Thesis (M.D.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 228-261).

Thesis (M.D.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 228-261) Also available in print.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Extreme controversy surrounds the uncertainty of pelvic mesh and sling devices to essentially cure patients of stress urinary incontinence (SUI). A relatively new product that has taken the market by storm is the tension free Vaginal Tape‐ Obturator (TVT‐O) mesh by Ethicon, Gynecare. It has obtained Center for Disease Control approval and labeled a “clinically proven, safe product with a 90% cure rate for urinary incontinence,” according to the manufactures website (Ethicon, Gynecare)4, 8. One side effect that is known about this particular device is its ability to leave patients post surgery with unbearable, chronic pelvic pain2. Although the mesh is needed to prevent urinary incontinence, it is pivotal that the quality of life of our patients does not suffer appreciably with elective, non‐life threatening procedures. Another common mesh product is the pelvic sling by Monarc. One‐study reports more than 95 percent of patients who underwent elective surgery with the insertion of Monarc sling achieved complete dryness and did not require the use of pads following the procedure22. These are successful outcomes, but what occurs with the minority of patients that have unfavorable outcomes such as chronic pain12, 15, 16? A retrospective study was completed to deduce the onset of pain and severity of pain caused by the TVT‐O mesh and Monarc mesh‐utilizing data from Dr. Hibner’s patients. There were 19 chronic pelvic pain patients with an average age of 50, standard deviation of 11 years, seen by Dr. Hibner and his colleagues. These patients completed the International Pelvic Pain assessment form upon their first visit to the office and SF‐36 scores of physical and mental scores were obtained. Results found physical scores of 29.5 and mental scores of 36 in pelvic pain patients, which were higher than certain other chronic, medical diseases1. We were able to conclude that patients with pelvic pain from mesh have lower physical and mental SF‐36 scores than patients with other chronic diseases representing a decreased quality of life overall.

Background: Pelvic radiotherapy is a well-established treatment for pelvic malignancies, with 30,000 patients per year in the UK receiving radical pelvic radiotherapy either alone or in combination with other oncological treatments. 80% develop acute gastrointestinal (GI) symptoms and 50% develop chronic GI symptoms and in parallel to improvements in survival, increasing numbers of patients are living to develop the long term consequences of treatment. Despite this, less than 20% of patients who develop chronic GI symptoms are ever referred to a gastroenterologist. Aims: 1. To determine the current practice of clinical oncologists and gastroenterologists with respect to management of chronic GI symptoms following pelvic radiotherapy in 2 parallel national surveys. 2. To determine whether specialist gastroenterological management of chronic GI symptoms following pelvic radiotherapy based on a structured algorithmic approach identifies GI diagnoses and improves outcomes. 3. To determine whether a GI care bundle comprising nutritional assessment and intervention and investigation of GI symptoms and subsequent treatment of diagnoses found is feasible and acceptable to patients. Findings: There is no formal robust screening for GI symptoms, low referral rates, patchy services, use of ineffective treatments and inadequate expertise. Oncologists underestimate the problem and under refer. Gastroenterologists are seeing low numbers of patients and lack expertise. Both groups state that a regional multidisciplinary service for patients with GI symptoms following pelvic radiotherapy would be desirable. Patients who develop GI symptoms following pelvic radiotherapy present with multiple symptoms (median 8) and thorough structured evaluation identified multiple potentially treatable diagnoses, with 28 patients (55%) having ≥2 causes for their GI symptoms. Half of diagnoses were unrelated to previous cancer treatment. Common diagnoses included radiation proctopathy, bile acid malabsorption, diverticulosis and colonic polyps. A clinically and statistically significant improvement in GI symptoms was found in parallel to GI intervention using inflammatory bowel disease questionnaire (IBDQ) (p=0.014), Vaizey incontinence questionnaire (VIQ) (p<0.0005) and the Common Terminology Criteria for Adverse Events (CTCAE) pelvic symptom questionnaire rectum-bowel subset (p=0.001). Initial data show that GI and nutritional intervention during pelvic chemoradiotherapy is both feasible and acceptable to patients. Conclusions: There is inadequate care and services for this patient group in the UK. GI intervention using a structured algorithmic approach is of benefit in terms of identifying potentially treatable diagnoses and improving symptoms. GI intervention during pelvic radiotherapy is feasible and acceptable to patients and ongoing work will determine the benefit of this intervention in terms of symptom control in the short and long term and cost benefit. A programme of mechanistic and clinical research is required to improve the understanding of this scenario.

Planes frequently used to identify radiologic and abdominal ultrasono‐graphic images such as transverse, coronal, and sagittal are generally not anatomically correct when applied to transvaginal ultrasonographic planes and images. More appropriate terminology specific for the planes imaged during transvaginal ultra‐sonography, such as TRANS‐pelvic and AP‐pelvic planes, are suggested. A TRANS‐pelvic plane refers to a plane imaged when the sound beam is directed across or from side to side in the pelvis. An AP‐pelvic plane refers to an image obtained when the sound beam is directed anteriorly and posteriorly.

No description available.

Background: Chronic pelvic pain (CPP) in women causes significant disability and distress. Like other chronic pain conditions, psychosocial variables likely play as key a role in the development and maintenance of CPP as physiological ones. The purposes of this study were to use the Biopsychosocial model to determine the predictors of pain and quality of life (QOL) and to specifically examine to effect of baseline catastrophizing on 12-month pain and QOL. Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire). Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R2 = .42, pβ = .46, p < .001) and baseline QOL (R2 = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R2 = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL. Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.

In 1996, a RCOG Study Group reporting on the prevention of pelvic infection highlighted the considerable role <i>C. trachomatis </i>played in female reproductive morbidity and the potential advantages of DNA based assays.  A national screening programme was suggested, as Sweden and the USA had demonstrated that screening women could decrease prevalence and pelvic inflammatory disease rates. In the UK, out with genito-urinary medicine clinics, awareness of the infection and screening was virtually non-existent.  Women attending obstetric and gynaecology-affiliated clinics were at increased risk of ascending infection compared to the general public and ideally placed for opportunistic screening.  However, patients were <i>TESTED </i>only if symptomatic, by specimens taken from the endocervix for culture or antigen detection assay.  It was from this background that the studies commenced.  The thesis comprises of: -  A questionnaire survey assessing sexually active women’s knowledge of <i>C. trachomatis </i>infection and perceived acceptability of different methods and settings for screening.  Women attending induced abortion and family planning clinics in Aberdeen and Leeds were recruited. -  A prevalence study, aiming to identify who should undergo screening.  Sexually active women attending six different clinical settings in Aberdeen’s Obstetrics & Gynaecology department were screened for <i>Chlamydia.</i> -  A study assessing test performance and acceptability of four different screening approaches (enzyme immunoassay of endocervical specimens and ligase chain reaction assay of endocervical, clinician-collected vulva!, and urine specimens) to opportunistically screen pregnant and non-pregnant women, under 25<i> </i>years of age. -  A study evaluating patient-collected vulval swabs, as an alternative to non-invasive screening by urine.  Women under 25 years of age attending a family planning clinic were opportunistically screened and test performance and acceptability evaluated. -  A study determining whether the measurement of chlamydial IgG antibodies alone or in combination with medical history and/or transvaginal ultrasound can predict tubal infertility in subfertile women.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.