Biomedical subjects
Publications and source records attributed to W G Hurt.
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.
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.
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.
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.
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.
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.
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.
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Five cases of so-called "adenoma malignum" of the cervix are presented. This term has been used to describe an extremely well-differentiated adenocarcinoma characterized histologically be distorted and architecturally irregular endocervical glands which penetrate deeply into the wall of the cervix, but without more than minimal and focal evidence of gland cell stratification, anaplasia, or mitotic activity. Despite this innocuour histologic appearance, these tumors have classically been thought to be clinically highly malignant, with an almost invariably rapid lethal outcome. This discrepancy between the histology and behavior has been presented as justification for the otherwise paradoxical name, "adenoma malignum". In the present series, all patients were treated with modern radiotherapeutic techniques, and four of the five are long-term survivors. Of the patients in the literature who died after rapid dissemination, none received treatment with acceptable radiotherapeutic techniques. Thus, we believe that with proper therapy this tumor is no more malignant than one would expect for a highly differentiated adenocarcinoma, and we suggest that the name, "adenoma malignum," be replaced by "minimal deviation adenocarcinoma of the cervix."
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