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PubMedDate not supplied

Preoperative needle biopsy and immunohistochemical analysis for gastrointestinal stromal tumor of the rectum mimicking vaginal leiomyoma.

Accurate preoperative diagnosis for gastrointestinal stromal tumor (GIST) was obtained using the endoscopic approach in about 50% of the cases. Preoperative assessment is quite important in reproductive women for the treatment of pelvic tumor. We report the first case of GIST of the rectum that was accurately diagnosed with preoperative needle biopsy from the vaginal wall. The case was a 38-year-old woman who presented with a history of genital bleeding. Internal examination revealed a round and elastic mass (7 x 7 cm) in the left pelvic cavity. The biopsy specimen from the left sidewall of the vagina using a manually manipulated biopsy needle showed strong reaction for CD34 and CD117 (c-KIT). The patient underwent low anterior resection of the rectum, tumor resection, and partial resection of the posterior vagina. Preoperative biopsy with vaginal approach might be helpful to make a diagnosis for pelvic tumor of unknown origin and unknown malignant potential.

Adult↗
PubMedDate not supplied

Vaginal vault suspension.

A laparoscopic approach to significant pelvic relaxation and vault prolapse, including technical aspects of the procedures involved and an anatomic rationale for the laparoscopic approach, are described. The results demonstrate good clinical outcomes in addition to low intraoperative and post operative morbidity. It is concluded that the laparoscopic approach to vault support has a superior result when compared to open vaginal alternatives.

Adult↗
PubMed1997

MR imaging of the female pelvis: current perspectives and review of genital tract congenital anomalies, and benign and malignant diseases.

MR imaging continues to be an integral problem-solving modality in the evaluation of congenital anomalies and acquired diseases of the female genital tract organs and provides effective clinical information to the practicing gynecologist in those patients in whom sonography is technically suboptimal or the results are equivocal. This article describes the state-of-the art MR imaging of the female pelvis and addresses its current perspectives in the following sections: (1) technical aspects of MR in imaging the female pelvis, (2) normal pelvic anatomy and variations that are seen on MRI, (3) role of MRI in the diagnosis of congenital uterine and vaginal anomalies, (4) MR imaging approach to diagnose congenital uterine and vaginal anomalies, (5) advantages and limitations of MR in the evaluation of various benign diseases and malignant neoplasms of the female genital tract, (6) a MR staging system and criteria for each gynecologic malignancy, (7) fundamental MR criteria to differentiate benign from malignant tumors and recurrent tumors from fibrosis, and (8) the present cost-effective value of MR in pregnancy and obstetrics. Magnetic resonance (MR) technology continues to be an important problem-solving modality in the evaluation of benign, malignant, and recurrent diseases of the female pelvic organs with the development of new software and improved hardware over the last few years. The main issues addressed in this article are (1) to review the basic and expanded applications of the current state-of-the art MR imaging in the diagnosis and management of various congenital and acquired disorders of the female pelvic organs, (2) to illustrate a simplified clinico-radiologic (MRI) approach to the diagnosis of congenital and acquired pathologies of the pelvic organs, (3) to provide relevant information to the clinicians to make rational choices among the competing imaging modalities, and (4) to outline the future potential of this modality in the pelvis.

Adolescent↗
PubMed1995

Vaginal hysterectomy by uterine morcellation: an efficient, non-morbid procedure.

OBJECTIVE: To evaluate the relationship between uterine size and a possible increase in operative morbidity and procedure failure rates in women undergoing total vaginal hysterectomy. METHODS: A retrospective chart analysis of all hysterectomies performed for histologically confirmed leiomyomata was completed. A total of 128 cases qualified. Patients were stratified into three groups: group I, patients undergoing vaginal hysterectomy with a uterine weight of 300 g or greater but less than 1000 g; group II, patients undergoing vaginal hysterectomy with a uterine weight of 100-299 g; and group III, patients undergoing abdominal hysterectomy with a uterine weight of 100-1000 g. The variables evaluated included the following: length of hospital stay, operative time, estimated blood loss, and operative complications. Data regarding failed vaginal hysterectomy requiring an abdominal approach were also obtained. RESULTS: Both vaginal hysterectomy groups had a significantly reduced length of stay compared with the total abdominal hysterectomy group. There was no significant difference in mean estimated blood loss between groups I and III. Similarly, there were no significant differences in complication rates among the three groups. Group I had an 84% (31 of 37) success rate versus 95% (40 of 42) for group II (not statistically significant). There were no significant differences in the mean uterine weight, estimated blood loss, and complication rate in unsuccessful versus successful vaginal hysterectomies. The estimated blood loss was significantly higher for unsuccessful vaginal hysterectomy. CONCLUSION: Uterine size alone is not an absolute contra-indication to vaginal hysterectomy. Large uterine size (greater than 300 g) was not related to a significant increase in failed vaginal hysterectomy. Conversely, failed vaginal hysterectomy was not size-dependent. Furthermore, there is no additional operative morbidity when vaginal hysterectomy is converted to a total abdominal hysterectomy because of a technical inability to complete the surgery vaginally.

Adult↗
PubMed1983

Traumatic rupture of female urethra.

Complete avulsion of the female urethra secondary to blunt trauma is uncommon. It is associated with pelvic fractures, and because of the close association of the urethra and vagina a vaginal laceration also occurs. The paucity of lesions associated with pelvic fracture may be explained by the relative mobility and shortness of the urethra in the female. The treatment of urethral trauma in females has not been established. Vaginal, transpubic, or retropubic approaches have been used successfully. We report on 3 cases of urethral trauma with anterior vaginal lacerations treated by retropubic approach with good results.

Accidents, Traffic↗
PubMed2005

Protection of macaques from vaginal SHIV challenge by vaginally delivered inhibitors of virus-cell fusion.

Human immunodeficiency virus type 1 (HIV-1) continues to spread, principally by heterosexual sex, but no vaccine is available. Hence, alternative prevention methods are needed to supplement educational and behavioural-modification programmes. One such approach is a vaginal microbicide: the application of inhibitory compounds before intercourse. Here, we have evaluated the microbicide concept using the rhesus macaque 'high dose' vaginal transmission model with a CCR5-receptor-using simian-human immunodeficiency virus (SHIV-162P3) and three compounds that inhibit different stages of the virus-cell attachment and entry process. These compounds are BMS-378806, a small molecule that binds the viral gp120 glycoprotein and prevents its attachment to the CD4 and CCR5 receptors, CMPD167, a small molecule that binds to CCR5 to inhibit gp120 association, and C52L, a bacterially expressed peptide inhibitor of gp41-mediated fusion. In vitro, all three compounds inhibit infection of T cells and cervical tissue explants, and C52L acts synergistically with CMPD167 or BMS-378806 to inhibit infection of cell lines. In vivo, significant protection was achieved using each compound alone and in combinations. CMPD167 and BMS-378806 were protective even when applied 6 h before challenge.

Administration, Intravaginal↗
PubMed1999

[Comparison of biomechanical properties of the vaginal fixation in bladder neck suspensions according to the Burch technique and a percutaneous technique].

UNLABELLED: Bladder neck suspension or colpo-suspension can be performed via retropubic or percutaneous transvaginal approaches. A higher success rate is observed for retropubic procedures. One of the hypotheses proposed, but not yet verified, is that the retropubic approach allows better quality vaginal fixation than the percutaneous approach. OBJECTIVE: The objective of this study was to compare the biomechanical properties of vaginal fixation according to the Burch procedure and according to a percutaneous technique (Vesica; Boston Scientific). MATERIAL AND METHODS: We performed bladder neck suspension according to the Burch technique (2 points) on the left and according to the Vesica percutaneous technique on the right, on 6 fresh cadavers (mean age 8-5 years), using the same suture material. Vaginal fixations were subsequently excised. The depth of penetration into the vagina was measured and a computerized traction test (Lloyd Instruments, France) was performed on these fixations. The maximum force of traction before rupture was measured. RESULTS: No significant difference was demonstrated for any of the measurements. CONCLUSION: Vaginal fixation of bladder neck suspension performed according to the Burch technique or via a percutaneous technique (Vesica) present equivalent biomechanical properties.

Aged↗
PubMed2001

Morbidity of 10 110 hysterectomies by type of approach.

BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed < or =30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies.

Adult↗
PubMed1986

The role of the office laboratory in the diagnosis of vaginitis.

In this article, a standardized approach to the evaluation of a patient with vaginitis is presented. The article includes detailed descriptions of specimen collection techniques, slide preparation, and the microscopic examination. In addition, a series of case histories is presented demonstrating how laboratory findings can be interwoven with history and physical findings to provide the correct diagnosis.

Adult↗
PubMed1988

Candidal vaginitis in hormone-treated mice: prevention by a chitin extract.

In view of findings from previous studies that a chitin soluble extract (CSE) blocked adhesion of Candida albicans in vitro and in vivo and prevented thereby a short lived candidal infection in naive mice, we attempted in the present study to block by CSE the development of a persistent infection, induced in hormone-treated animals. Continuous oestrus phase was obtained in mice by repeated weekly subcutaneous injections with estradiol benzoate. Intravaginal inoculation of the hormone-treated mice with 10(7)-10(10) C. albicans cells induced a persistent candidal infection. Fifty three mice were pretreated intravaginally prior to inoculation of C. albicans with 2.5, 5.0 or 10 mg/mouse of a CSE cream and followed up for development of infection in comparison to 30 untreated animals. Twenty four hrs post fungus inoculation the infection rate among the CSE treated mice was 11-23% VS 84% among the controls; the rate increased a week later to 97% among the controls VS 41-50% among the CSE treated. Administering the CSE to the mice prior--and post-yeast inoculation (37 mice), led to increased efficacy of the treatment. The data, indicating that CSE is an effective measure for preventing persistent candidal vaginitis, may open the way to consider a similar approach for prophylaxis of vaginitis in human susceptible populations.

Animals↗
PubMed2003

Multiple experimental designs to evaluate the role of T-cell-mediated immunity against experimental vaginal Candida albicans infection.

Studies to date suggest a limited protective role for Candida-specific Th1-type cell-mediated immunity (CMI) against Candida albicans vaginitis, despite protection against other mucosal Candida infections. Recent evidence suggests this may be due to immunoregulatory mechanisms that inhibit a more profound CMI response against C. albicans vaginal infections. The present study was designed to conduct an evaluation of the protective role of CMI against experimental C. albicans vaginitis using multiple approaches, including the use of T-cell-immunodeficient (SCID, Nude) and knockout (CD4) mice and several immunization designs in immunocompetent mice. Results showed, with few exceptions, that most T-cell-immunodeficient or knockout mice had a vaginal fungal burden similar to that of wild-type strains throughout the observation period. In addition, no correlation was observed between vaginal T-helper and proinflammatory cytokines and fungal burden, suggesting a generalized state of immunoregulation. Evaluation of the effects of various immunization designs that included different Candida antigens, routes of delivery and strains of mice yielded no protection against vaginal candidiasis. These studies provide further evidence of a lack of a protective role of T cells against C. albicans vaginitis, and continue to support the concept of immunoregulation against vaginal CMI responses.

Animals↗
PubMed2002

[Hysterectomy in Denmark. An analysis of postoperative hospitalization, morbidity and readmission].

INTRODUCTION: The aim of this study was to demonstrate the incidence of "standard" hysterectomy in Denmark, including surgical route, postoperative hospitalisation, morbidity, mortality, and readmission rate within 30 days. MATERIAL AND METHODS: We analysed data from the Danish National Patient Register over a two-year period (1998-2000) on hysterectomies for benign indications, carcinoma in situ cervicis uteri, and cancer corporis uteri stage 1. A stratified sample of 821 discharge résumés was reviewed for detection of complications. RESULTS: Over the two-year period, 10,171 women had "standard" hysterectomies followed by a median postoperative hospitalisation of four days. In departments performing more than 100 operations per year, the median hospital stay varied from three to 5.5 days. Eighty per cent of the hysterectomies were abdominal, 6% laparoscopically assisted, and 14% vaginal with marked regional variation in the choice of surgical approach. The number of vaginal hysterectomies varied from 0 to 67% in departments with a surgical activity of more than 100 per year. Eight per cent were readmitted within 30 days of the operation and the mortality rate was 0.6@1000. Extrapolation from the random sample to the entire population gives an estimated complication rate of a minimum of 18%. DISCUSSION: "Standard" hysterectomy in Denmark is associated with considerable morbidity and marked regional variation in the choice of surgical approach. The present study emphasises the need for a national hysterectomy database with the possibility of evaluating surgical activity, reducing morbidity rates, and developing homogeneous guidelines.

Carcinoma in Situ↗
PubMed1991

[Surgical treatment of vulvar stenosis. Technic description].

A surgical technique for the treatment of vulvar stenosis is described. The recto-vaginal space is approached by the cutaneous route, starting with incisions for resection of 2 skin triangles arranged as butterfly wings on either side of the midline. The sclerous cicatricial tissue between rectum and vagina is widely exposed and incised so that the lower part of the posterior vaginal surface can be dissected and mobilized without any risk of damaging the mucosa, since the tractions required for cleavage are exerted on the cutaneous side of the bridle. It is only at this stage that a median sagittal cutaneo-mucosal incision of the bridle is carried out, followed by a transverse suture without tension. This easily performed technique has been used in 11 cases without complication and with satisfactory long-term functional results.

Constriction, Pathologic↗
PubMed1998

New retroperitoneal culdoplasty and colpopexy at the time of laparoscopic total abdominal hysterectomy (L-TAH).

BACKGROUND: After a laparoscopic total abdominal hysterectomy, the safety of the translaparoscopic, prophylactic, retroperitoneal pouch of a Douglas reconstruction and vaginal vault suspension was evaluated. METHODS: This operation was adapted from the laparotomy approach and has been investigated from July, 1992, to July, 1996. Modest modifications have been introduced to meet laparoscopic technology requirements. Observational clinical trials have been conducted on 112 women. The surgery was performed through laparoscopy by suturing and tying method, with no vaginal approach. RESULTS: This clinical trial showed positive results for the operation, with no complications observed in this group of patients. After the operation, there were no symptoms or signs of a dysfunctional vagina, or pelvic relaxation. CONCLUSION: This preventive operation is safe and it restores the pelvic topography, functional anatomy, and it prevents post-hysterectomy vaginal dysfunction disorders.

Adult↗