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At least 253 records · Page 14Linked to original sources
PubMed2003

Effect of operative vaginal delivery on the outcome of permanent brachial plexus injury.

OBJECTIVE: To evaluate whether operative vaginal delivery worsens the extent and/or degree of permanent brachial plexus injury. STUDY DESIGN: We utilized a dataset (n = 104) of vaginal deliveries resulting in permanent brachial plexus injury that ultimately underwent litigation. We excluded patients on whom neonatal injury information was incomplete (n = 5). Patients who had an operative vaginal delivery (n = 33) were compared with those who did not (n = 66) in regard to neonatal outcome and the location and extent of neurologic injury. RESULTS: The 2 classes were similar in demographic and obstetric variables. There were no differences in rates of 5-minute Apgar scores < 7 (17.9%, or 5/28, vs. 5.2%, or 3/57, P = .1), complete neurologic injury to the brachial plexus (C5-T1) (39%, or 13/33, vs. 38%, or 25/66; P = 1.0) or avulsion of the nerve roots (44%, or 12/27, vs. 36%, or 18/50; P = .5) between those with operative or spontaneous vaginal delivery. CONCLUSION: Operative vaginal delivery did not increase the severity of impairment in a dataset of deliveries resulting in permanent brachial plexus injury.

Adult↗
PubMed1988

New class of antifungal agents: jasplakinolide, a cyclodepsipeptide from the marine sponge, Jaspis species.

Jasplakinolide is a cyclodepsipeptide which represents a new class of antifungal agents with potent activity against Candida albicans. Jasplakinolide is fungicidal against C. albicans with both a MIC and a minimum lethal concentration of 25 micrograms/ml in a broth dilution assay. This activity compares to that of the imidazole miconazole nitrate, which had a MIC of 6.2 micrograms/ml and a minimum lethal concentration of 50 micrograms/ml in the same assay. Topical administration of 2% jasplakinolide cream against a murine vaginal C. albicans infection was equivalent in efficacy to administration of miconazole nitrate at 2%. Subcutaneous administration of jasplakinolide was not effective against a systemic murine C. albicans infection.

Animals↗
PubMedDate not supplied

Treatment of sexually transmitted vaginosis/vaginitis.

Although much has been learned about sexually transmissible forms of vaginitis/vaginosis during the past decade, therapeutic options for these disorders remain limited. A single 2-g oral dose of metronidazole still remains highly effective against most Trichomonas vaginalis infections. Mildly resistant infections can usually be cured with metronidazole oral doses of 2 g daily for 3-7 days. When highly resistant infections occur, toxic levels of metronidazole may be needed for the drug to cure the infection. Metronidazole (500 mg twice daily for 7 days) continues to be highly efficacious in the treatment of bacterial vaginosis. Shorter oral treatment regimens that use single 2-g doses of metronidazole for 2-3 days appear promising but may be associated with higher relapse rates. Oral clindamycin (300 mg twice daily) or local 2% clindamycin cream (once daily for 7 days) also may be effective. Metronidazole intravaginal sponges (250-1,000 mg) used for 3 days may also be effective in the treatment of bacterial vaginosis.

Bacterial Infections↗
PubMed1984

Intraventricular hemorrhage. Incidence and outcome in a population of very-low-birth-weight infants.

The incidence, extent, and outcome of germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) were determined with the use of ultrasound and autopsy findings in 100 consecutive infants, with a birth weight of less than 1,500 g. Serial ultrasound examinations once or twice weekly were performed with the use of a portable real-time linear-array scanner. The overall incidence of GMH-IVH was 46%. Twenty infants had grade 1 (GMH), 24 had grade 2 (IVH +/- GMH), and two had grade 3 (IVH +/- GMH with intracerebral hemorrhage) conditions. The mortality in infants with GMH-IVH was 35%, compared with 13% in infants without GMH-IVH. Although 11 (37%) of 30 survivors with GMH-IVH had ventricular dilatation, only two infants required ventriculoperitoneal shunts for progressive hydrocephalus. The incidence of GMH-IVH was increased in outborn infants, in those delivered vaginally, and in those who required mechanical ventilation, bicarbonate therapy, or volume expansion in the first 24 hours. The long-term prognostic significance of the ultrasound findings was unknown and will be determined by follow-up studies.

Cerebral Hemorrhage↗
PubMed1999

Women's attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda.

The consistent and correct use of the male condom makes it highly effective in both disease prevention and as a contraceptive method. However, it is also well recognized that its use is under men's control. Because of this vital limitation, there have been frequent calls for female-controlled methods of HIV prevention, particularly from women from sub-Saharan Africa. Here we report on data collected in focus-group discussions (FGDs) with women aged 17-54 in South-Western Uganda. A total of 138 women, from rural villages, urban family planning clinics and a truck-stop town, were recruited to participate in 18 FGDs on the male condom, the female condom and existing formulations of vaginal microbicidal products. Three themes emerged: (i) problems with men's control over the male condom, (ii) the importance of control over and secrecy about protective measures and (iii) sexual pleasure associated with different methods. We found that the female condom, while being perceived as an improvement over the male condom, was recognized as having limited value because of the need to agree its use prior to sex taking place. Other products were considered to be significantly better than the female condom; the sponge, in particular, was perceived as having advantages over every other product. Women like the fact that it could be inserted some time before, and left in place some time after, sexual intercourse, that it was effective for multiple instances of intercourse, and that men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of ceding some control over sexual and reproductive health to women.

Adolescent↗
PubMed1977

[The diagnosis and treatment of mixed anaerobic vaginal dischargs (authors' transl)].

In about 5% of 3355 patients the microscopic examination of the vaginal discharge in normal saline showed a characteristic fast moving rod. More than 80% of these patients complained of a discharge with a foul smell during the menstrual period. Bactriology showed an anaerob gram negative rod which was difficult to grow and is as yet unclassified. Following treatment with one gram of Mimorazol every 12 hours for 3 doses, 71,5% of the patients were cured and showed a normal vaginal flora without further treatment. In around 24,13% of the patients the gram negative rod disappeared but a persistent mixed flora required further treatment. In 4.3% of the patients a recurrence occurred. An attempt was made to prevent recurrent infection prior to the follow-up examination by prohibition of sexual intercourse with an untreated partner, bathing in public swimming pools, and the use of sponges or wash cloths. In the course of the investigation the suspicion of contamination from the water of public pools became apparent. The diagnosis, treatment and transmission and the pathogenecity of the fast moving negative rod is discussed.

Female↗
PubMed2003

Self-collected versus provider-collected vaginal swabs for the diagnosis of bacterial vaginosis: an assessment of validity and reliability.

Bacterial vaginosis (BV) in pregnancy is related to numerous adverse events; however, the validity of different methods of vaginal swab collection to diagnosis BV among pregnant women is unclear. This study examines the validity of self-collected compared with provider-collected vaginal swabs and describes the intra-rater and inter-rater reliability of BV assessment among a sample of pregnant women early in gestation. Gram-stain evaluation of vaginal samples using the Nugent criteria was conducted to determine the overall and morphotype-specific BV scores. We found strong validity for the overall and morphotype-specific scores comparing self-collected swabs to provider-collected swabs. In addition, we found excellent overall and morphotype-specific inter-rater reliability and excellent intra-rater reliability in our sample. These study results support the use of self-collected vaginal swabs for diagnosing BV and document the reliability of BV assessment among pregnant women.

Adult↗
PubMed2005

Super-selective angiographic embolisation of a branch of the anterior pudendal artery for the treatment of intractable post-operative bleeding.

We describe a case of post-operative bleeding after a posterior fascial defect repair. This was refractive to exploration and vaginal packing so laparotomy would have been necessary. Superselective cannulation demonstrated bleeding from a branch of the anterior pudendal artery which had crossed the midline making identification difficult during vaginal exploration. The bleeding vessel was embolised using a mixture of PVA300 and Spongistan gel foam and the bleeding ceased. The use of embolisation in the peri-operative phase is discussed.

Angiography↗
PubMed2005

The Maternal-Fetal Medicine Unit cesarean registry: trial of labor with a twin gestation.

OBJECTIVE: The purpose of this study was to identify the success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery. STUDY DESIGN: Cases were identified in the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network's Cesarean Registry with a woman with a twin pregnancy who had had at least 1 previous cesarean delivery. RESULTS: During the study period (1999-2002), 412 women fulfilled the study criteria, and 226 women had elective repeat cesarean delivery. Of the 186 women (45.1% of total) who attempted a trial of labor, 120 women were delivered successfully (success rate, 64.5%), and 66 women (35.5%) had a failed trial of labor. Thirty of the failed trials of labor involved a vaginal delivery for twin A and cesarean delivery for twin B. Women who attempted a trial of labor with twins had no increased risk of transfusion, endometritis, intensive care unit admissions, or uterine rupture when compared with elective repeat cesarean delivery. Fetal and neonatal complications were uncommon in either group at>or=34 weeks of gestation. CONCLUSION: A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity. Perinatal morbidity is uncommon at>or=34 weeks of gestation.

Adult↗
PubMed1983

A phase I trial of beta-all-trans-retinoic acid delivered via a collagen sponge and a cervical cap for mild or moderate intraepithelial cervical neoplasia.

A phase I trial was conducted of the vitamin A derivative beta-all-trans-retinoic acid (vitamin A acid; TRA), delivered via a collagen sponge and cervical cap for mild or moderate intraepithelial cervical neoplasia. On the basis of known skin and mucosal membrane toxicity, a concentration of 0.05% TRA in a cream-based vehicle was selected as the starting dose and was escalated later with the use of a modified Fibonacchi scale. The delivery device and the TRA were changed daily for 4 days, and side effects were assessed on days 1, 2, 3, 4, 8, and 30 by clinical and colposcopic examination. Vaginal, cervical, and systemic toxicity were evaluated in 35 patients. No dose-related systemic effects were found; mild cervical inflammation increased in many patients at higher doses. Unacceptably high vaginal toxicity was reached at a TRA concentration of 0.484%. A concentration of 0.372% TRA is recommended for use in phase II trials in mild and moderate cervical intraepithelial neoplasia.

Biopsy↗
PubMed2004

A comparative study of induction of estrus and ovulation by three different intravaginal devices in ewes during the non-breeding season.

The aim of the present study was to compare three methods of estrus synchronization in ewes during the non-breeding season. Forty-two ewes were randomly grouped for three treatments with different intravaginal devices for 12 days: Group A) CIDR, Group B) Self-made P sponge, Group C) MAP (medroxyprogesterone acetate) cream sponge. Furthermore, all groups were divided into two treatments with (R) or without ram presence to examine the "ram effect". Blood was collected from all treated ewes, and progesterone (P(4)), estradiol 17-beta (E(2)) and luteinizing hormone (LH) concentrations were measured by enzyme-immunoassay. All ewes showed estrus behavior between Day 0 to 3 after device removal, and the mean onset times of their estrus were 23.0, 33.0 and 21.0 h for Groups AR, BR and CR, respectively. On Day 5 as examined by laparoscopy, the ovulation rates (and number of ovulated ewes) were 1.45 (11/11), 1.25 (12/14) and 1.21 (14/14) for Groups A, B and C, respectively. In Group C, the time to LH surge was significantly (P<0.05) later (32.4 h) than those in Groups A (27.0 h) and B (25.5 h). Ram presence did not affect the number of ovulated ewes, ovulation rate or time to LH surge. The ram introduction group had significantly (P<0.05) lower E(2) concentrations during the period from 0 h to 36 h than the groups without ram presence. These results suggest that the self-made P sponge or MAP cream sponge was effective as well as CIDR, and ram introduction was not necessary, for induction of estrus and ovulation during the non-breeding season.

Animals↗
PubMedDate not supplied

[Benzalkonium in local contraception and sexually-transmitted diseases].

In 96 women, followed in ambulatory from 1983 to 1986, the use as a local contraceptive of a sponge treated with benzalkonium has been studied. This substance has not only shown itself a good contraceptive but may result even a useful precautionary measure against STD.

Administration, Intravaginal↗
PubMed1992

Anal sphincter size measured by endosonography in healthy volunteers. Effect of age, sex, and parity.

The anal sphincter muscles consist of the circular internal and external sphincters together with the sling-shaped associated puborectalis muscle. Ten men, 10 women with no vaginal deliveries, and 10 women with one or more vaginal deliveries were studied with anal endosonography using a 7 MHz multiplanar endoprobe. The thickness of the internal sphincter and the thickness, length, and cross-sectional area of the external sphincter were measured and related to age, sex, and parity. Reproducibility was assessed by similar measurements on different days in 10 volunteers. Anal sphincter size was the same in men and women and was not affected by the number of child births. Internal sphincter muscle thickness increased with age. Anal manometry and electromyography with an anal sponge were performed in all volunteers but the results did not correlate to any of the anal sphincter dimensions. Our conclusion is that although there are some limitations, endosonography can be used to determine the size of the anal sphincter muscles.

Adult↗
PubMed2003

Correlates of IL-10 and IL-12 concentrations in cervical secretions.

Interindividual variations in host immune responses to HPV infection are thought to be important determinants of viral persistence and progression to cervical intraepithelial neoplasia and cancer. However, few studies have measured local immune markers at the site of infection (e.g., the cervical mucosa). We sought to determine biologic correlates of IL-10 and IL-12 concentrations in cervical secretions. Cervical secretions were passively collected using a WeckCel sponge from 247 women participating in a natural history study of human papillomavirus infection as part of an immunologic ancillary study. IL-10 and IL-12 concentrations were determined using standard ELISA assays. In general, IL-10 and IL-12 levels were significantly intercorrelated (Pearson's correlation coefficient = 0.6) but had somewhat different determinants. Significant increases (P < 0.05) in IL-10 concentrations were observed for nonovulatory phases of the menstrual cycle, postmenopausal status, recent use of oral contraceptives (OC), low secretion volume, macrolevels of heme contamination, and high vaginal pH. Increasing IL-10 levels were also observed among smokers, women with increasing numbers of lifetime sex partners, and women who report having less frequent sex (less than once per week), however, these results were not statistically significant. Significantly higher IL-12 concentrations were observed among recent OC users, women with low secretion volume, and women with a high vaginal pH. There was a non-statistically significant observation of increasing IL-12 levels among nonsmokers, women with increasing numbers of lifetime and recent pregnancies, and increasing levels of heme contamination. We failed to observe a significant association between HPV and IL-10 or IL-12 levels in this crosssectional sample. Future analyses of cervical cytokine levels and HPV infection should control for the inherent variation of local cytokine levels due to hormonal influences, hemoglobin contamination, pH, and cervical secretion volume differences.

Adult↗
PubMed2006

[Arterial injury associated with tension-free vaginal tape procedure successfully treated by radiological embolization: a case report].

A 75-year-old woman underwent a tension-free vaginal tape (TVT) procedure for urinary stress incontinence. The patient complained of lower abdominal pain, a feeling of lower abdominal distension and nausea three hours after the operation. In addition, systolic blood pressure decreased gradually to 80 mmHg. Enhanced computed tomography revealed a retropubic hematoma sized up to 16 cm X 12 cm X 11 cm and bleeding from a vessel running through the posterosuperior aspect of the pubic bone. Successively, arteriography was performed. The arteriogram also confirmed arterial injury, which was successfully treated by selective embolization using a gelatin sponge and pushable coils. Postoperative course was uneventful requiring neither blood transfusion nor surgical removal of the hematoma.

Aged↗
PubMed1975

Mid-trimester abortion induced by intravaginal administration of prostaglandin E2 suppositories.

Mid-trimester abortion was successfully induced in 70 of 71 patients by administration of vaginal PGE2 suppositories. The one patient who failed to abort with this method was pregnant in the blind horn of a duplex uterus. The mean abortion time for the successful inductions was 11.88 hours. Multiparous patients aborted somewhat faster than nulliparous patients, but the difference was not significant. Among the 70 successful inductions 42 patients aborted in 12 hours or less and only one patient had an abortion time of more than 24 hours. The drug appeared effective throughout the stages of gestation included in this series--from 8 to 27 weeks. Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. The development of uterine activity was gradual without the sudden rise in frequency of contractions and intrauterine baseline tonus that characterized prostaglandin administered by other methods. The most frequently encountered side effect of vaginal PGE2 suppositories was a temperature elevation, which returned to normal within a few hours of the last dose of the drug. Gastrointestinal disturbances--vomiting and diarrhea--were also common, despite a low initial dose of PGE2 and premedication with antiemetic and antidiarrheal agents. These side effects were in general well tolerated by the patients and never required termination of therapy. The cardiovascular effects of PGE2 in this series could be considered minimal. In a single patient surgical intervention was required to remove the placenta. In seven patients the placenta was removed by sponge forceps and in five patients the placenta was removed manually. There was an estimated blood loss exceeding 250 ml. in 10 patients, but transfusion was not required. Although white blood cell count rose significantly during the abortion period there were no significant changes in hematocrit or platelet count. Mid-trimester abortion with intravaginal administration of PGE2 suppositories appears to offer a valid alternative to the presently available techniques, with a rapid abortion time, high success rate, and low incidence of complications.

Abortion, Induced↗
PubMed2005

Tension-free vaginal tape procedure with manual-tapping method: a potentially useful technique.

AIM: Stress urinary incontinence (SUI) is accompanied by pelvic organ prolapse (POP) in many cases. We investigate a procedure to adjust the level of suspension of the mid-urethra using tension-free vaginal tape (TVT) under general anesthesia at the time of POP repair surgery. METHODS: Preliminary examination carried out prior to this study showed that the pressure stress applied by a surgeon is less than half of that induced using the cough-stress method: the manual-tapping method (MTM) showed an average intravesical urinary leak point pressure (IULPP) of 21.4 mmHg (range 19-23 mmHg), when the cough-stress method demonstrated an average IULPP >52.4 mmHg (range 45-58 mmHg; n = 3). An attempt was made to predict postoperative SUI by packing sponge gauze into the manually replaced vagina preoperatively. If SUI appeared, TVT was added to the repair operation for POP in those patients (n = 11). Lastly, the MTM was used to decide the level of urethral suspension during the TVT procedure following POP repair surgery under general anesthesia (n = 11). RESULTS: Eleven patients underwent the TVT procedure combined with POP repair surgery. The mean postoperative follow-up period was 23.8 months (range 9-40 months). There was no case of post-surgical ischuria. One patient showed a cystocele during the postoperative course. However, all other patients were relieved from the symptoms of POP, and none complained of SUI following the procedure. CONCLUSION: The MTM seems to be a more appropriate indicator by which to adjust the level of urethral suspension during the TVT procedure than the conventional method, particularly under general anesthesia. To prevent and cure perioperative SUI, the MTM as a TVT procedure combined with POP repair surgery under general anesthesia is a useful procedure.

Aged↗