Incisionless cystourethropexy--the Intac device--an initial experience.

Our aim was to evaluate a new minimally invasive device for the treatment of genuine stress incontinence in women by both objective and subjective measures of outcome. Fifteen women with Type I or Type II urinary stress incontinence were treated with a new per vaginal bone anchor device designed to fix periurethral tissues to the pubic bone. No patients had significant operative morbidity. After 6-13 months a follow-up questionnaire and repeat urodynamic testing was performed for all the women. Subjectively 73% of patients had improvement in symptoms and on urodynamic testing 53% of patients were cured.

The plight of premedical education: myths and misperceptions--Part II: science "versus" the liberal arts.

For decades it has been known that students who major in non-science fields perform as well as science majors who go to medical school. Yet the overwhelming majority of future medical students still major in biology or chemistry, and organic chemistry has come to be the defining premedical science course. This article traces the history of the liberal arts tradition, discusses its importance for medicine, and urges that readers think about the medical college in the age of the university. The author believes that the medical faculties should take a lead in helping to reshape the premedical as well as the medical education of future doctors.

The plight of premedical education: myths and misperceptions--Part I: The "premedical syndrome".

The preparation for medical study and the process of gaining admission to medical school have long been contentious subjects, plagued by myths and misperceptions. In the first of two articles about the plight of premedical education, the author focuses on the myths of the "premedical syndrome" and the "cutthroat" medical student. He describes the origins of these myths, what purposes they may serve, why they persist, and why he believes they truly are myths and not accurate reflections of reality.

The historiography of medicine in America.

What is the state of medical historiography in America? This discipline is now asking new questions, branching new directions and speaking to new audiences. The social and cultural contexts in which medicine moved and moves needs to be an effective integral part of approaching the historical studies. There is today, in the U.S.A., a new history of medicine more problem-oriented and interested in the culture of medicine and in the meaning of medicine to cultural history. This new interdisciplinary field of interest deals with the study of epidemics, seen as causative agents in historical developments and as a means of studying changing ideas; it deals also with the history of women, of their medical professionalization and of their diseases. American medical history, over the last thirty years, has reconstructed the medical practices of the past by using clinical records; between other fields of research, the history of psychiatry has become a particularly fertile field of scholarship, especially in its studies about hysteria and neurasthenia; finally, medical anthropology and the history of ancient and medieval medicine, has flourished and contribute today in a high significant way to the critical reconstruction of a cultural past of medicine, quite far away from the mere biographical historiographical researches.

Urinary retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual bladder volume.

OBJECTIVE: The three objectives of this study are: to investigate the incidence of post-partum urinary retention after vaginal delivery, to investigate the relationship between various obstetric parameters and the post-partum post-void residual bladder volume and to study the natural progression of the post-void residual bladder volume in patients with covert post-partum urinary retention. METHODS: Women who had a vaginal delivery (n = 691) in a teaching hospital during a 2-month period were studied. They were classified into three groups: normal patients, those with overt urinary retention, and covert urinary retention. Their day 1 post-partum post-void residual bladder volume were recorded and analyzed with respect to the obstetric parameters. Patients with covert retention were followed up daily with ultrasound to monitor their post-void residual volume. RESULTS: The incidences of overt and covert retention in our unit were 4.9% and 9.7%, respectively. The overall incidence of post-partum urinary retention after vaginal delivery was 14.6%. The duration of the first and second stages of labor were significantly associated with the post-partum post-void residual bladder volume. In all patients with covert retention, their post-void residual volume returned to normal within 4 days. CONCLUSION: Post-partum urinary retention is a common phenomenon that may be related to the process of parturition. Covert retention is a self-limiting phenomenon and specific treatment is unnecessary.

Are Hong Kong babies getting bigger?

OBJECTIVE: To establish recent birth weight trends in Hong Kong. METHOD: A total of 10,512 confinements for the years 1985-86, and 7857 for the years 1995-96 were analyzed. RESULT: There was a significant increase in maternal height, weight at booking, and maternal age, whereas the body-mass index was reduced slightly (P < 0.0001). Parity increased significantly, with the percentage of parous women rising from 44.1% to 55.6% (P < 0.0001). The percentage of female infants decreased from 49.5% to 47.9%. Despite these changes there was no significant difference in mean birth weights between the two groups. When birth weight was controlled for sex, parity, maternal height and weight there was a trivial increase of 15 g over time (P = 0.01). CONCLUSION: Birth weight has reached a plateau in Hong Kong despite a continuing increase in the regions' socioeconomic status, and evidence of improved nutritional well-being.

Why the university-based medical school should survive: a historical perspective.

Universities and medical education have been allied since the Middle Ages. In the United States, proprietary medical schools began to unite with universities at the turn of the century. At the end of the century, this traditional alliance is being questioned, even threatened, by marketplace demands, and medical schools and their universities continue to deal with internal struggles regarding teaching and research goals, and funding. In this paper, the author defines and discusses the origins of university-medical school tensions, provides a brief review of the history of university-based medical education in the United States, and describes some of the advantages and disadvantages of the alliance. Finally, he makes a case for why medical education must continue to be grounded in universities.

Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy.

BACKGROUND: To obtain a normogram of measurements of the uterine cervix by transvaginal sonography during the third trimester of normal primiparous pregnancies and to relate these measurements to the events surrounding labor. METHODS: A prospective observational study, set in Guangzhou, Peoples Republic of China, was undertaken. Fifty-five normal nulliparous Chinese women with singleton pregnancies were studied from 30 weeks gestation until delivery. Serial transvaginal ultrasound examinations were performed at 30, 32, 34 and 36 weeks gestation and weekly thereafter. RESULTS: There was a significant correlation between gestational age and cervical length and width. Funnelling of the internal os was present in 25% of cases, and its earliest appearance was at 36 weeks. There was no consistent relationship between funnel length and width and gestational age. The duration of the first stage of labor was inversely correlated with the last ultrasound measurement of cervical length, but there was no relationship with either cervical width nor the presence of funnelling. The cervical changes in this population differed from those found in Caucasians. CONCLUSIONS: There is a direct relationship between both cervical width and length and gestational age and an inverse relationship with cervical length and the duration of labor. Funnelling of the internal os was not a predictor of the early onset of labor. The dimensions and features of the Asian cervix differ from those of the Europeans, and this should be considered when conducting further studies of a similar nature.

The epidemiology of urinary dysfunction in Chinese women.

The epidemiology of urinary dysfunction in a Chinese population living in Hong Kong was investigated. Fifteen hundred ethnic Chinese women answered a telephone questionnaire including symptoms of urinary dysfunction, anthropometric measurements, obstetric history and place of birth. The relative predictive value of these factors was analyzed using logistic regression. The prevalence of urinary dysfunction was 13%. Ten percent reported stress incontinence, and 4% had urgency or urge incontinence. The strongest predictor was place of birth, with women born in mainland China having the highest prevalence of pure stress incontinence (OR 1.33, CI 1.1-1.6). For the symptoms of detrusor instability age was the strongest predictor, with women over 50 years being at greater risk (OR 2.8, CI 1.6-5.0). Contrary to earlier beliefs, urinary dysfunction in Chinese women is as common as in Caucasian women. Place of birth is the strongest predictor for pure stress incontinence, with women born in mainland China being at greater risk. This suggests that environmental factors in early life have a differential effect on the development of urinary incontinence.

The prevalence of urinary dysfunction in Hong Kong Chinese women.

OBJECTIVE: To determine the prevalence of urinary dysfunction in Hong Kong Chinese women. METHODS: A telephone survey was conducted in the territory of Hong Kong. The subjects were a sample of women between the ages of 10 and 90 years. The main outcome determined was the prevalence of urinary dysfunction. RESULTS: We made 3248 calls, resulting in 819 evaluable responses. Stress incontinence was reported by 21% (174) of respondents, urgency or urge incontinence in 15% (120), urinary frequency in 19% (154), nocturia in 20% (166), bed-wetting in 4% (31), and voiding difficulties in 13% (109). Stress incontinence occurred as the only symptom in 7% (53), the combination of urgency and frequency in 1% (11), and mixed symptoms in 6% (52). Four percent required protective underwear or pads, with 2% wearing protective underwear continuously; 4% were incapacitated by their incontinence. Symptoms of urgency, urge incontinence, frequency, and nocturia increased with increasing age, but voiding difficulties and nocturnal enuresis were unrelated to age. Stress incontinence, urgency, urge incontinence, frequency, nocturia, and voiding difficulties increased with increasing parity to para 4. CONCLUSION: Urinary dysfunction and its patterns appear to be as common and incapacitating in Hong Kong Chinese as they are in other populations.

Abdomino perineal repair of pulsion enterocele.

OBJECTIVES: To review the techniques, results and complications of the combined abdomino perineal repair and mersilene mesh sacrocolpopexy. METHODS: From March 1988 to December 1993; 45 cases of pulsion enterocele were treated by a combination of the Zacharin type abdomino perineal repair and mersilene mesh sacrocolpopexy. Forty cases were followed from between 1 month and 18 months (mean 5.95 months). The notes were reviewed retrospectively. RESULTS: There were 3 recurrences (7.5%). Complications were not insignificant: wound infection in 3, urinary tract infection in 6, bowel dysfunction in 8, ventral hernia, vaginal stricture necessitating surgical release, and brachial nerve plexus injury occurred once. In one patient a peritoneal cyst developed necessitating laparoscopic aspiration. CONCLUSIONS: The combined abdomino perineal and sacrocolpopexy procedure offers the restoration of normal anatomy and the relief of the symptoms of prolapse in 92.5% of patients. The complication rate is significant and it should be undertaken as a secondary procedure.

Genital prolapse: a legacy of the West?

A retrospective study was undertaken to determine if there has been a change in the incidence of genital prolapse and urinary stress incontinence in Chinese women in Hong Kong. The medical records of 2,312 consecutive patients admitted for major gynaecological surgery for benign conditions in 5 out of 7 major public teaching hospitals in Hong Kong for the calendar year of 1993 were reviewed by way of an audit of all gynaecological operations performed in these hospitals. A total of 578 cases (25%) were identified as having genital prolapse and or urinary problems.

Cushing syndrome in pregnancy secondary to an adrenal cortical adenoma.

Cushing syndrome in pregnancy is rare. This is explained by the syndrome's association with amenorrhoea, oligomenorrhoea, infertility and abortions. Cushing syndrome commonly presents with hypertension, weight gain, diabetes, striae or truncal obesity, all of which can be consistent with pregnancy in women without Cushing syndrome. We describe a case of Cushing syndrome in pregnancy secondary to an adrenal cortical tumour which was discovered after an abnormal glucose tolerance test. The woman developed classical features of Cushing syndrome including gestational diabetes and hypertension and was managed successfully to term after a unilateral adrenalectomy at 23 weeks. The case is reported not only because of its rarity but also because the diagnosis was made after a routine screening test for gestational diabetes. Early diagnosis and treatment of adrenal adenoma causing Cushing syndrome in pregnancy reduces maternal and fetal morbidity and mortality.

Sacrospinous colpopexy.

Sacrospinous colpopexy is a useful procedure in the cure of pulsion enterocele, high rectocele, and posthysterectomy vault prolapse. It allows the surgeon to correct coincident cystocele and rectocele and permits restoration of a relatively normal and comfortable vaginal depth and axis. It is a quick procedure, avoids intraabdominal trauma, has a high success rate and a low complication rate (1) and is useful in the management of patients who wish to maintain coital function. This paper retrospectively reviews the techniques, results and complications of 107 sacrospinous colpopexies performed in 104 patients over an 8-year interval.