hydraulic mechanical testing machine, all specimens were loaded in uniaxial tension until failure. RESULTS: Failure modes for BA-fixed pelves were as follows: 11 BA pull-out, 1 midsuture failure, and 9 suture cut by BA. Failure modes for the PSF pelves were as follows: 6 suture pull-outs through the bone, 14 midsuture failures, and 1 suture cut at the bone. PSF pelves required significantly higher loads to induce failure compared with BA pelves (PSF 92.63 +/- 22.62 N, BA 71.32 +/- 19.76 N, P <0.0002). In many cases, both PSF and BA were adequate points of fixation, and the major mechanism of failure was suture rupture. In pelves with suture failure, the load to induce failure was significantly higher in the PSF group (PSF 105.06 +/- 12.55 N, BA 86.06 +/- 7.78 N, P <0.0025). When the suture failed, PSF was better because BA fixation actually broke some sutures. The load required to induce failure was higher in the PSF groups in 19 (90.5%) of 21 pelves. CONCLUSIONS: Biomechanical testing using permanent monofilament suture did not demonstrate a superiority of BA suture fixation to PSF fixation. PSF appears superior, since BAs induced suture failure in many cases.

Biomechanical Phenomena↗
PubMed2000

Collagen injection therapy in elderly women: long-term results and patient satisfaction.

OBJECTIVES: To evaluate long-term results and patient satisfaction using collagen injection therapy in elderly women. METHODS: Periurethral injection of collagen using local anesthesia was performed on 58 women 65 years old or older (range 65 to 86, mean 73. 2) to treat stress urinary incontinence. All patients underwent urodynamic evaluation. Forty-nine patients (84.5%) had intrinsic sphincteric deficiency; 9 patients (15.5%) had genuine stress urinary incontinence. Twenty-one patients (36.2%) had no urethral hypermobility using Q-tip testing, and 37 (63.8%) had urethral hypermobility. RESULTS: At 2 months after injection, the initial response was assessed: 28 patients (48.3%) were totally dry and 18 (31.0%) were socially continent. Therapy was unsuccessful in 12 (20. 7%). To achieve continence, 1 to 4 injections (mean 1.9) were required. The average total volume to achieve success was 14.6 mL. No significant differences were observed in outcome, volume injected, or number of injections in patients with versus without urethral hypermobility. At a mean follow-up of 24.4 months (range 8 to 43), of the 46 patients who achieved continence, 19 (41.3%) developed recurrent leakage and required reinjection. The average interval to recurrence was 7.9 months (range 2 to 16). Of the 19 patients reinjected, only 8 (42.1%) regained continence. The long-term success rate after repeated injections was 35 (60.3%) of 58. An independent examiner contacted 40 patients for telephone interview. To date, 25 of the patients contacted noted a moderate or maximal level of symptom improvement, and 18 reported continued improvement in quality of life. Thirty-six patients noted minimal difficulty with the procedure, and 34 would recommend the treatment. CONCLUSIONS: Collagen is a safe, moderately effective alternative to manage stress urinary incontinence in elderly women. Elderly patients should be counseled that approximately 40% will experience recurrent leakage, which may not resolve with reinjection.

Aged↗
PubMed1999

The long-term course of shoulder complaints: a prospective study in general practice.

OBJECTIVE: Assessment of the long-term course of shoulder complaints in patients in general practice with special focus on changes in diagnostic category and fluctuations in the severity of the complaints. DESIGN: Prospective descriptive study. SETTING: Four general practices in The Netherlands. METHOD: All patients (101) with shoulder complaints seen in a 5 month period were included. Assessment took place 26 weeks and 12-18 months after inclusion in the study with a pain questionnaire and a physical examination. RESULTS: A total of 51% of the patients experienced (mostly recurrent) complaints after 26 weeks and 41% after 12-18 months. Diagnostic changes were found over the course of time, mostly from synovial disorders towards functional disorders of the structures of the shoulder girdle, but also the other way round. Although 52 of the 101 patients experienced complaints in week 26, 62% of those patients considered themselves 'cured'. After 12-18 months, 51% of the 39 patients experiencing complaints felt 'cured'. CONCLUSION: Many patients seen with shoulder complaints in general practice have recurrent complaints. The nature of these complaints varies considerably over the course of time, leading to changes in diagnostic category. Because of the fluctuating severity of the complaints over time, feeling 'cured' or not 'cured' is also subject to change over time.

Adult↗
PubMed1998

[Shoulder complaints in family practice; a simple approach].

In two patients with shoulder complaints, a man aged 56 years and a woman aged 43, the function of the shoulder girdle (structures of the cervical spine, the upper thoracic spine and the upper ribs) played an important role. A simple classification of shoulder complaints is presented in which the influence of the shoulder girdle is recognized: (a) synovial disorder: complaints originating from the structures of the glenohumeral joint, the subacromial space, the acromioclavicular joint or combinations of these, (b) shoulder girdle disorder: the complaints are caused by functional problems in the structures of the shoulder girdle, (c) combination disorder: both a synovial disorder and a functional disorder of the structures of the shoulder girdle are causing the complaints, making it impossible to determine which structure is the primary cause. Considering the limited therapeutic choices (at first nonsteroidal antiinflammatory drugs, followed in case of persistent complaints by injections of analgesics and corticosteroids for synovial complaints, or manipulative therapy for shoulder girdle complaints), a more detailed classification is not needed to determine a successful therapeutic strategy.

Acromioclavicular Joint↗
PubMed1998

Urodynamic findings in postprostatectomy incontinence.

Due to the large variability in the reported contribution of bladder dysfunction to postprostatectomy incontinence and the impact this dysfunction may have on the outcome of selected treatment, we retrospectively reviewed the videourodynamic findings of bladder and sphincteric function in patients with postprostatectomy incontinence. The contributions of bladder and sphincteric causes of incontinence are determined. Ninety-two patients had multichannel videourdynamic testing performed as part of a comprehensive evaluation for incontinence at least 1 year after prostatectomy. Using a 6-French double-lumen catheter in the bladder and a 10-French catheter in the rectum, all pressures were recorded continuously while in the upright position. Valsalva leak point pressures (VLPP) were measured in the absence of a bladder contraction at a 150-ml volume and at 50-ml increments thereafter until maximum functional capacity was reached. Bladder compliance and bladder capacity were determined and the presence of detrusor instability (DI) was documented. Sixty-five patients (71%) presented after radical prostatectomy (RP) and 27 patients (29%) after transurethral resection of the prostate (TURP). The predominant urodynamic finding was sphincteric incompetence as VLPP were obtained in 85 patients (92%) and ranged from 12 to 120 cm water. DI was a common finding, occurring in 34 patients (37%), and classified as follows: a) phasic instability in 22/34, b) tonic instability in 3/34, and c) mixed phasic and tonic instability in 9/34. However, we found DI to be the sole cause of incontinence in only 3/92 patients (3.3%). There was no statistically significant difference in the incidence of sphincteric incompetence after RP or TURP; however, TURP patients had a higher incidence of DI, which was statistically significant (P=0.019). There was no correlation of incontinence severity and VLPP when comparing preoperative pad usage to VLPP < or =70 or > or =71 cm water. Although bladder dysfunction may be contributing problem in patients with postprostatectomy incontinence, it is rarely the only mechanism for this disorder. VLPP does not correlate with incontinence severity. Although sphincteric incompetence is the most common mechanism contributing to incontinence after prostatectomy, bladder dysfunction may coexist or be an isolated cause of postprostatectomy incontinence. Therefore, urodynamic studies are important to illustrate the exact cause(s) of incontinence in each individual patient after prostatectomy.

Aged↗
PubMed1998

Collagen injection therapy for post-prostatectomy incontinence.

PURPOSE: Post-prostatectomy incontinence has an incidence of 5 to 12% and greatly affects quality of life. Since the approval of glutaraldehyde cross-linked collagen there is a renewed interest in injectable urethral bulking agents. We investigated the long-term efficacy and prognostic criteria for transurethral collagen injection therapy for men with post-prostatectomy incontinence. MATERIALS AND METHODS: From November 1993 to May 1995, 62 men with post-prostatectomy incontinence (54 after radical prostatectomy and 8 after transurethral resection of the prostate) were treated with collagen via a transurethral approach. Median followup was 29.0 months from the date of the last injection procedure. RESULTS: Social continence was defined as dry or minimal leakage requiring at most 1 pad daily with activity. Of 62 patients 38.7% achieved social continence and 8.1% became totally dry. The success rate was 35.2 for radical prostatectomy versus 62.5% for transurethral prostatic resection patients. Of the patients who achieved social continence with at least 1-year followup 23 (60.9%) remained so with no further treatment. At 2-year followup 21 patients (42.8%) maintained social continence. The success rate was 27.3% for those who wore a penile clamp or condom catheter before treatment (3 of 11 patients), and only 21.4% for those who underwent transurethral incision of a bladder neck contracture (3 of 14). A median of 4 injection procedures and 20.0 ml. collagen were required to achieve social continence. CONCLUSIONS: Transurethral collagen injection therapy is a reasonable treatment option for post-prostatectomy incontinence in select patients in whom more conservative therapy has failed. However, patients who have required a penile clamp, experienced continuous leakage or undergone transurethral incision of a bladder neck contracture are unlikely to respond well to this treatment.

Activities of Daily Living↗
PubMed1997

Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study.

OBJECTIVE: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice. DESIGN: Randomised, single blind study. SETTING: Seven general practices in the Netherlands. SUBJECTS: 198 patients with shoulder complaints, of whom 172 were divided, on the basis of physical examination, into two diagnostic groups: a shoulder girdle group (n = 58) and a synovial group (n = 114). INTERVENTIONS: Patients in the shoulder girdle group were randomised to manipulation or physiotherapy, and patients in the synovial group were randomised to corticosteroid injection, manipulation, or physiotherapy. MAIN OUTCOME MEASURES: Duration of shoulder complaints analysed by survival analysis. RESULTS: In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%). CONCLUSIONS: For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.

Anesthetics, Local↗
PubMed1997

The course of pain and the restriction of mobility in patients with shoulder complaints in general practice.

The objective of this research was to study the course of the pain and the restriction of mobility of the scapulohumeral joint (ROM) over time, and the factors influencing it, in patients with shoulder complaints in general practice. A total of 101 patients participated in this 25-week follow-up study. For the first 2 weeks, a non-steroidal anti-inflammatory drug (NSAID) was prescribed, after that period the physician could follow his usual therapeutic approach. The NSAIDs prescribed during the first 2 weeks resulted in a rapid decrease in the pain and the ROM. The group with the most severe pain consumed the most tablets, which resulted in a significant decrease in the pain and the ROM. It appeared that the course of the pain from week 2 to week 8 was significantly influenced by pain at inclusion, diagnosis and therapy. The most rapid decrease in the ROM appeared in the first 2 weeks. At week 0 and week 2, differences, in the ROM were seen in the subgroups for diagnosis pain score and age. The pain and the ROM showed most decrease in the first weeks. After 6 weeks hardly any changes were seen in the pain score and the ROM score. The margin of the pain score and the ROM score between the "cured" and the "not cured" patients was a very narrow one.

Adult↗
PubMed1997

Classification of shoulder complaints in general practice by means of cluster analysis.

OBJECTIVE: To determine if a classification of shoulder complaints in general practice can be made with a cluster analysis of variables of medical history and physical examination. METHOD: One hundred one patients with shoulder complaints were examined upon inclusion (week 0) and after 2 weeks. Eleven variables of the medical histories and 19 variables of the physical examinations were used for the analysis. RESULTS: The analyses of week 0 and week 2 reveal three stable clusters: one cluster with almost half of the patients who hardly had limitations in the range of scapulohumeral mobility (ROM), one cluster with a small number of patients with a short history of complaints and a limitation of scapulohumeral mobility in all directions (7 and 6, respectively), and a third cluster containing the rest of the patients, with 30% to 50% limitation in ROM. The degree of limitation in ROM decreased after 2 weeks. Comparison of the patients in the clusters of week 0 and week 2 revealed a shift of patients within the clusters, although the number of patients in the clusters remained almost constant. CONCLUSION: Only three stable clusters could be identified, which questions the suitability of more detailed classifications, such as described by Cyriax or the Dutch Guidelines for Shoulder Complaints, for the diagnosis of patients with shoulder complaints in general practice.

Adult↗
PubMed1997

Collagen injection therapy for female intrinsic sphincteric deficiency.

PURPOSE: Since glutaraldehyde cross-linked collagen was approved for use, studies have reported success or improved rates of 63 to 86%. Long-term efficacy with strictly defined outcome criteria has not been reported. We report our experience with collagen injection therapy for female patients with intrinsic sphincteric deficiency to establish efficacy, duration of response and clinical predictors of success. MATERIALS AND METHODS: A total of 96 women underwent collagen injection via a periurethral approach with local anesthesia. In all patients history, physical examination and video urodynamics documented intrinsic sphincteric deficiency without urethral hypermobility. Continence success was defined as dry or socially continent (minimal leakage requiring 1 or no pad daily even with strenuous activity). Median followup was 14.0 months. RESULTS: Of 94 patients 67.0% achieved continence, 38.3% became dry and 28.7% became socially continent. Of 35 patients who achieved continence with at least 1 year of followup 6 had regression. Therefore, 82.9% of those successfully treated remained so at 1 year and none had de novo detrusor instability. An average of 2.1 procedures and 11.9 ml. collagen were required to achieve continence. The 31 patients not achieving success underwent an average of 3.2 procedures with 16.1 ml. collagen. No major complications have occurred to date. CONCLUSIONS: Collagen injection achieves a reasonable rate of continence and good durability at 1 year of followup in female patients with intrinsic sphincteric deficiency and no urethral hypermobility.

Aged↗