Biomedical subjects
Publications and source records attributed to M P Umstad.
Many headaches following epidural analgesia are a consequence of a dural tap having occurred. However, this is not always the case and careful evaluation is required. A case of postpartum headache caused by an intracerebral haemorrhage is presented.
One hundred and sixty-eight women presenting to a Urinary Incontinence Clinic were studied. Only 52% had a urodynamic diagnosis that supported their clinical signs and symptoms. The response rates to various modalities of treatment for each urinary disorder are described. Fifty-one percent achieved a complete response with the treatment selected, 27% had a partial response, and 10% did not respond or deteriorated. Twelve percent of patients were lost to follow-up.
Between April 1984 and April 1990, 20 patients with a mean age of 27.9 years underwent presacral neurectomy at The Royal Women's Hospital, Melbourne, Australia. Overall, 11 of the 19 patients (58%) assessable for follow-up were totally cured of pain and 8 (42%) were partially cured. The most common indication for presacral neurectomy was secondary dysmenorrhoea, usually in association with endometriosis or pelvic adhesions. In 4 patients with uterine dysmenorrhoea not associated with pelvic pathology the operation produced a complete cure. The general consensus of gynaecological opinion is that presacral neurectomy should still be reserved for a limited number of carefully selected patients in whom other methods of treatment have been exhausted. It is imperative that a prior psychological assessment should be undertaken whenever a functional component is suspected. Whilst pain of uterine origin may be cured by presacral neurectomy, lateral pelvic pain of adnexal origin requires ovarian sympathectomy.
The first 100 patients undergoing first trimester transabdominal chorionic villus sampling (placental biopsy) in our hospital are reviewed. At the time of follow up 24 patients had delivered, 68 pregnancies were at 24 weeks or more and progressing normally, 7 pregnancies were terminated and there was only 1 spontaneous miscarriage. The advantages of the transabdominal approach are discussed.