Long-term effects ten years after maximal electrostimulation of the pelvic floor in women with unstable detrusor and urge incontinence.

OBJECTIVE: The purpose was to study any long-term therapeutic effects of maximal electrical stimulation in female urge incontinence. METHODS: A postal questionnaire containing six questions about urinary incontinence was distributed to 30 women who had been treated with maximal stimulation because of unstable detrusor and urge incontinence 9-13 years earlier. The response rate was 90% (27 women). The mean age at follow-up was 62 years. RESULTS: Twenty-one (78%) women reported symptoms of urge incontinence. Among them, 13 had this problem daily, whereas eight only had problems weekly or even more seldom. Nineteen (70%) women reported symptoms of stress incontinence. Twenty-one women would have recommended maximal stimulation to a friend today. CONCLUSION: After approximately ten years most of the women had symptoms of urge incontinence. This was, however, a minor problem among a third of them. A majority of the women were satisfied with maximal stimulation as a treatment modality. The treatment had not prevented a later occurrence of stress incontinence.

CO2 laser conization for cervical intraepithelial neoplasia grade II-III: complications and efficacy.

AIMS: To examine per- and postoperative complication rates and efficacy of laser conization in the treatment of cervical intraepithelial neoplasia (CIN) grade II-III. MATERIAL AND METHODS: Eligible for analyses were all women treated with their first laser conization because of CIN II-III during the time-period January 1, 1983 to December 31, 1992. The study population comprises 1081 women who were permanent residents of one Norwegian county (Sør-Trøndelag). All analyses were performed in SPSS applying chi-square for trend, Mann-Whitney test, survival analyses and logistic regression. RESULTS: In total 86 women (8.0%) were observed with one or two (4:86) complications. Bleeding was most frequent (n = 66) followed by symptomatic cervical stenosis (n = 18). Most bleeding complications (74.2%) occurred one to two weeks postoperatively. Both bleeding complications and the occurrence of cervical stenosis were associated with cone height. Three emergency hysterectomies, two for bleeding and one for bladder perforation, were performed. Persistent disease was diagnosed in 1.9% (20:1053) of the women. All women with persistent disease were diagnosed among those with CIN III. Persistent disease was more than 20 times more common among women with disease-involved resection margins compared to those with free resection margins. CONCLUSIONS: Our evaluation of ten years' consistent use of conization by CO2 laser in the treatment of CIN II-III in an unselected population showed a low overall complication rate (8%) and very high efficacy (CIN II 100%, CIN III 98.1%) of the treatment.

Randomized double-blind trial of low- and moderate-dose lidocaine regional anesthesia for forearm fractures in childhood.

We undertook a randomized double-blind trial to compare the efficacy of 1.5 mg/kg body weight (low dose) and 3 mg/kg (moderate dose) lidocaine regional anesthesia for closed reductions of forearm fractures in childhood. Of the 283 children studied, 143 were randomized to the moderate-dose group and 140 to the low-dose group. The characteristics of the children and their injuries did not differ significantly. There were no complications due to lidocaine toxicity. In children with angulated and incompletely displaced fractures, satisfactory anesthesia was achieved in 94% of those receiving the low dose and in 97% of those receiving the moderate dose of lidocaine. In children with completely displaced fractures, satisfactory anesthesia was achieved in 93% of those receiving the moderate dose but in only 67% of those receiving the low dose of lidocaine. We conclude that the low-dose lidocaine protocol is suitable for children requiring closed reductions of angulated and incompletely displaced fractures of the forearm. In contrast, the moderate-dose lidocaine protocol is more reliable in children with displaced forearm fractures. Meticulous adherence to the protocols is essential to prevent systemic lidocaine toxicity from premature deflation of the tourniquet. This potential risk is further reduced by use of the low-dose protocol, which is applicable to approximately 70% of the children with forearm fractures requiring closed reductions.

Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.

Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey.

STUDY OBJECTIVE: The aim was to validate a simple severity index of female urinary incontinence for subsequent use in an epidemiological survey. DESIGN: The index was created by multiplying the reported frequency (four levels) by the amount of leakage (two levels). The resulting index value (1-8) was further categorised into slight (1-2), moderate (3-4), and severe (6-8). It was validated against a 48 hour "pad weighing" test. Thereafter, an anonymous postal questionnaire survey was performed and the index was used to assess the severity of the leakage. A question about the impact of incontinence was also included. SETTING: The outpatient clinic of the Department of Gynaecology and Obstetrics, Trondheim University Hospital and the rural community of Rissa, Norway. PARTICIPANTS: Altogether 116 incontinent women referred to the clinic by their GP and all 2366 adult women living in Rissa. RESULTS: The difference in median pad weights between moderate and slight incontinence was 9g/24h (95% confidence interval 0-27). The corresponding difference between severe and moderate incontinence was 17g/24h (95% CI 5-30). In the epidemiological survey 29.4% reported urinary incontinence (response rate 77%). The prevalence tended to be highest in middle life and old age. Forty six per cent were classified as slight, 27% moderate, and 27% severe. There was a strong correlation between severity and impact (R = 0.59, p < 0.001). CONCLUSION: The severity index may be a useful tool for assessing the severity of female urinary incontinence in epidemiological surveys. It is confirmed that urinary incontinence is very prevalent in adult women, but most should not be regarded as potential patients.

Accessory diaphragm contributing to respiratory insufficiency in a child with progressive thoracolumbar spinal scoliosis.

A patient with an accessory right diaphragm discovered during thoracotomy for correction of severe thoracolumbar scoliosis is presented to illustrate the diagnostic difficulties that may occur in children with accessory diaphragm. The patient had presented at an early age with respiratory symptoms which were assumed to be asthmatic in aetiology and complicated by progressive chest deformity. The respiratory symptoms in accessory diaphragm can be improved by surgery.

Complete dislocation of the knee without disruption of both cruciate ligaments.

Complete dislocation of the knee is recognized to be an extremely severe injury, representing one of the few true orthopedic emergencies. There is major trauma to the ligaments, capsule, and tendons, with a high incidence of associated damage to the popliteal artery and peroneal nerve. Resulting disability can be great, reflected by pain, stiffness, or instability of the knee; neurologic deficits in the foot and ankle; and even amputation if the vascular injury is not addressed promptly. Most accounts of knee dislocations in the literature have suggested that disruption of both cruciate ligaments is necessary for a complete dislocation to occur. This consensus is based on clinical observations and some laboratory investigations of ligament failure patterns. This report presents four cases of complete tibiofemoral knee dislocation without disruption of both cruciate ligaments. We also review the literature on knee dislocations with an emphasis on the biomechanics of soft tissue restraints about the knee and analyze how sufficient laxity can occur, with one cruciate ligament remaining intact, to allow for complete knee dislocation.

Benign paroxysmal torticollis of infancy.

Benign paroxysmal torticollis is a self-limiting condition occurring during infancy. It resolves by the age of two to three years. Periodic episodes of torticollis may randomly alternate from side to side and be associated with other symptoms. The aetiology is unknown and no treatment is effective. It is relatively uncommon, and has not been previously reported in the orthopaedic literature, although initial referral may well be to an orthopaedic surgeon. We report four cases, and review the literature.

Fertility after complicated and non-complicated use of IUDs. A controlled prospective study.

From 1980 to 1985, 600 women participated in a prospective study of three copper IUDs. Women who had removed their IUD by April 1985 because of IUD-related complications or planned pregnancy after non-complicated use were examined for return of fertility. Within 39 months after removal, all 97 women who planned pregnancy had conceived. By April 1987, one of the 147 women with a previous IUD complication needed a fertility work-up. Among the remaining 146 women, 72 women had conceived, while 74 women neither had pregnancy plans nor had conceived after IUD removal. Three (1.8%) out of the 169 pregnancies after IUD removal were extrauterine; 17 (10.1%) were spontaneous abortions. One percent of the women planning pregnancy requested induced abortion, compared to 29% among women who removed the IUD due to complications (p less than 0.01). From these data we conclude that use of copper-containing IUDs did not affect subsequent fertility.

A randomized trial of three copper IUDs (MLCu250, MLCu375 and Nova-T).

A randomized prospective trial of three copper IUDs, Nova-T, MLCu375 and MLCu250, including 200 of each, is presented. Insertion was done at the hospital outpatient clinic on normally menstruating women and on women in puerperio. Follow-up was scheduled after 12, 24 and 36 months. Pregnancy rates were low for all 3 models. Pearl indices after 3 years were 0.5, 0.9 and 0.8 for Nova-T, MLCu375 and MLCu250 respectively (NS). Abnormal bleeding and/or pain was the most frequent termination cause. Minor differences in the termination rates because of abnormal bleeding and/or pain were found and are discussed. The continuation rates based on all medically relevant IUD removals were 74%, 73% and 81% after 3 years for Nova-T, MLCu375 and MLCu250 respectively. No important difference in clinical performance between the three copper IUDs could be demonstrated.

Return of fertility after use of IUDs (Nova-T, MLCu250 and MLCu375).

In a randomized prospective study of three copper-containing IUDs, those women who terminated contraception in order to become pregnant were studied for return of fertility. The gross cumulative pregnancy rate was 79.3 after 11 months and 90.4 after 23 months of observation. There were no significant differences in the return of fertility related to the type of IUD, duration of use, parity or maternal age. However, parous women showed a tendency to initiate pregnancy more easily than nulliparous women (p less than 0.10). The seven women who did not conceive within 18 months of IUD removal had a fertility work-up. Five of these women later became pregnant after clomiphene stimulation. In no case could tubal pathology be identified as the sole explanation for infertility. After 35 months of observation, 95 out of 97 past users of IUDs have conceived. The use of copper-containing IUDs does not seem to affect subsequent fertility among women living in stable relationships.

Comparative pharmacokinetics and subacute toxicity of di(2-ethylhexyl) phthalate (DEHP) in rats and marmosets: extrapolation of effects in rodents to man.

Certain phthalate esters and hypolipidemic agents are known to induce morphological and biochemical changes in the liver of rodents, which have been associated with an increased incidence of hepatocellular tumors in these species. There is evidence that hypolipidemic agents do not induce these effects in either subhuman primates or man. The oral and intraperitoneal administration of di(2-ethylhexyl) phthalate (DEHP) to the marmoset monkey at doses up to 5 mmole DEHP/kg body weight/day for 14 days did not induce morphological or biochemical changes in the liver or testis comparable with those obtained in rats given the same amount of DEHP. In the marmoset, the excretion profile of [14C]-DEHP following oral, IP, and IV administration and the lower tissue levels of radioactivity demonstrated a considerably reduced absorption in this species compared to the rat. The urinary metabolite pattern in the marmoset was in many respects qualitatively similar to but quantitatively different from that in the rat; the marmoset excreted principally conjugated metabolites derived from omega- 1 oxidation. The pharmacokinetic differences between these two species indicate that the tissues of the marmoset are exposed to a level of DEHP metabolites equivalent to the complete absorption of a dose of Ca. 0.1 to 0.25 mmole DEHP/kg body weight/day without significant toxicological effects. These exposure levels are at least 100-fold greater than the worst estimates of incidental human exposure (ca. 0.0015 mmole/kg/day). They are comparable with the human therapeutic dose of many hypolipidemic drugs (ca. 0.15 mmole/kg/day), a dose at which it is claimed that there is an absence of morphological or biochemical changes to human or subhuman primate liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Microcomputer-based system for registration of oxygen tension in peripheral muscle.

For registration of oxygen tension fields in peripheral muscle a microcomputer based system was designed on the M6800 microprocessor. The system was designed to record the signals from a multiwire oxygen electrode, MDO, which is a multiwire electrode for measuring oxygen on the surface of an organ. The system contained patient safety isolation unit built on optocopplers and the upper frequency limit was 0.64 Hz. Collected data were corrected for drift and temperature changes during the measurement by using pre- and after calibrations and a linear compensation technique. Measure drift of the electrodes were proved to be linear and thus the drift could be compensated for. The system was tested in an experiment on pig. To study the distribution of oxygen statistically mean, standard deviation, skewness and curtosis were calculated. To see changes or differences between histograms a Kolmogorv-Smirnov test was used.

Fine needle aspiration biopsy. A reliable diagnostic tool in the management of thyroid nodules.

Fine needle aspiration biopsy (FNAB) has been suggested as a diagnostic alternative to routine thyroidectomy for solitary thyroid nodules. During a 15-month period, 51 patients underwent FNAB prior to thyroidectomy. FNAB demonstrated an accuracy of 73 per cent in predicting benign or malignant disease and would have reduced the number of thyroidectomies by 55 per cent. Furthermore, it was found to be safe and more cost-effective than traditional thyroid nodule evaluation and management.

Clinical experience with a triphasic oral contraceptive.

A triphasic combined oral contraceptive containing fluctuating amounts of ethinylestradiol and levonorgestrel was tested clinically in a multicenter trial at six hospitals in Norway. 367 women were included in the study, 3 588 cycles were studied, and the follow up period was 12 months. The one year continuation rate was 67%. Five pregnancies occurred during the study period. All of them had to be considered as patient failures. The causes for stopping medication were side effects in about 50% and the rest for personal reasons. The cycle control taking into account duration of bleeding, amount of flow, and intermenstrual bleeding was good and comparable to the low-dose monophasic combined pills. The incidence of side effects was low. One woman had an increase in systolic blood pressure to more than 140 mmHg. Thrombophlebitis was not registered. In conclusion the triphasic oral contraceptive was effective and had a good cycle control and low incidence of side effects.

PIP: A triphasic combined oral contraceptive (OC) containing fluctuating amounts of ethinyl estradiol and levonorgestrel was tested clinically in a multicenter trail at 6 hospitals in Norway. 367 women were included in the study, 3588 cycles were studied, and the follow-up period was 12 months. The 1 year continuation rate was 67% 5 pregnancies occurred during the study period. All were considered patient failures. The causes for stopping medication were side effects in about 50% and the rest for personal reasons. The cycle control taking into account duration of bleeding, amount of flow, and intermenstrual bleeding was good and comparable to the low-dose monophasic combined pills. The incidence of side effects was low. 1 woman had an increase in systolic blood pressure to more than 140 mmhg. Thrombophlebitis was not registered. In conclusion, the triphasic OC was effective and had good cycle control and low incidence of side effects.

Thyroid cancer: diagnosis and management based on a review of 142 cases.

Review of 142 patients with thyroid cancer diagnosed and treated in a community hospital from 1958 through 1972 suggests that total thyroidectomy and radical neck dissection are unwarranted in the treatment of papillary carcinoma. Radioactive iodine scanning and needle biopsy are also shown to be unreliable indexes of malignancy. An operation approach to the management of specific thyroid cancers is presented.