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Biomedical subjects

J F Steege

Publications and source records attributed to J F Steege.

At least 19 recordsLinked to original sources
PubMed2001

Clinical utility of pelvic pain mapping.

STUDY OBJECTIVE: To survey physicians' opinions concerning the impact of pelvic pain mapping on clinical management and surgical decisions. DESIGN: Opinions of physicians based on clinical experience (Canadian Task Force classification III). SETTING: Evening meetings appended to two national meetings. MEASUREMENTS AND MAIN RESULTS: After viewing videotaped interviews, physical examinations, standard laparoscopy, and pelvic pain mapping at laparoscopy in two patients, practicing gynecologists completed questionnaires recording their opinions about the utility of pelvic pain mapping. A second group of gynecologists viewed only one tape. The first group considered pain mapping to be moderately or extremely useful (patient 1, 57.9%; patient 2, 73.7%). Mapping data either made surgeons change the surgical procedure they would have chosen or further clarified the diagnosis (patient 1, 68.4%; patient 2, 84.2%). Of the second group of 67 surgeons, 73% thought that mapping results would have made them change their surgical approach. CONCLUSION: In appropriate cases, pelvic pain mapping during microlaparoscopy under conscious sedation can provide information that may influence surgical decisions as well as general clinical management.

Adult↗
PubMed2001

Hormone replacement improves hemodynamic profile and left ventricular geometry in hypertensive and normotensive postmenopausal women.

BACKGROUND: Postmenopausal estrogen replacement, with or without progestins, has been related to lower cardiovascular risks. OBJECTIVE: We investigated whether the actions of estrogen on vascular resistance contribute to this cardioprotective effect. DESIGN AND METHODS: In a 6-month double-blind study, pre- and post-treatment blood pressure, cardiac index, total vascular resistance index and plasma catecholamine responses during baseline and mental stressors were compared in 69 women (including 19 with mild hypertension but no history of heart disease). Women were randomized to receive either conjugated estrogens alone, estrogens plus medroxyprogesterone, or placebo. RESULTS: Both groups on active hormone replacement showed similar decreases in vascular resistance and modest blood pressure reductions, which differed from the unchanged responses of those on placebo (P< 0.05) after 3 and 6 months of treatment. Hypertensive women showed greater reductions in vascular resistance than normotensives (P< 0.05) and their blood pressure reductions tended to be larger. Women receiving hormone replacement showed increased stroke volume and cardiac index at 6 months, particularly among hypertensives and those receiving medroxyprogesterone (P < 0.05). Hormone replacement was also related to decreases in plasma norepinephrine. Finally, in 33 women receiving hormone replacement, significant 5 and 3% decreases in echocardiographic measures of left ventricular mass index and relative wall thickness were evident at 6 months (P < 0.05), while 20 placebo-treated women showed no reliable echocardiographic improvements (P= NS). CONCLUSIONS: These findings suggest that estrogen-mediated reductions in hemodynamic load on the heart may contribute to the reduced risk of cardiovascular events in relatively healthy postmenopausal women who use hormone replacement.

Adult↗
PubMed2000

Postlaparoscopic cholecystectomy pelvic gallstones associated with chronic pain.

A 23-year-old gravida 1, para 1 woman experienced chronic pelvic pain and cul-de-sac nodularity starting 1 year after laparoscopic cholecystectomy. Repeat laparoscopy revealed numerous clusters of gallstones that were removed, resulting in resolution of her symptoms. Gallstones should be included in the differential diagnosis of the symptomatic patient with a history of cholecystectomy, and surgical records should be carefully reviewed for spillage of stones. It is feasible to remove gallstones laparoscopically.

Adult↗
PubMed1999

Risk adjustment for complications of hysterectomy: limitations of routinely collected administrative data.

OBJECTIVE: We sought to determine the utility of routinely collected administrative data for risk adjustment for complications of hysterectomy. STUDY DESIGN: Using abstracted discharge data on 107, 648 women undergoing hysterectomy in North Carolina from 1988 through 1994, we constructed logistic regression models for the prediction of medical and surgical complications incorporating coded demographic, diagnostic, and procedural data. RESULTS: The overall complication rate was 16%, with surgical complications (11.8%) more common than medical complications (6.7%). Hysterectomy type, teaching hospital status, patient age >/=65 years, and insurance status of Medicaid or no insurance were significantly associated with both medical and surgical complication risk, as were procedures performed for cancer or pregnancy complications. Models that incorporated coded comorbidity were better predictors of medical complications (C = 0.714) than surgical complications (C = 0.630). CONCLUSION: Although surgical complications of hysterectomy are more common than medical complications, risk adjustment methods that use routinely collected administrative data are better at predicting medical complications. Ambiguities in coding, misclassification, and uncoded factors such as disease severity limit the utility of administrative data for risk adjustment for hysterectomy complications.

Adult↗
PubMed1998

A health-related quality-of-life instrument for symptomatic patients with endometriosis: a validation study.

OBJECTIVE: This study was designed to evaluate the reliability, validity, and responsiveness of a newly developed, health-related quality-of-life measure. STUDY DESIGN: A total of 137 women (122 from a Phase III clinical trial and 15 from a private practice setting) with endometriosis completed the questionnaire several times. RESULTS: Reproducibility and internal-consistency reliability were acceptable with intraclass correlation coefficients ranging from 0.94 to 1.00 and Cronbach's alpha coefficients ranging from 0.84 to 0.97. Construct validity was demonstrated on the basis of correlations between items and scales. Health-related quality of life varied in a consistent manner according to clinician-rated measures of pelvic pain and dysmenorrhea and patient-reported levels of endometriosis pain, but no relationship emerged according to the revised American Fertility Society classification. In general, the questionnaire was moderately to highly responsive to change. CONCLUSION: This is the first comprehensive health-related quality-of-life questionnaire available for use with endometriosis patients that has demonstrated reliability, validity, and responsiveness.

Adolescent↗
PubMed1998

Measurement of serosal temperatures and depth of thermal injury generated by thermal balloon endometrial ablation in ex vivo and in vivo models.

OBJECTIVE: To evaluate the safety profile of endometrial ablation performed with a thermal balloon as defined by serosal temperature elevation and depth of injury. DESIGN: Observational study with histopathologic correlation conducted in ex vivo and in vivo phases. SETTING: Academic medical center. PATIENT(S): Twenty patients undergoing total abdominal hysterectomy. INTERVENTION(S): Endometrial ablation with a thermal balloon. MAIN OUTCOME MEASURE(S): Serosal temperature elevation and histologic depth of injury. RESULT(S): Ex vivo phase results revealed serosal temperatures remained within a safe physiologic range (<45 degrees C). Greatest depth of myometrial injury in the premenopausal uteri was 5.8 mm over the anterior lower uterine segment. In postmenopausal uterus. the greatest depth of myometrial injury was 3.8 mm in the anterior midline. In vivo phase results revealed mean (+/- SD) peak serosal temperatures of 36.1 +/- 1.6 degrees C. As with the ex vivo phase. histologic examination revealed deep endometrial and superficial myometrial damage to all areas. The greatest depth of myometrial injury occurred in the midfundus at 3.4 mm. CONCLUSION(S): No patients experienced complications or adverse events secondary to treatment. Results showed that transuterine thermal injury is a highly unlikely scenario. In both phases of this study, histologic examination revealed that temperatures exposed to the endometrial layer were sufficient to cause tissue damage.

Adult↗
PubMed1998

Thermal balloon and rollerball ablation to treat menorrhagia: a multicenter comparison.

OBJECTIVE: To compare the clinical efficacy and safety of a thermal uterine balloon system with hysteroscopic rollerball ablation in the treatment of dysfunctional uterine bleeding. METHODS: Two hundred fifty-five premenopausal women were treated in a randomized multicenter study comparing thermal uterine balloon therapy with hysteroscopic rollerball ablation for the treatment of menorrhagia. Preprocedural and postprocedural menstrual diary scores and quality-of-life questionnaires were obtained. Twelve-month follow-up data are presented on 239 women. RESULTS: Twelve-month results indicated that both techniques significantly reduced menstrual blood flow with no clinically significant difference between the two groups as reflected by return to normal bleeding or less (balloon 80.2% and rollerball ablation 84.3%). Multiple quality-of-life questionnaire results were also similar, including percent of patients highly satisfied with their results (balloon 85.6% compared with rollerball 86.7%). A 90% decrease in diary scores was seen in more than 60% of patients in both groups. Procedural time was reduced significantly in the uterine balloon therapy group. Intraoperative complications occurred in 3.2% of the hysteroscopic rollerball patients, whereas no intraoperative complications occurred in the thermal balloon group. CONCLUSION: In the treatment of dysfunctional uterine bleeding, uterine balloon therapy is as efficacious as hysteroscopic rollerball ablation and may be safer.

Adult↗
PubMed1998

Superior hypogastric block during microlaparoscopic pain mapping.

Pelvic pain mapping during laparoscopy performed under conscious sedation can provide useful information about visceral and somatic sources of chronic pelvic pain. Diagnostic superior hypogastric plexus block can be performed under direct laparoscopic visualization and the pelvis then remapped to determine if painful areas are supplied by hypogastric plexuses. Results of mapping may allow more informed selection of patients for presacral neurectomy.

Adult↗
PubMed1998

A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.

OBJECTIVE: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy. METHODS: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed. RESULTS: Sixty-five women at three institutions underwent laparoscopically assisted vaginal hysterectomy (n = 34) or abdominal hysterectomy (n = 31). Three patients in the laparoscopic group required conversion to abdominal hysterectomy. Mean operating time was significantly longer for laparoscopically assisted vaginal hysterectomy (179.8 versus 146.0 minutes). There were no differences in blood loss or incidence of intraoperative complications. There was a higher incidence of wound complications in the abdominal hysterectomy group, but no significant difference in the frequency of postoperative complications. Laparoscopically assisted vaginal hysterectomy required a significantly shorter mean hospital stay (2.1 days) and convalescence (28.0 days) than abdominal hysterectomy (4.1 days and 38.0 days, respectively). There were no significant differences in mean hospital charges between the study groups (laparoscopic $8161, abdominal $6974). CONCLUSION: Except for operating time, there are no differences between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy regarding intraoperative characteristics among abdominal hysterectomy candidates. Postoperatively, laparoscopically assisted vaginal hysterectomy requires a shorter hospital stay and convalescence. Hospital charges are similar between the procedures. A larger number of cases will help determine the indications for laparoscopically assisted vaginal hysterectomy.

Adult↗
PubMed1997

The association of sexual abuse with pelvic pain complaints in a primary care population.

OBJECTIVE: Our purpose was to determine the prevalence of sexual abuse during childhood and adulthood and its association with pelvic and other pain complaints in a population of reproductive-aged women. STUDY DESIGN: A 10-page questionnaire was administered to 581 nonpregnant women aged 18 to 45 years examined in primary care offices. RESULTS: The reported incidences of childhood and adult sexual abuse were 26% and 28%. In regression analyses, with the exception of irritable bowel syndrome, women with only a history of childhood sexual abuse and no abuse later in life are not more likely than nonabused women to report pain syndromes. By contrast, with the exception of dysmenorrhea, all pain complaints studied were more common in women reporting abuse both as children and as adults. CONCLUSIONS: Sexual abuse that occurs during childhood and again as an adult is strongly associated with pelvic pain complaints.

Adolescent↗
PubMed1997

Office assessment of chronic pelvic pain.

Discussion after the completion of the history and pelvic examination should center on education of the patient and her family about the multifactorial nature of chronic pain, and hence the necessity to use multiple treatment methods. The previously described detailed nature of the examination will help the clinician in directing further diagnostic and treatment efforts, as well as in making referrals.

Chronic Disease↗
PubMed1996

The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices.

OBJECTIVE: To determine the prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in a clinical population of reproductive-age women. METHODS: A ten-page questionnaire was administered to a consecutive sample of women age 18-45 years who were approached in the waiting areas of two obstetrics and gynecology practices and three family medicine practices in central North Carolina. Of 701 women approached to fill out the questionnaire, 581 (83%) returned completed forms suitable for analysis. RESULTS: The reported prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome was 90, 46, 39, and 12%, respectively. Low income was found to be a risk factor for dysmenorrhea and dyspareunia, and African-American race was found to be a risk factor for pelvic pain. Pelvic pain was also more common among women 26-30 years old. Otherwise, dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome were not associated with age, parity, marital status, race, income, or education. CONCLUSION: Dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome are common complaints among women of reproductive age and are not consistently associated with demographic risk factors. Therefore, inquiry about these pelvic pain complaints should be a routine part of health care for women.

Adolescent↗
PubMed1996

Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.

OBJECTIVE: To determine the prevalence of chronic pelvic pain in U.S. women aged 18-50 years, and to examine its association with health-related quality of life, work productivity, and health care utilization. METHODS: In April and May 1994, the Gallup Organization telephoned 17,927 U.S. households to identify women aged 18-50 years who experienced chronic pelvic pain, ie, of at least 6 months' duration. Those who reported chronic pelvic pain were surveyed on severity, frequency, and diagnosis; quality of life; work loss and productivity; and health care utilization. RESULTS: Among 5263 eligible women who agreed to participate, 773 (14.7%) reported chronic pelvic pain within the past 3 months. Those who reported chronic pelvic pain had significantly lower mean scores for general health than those who did not (70.5 versus 78.8,P<.05), and 61% of those with chronic pelvic pain reported that the etiology was unknown. Women diagnosed with endometriosis reported the most health distress, pain during or after intercourse, and interference with activities because of pain. Estimated direct medical costs for outpatient visits for chronic pelvic pain for the U.S population of women aged 18-50 years are $881.5 million per year. Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity. CONCLUSION: Frequently, the cause of chronic pain is undiagnosed, although it affects approximately one in seven U.S. women. Increased awareness of its cost and impact on quality of life should promote increased medical attention to this problem.

Adolescent↗
PubMed1994

Repeated clinic laparoscopy for the treatment of pelvic adhesions: a pilot study.

OBJECTIVE: To evaluate the safety and feasibility of repeat outpatient laparoscopy following laparoscopic lysis of extensive pelvic adhesive disease in a standard operating room setting. METHODS: In a pilot study, eight patients with chronic pelvic pain associated with severe pelvic and abdominal adhesive disease underwent standard operative laparoscopic adhesiolysis. Tenckhoff catheters were placed in the abdominal wall during the procedure to allow repeat laparoscopy in an outpatient clinic setting with a 2-mm laparoscope. Successful adhesiolysis was documented in follow-up laparoscopy with the Optical Catheter System, performed 3 months later in four patients. RESULTS: Laparoscopy via the Tenckhoff catheters was accomplished in 26 of 32 attempts (81.3%). One patient had re-forming adhesions lysed with the Optical Catheter System. Simultaneous vaginal ultrasound enhanced visualization of the cul-de-sac. CONCLUSIONS: Outpatient clinic laparoscopy with a 2-mm laparoscope may prove practical for general diagnostic purposes. If validated in controlled trials with larger populations, the procedure may be an effective treatment of pelvic adhesive disease.

Adult↗
PubMed1993

The effects of aerobic exercise on premenstrual symptoms in middle-aged women: a preliminary study.

The effects of aerobic exercise and strength training on premenstrual symptoms were evaluated in 23 healthy premenopausal women. Premenstrual symptoms were assessed at baseline and following 3 months of exercise participation. Women who engaged in aerobic exercise significantly increased their aerobic capacity, while the women who participated in non-aerobic exercise did not. Results showed that while participation in both exercise conditions was associated with general improvement in many premenstrual symptoms, subjects in the aerobic exercise group improved on more symptoms, especially premenstrual depression.

Depression↗