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PubMed1975

Drug hoarding in a rural community in Israel. Results of a pilot epidemiologic investigation.

The total quantity of drugs hoarded in a rural village in Israel was established as a result of a comprehensive house-to-house search. In 43 of the 44 houses in the village, hoarded drugs were found. The average number of different drugs found per household was 15.5 and the median number, 9.5. Analgesic and antipyretic drugs, topical skin preparations and antibiotics were found most frequently among a total of 166 identifiable medicines. The drugs found included 5,998 tablets and capsules, 3,327 ml of liquid preparations, 1,290 g of creams and powders and 369 suppositories and pessaries. These findings are discussed in relation to the drug expenditure of the largest Israel health insurance fund, the serious health hazards which they present, and their possible relevance to the total Israel population. The possibility of a "hoarding-prone" personality is raised.

Analgesics↗
PubMed2002

Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women.

PURPOSE: We studied the possible causes of chronic retention after radical cystectomy and orthotopic bladder substitution in women. MATERIALS AND METHODS: Between January 1995 and January 2001, 136 women with a mean age plus or minus standard deviation of 52 +/- 8 years underwent standard radical cystectomy and orthotopic substitution for organ confined bladder cancer. Videourodynamics, pelvic floor electromyography, pelvic floor magnetic resonance imaging and pan-endoscopy were done. In the last 37 cases some technical modifications were adopted to circumvent the development of chronic urinary retention. RESULTS: One woman died postoperatively of massive pulmonary embolism. Of the 100 patients evaluable at a mean followup of 36 months 95 were continent in the daytime, 86 were continent at night, 2 were completely incontinent and 16 were in chronic retention. Videourodynamics showed that retention was mechanical in nature due to the pouch falling back in the wide pelvic cavity, resulting in acute angulation of the posterior pouch-urethral junction. In addition, herniation of the pouch wall through the prolapsed vaginal stump was observed in most cases. Pelvic floor electromyography demonstrated complete pelvic floor silence during voiding. No abnormality of the pelvic floor or rhabdosphincter was noted on magnetic resonance imaging. Pan-endoscopy showed a normal urethra with no urethroileal stricture. A 4 mg. dose of the alpha1-adrenergic blocker doxazosin daily was ineffective, excluding the possibility that sprouting from adjacent adrenergic neurons into the denervated proximal urethral muscles may have been the cause of this problem. After omental packing behind the pouch, suturing of the peritoneum on the rectal wall to the vaginal stump, suspension of the latter by the preserved round ligaments and suspension of the pouch near its dome to the back of the rectus muscle at cystectomy the incidence of chronic retention decreased from 18.7% (14 of 75 cases) before to 8% (2 of 25) after modifications. Furthermore, after vaginal wall descent was mechanically corrected by a pessary there was significant improvement in evacuation. CONCLUSIONS: Strong evidence was provided that chronic urinary retention after orthotopic substitution is due to anatomical rather than to functional or neurogenic reasons. Modifications to increase back support of the pouch with ventral suspension near its dome and support the vaginal stump are recommended to avoid this complication.

Chronic Disease↗
PubMed2002

Interleukin 8 in the cervix of non-pregnant ewes.

Studies of cervical artificial insemination of ewes at hormone-synchronized oestrus indicate that the cervix remains relatively impenetrable to semen, in contrast to naturally breeding animals. During parturition the inflammatory response plays an important part in cervical dilation and possibly, to a lesser extent, in the non-pregnant cervix at oestrus to facilitate the transcervical transport of semen. The expression of interleukin 8 (IL-8), a pro-inflammatory cytokine in the ovine cervix, has been mapped and quantified, using semi-quantitative in situ hybridization, to ascertain the role played by inflammation in the ovine cervix during natural and artificially induced oestrous cycles. IL-8 gene expression was observed in both the luminal epithelium and fibroblastic cells of the cervix. The presence of IL-8 was confirmed using immunohistochemistry. IL-8 gene expression in the luminal epithelium varied throughout the oestrous cycle and was highest at oestrus and at day 5 of the oestrous cycle. In ewes artificially induced to ovulate, either by the withdrawal of progesterone pessaries after treatment for 12 days, or by two i.m. injections of prostaglandin 9 days apart, IL-8 gene expression at oestrus was significantly lower than it was at natural oestrus. Insemination increased IL-8 gene expression in progesterone-synchronized ewes. These data support the hypothesis that IL-8-induced inflammation is important in normal cervical function and that this process is inhibited during artificial synchronization of the oestrous cycle and is increased by exposure to semen.

Animals↗
PubMed2002

Spermicides 2002: an overview.

The first-ever written prescription for a contraceptive (barrier method) tampon can be found in the Ebers Papyrus, a compendium of medical practices written in 1550 BC. Modern spermicides are produced in a variety of formulations, including gels, foams, creams, suppositories, pessaries, capsules, foaming tablets and films. Spermicides are relatively inexpensive and widely available over the counter. Most of the currently used spermicides contain the chemical agent (non-ionic detergent) nonoxynol-9. The spermicide 'as a commonly used method' has a very high failure rate (one pregnancy in every four women using this method of contraception for 1 year). Implementation of other, much more effective methods of contraception has made spermicides less and less popular, but recently their potential properties against HIV and STI pathogens (a cause of sexually transmitted diseases) have led to new attention for these products. These properties have been widely evaluated in clinical trials, but the final conclusion does not favor spermicides as the tool for the global fight against HIV/AIDS. There is an urgent need for the invention of a chemical product that, for dual protection, would be administered vaginally before sexual intercourse to kill HIV and other STI pathogens, and at the same time disable or kill sperm. The new era for barrier methods should begin from the development of novel microbicides.

Contraception↗
PubMed2002

[Management of threatening preterm labor with intact membranes: indications for antibiotics].

OBJECTIVE: To analyse the benefits and disadvantages of systematic antibiotic therapy in patient presenting a preterm labor with intact membranes. METHODS: We reviewed French and English reports on Medline using to the following key words: "antibiotic therapy and preterm labor, preterm labor, streptococcus B, vaginose, mycoplasma, antenatal infection". RESULTS: The systematic prescription of antibiotics is not recommended for patients presenting preterm labor who have intact membranes and no symptoms of infection. The benefit of antibiotics is small and shows a tendency to prolong the pregnancy and the reduction of maternal infection. No benefit has been shown for neonatal results. When early-onset neonatal sepsis develops in a case in which antepartum chemoprophylaxis was used, the isolated bacteria will present an increasing risk of bacterial drug resistance. Local treatment (cream or pessary) do not belong in the treatment of threatening preterm labor and are not recommended for the prevention of prematurity or materno fetal infection. Risk groups of patients who present a positive vaginal colonization are subject to discussion. Studies do not allow us to ascertain that antibiotics have a beneficial effect on prematurity in these groups. Antibiotics are recommended for the treatment of asymptomatic bacteriuria. This treatment reduces prematurity and maternal infections. Despite poor consensus criteria, if threatening preterm labor is associated with a bacteriuria, experts usually recommend treatment.

Anti-Bacterial Agents↗
PubMed1992

[The effect of repeated administration of carbetocin (Depotocin, Spofa) in the first days postpartum on levels of thyroxine, triiodothyronine, 17 beta-estradiol, progesterone and on fertilization].

Application of new procedures in the sphere of the control of sexual functions requires an extension of present knowledge of postparturient endocrinium or endogenic factors comprised in postparturient physiology of sexual activity. According to recent data, oxytocin, besides its uterotonic and luteolytic activity, acts as an ovarian factor in the local intrafollicular regulation of stereidogenesis and as a modulator of uterine secretion of prostaglandines. Based on present knowledge of oxytocin effects, this study was aimed at investigation of the influence of repeated carbetocin (Depotocin inj. Spofa) administration on the dynamics of changes in thyroxine (T4), triiodothyronine (T3), 17 beta-estradiol (E2), progesterone (P4) concentrations and their mutual correlations from the 36th hour till the 51st day after parturition. Simultaneous study of a possible delayed influence of applied carbetocin on conception of ewes after oestrus evocation on day 51 after lambing was carried out. Nineteen ewes of the Slovak Merino breed, lambed in the first decade of February, were assigned to the experimental (n = 9) and to the control group (n = 10). Experimental ewes were subjected to repeated postparturient carbetocin treatment at the dose 0.07 mg per animal. The first dose was applied i. m. in 24 hours, and the second in 72 hours after parturition. On day 51 oestrus was induced in nine ewes of each group by combined treatment with chlorsuperlutin (Agelin, vaginal pessaries, Spofa) and PMSG (500 I.U./animal). On the day of PMSG application ewes were housed together with rams for the period of the next six days. Samples of blood were taken 24 hours before parturition (-1st day), up to 36 h after parturition and on days 4, 7, 14, 17, 21, 25, 34, 42 and 51 after parturition. Concentrations of T4, T3, E2 and P4 were determined by commercial kits RIA-test-T4; RIA-test-T3; RIA-test-ESTRA and RIA-test-PROG (URVJT Kosice). Animal of the control group showed variations of T4 concentrations (Tab. I, Fig. 1) at the level of original values (59.4 +/- 9.69 nmol.l-1) up to the 21st day with the exception of temporary drop on day 4 and rise on day 7, insignificant compared to the -1st day. T4 concentrations of the control group displayed an intermittent increasing trend with the statistically insignificant peak after 36 h and on day 17, compared to the -1st day. After the 21st day controls revealed a sustained moderate increase while the experimental ewes displayed a decline of its concentrations until the 51st day.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

A case of adenocarcinoma of the endometrial type mixed with a clear cell component that metastasized to the vagina.

We present a patient with adenocarcinoma of the endometrial type mixed with a clear cell component (AMC) that metastasized to the vagina and one of the pelvic lymph nodes. She underwent a radical hysterectomy and pelvic and paraaortic lymphadenectomy, and then received postoperative adjuvant chemotherapy. Histologic features of the endometrial tumor included clear cell adenocarcinoma with an approximate 10% extent to endometrioid adenocarcinoma. On the other hand, histologic examination on the vaginal tumor predominatly showed clear cell adenocarcinoma and also revealed endometrioid adenocarcinoma to a very small extent, suggesting metastasis to the vagina from AMC. On immunohistochemical examination, expression of vascular endothelial growth factor (VEGF)-A, VEGF-C and VEGF-D was apparently stronger in the component of clear cell adenocarcinoma than in that of endometrioid adenocarcinoma. She has been a disease-free survivor for 26 months. Interestingly, locations of endometrial and vaginal lesions were consistent with the sites of an intrauterine device and ring pessary insertion, respectively.

Adenocarcinoma, Clear Cell↗
PubMed2003

[Survey of the practice of cervical ripening and labor induction in France].

OBJECTIVES: Labor induction is a widespread medical practice in France. The medical or obstetric indications for induction as well as the protocols used probably vary from one maternity to another. The objective of this national survey was to describe current medical practices and procedures in France, regarding labor induction and cervical ripening, eight years after the national consensus on labor induction management. A second objective was to assess mothers' opinion on the induction of their labor/level of satisfaction on their childbirth experience. MATERIALS AND METHODS: The sample of maternities was randomly extracted from a list published by the French Ministry of Health. Sampling was performed according to maternity size, geography, and private vs public. Medical information was collected on consecutive labor induction cases in each maternity. Mother's opinions were estimated through a score based on the validated Labour Agentry Scale. RESULTS: Within the 38 maternities included, 21 (55.3%) were public, and 17 (44.7%) private. 1192 women were included in this study and 1090 (91.4%) answered the questionnaire on level of satisfaction. Global rate of elective induction (no medical or obstetric indication) was 24.8% (n=295). Prostaglandins are almost as widely used as oxytocin (45.8% and 47.7% of total labor inductions, respectively). Mostly used methods of delivering prostaglandin are intravaginal (27.1%), controlled-release pessaries (10.2%) and intracervical (8.1%). Among the elective inductions, an important rate of unfavorable cervix was found (n=81, 27.5%) as well as a quite high level of use of prostaglandins (n=51, 17.3%). The statistically independent criteria linked to a high satisfaction score are an older age (OR=1.58; CI 95% [1.80-3.33]), an elective induction (OR=2.44; IC 95% [1.80-3.33]) and a favorable cervix (OR=1.47; [1.08-1.98]). CONCLUSION: The use of prostaglandins in labor induction and cervical ripening is now widespread in France. This technique is not always used in accordance with available scientific data. These results should lead health professionals to set up an evaluation process for their practices, when these are not based on clear scientific evidence.

Adult↗
PubMed1992

Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.

Female↗
PubMed2004

Subtotal uterine prolapse and pregnancy.

THE AIM: A successful reposition of a subtotal gravid uterus of an 29 year old patient and prevention of a spontaneous abortion is presented. METHODS AND RESULTS: An 29 year old patient was admitted to the clinic due to pains in the lower abdomen, miction difficulties and a subtotal uterine prolapse. During the examination in the gynecological position upon disinfection completed, a manual reposition of a gravid uterus was performed. During the reposition, we found the uterus in contraction and the cervical channel one-finger size opened up to the internal cervical os. We introduced Mikulitz tampon as a support while the patient undergone laboratory and anesthesiology pre-operative program. In a short OET anesthesia, the uterine reposition was performed by Smith-Hodge pessary 85 mm and cerclage sec. McDonald in order to prevent a spontancous abortion caused by cervical insufficiency. The postoperative status of the patient was regular/normal. We recommended a bed rest and diazcpam (Apaurin) tbl a 3 mg 3 x 1. CONCLUSION: Complete treatment was performed under the short OET anesthesia, and a recovery of the patient was successful. All parameters of the pregnancy were normal.

Adult↗
PubMed2005

Selecting medications for the treatment of urinary incontinence.

In response to the growing population of older patients with incontinence, pharmaceutical companies are developing new drugs to treat the condition. Before prescribing medications for incontinence, however, physicians should determine the nature and cause of the patient's incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation, and overflow bladder. The best treatment for urge incontinence is behavior therapy in the form of pelvic floor muscle exercises. Medications, used as an adjunct to behavior therapy, can provide additional benefit. Many therapies are available for patients with stress incontinence, including pelvic floor muscle exercise, surgery, intravaginal support devices, pessaries, peri-urethral injections, magnetic chairs, and intraurethral inserts. No medication has been approved for the treatment of stress incontinence, although medications are under development.

Adrenergic Uptake Inhibitors↗
PubMed2005

A pharmacoepidemiological approach to investigating inappropriate physician prescribing in a managed care setting in Israel.

OBJECTIVE: To identify cases of inappropriate physician prescribing in a managed care setting in Israel that may have resulted from misuse of magnetic-stripe membership cards. STUDY DESIGN: Retrospective drug utilization analysis of electronic patient prescription data. METHODS: In a managed care setting involving approximately 1000 physicians who issue approximately 1.4 million prescriptions annually, the rate of prescription of sex-specific drugs to patients of the opposite sex for which the drugs are indicated was evaluated for 2003. The categories of drugs included in the analysis were drugs for the treatment of benign prostatic hyperplasia or erectile dysfunction that were prescribed to women, as well as oral contraceptives, vaginal pessaries, hormone therapy, or raloxifene hydrochloride prescribed to men. RESULTS: Throughout the study year, 193 different physicians wrote 341 prescriptions that matched the drug inclusion criteria for 210 different patients. The most frequently observed scenario involved the prescription for women of selective alpha-blockers, including alfuzosin hydrochloride, tamsulosin hydrochloride, and terazosin hydrochloride, that are indicated exclusively for the treatment of benign prostatic hyperplasia. CONCLUSIONS: The electronic patient record system used in the health maintenance organization studied was programmed to block the prescription of sex-specific drugs for patients of the opposite sex for which they are intended unless proper authorization has been obtained. Furthermore, periodic investigation into prescription impropriety may be easily accomplished through the implementation of pharmacoepidemiological methods commonly used in drug utilization studies.

Cost Sharing↗
PubMed2005

[Chronic renal failure secondary to uterine prolapse].

Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.

Aged↗
PubMed2005

[Female urinary incontinence].

Several million women suffer from urinary incontinence in Germany. Stress and urge incontinence are especially clinically relevant. Training of the pelvic floor muscles (vaginal cones, electrical stimulation, biofeedback, and so forth) plays a central role in the conservative therapy of stress incontinence. The use of devices such as incontinence tampons and urethral pessaries is also common. A medication for the therapy of stress incontinence, which improves the closure of the urethral sphincter, has been on the market since 2004. In the operative area,the insertion of a tension-free vaginal tape (TVT) has gained acceptance in recent years. Anticholinergics are the primary medication used in the treatment of urge incontinence. Local estrogens, low frequency electrical stimulation, phytotherapeutics and the like have supportive effects.

Aged↗
PubMed1976

Acquired gynaetresia in Ibadan.

Acquired atresia of the vagina is much less common than the congenital type, but more frequent in the tropics than in the developed countries (Lawson and Stewart, 1967). This is because most of the causes which include chemical vaginitis (Frith, 1960), female circumcision (Mustafa, 1966) and birth injuries (Lawson and Stewart, 1967) are largely confined to the tropics, due to poverty, ignorance and lack of good medical facilities. In the developed parts of the world, acquired gynatresia is rare, and perhaps follow mainly colporrhaphies and intra-vaginal irradiation from treatment of pelvic malignancies, (Patterson and Rhodes 1958, Whitely, 1964). In Ibadan, Nigeria, however, by far the commonest cause of vaginal atresia is chemical vaginitis from vaginal insertion of local caustic pessaries, for the treatment of certain gynaecological problems. This paper is, therefore, designed to highlight the clinical presentation of acquired gynaetresia as seen in Ibadan with particular emphasis on its incidence, causation, symptomatology and operative management.

Adolescent↗
PubMed2005

Effect of prostaglandin E2 for cervical priming on fetal hemodynamics.

OBJECTIVE: To assess the effect of the prostaglandin E2 (PGE2) on fetal vascular blood flow during cervical priming. STUDY DESIGN: In a prospective, observational study, 32 pregnant women > or =37 weeks of gestation requiring PGE2 for induction of labor were recruited. The resistance indices (RIs) of umbilical artery, middle cerebral artery, renal artery and ductus venosum were measured before, 2 and 4 hours after insertion of a PGE2 vaginal pessary. RESULTS: There were no significant changes in RIs of various fetal vessels during cervical priming with PGE2. CONCLUSION: There was no significant change in fetal hemodynamics after vaginal prostaglandin administration. This finding provides further evidence to support the safety of prostaglandin for normal fetuses.

Administration, Intravaginal↗
PubMed2005

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology.

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.

Clinical Competence↗
PubMed2003

Genital prolapse in women of Bhaktapur, Nepal.

Genital prolapse is one of the commonest reproductive morbidity in developing country. Common predisposing factors are multiparity, early postpartum sternous activity, advanced age and menopause. This study conducted in Bhaktapur district in five months included 1337 women aged 20 and above. The prevalence of female genital prolapse found to be 7.55%. Maximum numbers of women were having children eight and more (48.51%). Only 1.9% of women with genital prolapse were nulliparous. Home delivery is still common in Bhaktapur, 79% of women with genital prolapse had all children born at home without help. Regarding post partum activity majority of them (64.3%) told that they took rest at least one month after delivery but 26.73% started working in field in 2-3 weeks after delivery. The use of pessary is 25% among female with genital prolapse but only a few were following medical advice to change the ring. Nine women were having impacted ring in situ for years.

Adult↗