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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
PubMed2001

Compartment syndrome associated with lithotomy position and intermittent compression stockings.

BACKGROUND: Compartment syndrome is a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space. CASE: A 43-year-old black woman, para 3, had repair of a recurrent vesicovaginal fistula. She was placed in a low lithotomy position with thigh length sequential compression sleeves. The procedure lasted more than 5 hours. On postoperative day 1, she complained of pain in her right leg and foot. Compartment syndrome was diagnosed and emergency fasciotomy was done. CONCLUSION: Gynecologists should be aware of the possibility of compartment syndrome during prolonged procedures with patients in the lithotomy position. Concomitant intermittent compression sleeves might further increase the risk. Early diagnosis and treatment of compression syndrome are essential to minimize long-term neurovascular morbidity.

Adult↗
PubMed2001

The routine use of cystoscopy with the Burch procedure.

OBJECTIVE: We sought to determine the incidence of unsuspected injury to the lower urinary tract as detected by intraoperative cystoscopy when the Burch procedure is performed. STUDY DESIGN: We reviewed the records of 181 women who underwent pelvic surgery, which included a Burch retropubic urethropexy for genuine stress urinary incontinence, between Jan 1, 1998, and Dec 31, 1999. All patients underwent intraoperative cystoscopy at the completion of the Burch procedure after the administration of intravenous indigo carmine dye. RESULTS: There were 6 (3.3%) injuries to the lower urinary tract. Five of the injuries were cystotomies that had been recognized during operation. One obstructed left ureter was detected by cystoscopy and relieved by the release of left paravaginal repair sutures. No unsuspected injuries that were detected by cystoscopy were attributable to the Burch procedure. CONCLUSIONS: The lower urinary tract injury rate was 3.3%. All but one injury was recognized before cystoscopy. The one injury was attributed to concomitant paravaginal repair and not to the Burch procedure.

Adult↗
PubMed1999

Understanding lower urinary tract function in women soon after bladder neck surgery. Continence Program for Women Research Group.

The aim of this work was to correlate anatomic and urodynamic measures with function following bladder neck surgery. Eighty-seven women who underwent bladder neck surgery at two tertiary academic medical centers in the southeastern U.S. were studied in this prospective outcomes analysis. Preoperative and 6-week and 6-month postoperative status was assessed with urodynamic testing, physical examination, and condition-specific quality of life instruments. Correlations of dynamic urethral obstruction (quantified by pressure transmission ratio, PTR, determinations) and urethral support (quantified by urethral axis measurements) with functional status were determined. At 6 weeks, 50% of the subjects with inadequate dynamic obstruction (PTR < 90%) had genuine stress incontinence (GSI) compared to 5% of those with PTR >/= 90% (P = .00002). Of those with excessive obstruction (PTR > 110%), 32% had detrusor instability (DI) and 47% had emptying phase dysfunction (EPD) compared to 6% and 24%, respectively, of those with PTR </= 110% (P = .006 and P = .04). At 6 months, subjects with excessive obstruction were more likely to have EPD than other subjects (75% vs. 27%, P = .001). Those with optimal dynamic obstruction (PTR >/= 90% but </= 110%) were more likely to have normal function (no GSI, no DI, and no EPD) than those with higher or lower PTRs (59% vs. 34%, P = .04). Urethral axis measurements did not correlate with functional status at either follow-up session. The magnitude of dynamic urethral obstruction is related to function after bladder neck surgery. Excessive obstruction is associated with DI and EPD, inadequate obstruction with GSI, and optimal obstruction with normal function. Neurourol. Urodynam. 18:629-637, 1999.

Adult↗
PubMed1998

Microsatellite instability in sarcomas.

BACKGROUND: Microsatellite instability (MIN) has been studied in a variety of carcinomas and gynecologic sarcomas, but never in musculoskeletal sarcomas. METHODS: We evaluated 16 skeletal and soft tissue sarcomas at nine genetic loci from chromosomal regions 1q, 5q, 7q, 12p, 13q, 17p, 19q, and two at 11p--all potential regions of interest regarding musculoskeletal sarcomas. RESULTS: MIN was identified at one or more loci in seven of the cancers studied (44%). Three tumors had more than one locus with MIN and one tumor, a high-grade osteogenic sarcoma, had five of nine loci positive for MIN. CONCLUSION: These results indicate that musculoskeletal sarcomas show instability in areas inside and outside the loci of known oncogenes. Areas of mismatch repair, as heralded by MIN, may contribute to the vast heterogeneity of these neoplasms.

Adolescent↗
PubMed1998

Pathophysiology of pelvic organ prolapse.

Pelvic organ prolapse is usually caused by weakness of the pelvic diaphragm. Descent of the pelvic diaphragm places stress on the endopelvic connective tissue support system. Subsequent increases in intra-abdominal pressure result in prolapse. In the majority of cases, labor and childbirth are thought to be the primary factors responsible for pelvic neuropathies and tissue damage that predispose to the development of POP. Certain connective tissue defects, congenital defects, and operative procedures also contribute to pelvic support defects.

Connective Tissue Diseases↗
PubMed1998

Reliability and correlation of measurements during and after bladder neck surgery. The Continence Program for Women Research Group.

OBJECTIVES: To assess the reliability of seven intraoperative measurements of the effects of bladder neck suspension and correlate these measurements with postoperative dynamic urethral obstruction, quantified as the cough-pressure transmission ratio. PATIENTS AND METHODS: Sixty women undergoing surgery for bladder neck hypermobility had seven measurements performed in duplicate: (i) the endoscopic appearance of the bladder neck: (ii) the bladder neck-retropubic surface distance (BN-RP distance); (iii) urethral axis; (iv) slow urethral pressure profilometry (UPP); (v) fast UPP; (vi) straining UPP; and (vii) dynamic UPP. Reliabilities were assessed by computing the intraclass correlation coefficient (R) for continuous data or Kappa statistic (K) for ordinal data. Pearson correlation coefficients were used to assess the relationships between the intra-operative measures and postoperative pressure transmission. RESULTS: The intra-operative reliabilities for maximum pressure, length and area from the three UPP techniques were high (R=0.88-0.98) as were those for urethral axis measurements (R=0.98). In contrast, reliabilities were poor for pressure transmission ratios (R=0.15-0.33), BN-RP distance (R=0.55), and endoscopic appearance (K=0.10). There were significant correlations of the pressures from the UPPs and intra-operative pressure transmission ratios with postoperative pressure transmission ratios; however, the poor intra-operative reliability of intra-operative pressure transmission limits their usefulness. None of the other measures correlated significantly with postoperative pressure transmission ratios. CONCLUSIONS: Of the measures studied, only intra-operative UPPs had both high reliability and good postoperative correlations.

Aged↗
PubMed1996

Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group.

OBJECTIVE: Severe prolapse may mask potential genuine stress urinary incontinence in women. Some have suggested that a suspending urethropexy be performed in women who have potential genuine stress incontinence demonstrated by barrier reduction of the prolapse preoperatively. Our aim was to compare outcomes after prolapse surgery that included a formal bladder neck suspension with those operations that did not. STUDY DESIGN: This prospective randomized clinical trial assigned 32 women with bladder neck hypermobility and stage III or IV pelvic organ prolapse to receive either a needle colposuspension or bladder neck endopelvic fascia plication as part of the vaginal reconstructive surgery. Twenty-nine subjects underwent detailed clinical, anatomic, urodynamic, and quality-of-life evaluations before and 6 weeks and 6 months after surgery; 23 completed urinary diary and quality-of-life evaluations after a mean of 2.9 years. RESULTS: Needle colposuspension increased short-term complications without providing additional protection from de novo stress incontinence. Barrier testing before surgery predicted urethral sphincteric resistance after surgery; however, such testing neither predicted a patient's function after surgery nor indicated the need for a suspending urethropexy. The combination of a needle colposuspension with a sacrospinous ligament suspension predisposed to the early development of support defects of the upper anterior vaginal segment and to failure of bladder neck support. CONCLUSIONS: Preoperative barrier testing in women with severe prolapse is not useful in identifying individuals who require a suspending urethropexy. Needle colposuspension increases short-term complications, lacks durability, and may predispose to early and severe recurrent anterior prolapse when performed with a sacrospinous ligament vault suspension.

Aged↗
PubMed1995

Wound infection after abdominal hysterectomy: effect of the depth of subcutaneous tissue.

OBJECTIVE: Our purpose was to determine the effect of the depth of the subcutaneous tissue at the operative site on abdominal wound infection after hysterectomy. STUDY DESIGN: A prospective study was performed of women undergoing abdominal hysterectomy and not receiving antibiotic prophylaxis who underwent maximum vertical measurement of their subcutaneous incisions before the abdominal cavity was surgically entered. Additional demographic and perioperative data previously associated with wound infection were collected and analyzed. Surgical technique was standardized among the three attending surgeons involved. RESULTS: Wound infection occurred in 17 of 150 (11.3%) women undergoing abdominal hysterectomy. Univariate analysis identified the following risk factors as being significantly associated with wound infection: depth of subcutaneous tissue (p = 0.0004), preoperative serum albumin (0.0015), weight (p = 0.0029), and body mass index (p = 0.0032). Logistic regression analysis confirmed the thickness of the subcutaneous tissue as the only significant risk factor for wound infection (p = 0.04) (odds ratio 1.37, 95% confidence interval 1.01 to 1.86). No patients with a maximum depth of subcutaneous tissue < 3 cm had a wound infection. CONCLUSION: We conclude that the depth of subcutaneous tissue is the most significant risk factor associated with abdominal wound infection after hysterectomy.

Abdomen↗
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 in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Adult↗
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↗
PubMed1988

The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies.

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.

Adult↗