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PubMed1982

[Operative treatment of vesico-vaginal fistulae].

During a period of 16 years, 40 cases of vesico-vaginal fistulae were treated. In 21 of the cases a fistula closing operation could be carried out, 8 vaginally and 13 suprapubically. Out of the 40 cases 19 were cured. In most cases the fistula was approached abdominally and closed by a single-layer method, leaving the vaginal defect open for drainage. This method was suitable for all types of vesico-vaginal fistulae, independent of their size and location but especially suitable for fistulae occurring after irradiation where severe tissue changes had occurred. Urinary diversion is often the only way of helping these patients and the indications for the various types of diversion are discussed.

Adult↗
PubMed1999

Laparoscopically assisted Schauta operation: learning experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital.

OBJECTIVES: The aim of this study was to show the learning experience of the employment of laparoscopic lymphadenectomy followed by a Schauta operation to treat patients with cervical carcinoma at a university hospital and to evaluate the feasibility, complications, hospital stay, delay in return to work, and overall survival of this procedure. METHODS: Between June 1, 1993, and December 30, 1997, 56 patients were selected. Surgical treatment began with a pelvic laparoscopic lymphadenectomy followed by a Schauta operation. Patients were staged according to FIGO criteria (Ia2, 10 cases; Ib1, 33 patients; Ib2, 8 cases; IIa, 3 cases; and IIb, 2 patients). Patients had a follow-up of 47 months. Overall survival was calculated with Kaplan-Meier tables. RESULTS: The procedure was not completed in 9 pts, in 5 cases among the first 20 pts that were entered on the trial due to technical problems and in 4 due to extracervical spread of disease (2 with gross laparoscopically unresectable lymph node metastases, 1 with parametrial infiltration, and 1 with rectovaginal septum involvement). In the 47 pts in which the procedure could be completed, the laparoscopic approach was done in 102 min and the vaginal part in 165 min. There were 4 complications: 1 ureteral injury, 1 abscess of the ischiorectal fossa, 1 hematoma of the Schuchardt incision, and 1 case of leg edema. The mean number of resected nodes was 17. Among the 47 cases in which the surgical procedure was completed, overall survival was 100% for Stage Ia, 88% for Ib1, and 85% for Ib2 after a mean follow-up of 4 years. Four pts have relapsed and died; 3 were stage Ib1 and the other was stage Ib2. They had pelvic recurrences. CONCLUSIONS: This surgery is secure and has an excellent outcome, so it can be considered a valid approach for the treatment of patients with cervical carcinoma, but in our hands, 20 cases were needed to obtain the minimum skill needed to perform it.

Adult↗
PubMed1996

Hysteroscopy versus hysterectomy for the treatment of abnormal uterine bleeding: a comparison of cost.

OBJECTIVE: To compare the costs of hysteroscopic treatment of abnormal uterine bleeding with the costs associated with abdominal and vaginal hysterectomy. DESIGN: Retrospective review. SETTING: Academic medical center and outpatient gynecology practice. PATIENTS: A list of all women undergoing an endometrial ablation (n = 60), hysteroscopic myomectomy (n = 14), abdominal (n = 192), or vaginal (n = 37) hysterectomy between June 1, 1987 and June 1, 1992 for the treatment of abnormal uterine bleeding was generated by a computer search of billing records using the appropriate ICD-9-CM codes. MAIN OUTCOME MEASURE: The direct cost per case for each patient were defined as the sum of the surgeon's fee, all related hospital and operating room charges, the anesthesiologist's fee, and the cost of preoperative medications. When the initial procedure failed, the cost associated with any additional surgery was accounted for in the determination of the direct cost per case. Indirect costs per case were calculated based on known demographic data, recovery time, and the cost in lost productivity during recuperation. Mean direct and indirect costs per case were determined for each procedure and compared. RESULTS: The mean direct cost per case for endometrial ablation was $5,159 and for myomectomy and ablation was $5,525. The direct cost per case was not different between the hysteroscopic procedures but both were significantly less expensive than either vaginal ($8,132) or abdominal ($8,833) hysterectomy. Total hospital cost also was significantly less for the hysteroscopic procedures than for hysterectomy by either technique. The indirect costs associated with the hysteroscopic procedures were significantly less than those incurred by abdominal and vaginal hysterectomy. CONCLUSIONS: The total direct and indirect cost per case of an hysteroscopic approach to the treatment of abnormal uterine bleeding is significantly less than that associated with vaginal or abdominal hysterectomy. This difference persists when the cost of failure of an hysteroscopic procedure is accounted for.

Adult↗
PubMed2001

Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women.

Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over-reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework.

Anthropology, Cultural↗
PubMed1990

Genital findings in prepubertal girls selected for nonabuse: a descriptive study.

This project was designed to collect normative data on the genital anatomy from a sample of nonabused prepubertal girls. A total of 114 girls between the ages of 10 months and 10 years were examined and photographed with a colposcope. After screening for the onset of puberty and the possibility of undetected abuse, 93 subjects remained. Examination techniques included a supine labial separation approach, a supine labial traction method, and a prone knee-chest position. Common genital finding included erythema of the vestibule (56%), periurethral bands (50.6%), labial adhesions (38.9%), lymphoid follicles on the fossa navicularis (33.7%), posterior fourchette midline avascular areas (25.6%), and urethral dilation with labial traction (14.9%). The hymenal orifice opened more frequently during the knee-chest (95.2%) and the labial traction (90.5%) methods than with the supine separation (79.3%) approach. Hymenal findings included mounds (33.8%), projections (33.3%), and "septal remnants"/midline hymenal tags (18.5%). Intravaginal findings of vaginal ridges (90.2%) and rugae (88.7%) were found primarily through the labial traction approach. The cervix was visualized without the use of speculum in 69% of the children during the knee-chest examination. Unusual findings included posterior fourchette friability (4.7%), anterior hymenal clefts (1.2%), and notches of the hymen (6%). One child had an imperforate hymen (1.2%) and 2 (2.5%) had hymenal septa. A vaginal discharge was detected in 2 (2.6%) and a foreign body in 1 (1.3%). Tables that include the vertical and horizontal hymenal orifice diameters by age group and by method are presented.

Child↗
PubMed2000

Long-term vaginal antibody delivery: delivery systems and biodistribution.

Topical delivery systems can provide prolonged delivery of antibodies to the vaginal mucosal surface for long-term protection against infectious diseases. We examined the biodistribution of antibodies during 30 days of vaginal antibody delivery in mice. Different antibody preparations (including monoclonal IgG and IgM, as well as several different (125)I-labeled IgGs) were administered by polymer vaginal rings, which were designed to provide continuous antibody delivery. Antibody concentrations remained high in the vaginal secretions for up to 30 days after disk insertion; radiolabeled antibody was also found, at approximately 100 times lower concentration, in the blood and other tissues. The measured concentrations agreed reasonably well with a simple pharmacokinetic model, which was used to calculate mucosal and systemic concentrations as a function of antibody delivery and elimination rates. Results from the model were consistent with previously reported antibody pharmacokinetic measurements: the half-life for antibody elimination for the vagina was approximately 3 h; the half-life for IgG(1) clearance from the blood was >1 day; and the overall permeability constant for vaginal uptake of IgG was approximately 0.01 to 0.03 h(-1). These results provide important information for the design of controlled antibody delivery devices for vaginal use, and suggest that high-dose, long-term vaginal administration of antibodies may be a reasonable approach for achieving sustained mucosal and systemic antibody levels.

Administration, Intravaginal↗
PubMed1993

[Intrafascial vaginal hysterectomy (IVH) with or without pelviscopic assistance].

During the past few years, new techniques have supplemented the vaginal and abdominal techniques of hysterectomy, namely, the pelviscopic/laparoscopic methods C*I*S*H* (Classic Intrafascial S*E*M*M* Hysterectomy, S*E*M*M* denoting Serrated Edged Macro-Morcellated) and LAVH (Laparoscopic Assisted Vaginal Hysterectomy). With C*I*S*H*, the uterus is supravaginally removed with pelviscopy and morcellated intraabdominally after having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool), whereas with LAVH, the uterus is peeled laparoscopically, but ultimately removed from the abdomen per vaginam. The next method to be developed from C*I*S*H* was, initially, TUMA (Total Uterine Mucosa Ablation) where the residual uterine muscle remains in situ. Following that, IVH (Intrafascial Vaginal Hysterectomy) was developed as a minimal invasive approach. After having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool). Hysterectomy is performed with the technique employed up to now with anterior precipitation of the uterus. The cardinal and sacrouterine ligaments, uterine arteries and the vagina remain uninjured. Since no sensitively innervated tissue is transected, this operation is postoperatively largely painless. Likewise, the innervation of the urinary bladder and rectum is not damaged and there is also no impairment of sexual feeling. The time required for the operation corresponds with that of the routine time required so far, when performing vaginal hysterectomy. Vaginal surgery is significantly facilitated by the fact, that the cervix is practically absent when the uterus is precipitated anteriorly.

Equipment Design↗
PubMed2003

[Uterine myomatosis--abdominal hysterectomy, vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy?].

OBJECTIVE: To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods. In the first period (1987-1991) the operative procedures--hysterectomies--were performed usually by the classical abdominal approach. In the second period (1997-2001) the modern trend of minimal invasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY, LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for the selection of hysterectomy in cases of uterine fibroids are presented. STUDY DESIGN: Retrospective study. STUDY SETTING: Department of Obstetrics and Gynecology, Medical Faculty and University Hospital, Palacký University, Olomouc. METHODS: The total of 1172 patients (604 in the first period and 568 in the second period) were operated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assisted vaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass, weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesia and per and postoperation complications (blood loss, conversion of vaginal to abdominal approach, inflammatory complications and administration of antibiotics) were also evaluated. RESULTS: Each of the chosen surgical procedures has advantages and disadvantages. Abdominal hysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings. The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHY represents the operation which combines advantages of both AHY and VHY and fulfills also the criteria for minimal invasive surgery. CONCLUSION: The choice of the optimal surgical procedure in patients with uterine fibroids depends on the complex assessment of the preoperative finding, the technical possibilities of the setting and the experience of the surgeon. The goal is to chose the safest but at the same time least invasive surgical procedure.

Female↗
PubMed1999

Loop electrosurgical excision procedure for partial upper vaginectomy.

OBJECTIVES: Partial upper vaginectomy consists of removal of the vaginal apex and is indicated for the diagnosis and treatment of vaginal intraepithelial neoplasia and recurrent cancer. We present a novel surgical approach to partial upper vaginectomy by use of the loop electrosurgical excision procedure. STUDY DESIGN: A total of 15 consecutive patients with abnormal vaginal cytologic results were treated by the loop electrosurgical excision procedure for partial upper vaginectomy. After submucosal injection of local anesthetic, the loop electrode was used to resect the upper third of the vagina. An iodoform vaginal pack was placed for 24 hours. All patients with high-grade vaginal intraepithelial neoplasia received intravaginal 5-fluorouracil cream postoperatively. RESULTS: The mean blood loss was 0 mL, and the mean surgical time was 30 minutes. A complication developed in 1 patient (7%). One case of invasive carcinoma was diagnosed. No recurrences have developed in any patients with vaginal intraepithelial neoplasia after hysterectomy. CONCLUSIONS: The loop electrosurgical excision procedure for partial upper vaginectomy can be performed quickly, with minimal blood loss, minimal complications, and minimal recurrence of neoplasia, and it provides a histologic specimen for evaluation.

Adult↗
PubMed2006

[Laparoscopy and gynecologic cancer in 2005].

All the surgical procedures, which may be required to treat a gynecologic cancer, can be performed endoscopically. However prospective randomized studies required to confirm the oncologic efficacy of the technique are still lacking in gynecology, whereas such studies are available in digestive surgery. Animal studies suggested that the risk of tumor dissemination in non traumatized peritoneum is higher after a pneumoperitoneum than after a laparotomy. Experimental studies also emphasized two points: the surgeon and the surgical technique are essential, all the parameters of the pneumoperitoneum may influence the postoperative dissemination. Changing these parameters we may, in the future, be able to create a peritoneal environment adapted to oncologic patients in order to prevent or to decrease the risks of peritoneal dissemination and/or of postoperative tumor growth. Until the results of prospective randomized studies become available, the preoperative selection of the patients and the surgical technique should be very strict. In patients with endometrial cancer, the laparoscopic approach should be reserved to clinical stage I disease, if the vaginal extraction is anticipated to be easy accounting for the volume of the uterus and the local conditions. In cervical cancer, the laparoscopic approach should be reserved to patients with favorable prognostic factors: stage IB of less than 2 cm in diameter. Laparoscopy is the gold standard for the surgical diagnosis of adnexal masses. But the puncture should be avoided whenever possible. The surgical treatment of invasive ovarian cancer should be performed by laparotomy whatever the stage. In contrast restaging of an early ovarian cancer initially managed as a benign mass, is a good indication of the laparoscopic approach. The laparoscopic management of low malignant potential tumors should include a complete staging of the peritoneum. Knowledge of the principles of endoscopy and of oncologic surgery is required. Teaching and diffusion of endoscopic oncological techniques are among the major challenges of gynecologic surgery within the next few years.

Animals↗
PubMed1981

Short arrest of cervical dilatation: a risk for maternal/fetal/infant morbidity.

The characteristics of short arrest of dilatation (failure to dilate in active labor for greater than or equal to 1 hour, but less than 2 hours) were assessed by evaluating 2,489 consecutive deliveries. Short arrests were found to be similar to secondary arrests of dilatation as maternal/fetal/infant risks. Short arrest was associated with an increase in labor abnormality, fetal distress, evidence of maternal/infant trauma, an operative delivery. The findings of this study suggest that hourly vaginal examination to detect short arrest is a reasonable approach to following the progress of labor, and that electronic fetal monitoring may be indicated when short arrest of dilatation is diagnosed. Although the risk for operative delivery was found to be increased, over 80% of the patients with short arrest had normal vaginal deliveries.

Birth Weight↗
PubMed2006

Direct application of plasmid DNA containing type I interferon transgenes to vaginal mucosa inhibits HSV-2 mediated mortality.

The application of naked DNA containing type I interferon (IFN) transgenes is a promising potential therapeutic approach for controlling chronic viral infections. Herein, we detail the application of this approach that has been extensively used to restrain ocular HSV-1 infection, for antagonizing vaginal HSV-2 infection. We show that application of IFN-alpha1, -alpha5, and -beta transgenes to vaginal mouse lumen 24 hours prior to HSV-2 infection reduces HSV-2 mediated mortality by 2.5 to 3-fold. However, other type I IFN transgenes (IFN- alpha4, -alpha5, -alpha6, and -alpha9) are non effectual against HSV-2. We further show that the efficacy of IFN-alpha1 transgene treatment is independent of CD4+ T lymphocytes. However, in mice depleted of CD8+ T lymphocytes, the ability of IFN-alpha1 transgene treatment to antagonize HSV-2 was lost.

Journal Article↗
PubMedDate not supplied

[Modern methods for the evaluation of qualitative and quantitative changes in the characteristics of intestinal and vaginal microflora].

Disturbances in normal intestinal and vaginal microflora in women have recently become quite frequent. This accounts for the need of bacteriological laboratories for introduction of reliable methods for the diagnosis of such disturbances. Correct methodological approaches to objective evaluation of the state of intestinal and vaginal microflora are described. The methods used in the study of anaerobic microflora (lacto- and bifidobacteria, eubacteria, peptostreptococci, clostridia, bacteriods, fusobacteria) and facultative anaerobic microorganisms (enterobacteria, staphylococci, streptococci, Gardnerella, fungi of the genus Candida) have been analyzed. All stages of the study are described in consecutive order: the transportation of the material under study, its treatment in a laboratory, the spectrum of selective nutrient media for the isolation of microorganisms, methods of their identification.

Bacteria↗
PubMed2006

A new approach to treatment of early-stage cervical carcinoma: entire laparoscopic abdominal radical hysterectomy with bilateral pelvic lymphadenectomy without vaginal cuff closure--case reports.

OBJECTIVE: The objective of this study is to describe a new technique of laparoscopic radical hysterectomy without vaginal cuff closure. METHODS: Three patients underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection using an Argon Beam Coagulator. Four trocars were used: umbilical port for the camera, two ports for the operating surgeon and a fourth port for use by the surgical assistant. RESULTS: All patients were clinically staged IB1. Ages were 53, 64 and 58 and BMI was 19.5, 25.2 and 21.4, respectively. Duration of surgery was 375, 325 and 335 minutes, respectively, from first trocar insertion to last closing stitch. Estimated blood loss was 300, 100 and 400 ml and removed pelvic lymph nodes 18, 15 and 26, respectively. The patients tolerated the surgical technique and recovered satisfactorily. CONCLUSION: These are the first three cases of early-stage cervical carcinoma patients who have been treated with entirely laparoscopic abdominal radical hysterectomy (LARH) and bilateral pelvic lymphadenectomy (BPL) without vaginal cuff closure. To our knowledge, this has not been previously described in the literature. It is feasible and was well tolerated in this small series of patients.

Adenocarcinoma↗
PubMed2003

[Asymptomatic uterine rupture after two spontaneous vaginal deliveries following prior cesarean section].

We present the case of an almost asymptomatic uterine rupture after two consecutive vaginal deliveries after a prior cesarean delivery (first child). Uterine rupture is rare even after a prior cesarean delivery, permitting a trial of labor after a cesarean delivery in spite of the increased risk of uterine rupture. Vaginal birth after previous cesarean delivery, however, demands a cautious approach. Appropriate recommendations have been published by the ACOG and the 'AG fOr fetomaternale Medizin' (a branch of the German Society of Obstetrics and Gynaecology). In our case diagnosis was made by an vaginal ultrasound examination 7.5 weeks after an uncomplicated vaginal delivery. An additional MRI examination did not result in substantial extra information. For that reason it will be indicated only in exceptional cases. To answer the question whether a vaginal ultrasound examination should routinely be offered after an uncomplicated vaginal delivery with a prior cesarean delivery in the history to preclude uterine rupture further studies are necessary.

Adult↗
PubMed2006

Recombinant vesicular stomatitis virus vectors expressing herpes simplex virus type 2 gD elicit robust CD4+ Th1 immune responses and are protective in mouse and guinea pig models of vaginal challenge.

Recombinant vesicular stomatitis virus (rVSV) vectors offer an attractive approach for the induction of robust cellular and humoral immune responses directed against human pathogen target antigens. We evaluated rVSV vectors expressing full-length glycoprotein D (gD) from herpes simplex virus type 2 (HSV-2) in mice and guinea pigs for immunogenicity and protective efficacy against genital challenge with wild-type HSV-2. Robust Th1-polarized anti-gD immune responses were demonstrated in the murine model as measured by induction of gD-specific cytotoxic T lymphocytes and increased gamma interferon expression. The isotype makeup of the serum anti-gD immunoglobulin G (IgG) response was consistent with the presence of a Th1-CD4+ anti-gD response, characterized by a high IgG2a/IgG1 IgG subclass ratio. Functional anti-HSV-2 neutralizing serum antibody responses were readily demonstrated in both guinea pigs and mice that had been immunized with rVSV-gD vaccines. Furthermore, guinea pigs and mice were prophylactically protected from genital challenge with high doses of wild-type HSV-2. In addition, guinea pigs were highly protected against the establishment of latent infection as evidenced by low or absent HSV-2 genome copies in dorsal root ganglia after virus challenge. In summary, rVSV-gD vectors were successfully used to elicit potent anti-gD Th1-like cellular and humoral immune responses that were protective against HSV-2 disease in guinea pigs and mice.

Animals↗
PubMed1995

Laparoscopic assisted vaginal hysterectomy: an audit plus a word of caution.

Laparoscopic assisted vaginal hysterectomy (LAVH) performed in 109 cases has been reviewed. In this series the mean operative time was 89 minutes and mean inpatient hospitalization was 3.7 days. Throughout the review, 6 patients were considered to have major complications and each is discussed. The association of previous caesarean section and bladder damage is noted. LAVH widens the indications available for vaginal hysterectomy in younger women in whom the abdominal approach would previously be indicated, but extra caution is advised when this technique is first introduced to a gynaecological service.

Adult↗
PubMed2003

Inhibition of HIV infectivity by a natural human isolate of Lactobacillus jensenii engineered to express functional two-domain CD4.

The predominant mode of HIV transmission worldwide is via heterosexual contact, with the cervico-vaginal mucosa being the main portal of entry in women. The cervico-vaginal mucosa is naturally colonized with commensal bacteria, primarily lactobacilli. To address the urgent need for female-controlled approaches to block the heterosexual transmission of HIV, we have engineered natural human vaginal isolates of Lactobacillus jensenii to secrete two-domain CD4 (2D CD4) proteins. The secreted 2D CD4 recognized a conformation-dependent anti-CD4 antibody and bound HIV type 1 (HIV-1) gp120, suggesting that the expressed proteins adopted a native conformation. Single-cycle infection assays using HIV-1HxB2 carrying a luciferase reporter gene demonstrated that Lactobacillus-derived 2D CD4 inhibited HIV-1 entry into target cells in a dose-dependent manner. Importantly, coincubation of the engineered bacteria with recombinant HIV-1HxB2 reporter virus led to a significant decrease in virus infectivity of HeLa cells expressing CD4-CXCR4-CCR5. Engineered lactobacilli also caused a modest, but statistically significant, decrease in infectivity of a primary isolate, HIV-1JR-FL. This represents an important first step toward the development of engineered commensal bacteria within the vaginal microflora to inhibit heterosexual transmission of HIV.

Antiviral Agents↗