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Biomedical subjects

W A Addison

Publications and source records attributed to W A Addison.

At least 37 records · Page 2Linked to original sources
PubMed1992

Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele. Evolution of operative techniques.

Abdominal sacral colpopexy with retroperitoneal interposition of a suspensory hammock between a prolapsed vaginal vault and the anterior surface of the sacrum was performed on 163 women for correction of vaginal vault prolapse during 18 consecutive years, from 1972 through 1989. Hysterectomy had previously been performed on 160 of the patients, 2 patients had congenital absence of the uterus, and 1 patient underwent vaginal hysterectomy at the time of the sacral colpopexy. The patients had been followed for 9 months to 18 years at this writing, with a median follow-up of 33 months. An additional 25 patients underwent successful sacral colpopexy since the end of the study period, but those data are not included here. Modifications of surgical techniques have evolved from our experience.

Adolescent↗
PubMed1991

Necrotizing fasciitis in irradiated tissue from diabetic women. A report of two cases.

Two diabetic women with pelvic malignancies developed necrotizing fasciitis within the irradiation fields. Despite aggressive surgical and medical therapy, both died when their health became too unstable for them to tolerate further surgery to resect the residual infection. We attribute their poor outcome to several factors. First, postradiation tissue changes obscured the early clinical findings necessary for a prompt diagnosis and made the identification of adequate surgical margins difficult. Second, diabetic patients have increased susceptibility to this infection. Third, the cumulative effects of radiation, diabetes mellitus and other factors that are common in patients with gynecologic malignancy (advanced age, vascular disease, obesity) favor the development, progression and persistence of necrotizing fasciitis. Radiographic studies were helpful in defining the extent of the infection in one patient.

Aged↗
PubMed1991

Choice of operation for genuine stress incontinence.

Surgery, the definitive treatment for most patients with genuine stress urinary incontinence, continues to evolve, as does the rationale for choice and application of given operations. The history of surgical progress to the present is well covered by Kohorn (Obstet Gynecol Clin North Am 1989, 16:841-852) and includes those operations that have progressively supplanted the anterior colporrhaphy on which the gynecologist traditionally depended. Emphasis on the secure retropubic placement of the bladder neck has led to the development of a number of modifications of open retropubic cystourethropexy, minimal incision needle suspension techniques, and various sling operations; recently reported modifications are acknowledged. The rationale of curing incontinence by restoring normal anatomy in the course of identifying and repairing discrete fascial defects has led to increased acceptance and use of the paravaginal or obturator shelf repair.

Female↗
PubMed1991

Thumbtack use for control of presacral bleeding, with description of an instrument for thumbtack application.

There is well-known difficulty in controlling hemorrhage from presacral vessels. There are reports on the use of thumbtacks to secure hemostasis in the face of presacral hemorrhage. This communication reports the successful use of thumbtacks to establish presacral hemostasis and describes a simple instrument designed to afford easier and more precise anterior sacral application of thumbtacks. The instrument is easy to make. It was devised because of difficulty encountered with manual placement of hemostatic thumbtacks and the absence of totally satisfactory delivery by any of the standard surgical instruments available.

Blood Vessels↗
PubMed1990

Suprapubic teloscopy: extraperitoneal intraoperative technique to demonstrate ureteral patency.

A simple method for intraoperative visualization of the ureteral orifices to demonstrate ureteral function is described. This method, called suprapubic teloscopy because only the telescope of a cystoscope is used for visualization, allows intraoperative assessment without the need for completely closing the abdomen or repositioning the patient. The use of this equipment, standard in all operating suites, is detailed, and experience with 37 patients is presented.

Endoscopes↗
PubMed1990

Prazosin-induced stress incontinence.

A case of genuine stress incontinence due to prazosin, a common antihypertensive drug, is presented. Prazosin exerts its antihypertensive effects through vasodilatation caused by selective blockade of postsynaptic alpha-1 adrenergic receptors. As an alpha-blocker, it also exerts a significant relaxant effect on the bladder neck and urethra. The patient's clinical course is described and correlated with initial urodynamic studies while on prazosin and subsequent studies while taking verapamil. Her incontinence resolved with the change of medication. The restoration of continence was accompanied by a substantial rise in maximum urethral pressure, maximum urethral closure pressure, and functional urethral length. Patients who present with stress incontinence while taking prazosin should change their antihypertensive medication before considering surgery, because their incontinence may resolve spontaneously with a change in drug therapy.

Female↗
PubMed1989

Failed abdominal sacral colpopexy: observations and recommendations.

Abdominal sacral colpopexy provides effective surgical management of the vagina that has prolapsed after hysterectomy. Recurrences of prolapse after this operation are rare. Three patients are presented who did exhibit recurrent prolapse necessitating another operation. In two patients, the synthetic mesh used for colpopexy had separated from the vagina. In the remaining patient, the posterior vaginal wall had ruptured distal to the attachment of mesh to the vagina. In each patient, the mesh had become completely interpenetrated by tissue. We believe that failures can be minimized by suturing the suspensory mesh to the vagina over as extended an area as possible. Reasons for this belief are addressed, and techniques for achieving such an attachment are described. A meticulous culdoplasty beneath the suspensory mesh is also considered important, as is the use of permanent sutures placed through the full thickness of the vagina in attaching the mesh.

Female↗
PubMed1988

Direct fluorescent antibody testing for endocervical Chlamydia trachomatis: factors affecting accuracy.

Endocervical swabbings obtained after two previous cleansing swabs from 202 women with indications for testing for genital chlamydial infection were evaluated for the presence of Chlamydia trachomatis by culture and two direct fluorescent monoclonal antibody tests. In comparison with culture, the two direct fluorescent antibody tests showed sensitivities of 37.5 and 56.5% and specificities of 97.0 and 99.4% when read by experienced microbiology technologists recently trained in chlamydia direct fluorescent antibody interpretation and blinded to culture results. Overall sensitivities of 69.6 and 78.3% for the direct fluorescent antibody tests were obtained by an expert interpreter during discrepancy analysis. When only direct fluorescent antibody test specimens from the first swab after endocervical cleansing were considered, recently trained interpreters obtained sensitivities of 53.8 and 69.2%, and both direct fluorescent antibody tests were 100% sensitive for the expert interpreter. These data emphasize the critical importance of observer expertise and swab order to the accuracy of chlamydia direct fluorescent antibody tests. Previous studies of these tests are examined to determine how these factors and others may have influenced the outcome.

Adult↗
PubMed1988

Necrotizing fasciitis arising from a suprapubic catheter site. A case report.

Necrotizing fasciitis is an unusual complication of gynecologic surgery. A woman developed necrotizing fasciitis at the site of suprapubic urinary catheter placement. The diagnostic criteria for necrotizing fasciitis were fulfilled by the patient, whose predisposition for the disease was undiagnosed diabetes mellitus. This rare complication of suprapubic catheter drainage must be considered in high-risk patients presenting with an inflammation at this site of cutaneous trauma.

Catheters, Indwelling↗
PubMed1987

Who should have intravenous pyelograms before hysterectomy for benign disease?

A review of 493 cases was undertaken to identify which patients undergoing hysterectomy for benign disease had received a preoperative intravenous pyelogram (IVP), an abnormality identified by IVP, and intraoperative ureteral injuries. Intravenous pyelograms were performed on 299 patients (60.6%). Factors significantly associated with obtaining a preoperative IVP included an abdominal approach, uterine size of 12 weeks or greater, and uterine prolapse. Seventy-seven patients (27%) had an abnormal IVP; factors likely to be associated with abnormality included uterine size of 12 weeks or larger or an adnexal mass of 4 cm or larger. Endometriosis, pelvic inflammatory disease, pelvic relaxation, and previous intra-abdominal surgery were not associated with an increased prevalence of abnormal IVP findings. Two ureteral injuries were documented, one in the IVP group (0.3%) and one in the non-IVP group (0.5%). Clinical findings may be used to select for a preoperative IVP those patients who are likely to have abnormalities of importance to the pelvic surgeon.

Adult↗
PubMed1985

Abdominal sacral colpopexy with Mersilene mesh in the retroperitoneal position in the management of posthysterectomy vaginal vault prolapse and enterocele.

During a 12-year study period from 1972 to 1984, 56 patients underwent abdominal sacral colpopexy with retroperitoneal interposition of a suspensory hammock between a prolapsed vaginal vault and the anterior surface of the sacrum. They were followed from 6 months to 12 1/2 years, and constitute the basis of this report. In most patients, a synthetic mesh was the material interposed. Hysterectomy had previously been performed on 53 patients, and in two patients there was congenital absence of the uterus. Indications for abdominal sacral colpopexy, surgical technique, complications, and results of operation are discussed. Seven additional patients underwent this operation after termination of the defined study period.

Abdominal Muscles↗
PubMed1985

Endometrial biopsy, bacteremia, and endocarditis risk.

Although bacterial endocarditis in women at risk because of endocardial lesions frequently follows pregnancy-related pelvic surgery, endometrial biopsy with or without brushing for cytology was not known to be associated with bacteremia or endocarditis risk. Because a patient who developed acute bacterial endocarditis as a result of endometrial biopsy performed without antibiotic prophylaxis was encountered, 50 subsequent patients undergoing endometrial brushing and biopsy were studied and postprocedure bacteremia was found in four, all of whom were premenopausal.

Adult↗
PubMed1984

Necrotizing fasciitis of vulvar origin in diabetic patients.

Necrotizing fasciitis is a rare, rapidly progressive, and often fatal infection of the superficial fascia and subcutaneous tissues. The integrity of the deep muscle fascia is usually not breeched, thus limiting the depth of involvement. Centrifugal spread within the planes of the superficial fascia and subcutaneous tissues is characteristic. Patients with diabetes mellitus constitute the group most vulnerable to necrotizing fasciitis, and a vulvar or perineal origin is associated with particularly high mortality. The authors report four such patients. Other apparent predisposing factors are advancing age, peripheral vascular disease, chronic debilitating illness, malnutrition, and possibly other states predisposing patients to immunodeficiency. None of these factors is an absolute prerequisite to the development of necrotizing fasciitis.

Adult↗