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Biomedical subjects

John F Steege

Publications and source records attributed to John F Steege.

18 recordsLinked to original sources
PubMed2006

Identification of diagnostic subtypes of chronic pelvic pain and how subtypes differ in health status and trauma history.

OBJECTIVE: Our primary aim was to identify subtypes of chronic pelvic pain and to compare the cases of women with the identified subtypes on health status and trauma history. We hypothesized that women with diffuse abdominal/pelvic pain would have greater health impairment and report more lifetime trauma than women with vulvovaginal pain or cyclic pain. STUDY DESIGN: We collected questionnaire data on 289 consecutive women patients from a university chronic pelvic pain clinic. From patient records, 1 gynecologist identified chronic pelvic pain subtypes on the basis of reported symptoms and the localization of pain during examination. We used analysis of covariance with pairwise contrasts. RESULTS: Seven diagnostic subtypes were identified. Patients with diffuse abdominal/pelvic pain had more trauma and worse mental and physical health status compared with patients with vulvovaginal pain and cyclic pain. Those patients with abdominal/pelvic pain also had poorer health than patients with neuropathic and fibroid pain. Endometriosis was unrelated to health status. CONCLUSION: There is immense need for further research to define subtypes of chronic pelvic pain.

Adolescent↗
PubMed2006

Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic.

OBJECTIVE: The purpose of this study was to describe long-term outcomes for women with chronic pelvic pain (CPP) after evaluation in a CPP specialty clinic. STUDY DESIGN: This was a prospective observational cohort study of women treated for CPP at the UNC Pelvic Pain clinic between 1993 and 2000. The primary outcome was improvement in pain and the main exposure was treatment group: primarily medical (pharmacotherapy, psychotherapy, physical therapy, or combinations of the 3) or surgical (hysterectomy, resection or ablative procedures, oophrectomy, diagnostic surgery, pain mapping, vulvar or vestibular repair). Univariate, bivariate, and multivariable analyses were performed to look for relationships between background characteristics, treatment group, and improvement in pain. RESULTS: Of 370 participants; 189 had surgical treatment and 181 had medical treatment. One year after evaluation, 46% reported improvement in pain and 32% improvement in depression. Improvement in pain was similar in both treatment groups and odds of improvement were equal even after adjusting for background characteristics, psychosocial comorbidity, and previous treatments. CONCLUSION: One year after evaluation in a CPP specialty clinic, women experienced modest improvements in pain and depression after recommended surgical or nonsurgical treatment.

Adolescent↗
PubMed2006

Too soon, too late, too often, too seldom?

Many variables determine the appropriate timing of diagnostic laparoscopy for suspected endometriosis. When initial treatments fail to relieve pain attributed to endometriosis, more detailed assessment is often indicated rather than escalation of treatment.

Adult↗
PubMed2006

Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic.

OBJECTIVE: To determine the prevalence of 2 musculoskeletal pain disorders among women presenting to a referral chronic pelvic pain clinic. STUDY DESIGN: This was a retrospective, cross-sectional study of 987 women (aged 14-79) presenting for evaluation from 1993 to 2000 at a university-based gynecologic chronic pelvic pain clinic. RESULTS: At the initial visit, all women completed standardized interviews and underwent a pelvic examination. Single-digit palpation of the levator ani and piriformis muscles was performed intravaginally. Among these women, 212 of 955 (22%) had tenderness of the levator ani muscles, while 128 of 943 (14%) had tenderness of the piriformis muscle (pain score > 3 of 10 on a visual analogue scale). Both levator ani tenderness and piriformis tenderness were associated with a higher total number of pain sites, previous surgery for pelvic pain, Beck Depression Inventory score, McGill Pain Inventory score and pain worsened with bowel movements (p < 0.05). CONCLUSION: Piriformis and levator ani pain are present in a significant proportion of female chronic pelvic pain patients. Further research into the natural course, diagnosis and treatment of pelvic musculoskeletal pain is needed to determine its true contribution to chronic pain.

Adolescent↗
PubMed2005

Preoperative ultrasound to predict infraumbilical adhesions: a study of diagnostic accuracy.

OBJECTIVE: The purpose of this study was to determine the test characteristics of preoperative abdominal ultrasound in predicting infraumbilical adhesions in women. STUDY DESIGN: This was a diagnostic test study of 60 women at risk for intra-abdominal adhesions undergoing laparoscopy or vertical laparotomy. Participants underwent periumbilical sonographic measurement of visceral slide (longitudinal movement of the viscera during a cycle of respiration). RESULTS: Prevalence of infraumbilical bowel adhesions was 12%. A visceral slide threshold <1 cm to predict adhesions had sensitivity = 86%, specificity = 91%, positive predictive value = 55%, and negative predictive value = 98%. On stratifying visceral slide (<0.8 cm, > or =0.8 and <1 cm, and > or =1 cm), the likelihood ratios for detecting adhesions were 15.1, 5.0, and 0.2, respectively. CONCLUSION: Measuring visceral slide improves preoperative prediction of both presence and absence of bowel adhesions in patients with previous abdominal operations or infection; this technique may assist in avoiding iatrogenic bowel injury.

Adult↗
PubMed2005

Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain.

OBJECTIVE: We sought to describe irritable bowel syndrome (IBS) treatment among women with chronic pelvic pain. STUDY DESIGN: We performed a cross-sectional study of new chronic pelvic pain patients between 1993 and 2000 (n = 987). IBS was defined by Rome I criteria. IBS treatment was defined as lower gastrointestinal drugs or referral. Analyses were descriptive and multivariable. RESULTS: IBS occurred in 35% of patients. In the highest quartile of pain, women with IBS were not more likely to have IBS treatment initiated. In the lowest three quarters of pain, women with IBS were 5.08 times more likely to have IBS treatment initiated. IBS was not diagnosed 40% of the time. IBS treatments were not recommended to 67% of patients with IBS. More than 35% of patients were prescribed narcotics. CONCLUSION: IBS is not consistently diagnosed and treated even in a pelvic pain clinic. Yet, treatment of IBS may reduce the overall abdominal pain of these patients.

Adult↗
PubMed2005

Musculoskeletal causes of chronic pelvic pain: a systematic review of existing therapies: part II.

UNLABELLED: Chronic pelvic pain is a common clinical problem with many causes. In addition to gynecologic causes, it is important to evaluate other potential etiologies, including the pelvic musculoskeletal system. There have been few published studies on musculoskeletal causes of pelvic pain and its treatment. The objective of this study was to evaluate treatment of pelvic musculoskeletal pain among women with chronic pelvic pain. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Additional articles were sought by discussion with a clinician specializing in this field and review of relevant textbook bibliographies. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain outcome measure. Each report must have described at least four patients. For each selected article, two investigators separately summarized pertinent data on study characteristics, patient profiles, intervention characteristics, and treatment outcomes. Discrepancies were resolved by discussion. Twenty-nine treatment studies met entry criteria. The existing literature largely consists of retrospective, uncontrolled observational studies. The two studies that feature control groups lack sufficient size and scope to allow generalizability. Properly designed and executed randomized, controlled trials are urgently needed to determine the true effectiveness of treatments for pelvic musculoskeletal pain. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the current data on musculoskeletal causes of chronic pelvic pain, to outline the various techniques used to treat musculoskeletal causes of chronic pelvic pain, and to recall the lack of evidence based data on the subject and need for randomized controlled trials.

Adult↗
PubMed2005

Musculoskeletal causes of chronic pelvic pain: a systematic review of diagnosis: part I.

UNLABELLED: Chronic pelvic pain in women has multifactorial etiology, but pelvic musculoskeletal dysfunction is not routinely evaluated as a cause by gynecologists. Whether diagnostic tests can reliably identify women with such conditions is unclear. The objective of this study was to determine the level of support in the literature for diagnostic tests of pelvic musculoskeletal problems. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain diagnostic test. Relevant bibliographies were also searched, and outside consultation with a pain researcher was sought to identify additional needed studies. For each selected article, 2 investigators separately summarized relevant data on study characteristics, patient profiles, and test efficacy. Discrepancies were resolved by discussion. Six diagnostic studies were identified that met entry criteria. No gold standard diagnostic tests exist for pelvic musculoskeletal problems, and the methodologic quality of available studies is low. Studies defining such clinically useful tests are needed to further refine a rational approach to chronic pelvic pain management. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the paucity of evidence-based literature and valid consensus of diagnostic criteria and modalities in defining the musculoskeletal causes of chronic pelvic pain in women, to recall that there is no gold standard diagnostic test for pelvic musculoskeletal problems, and to recall that the statistical evaluation of the methods described were wanting.

Chronic Disease↗
PubMed2004

Cardiovascular effects of 6 months of hormone replacement therapy versus placebo: differences associated with years since menopause.

OBJECTIVE: In response to post-Women's Health Initiative dialog regarding individualized hormone replacement therapy (HRT), this study evaluates cardiovascular and neuroendocrine effects of HRT versus placebo in postmenopausal women grouped according to time since menopause. STUDY DESIGN: Resting and stress blood pressure (BP), hemodynamic, plasma catecholamine, and cholesterol levels were obtained in 69 women randomly assigned to placebo or active HRT in a 6-month double-blind study. Analyses evaluated if treatment effects differed among those postmenopausal less than 5 years versus 5 years or more. RESULTS: Compared with the placebo-treated and HRT > or =5 groups, the HRT < 5 group showed reduced BP (P<.0007) and trends toward reduced vascular resistance and norepinephrine (P<.07). HRT > or =5 group generally did not differ from placebo. CONCLUSION: Reduced BP and sympathetic tone are evident in some HRT users, with diminishing benefit after the initial postmenopausal years. Time since menopause may be an important consideration in making individualized patient treatment decisions.

Adult↗
PubMed2004

Obesity: physiologic changes and challenges during laparoscopy.

OBJECTIVE: The purpose of this report was to describe the evidence for the benefits of laparoscopic surgery in obese patients, to review the physiologic abnormalities that are associated with obesity, and to explore surgical techniques that will enable surgeons to perform laparoscopy successfully in obese patients. STUDY DESIGN: This article is a review of the available literature on obesity, the physiologic changes that occur in obese patients, and the impact of these changes on laparoscopy outcomes. RESULTS: Obesity is associated with sudden death and a wide range of morbid conditions such as hypertension, atherosclerosis, angina, chronic obstructive disease, and diabetes mellitus. Recent studies have demonstrated that obese patients who undergo laparoscopy have shorter hospital stays, less postoperative pain, and fewer wound infections when compared with obese patients who undergo laparotomy. Laparoscopy patients also have fewer postoperative ileus and fevers. CONCLUSION: With thorough preparation and careful preoperative evaluation, laparoscopy can be performed safely and is the preferred surgical method in obese patients.

Adipose Tissue↗
PubMed2004

The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain.

Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic pain. In the evaluation of chronic pelvic pain, laparoscopic techniques vary from conservative procedures, such as pain mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic pain.

Female↗
PubMed2004

Documenting the current definitions of chronic pelvic pain: implications for research.

OBJECTIVE: We examined chronic pelvic pain definitions used in published research, because the definition has direct implications for investigating causation and evaluating treatment. DATA SOURCES: MEDLINE was searched for published articles in an Abridged Index Medicus journal from 1966 to 2001, restricted to humans, females, and English language. "Chronic pelvic pain" was used as a keyword. METHODS OF STUDY SELECTION: We reviewed 101 abstracts of publications of chronic pelvic pain. Forty-three articles met the criteria of human, female, English language, chronic pelvic pain, and use of an experimental, cohort, case-control, or cross-sectional study design. TABULATION, INTEGRATION, AND RESULTS: The following were not explicitly specified in the chronic pelvic pain definitions in these articles: duration of pain in 44%, restriction by pathology in 74%, location of pain in 93%, restriction by comorbidity in 95%, and additional inclusion/exclusion criteria in 65%. CONCLUSION: We conclude that an explicit chronic pelvic pain definition is not used for research of this population. The use of a poor operational chronic pelvic pain research definition reduces the ability to investigate causation and improve treatment of this condition.

Chronic Disease↗
PubMed2004

Prevalence and characteristics of irritable bowel syndrome among women with chronic pelvic pain.

OBJECTIVE: We sought to evaluate whether there are unique characteristics associated with irritable bowel syndrome (IBS) within a population that has chronic pelvic pain. METHODS: This cross-sectional study of new referral patients attending a pelvic pain clinic between 1993 and 2000 (N = 987) evaluated characteristics associated with IBS at entry to the clinic. The characteristics that we evaluated included demographic characteristics, clinical diagnoses, history of abuse, depression, pain, and prior abdominal surgeries. RESULTS: Thirty-five percent of chronic pelvic pain patients had IBS defined by Rome I criteria. Age 40 years or older (odds ratio [OR] = 1.98, 95% confidence interval [CI]: 1.27, 3.11), muscular back pain (OR = 5.37, 95% CI: 0.98, 29.29), Symptom Checklist-90 global index score in top quartile (OR = 1.77, 95% CI: 1.09, 2.86), depression (OR = 1.93, 95% CI: 1.24, 3.01), 6 or more pain sites (OR = 1.67, 95% CI: 1.01, 2.78), and history of adult physical abuse (OR = 1.51, 95% CI: 1.01, 2.26) were associated with IBS in the final reduced multivariable model. CONCLUSION: Specific characteristics distinguish women with IBS suggesting that IBS and chronic pelvic pain are not simply manifestations of the same disorder. Our findings could help physicians attempt to effectively treat women with IBS and chronic pelvic pain. Physicians could diagnose and treat IBS in conjunction with treatment for chronic pelvic pain.

Adult↗
PubMed2004

Quality of life and sexual function after hysterectomy in women with preoperative pain and depression.

OBJECTIVE: We sought to examine differences in quality of life and sexual function after hysterectomy among women with preoperative pain and depression. METHODS: We analyzed data from a cohort study of 1,249 women who had hysterectomies for benign conditions. Participants were interviewed, before surgery and at 5 intervals after, regarding pelvic pain, depression, quality of life, and sexual function. We compared quality of life and sexual function at 6 and 24 months among women with preoperative pelvic pain alone, depression alone, both pelvic pain and depression, or neither. RESULTS: At 24 months, women with pain and depression had reduced prevalence of pelvic pain (96.7% decreased to 19.4%), limited physical function (66.1% to 34.3%), impaired mental health (93.3% to 38.1%), and limited social function (41.1% to 15.1%). Women with pain only improved in pelvic pain (95.1% to 9.3%) and limited activity level (74.3% to 24.2%). The group with depression only had improvement in impaired mental health (85.1% to 33.1%). Dyspareunia decreased in all groups. Compared with women who had neither pain nor depression, women with depression and pain had 3 to 5 times the odds of continued impaired quality of life: odds ratio (OR) 2.73, 95% confidence interval (CI) 1.78-4.19 for limited physical function; OR 3.41, 95% CI 2.13-5.46 for impaired mental health; OR 5.76, 95% CI 2.79-11.87 for limited social function; OR 4.91, 95% CI 2.63-9.16 for continued pelvic pain; and OR 2.41, 95% CI 1.26-4.62 for dyspareunia. CONCLUSION: Women with pelvic pain and depression fare less well 24 months after hysterectomy than women who have either disorder alone or neither. Nevertheless, these women improve substantially over their preoperative baseline in all the quality of life and sexual function areas assessed. LEVEL OF EVIDENCE: II-2

Adult↗
PubMed2004

Vaginal apex resection: a treatment option for vaginal apex pain.

OBJECTIVE: Vaginal apex pain is a subset of chronic pelvic pain commonly treated with surgical excision of the vaginal apex. Our objective was to estimate long-term postoperative pain levels, recovery time, and return to sexual function in women who have undergone vaginal apex repair for chronic vaginal apex pain. METHODS: Since 1995, 45 women have undergone vaginal apex repair at our institution. All were asked to complete a questionnaire describing pain levels, sexual function, daily activities, ability to work, and medical therapy before and after surgical repair of the vaginal apex. Demographic background, previous medical history, and surgical history were abstracted from the medical records. Fisher exact and Wilcoxon rank sum tests were used to determine associations among baseline characteristics and various outcomes. McNemar chi(2) testing was use to compare before and after pain levels. RESULTS: Twenty-seven women constituted the study sample and were available for evaluation before and after vaginal apex repair. Sixty-seven percent of respondents experienced resolution of pelvic pain after vaginal apex repair for a median of 20 months. The number of women experiencing pain with daily activities decreased from 92% before vaginal apex repair to 41% after vaginal apex repair, and 30% reported sexual activity without dyspareunia after vaginal apex repair (P = .004). Sixty-one percent of women returned to work after vaginal apex repair. Most patients required continued medical therapy after vaginal apex repair. CONCLUSION: Vaginal apex repair improves general levels of pelvic pain in some patients diagnosed with vaginal apex pain. Pain relief after vaginal apex repair is temporary, and women are likely to need continued medical therapy.

Adult↗
PubMed2003

Self-reported heavy bleeding associated with uterine leiomyomata.

OBJECTIVE: To characterize the relationship between self-reported bleeding symptoms and uterine leiomyoma size and location. METHODS: The leiomyoma status of a randomly selected sample of women aged 35-49 in the Washington, DC, area was determined using abdominal and transvaginal ultrasound to measure size and location of leiomyomata found at screening. Women were asked about symptoms of heavy bleeding (gushing-type bleeding, long menses, pad/tampon use) in a telephone interview. Using multivariable regression, we examined the relationships between leiomyoma characteristics and heavy bleeding symptoms among 910 premenopausal women. RESULTS: Women with leiomyomata (n = 596) were more likely to report gushing-type bleeding than women without leiomyomata; risk increased with leiomyoma size. Adjusted relative risks with 95% confidence intervals (CI) for women in each leiomyoma size category compared with the reference category (women without leiomyomata) were as follows: adjusted relative risk of 1.4 (95% CI 1.1, 1.9) for diffuse only, adjusted relative risk of 1.4 (95% CI 1.1, 1.8) for small leiomyomata (less than 2 cm), adjusted relative risk of 1.6 (95% CI 1.3, 2.0) for medium leiomyomata (2-5 cm), and adjusted relative risk of 1.9 (95% CI 1.5, 2.5) for large leiomyomata (greater than 5 cm). Reported use of eight or more pads/tampons on the heaviest days of menstrual bleeding increased with leiomyoma size, with a nearly 2.5-fold risk for women with large leiomyomata compared with women without leiomyomata (adjusted relative risk of 2.4; 95% CI 1.8, 3.1). Nonsubmucosal leiomyomata were associated with essentially the same increase in heavy bleeding as submuscosal leiomyomata of similar size. CONCLUSION: Small leiomyomata were associated with increased risk of heavy bleeding, and risk increased with size. Contrary to published articles, nonsubmucosal leiomyomata were associated with heavy bleeding to the same extent as submucosal leiomyomata.

Adult↗
PubMed2003

Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis.

OBJECTIVE: To assess the effectiveness of nightly application of 5% lidocaine ointment for treatment of vulvar vestibulitis. METHODS: Over 17 months, we assessed women presenting to our pain clinic for evaluation of introital pain; 61 women met the criteria for vulvar vestibulitis and participated in a treatment trial. We measured daily pain and intercourse-related pain using a 100-mm visual analog scale. We compared ability to have intercourse and pain ratings before and after treatment, and investigated whether prior treatment or gynecologic comorbidities predicted response to treatment. RESULTS: After a mean of 7 weeks of nightly treatment, 76% of women reported ability to have intercourse, compared with 36% before treatment (P =.002). Intercourse-related pain score was 39.11 (95% confidence interval [CI] 30.39, 47.83) points lower after treatment (P <.001), with a decrease of 10.37 (95% CI 3.53, 17.21) points in daily pain score (P =.004). We found no association between response to prior episodic use of lidocaine and response to nightly therapy with lidocaine ointment. Few patient characteristics predicted response to treatment; however, women with interstitial cystitis and other vulvar conditions were least likely to benefit. CONCLUSION: Long-term, nightly application of 5% lidocaine ointment shows promise as a treatment for management of vulvar vestibulitis; a randomized, double-blind, clinical trial is warranted.

Administration, Topical↗