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Biomedical subjects

W G Hurt

Publications and source records attributed to W G Hurt.

At least 19 recordsLinked to original sources
PubMed1991

Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction.

Forty-seven women had urethral pressure profile determinations performed at rest and during a Kegel pelvic muscle contraction, after brief standardized verbal instruction. Twenty-three (49%) had an ideal Kegel effort--a significant increase in the force of urethral closure without an appreciable Valsalva effort. Twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence. Age, parity, weight, estrogen deprivation, prior continence surgery or hysterectomy, and passive urethral function did not predict a successful effort. We concluded that simple verbal or written instruction does not represent adequate preparation for a patient who is about to start a Kegel exercise program.

Adult↗
PubMed1991

Outpatient gynecologic procedures.

The majority of gynecologic surgical procedures can be performed on an outpatient basis. Utilization of outpatient surgical centers helps reduce the cost of health care, lessens the disruption of patients' personal lives, and promotes their recovery through early ambulation and a lower incidence of postoperative nosocomial complications. Patient education and improvements in anesthetic and surgical techniques will allow additional and more complicated gynecologic procedures to be performed in outpatient surgical centers. In doing so, the surgeon must not increase the overall risk of the procedure or compromise the surgical technique in a way that may produce a result that is not as good or as durable as the same procedure performed on an inpatient basis.

Abortion, Induced↗
PubMed1991

Ectopic pregnancy in an urban teaching hospital: can tubal rupture be predicted?

We evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadotropin (hCG-beta subunit) were significantly higher in patients with ruptured versus unruptured ectopic pregnancies (16,612 mIU/mL vs 6406 mIU/mL), no breakpoint excluded the possibility of tubal rupture. In fact, one third of ectopic pregnancies in patients with a serum beta-hCG level below 100 mIU/mL were ruptured. We conclude that clinical symptoms and signs are poor predictors of tubal rupture. In addition, absolute values of serum beta-hCG are not helpful in excluding the possibility of rupture.

Adult↗
PubMed1990

Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy.

To assess the relationship between either bacterial vaginosis or trichomoniasis vaginitis and posthysterectomy infection, preoperative evaluation of the vaginal secretions was performed in 161 women undergoing abdominal hysterectomy. Thirty-two patients (19.9%) and 27 patients (16.8%), respectively, met the diagnostic criteria for bacterial vaginosis and trichomoniasis vaginitis. Patients with either bacterial vaginosis or trichomoniasis vaginitis were more likely than control subjects to have cuff cellulitis, cuff abscess, or both (relative risk 3.2, 95% confidence interval 1.5 to 6.7 for bacterial vaginosis; relative risk 3.4, 95% confidence interval 1.6 to 7.1 for trichomoniasis vaginitis). Preoperative vaginitis had no effect with respect to the incidence of postoperative wound infection, urinary tract infection, or intravenous line phlebitis. Bacteroides sp., Peptostreptococcus sp., and/or Gardnerella vaginalis ("bacterial vaginosis organisms") were isolated from the vaginal cuff in the majority of patients with postoperative cuff cellulitis. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for the development of posthysterectomy cuff cellulitis.

Adult↗
PubMed1989

Seminoma in pubertal patient with androgen insensitivity syndrome.

The case of a 14-year-old girl with complete androgen insensitivity syndrome and metastatic seminoma is reported. She was treated by bilateral adnexectomy, removal of paraaortic lymph nodes, postoperative radiation, and estrogen replacement therapy. She represents the fourth case of gonadal malignancy to be reported in a teenage patient with androgen insensitivity syndrome.

Adolescent↗
PubMed1988

Dynamic urethral pressure profilometry pressure transmission ratio determinations after continence surgery: understanding the mechanism of success, failure, and complications.

Twenty-two women who had previously undergone continence surgery for the correction of stress urinary incontinence were evaluated with dynamic urethral pressure profilometry and had bladder-to-urethra pressure transmission ratios calculated. Eight of the subjects had recurrent or persistent genuine stress incontinence (group 1), seven had detrusor instability (group 2), and seven had normal continence and detrusor function (group 3). In addition, we evaluated ten subjects with detrusor instability but no previous surgery (group 4). There were clear and significant differences in pressure transmission ratios between the four groups. These differences suggest that subjects in group 1 have the same basic mechanisms of incontinence (ie, inefficient pressure transmission to the urethra as reflected by pressure transmission ratios less than 90%) as do never-operated women with genuine stress incontinence. Subjects in group 2 had pressure transmission ratios that were significantly higher than those in either group 3 or 4. This supports the hypothesis that obstruction may play a role in post-continence surgery detrusor instability, but not in idiopathic detrusor instability. Group 2 subjects had pressure transmission ratios very close to the ideal of 100%. We postulate that continence procedures that consistently result in pressure transmission ratios close to 100% should have the greatest chance for success without inducing complications.

Adult↗
PubMed1988

Lichen planus of the vulva.

Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.

Atrophy↗
PubMed1986

Genital condylomas in immunosuppressed women: a therapeutic challenge.

Of 30 immunosuppressed women with genital condylomas, 20 (67%) had associated neoplasia of the lower genital tract. We retrospectively studied 11 patients with flat condylomas confined to the cervix; all lesions were eradicated by conventional therapy. Three patients studied retrospectively and 16 studied prospectively had condylomatous lesions involving several sites within the lower genital tract. These lesions were unusually resistant to various treatment methods. Maintenance therapy with 5-fluorouracil (5-FU) cream resulted in a significantly higher control rate (6/7 patients, 86%) than could be achieved otherwise (2/9 patients, 22%; P less than .025). We conclude that ablative therapy by surgery or topical chemical agents followed by maintenance therapy with 5-FU cream may be the treatment of choice for condylomas and other human papillomavirus-associated lesions of the lower genital tract in immunosuppressed women.

Adult↗
PubMed1979

Behçet's syndrome associated with pregnancy.

A case of Behçet's syndrome diagnosed during pregnancy is reported. It is believed that this condition is more common in the United States than previously thought. It should be considered in the differential diagnosis of genital ulceration.

Adult↗
PubMed1979

Cryotherapy of the cervix.

Cryotherapy is most useful in treating mild and moderate dysplasia of the ectocervix and symptomatic benign chronic cervicitis. It has almost replaced electrocauterization of the cervix and has reduced the need for conization. Cytology and colposcopy are essential in the selection of patients for this procedure and in evaluating their response to therapy.

Colposcopy↗
PubMed1978

Direct electronic urethrocystometry.

Direct electronic urethrocystometry simultaneously records pressures in the bladder, proximal urethra, and abdomen in a patient at rest and under stress while the bladder fills with urine. It documents the presence or absence of detrusor contractions and is an essential part of the evaluation of patients with detrusor dysfunction and urinary incontinence.

Female↗
PubMed1978

Laparoscopic tubal occlusion with silicone rubber bands.

Application of the silastic ring to the Fallopian tubes through the laparoscope seems to be a simple, safe and acceptable method of tubal sterilization. The technique and results in 337 patients are described. In the majority of cases, the procedure was effected in the outpatient department under local anaesthesia. Transsection of the tube (with or without bleeding), tearing of the mesosalpinx, and avulsion of the tube at the uterotubal junction were the most common complications; with experience and adherence to the proper technique of ring application, the above can be minimized. The pregnancy rate following this procedure seems to be acceptable, but long-term follow-up is necessary for definitive conclusions.

Adolescent↗
PubMed1978

Cervical cytology: use and follow-up.

The Pat smear was introduced to clinical medicine 35 years ago. It is the most practical means of screening for precancerous lesions of the cervix. Endocervical and ectocervical samples improve detection. Colposcopy and colposcopically directed biopsy will document the most advanced lesion in almost all cases. The need for conization has been greatly reduced. Treatment of intraepithelial neoplasia will prevent the development of invasive cancer of the cervix.

Colposcopy↗
PubMed1977

Dysfunctional detrusor control.

Detrusor muscle dysfunction is a common reason for lower urinary tract symptomatology in women. This report summarizes observations in 35 patients diagnosed as having detrusor dysfunction. Similar involuntary detrusor contractions were observed in 25 incontinent patients and in five patients who were not incontinent but who had urgency and frequency of urination. The incontinent patients were separated into the "urge incontinence" group and the "detrusor dyssynergia" group, based on whether or not the detrusor contraction was preceded by a strong sensation of urge. The patients who were not incontinent were grouped as "urgency frequency syndrome." No patient had urinary tract infection, neurological, urologic, or metabolic disease. Thirty patients responded satisfactorily to similar management consisting of bladder drills and anticholinergic drug therapy. Decreased cortical inhibitory activity seems to be a common pathophysiologic mechanism.

Adult↗
PubMed1977

Adenocarcinoma of the cervix: histopathologic and clinical features.

Primary adenocarcinoma of the cervix and endocervix is an unusual lesion. It is cytologically evasive, diagnostically challenging, histologically variable, and therapeutically perplexing. During the period 1954 through 1971, 53 cases were diagnosed at the Medical College of Virginia, representing 3% of all invasive cervical carcinomas. Clinical material, therapy, and five-year survival statistics have been complied for each histologic type of adenocarcinoma. The average age of the patients was 53.8 years, and the most frequent complaint was abnormal uterine bleeding. Histologically, the majority had adenocarcinomas of the endocervical type. Others, in order of descending frequency, had endometrioid, clear cell, colloid, and adenoid cystic carcinomas. Patients treated for endometrioid carcinomas had the best five-year survival rates. Standardization of the diagnostic process and the use of modern radiation therapy have significantly improved survival. All patients having radiation plus operation or operation alone lived five years or more.

Adenocarcinoma↗
PubMed1977

Laparoscopic sterilization with silicone rubber bands.

Laparoscopic sterilization with silicone rubber bands was performed on 202 healthy females in an attempt to assess the simplicity, safety, and effectiveness of the technique. The procedure was performed under local anesthesia and analgesia in 156 subjects while in 46 it was done under general anesthesia. One hundred and eighty-two were interval operations while 18 were combined with first trimester abortions. Avulsion of the uterine tube leading to bleeding occurred in three instances and this was the only complication of some concern in this series. No laparotomy was required to treat any immediate complications. Two pregnancies had occurred by July 1976. Both were found to be luteal phase pregnancies. This technique appears to be relatively simple and safe. Complications are few in experienced hands and are avoidable by careful selection proper technique.

Female↗
PubMed1977

Leiomyomatosis peritonealis disseminata. Report of a case and review of the literature.

The eighth documented case of leimoyomatosis peritonealis disseminata (LPD) is presented. Histologic evidence for concomitant intravenous leiomyomatosis and early development of a leiomyoma in a vessel wal was noted in the present case. Electronmicroscopic studies proved the smooth muscle origin of the tumors in this case. Intriguing features of this disease are its grossly malignant appearance, relatively benign histology, and generally favorable clinical behavior. Because women of reproductive age, especially in the fourth decade, are affected, hormones may play a role in the etiology of LPD. Intraoperative diagnosis requires frozen-section examination and treatment has included extirpation of involved tissues, wherever possible. Also advocated is surgical castration which may remove the hormonal stimulus for the growth of any residual tumor. Since LPD bears a close resemblance to genital leiomyosarcoma, it warrants proper recognition and management.

Adult↗