Biomedical subjects

R M Ellerkmann

Publications and source records attributed to R M Ellerkmann.

3 recordsLinked to original sources

PubMed2001

Correlation of symptoms with location and severity of pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to compare the symptoms that are related to pelvic floor dysfunction with the location and severity of the coexisting prolapse. STUDY DESIGN: Two hundred thirty-seven consecutive patients with symptomatic pelvic organ prolapse came to Johns Hopkins Medicine during a 24-month period beginning in July 1998 and completed a symptom-specific Likert scale questionnaire that included standardized questions that were compiled from commonly used validated instruments. All questionnaires were completed by the patients before they were seen by a physician. Further evaluation included a standardized physical examination that included the International Continence Society's system for grading uterovaginal prolapse. Symptoms were categorized according to both severity and associated anatomic compartment. Symptoms that were related to urinary and anal incontinence and voiding, defecatory, sexual, and pelvic floor dysfunction were analyzed with respect to location and severity of pelvic organ prolapse with the use of the nonparametric correlation coefficient, Kendall's tau-b. RESULTS: The mean age of the women was 57.2 years (range, 23-93 years); 109 of the women (46%) had undergone hysterectomy. Overall, stage II was the most common pelvic organ prolapse (51%) that was encountered. In 77 patients (33%), anterior compartment pelvic organ prolapse predominated; 46 patients (19%) demonstrated posterior compartment prolapse, whereas 26 patients (11%) had apical prolapse. In 88 patients (37%), no single location was more severe than another. Voiding dysfunction that was characterized by urinary hesitancy, prolonged or intermittent flow, and a need to change position was associated with the increasing severity of anterior and apical pelvic organ prolapse. Pelvic pressure and discomfort along with visualization of prolapse were strongly associated with worsening stages of pelvic organ prolapse in all compartments. Defecatory dysfunction characterized by incomplete evacuation and digital manipulation was associated with worsening posterior compartment pelvic organ prolapse. Impairment of sexual relations and duration of abstinence were strongly associated with worsening pelvic organ prolapse. An inverse correlation was observed between increasing severity of pelvic organ prolapse and urinary incontinence and enuresis. CONCLUSION: Women with pelvic organ prolapse experience symptoms that do not necessarily correlate with compartment-specific defects. Increasing severity of pelvic organ prolapse is weakly to moderately associated with several specific symptoms that are related to urinary incontinence and voiding, defecatory, and sexual dysfunction.

Adult↗

PubMed1999

A view from the family: years after a loved one has died of ovarian cancer.

OBJECTIVE: When cancer strikes a patient, it has a major impact on the family. Whereas many health care providers deal with the family while the patient is living, few have any long-term interactions after she has died. The purpose of this study is to interface with family members and reflect upon the impact ovarian cancer had on them. METHODS: A retrospective chart review was conducted of 222 patients who had been diagnosed and treated for ovarian carcinoma between the years 1990 and 1994 at Maine Medical Center, a tertiary care medical center. Of these, 34 patients who had been deceased for longer than 1 year were selected on the basis of specific criteria. The families of these individuals were each mailed a questionnaire comprising seven questions tailored to evaluate one family member's impressions and experiences of coping with a loved one who had died from ovarian cancer. Candid responses of any length were invited. RESULTS: Written responses were received from 32 of the 34 families that were mailed questionnaires. Of those responding, 65% were spouses, 22% were children, and 13% were siblings of the deceased. Each questionnaire was answered by only one relative, and the majority of questions posed received multiple detailed answers. According to the vast majority of respondents, the worst part of treatment was continuing chemotherapy. The most common emotion expressed by family members at the time of diagnosis was one of something having gone wrong. Both travel and living longer appeared to be the most treasured aspects of the patient's life once the diagnosis had been made. Watching their loved one suffer and the overwhelming sense of helplessness were the worst aspects of the disease process. The loved one was most often thought of on her birthday, and 90.6% of the respondents thought another female in their family was likely to get ovarian cancer. CONCLUSION: This study attempted to define those concerns and thoughts that remain important to family members whose loved ones had died from ovarian cancer. Common emotions expressed by family members years after the death of their loved one include their sense of surprise at the diagnosis, their sense of helplessness during the progression of the disease, and their pain in watching their loved one suffer. For them, the worst part of their loved one's treatment was continued chemotherapy, and a common unfounded fear was that another female family member would likely die from ovarian cancer. The responses encourage us as health care providers to remain in touch with these families even after the death of their loved one and to address the misconceptions, fears, and anxieties that our patients and their families may have.

Family↗

PubMed1998

Pelvic radical surgery.

The management of gynecological malignancies is dictated by the stage and nature of the disease. Often, the optimal treatment requires radical pelvic surgery. This is especially true in cervical, ovarian, and vulvar carcinoma. Radical hysterectomy, exenterative procedures and tumor debulking comprise the armamentarium of gynecological oncologists. This article attempts to review the different surgical strategies with attention to their respective indications, potential complications, and overall efficacy.

Carcinoma↗