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At least 919 records · Page 51Linked to original sources
PubMed1995

Urinary trypsin inhibitor suppresses premature cervical ripening.

UNLABELLED: Unknown signals from the fetus are thought to be involved in the onset of parturition. We recently discovered that urinary trypsin inhibitor (UTI) from fetal urine inhibits uterine muscle contraction. OBJECTIVES: The aim of this research was to elucidate the mechanism of action of UTI in suppressing cervical maturation. STUDY DESIGN: Non-pregnant and pregnant rabbits pretreated with and without UTI suppositories containing 1000 U (400 micrograms) for 3 days were treated for 2 days with vaginal suppositories containing 100 ng of interleukin-8 (IL-8). RESULTS: IL-8 induced softening and dilatation of the rabbit cervices. In contrast UTI inhibited IL-8 induced cervical softening and dilatation. Water content, collagen content, neutrophil counts, elastase activity and collagenase activity of the cervix were increased by IL-8, but they did not increase by IL-8 with UTI. CONCLUSION: These results suggest that UTI inhibits cervical maturation induced by IL-8.

Animals↗
PubMed1996

Concentrated oxytocin plus low-dose prostaglandin E2 compared with prostaglandin E2 vaginal suppositories for second-trimester pregnancy termination.

OBJECTIVE: To examine the efficacy and side effects of concentrated oxytocin plus low-dose prostaglandin (PG) E2 compared with a standard dose of vaginal PGE2 for second-trimester pregnancy termination. METHODS: Patients with obstetric or fetal complications were randomly assigned to receive either a 20-mg PGE2 vaginal suppository every 4 hours (n = 81) or a concentrated oxytocin infusion plus a 10-mg PGE2 vaginal suppository every 6 hours (n = 73). Treatment success was defined as delivery (or imminent delivery) within 24 hours of therapy. Women who failed their assigned regimen were crossed to the alternate method. RESULTS: Indications for delivery were similar in the two groups. The success rate with oxytocin was 89%, compared with 81% with vaginal PGE2 (relative risk 0.92, 95% confidence interval 0.8-1.04; P = .2). Maternal fever (P < .001), nausea (P = .02), and vomiting (P = .003) occurred significantly more often in women who received a 20-mg PGE2 vaginal suppository every 4 hours. CONCLUSION: Concentrated oxytocin plus low-dose PGE2 should be considered as an alternative to vaginal PGE2 for indicated second-trimester pregnancy termination.

Abortion, Induced↗
PubMed1994

Formulation and in vitro study of antibacterial vaginal suppositories.

Vaginal suppositories frequently used in gynaecological therapy were studied. Several antibacterial pharmacons are used for the topical treatment of vaginitis of various origins. In view of the fact that the liberation of the given active substance and the subsequent therapeutic effect may be improved or inhibited by the vehicle, our aim was to find the optimal suppository base for vaginal suppositories containing sulfadimidine, chloramphenicol and gentamicin sulfate by means of in vitro experiments. On the basis of breaking hardness, disintegration time and spreading properties the French Suppocire NA product, and compositions of macrogols with lower molecular weight proved to be the best lipophilic and hydrophilic bases, respectively. Among the lipophilic bases the in vitro drug liberation of Suppocire NA was significantly better (P < 0.05) than the other lipophilic bases. This vehicle is recommended for the topical treatment of vaginitis, as these suppositories have the further advantage that they can easily be produced on a magistral, galenical or industrial scale as well.

Anti-Infective Agents, Local↗
PubMed1984

"O" ring urinary ostomy appliance.

A non-adhesive urostomy system represents a major departure from ostomy appliances that have been used to date. Experience of 123 ostomates who have lived with the traditional as well as the new appliance indicates a high degree of patient acceptance and satisfaction. The "O" ring appliance promises to simplify and improve the quality of life for patients who are committed to this form of urinary disposition.

Disposable Equipment↗
PubMed1993

Oestradiol-releasing vaginal ring for treatment of postmenopausal urogenital atrophy.

A silicone vaginal ring releasing 5-10 micrograms oestradiol/24 h for a minimum of 90 days has been developed for treatment of urogenital mucosal atrophy. The efficacy, safety and acceptability of the oestradiol-releasing ring were studied in 222 postmenopausal women with symptoms and signs of atrophic vaginal mucosa. The maturation of the vaginal epithelium, as measured by cytological parameters, was significantly improved during treatment. No proliferation of the endometrium was encountered. The therapy had a significant effect on symptoms (vaginal dryness, pruritus vulvae, dyspareunia, urinary urgency) and on signs of atrophic vaginitis, with cure/improvement registered in > or = 90%. The patient acceptability was high, since > or = 90% did not report any discomfort with the ring. Almost all of the sexually active women had the ring in place during coitus and in < or = 2% of cases discomfort was noticed by them or the partner. It is concluded that a vaginal silicone ring giving a continuous release of an ultra-low dose of oestradiol is an effective and safe treatment for urogenital oestrogen deficiency. No addition of progestagen is needed.

Administration, Intravaginal↗
PubMedDate not supplied

Common problems of urination in nonpregnant women: causes, current management, and prevention strategies.

This article uses a case-based approach to review common problems of urination in nonpregnant women, including overactive bladder; stress, urge, and mixed incontinence; and retention and prolapse. Up-to-date clinical issues related to assessment, diagnosis, treatment, and follow-up are reviewed, with a discussion of underlying pathophysiology and prevention strategies. Suggestions are made for relevant curriculum content at both the basic and advanced levels of advanced practice education.

Adolescent↗
PubMed1992

Midtrimester pregnancy termination: a randomized trial of prostaglandin E2 versus concentrated oxytocin.

OBJECTIVES: The purpose of this study was to determine whether a concentrated oxytocin infusion can reliably effect uterine evacuation in the midtrimester and whether such an infusion is associated with fewer side effects than prostaglandin E2 vaginal suppositories. STUDY DESIGN: Patients received either prostaglandin E2 (n = 42) or oxytocin (n = 45) for indicated midtrimester abortions in a prospective, randomized trial. Treatment consisted of either prostaglandin E2 vaginal suppositories (one every 4 hours) or infusions of an escalating concentration of oxytocin (one every 4 hours). Unless delivery had occurred or was imminent after 24 hours, the agent was considered to have failed, and patients were crossed to the alternative method. RESULTS: Delivery indications were similar between the two groups. There were 6 (14%) first-agent failures with prostaglandin E2 and 9 (20%) with oxytocin (p = 0.48). Considering the failures and subsequent crossovers, 103 patient trial regimens were completed. Fever, nausea, vomiting, and diarrhea were more frequent with prostaglandin E2 (p < 0.005). CONCLUSIONS: Concentrated oxytocin is a satisfactory alternative to prostaglandin E2 for midtrimester abortion.

Abortifacient Agents↗
PubMed1985

Is more than one application of an antifungal necessary in the treatment of acute vaginal candidiasis?

The results of all the controlled trials carried out at the Department of Genito-Urinary Medicine at the Cardiff Royal Infirmary over the past 16 years are summarized. All except one of these trials were carried out with patients having acute vulvovaginal candidiasis. One trial involved treating only patients with recurring candidal infection. In all the acute trials, there were practically no mycologic relapses 7 days after completion of treatment whatever the regimen used, but at 35 days after completion of treatment the mycologic relapse rate was in the region of 20% to 25%. It is concluded that following the elimination of any known predisposing cause of vaginal candidiasis, the intravaginal application of 500 mg of an imidazole preparation is as effective a treatment as any other regimen. In recurrent cases, monthly treatment with such a dose may be adequate to control the patient's symptoms. Mycologic relapse may not be accompanied by symptoms, but in recurrent cases there is a closer relation between mycologic relapse and symptoms.

Amphotericin B↗
PubMed1996

A one-year multicenter study of efficacy and safety of a continuous, low-dose, estradiol-releasing vaginal ring (Estring) in postmenopausal women with symptoms and signs of urogenital aging.

OBJECTIVE: We studied the efficacy, safety, and acceptability of an estradiol-releasing (6.5 to 9.5 micrograms per 24 hours) silicone vaginal ring (Estring) in postmenopausal women with symptoms and signs of urogenital aging during a treatment period of 1 year. STUDY DESIGN: The study was open with blind analysis of vaginal cytologic testing. In addition to gynecologic examination, subjective symptoms were assessed and vaginal pH and urinary samples (for bacteriuria) were obtained before insertion of Estring. This procedure was repeated every 3 months up to 1 year's treatment, together with requests concerning acceptability and adverse experiences. At inclusion and end of Estring treatment, vaginal smears for evaluation of cytologic results were obtained. RESULTS: Estring induced a high maturation value in the vaginal mucosa and restored vaginal pH to levels normality seen in fertile women (< 5.5). For most variables a 90% responder rate (proportion of cured and improved patients) was found after 3 months and up to 1 year regarding subjective symptoms and objective signs of vaginal mucosal atrophy. Twenty-eight (20%) of 136 women, withdrew from the study, 8 (6%) of them because of adverse events. Three women reported vaginal bleeding, none associated with malignancy or endometrial proliferation. Ten (7%) reported vaginal irritation, and in two cases vaginal ulcers were found. About 90% did not remove the ring during any of the 3-month treatment periods, and 78% used the four consecutive rings continuously up to 1 year. The ring was given a strong preference (p < 0.001) by patients with previous experience of other administration forms. CONCLUSION: Estring represents a safe, highly effective, and very well-accepted administration form for long-term treatment of urogenital disorders caused by estrogen deficiency in postmenopausal women.

Administration, Intravaginal↗
PubMed1997

A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare the effect of vaginal administration of misoprostol (Cytotec) with that of dinoprostone (Cervidil) on cervical ripening and labor induction. STUDY DESIGN: Two hundred patients with indications for induction of labor and unfavorable cervical examinations were randomly assigned to receive vaginally administered misoprostol (prostaglandin E1) or the dinoprostone (prostaglandin E2) vaginal insert. Twenty-five microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of six doses. Additional misoprostol was not given after either spontaneous rupture of membranes, adequate cervical ripening (Bishop score of > or = 8 or cervical dilatation of > or = 3 cm), or beginning of active labor. The vaginal insert, Cervidil, containing 10 mg of dinoprostone in a timed-release preparation was placed in the posterior vaginal formix for a maximum period of 24 hours. The vaginal insert was removed for spontaneous rupture of membranes, entry into active labor, adequate cervical ripening, or abnormality of uterine contractile pattern or fetal cardiac activity. RESULTS: Of the 200 patients enrolled, 99 were randomized to misoprostol and 101 to dinoprostone. The average interval from start of induction to vaginal delivery was 1 hour shorter in the misoprostol group (1296.7 +/- 722.1 minutes) than in the dinoprostone group (1360.0 +/- 792.0 minutes), but this difference was not statistically significant (p = 0.97). Oxytocin augmentation of labor was used in 50 (50.5%) misoprostol-treated patients and 43 (43.5%) dinoprostone-treated patients (relative risk 1.14, 95% confidence interval 0.86 to 1.51, p = 0.35). There were no significant differences between routes of delivery with misoprostol or dinoprostone. Overall, 38 patients (19.3%) had cesarean deliveries. There was a significantly lower prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the misoprostol group (7.1%) than in the dinoprostone group (18.4%) (relative risk 0.52, 95% confidence interval 0.31 to 0.89, p = 0.02). There were no significant differences in frequency of uterine hyperstimulation or hypertonus. Abnormal fetal heart rate tracings were found in 23 (23.2%) of misoprostol-treated patients and 35 (35.7%) of dinoprostone-treated patients (relative risk 0.73, 95% confidence interval 0.52 to 1.01, p = 0.0546). No significant differences were found in meconium passage, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit between the two groups. CONCLUSIONS: Vaginally administered misoprostol is as effective as dinoprostone for cervical ripening and the induction of labor. Mean time intervals to delivery, need for oxytocin augmentation, and routes of delivery were similar between the two groups. Incidence of uterine tachysystole with misoprostol every 4 hours was significantly less than with dinoprostone.

Cervix Uteri↗
PubMed2000

A randomized comparison of the effects on vaginal and cervical epithelium of a placebo vaginal ring with non-use of a ring.

Little is known about the effects of contraceptive vaginal rings on the vaginal surface epithelium, although most studies have not demonstrated any significant deleterious effect. However, one study found that some medium-to-long-term levonorgestrel-releasing ring users developed chronic erythematous and ulcerative lesions in the posterior vaginal fornix. Subsequently, this ring was completely redesigned (IVR-2) with different dimensions and much greater flexibility. The first version of IVR-2 was designed as a placebo ring to explore effects on the vagina and cervix without addition of a progestogen. One-hundred-sixty-six healthy sexually active women volunteers were recruited in four centers and randomly assigned for 6 months to either placebo ring use or control (non-use) using a predetermined randomization code generated by WHO in a 2:1 ratio. Careful inspections of the vaginal and cervical epithelium were performed with a colposcope at admission and at 2-month intervals. No clinically significant lesions were detected in any center either among ring users or controls. However, a number of minor changes in appearance of the vaginal and cervical epithelium (erythema, petechiae, ecchymosis, and minor aceto-white changes) were described from the Sydney Center, some of which were present on admission and some of which were found on subsequent examination. Ten of eleven "red" changes on the cervix and vagina were noted in IVR-2 users, and only one in the controls, suggesting a contribution by the IVR-2 to minor epithelial surface changes. Five of ten resolved completely with continued ring use. There was no correlation in this study between epithelial changes and cigarette smoking or frequency of intercourse in the 14 days prior to colposcopic examination but a significant relationship between tampon use in the last 7 days and all epithelial changes (p = 0.05) and especially red changes (p = 0. 027) was noted. Red changes were significantly less likely to be found among condom users (p = 0.007). The IVR-2 placebo ring did not produce clinically significant changes in the vaginal epithelium and cervical mucosa and a carefully controlled and randomized study should be considered to compare the epithelial appearances in women using a placebo IVR-2 and one releasing 20 microg levonorgestrel.

Biopsy↗
PubMed2000

A new vaginal antimicrobial contraceptive formulation: phase I clinical pilot studies.

Pilot clinical trials were performed with a new vaginal suppository called "Long Acting, Sustained Release of Spermicide" ("LASRS"). No visual or colposcopic lesions or patient complaints occurred as a result of using LASRS with increasing doses of nonoxynol-9 (up to 20%) for 5 days or of applying the highest dose of nonoxynol-9 (20%; total 400 mg) for 8 h. Colposcopic or visual lesions were also not induced when LASRS with 20% nonoxynol-9 was used for 7 consecutive days by the study participants except for those who developed symptomatic monilia vaginitis. Symptoms were reported although these were mostly minor. A long-lasting, bioadhesive, translucent layer (film) of formulation formed over the vaginal and cervical surfaces. Postcoital spermicidal studies showed LASRS to be highly effective for prolonged periods of time. Although intercourse was delayed for 5 to 8.5 h after insertion of the formulation, an average of only 0. 2 motile sperm/HPF could be found in cervical mucus. These studies suggest LASRS to possess advantages over presently marketed formulations by having long-term efficacy and by forming a bioadhesive, presumably protective layer over the genital tract epithelium. The results also suggest the formulation to decrease the vaginal irritation caused by nonoxynol-9 as noted by colposcopy. These pilot data support a more extensive study with the LASRS suppository.

Adult↗
PubMed2001

Second trimester medical abortion with mifepristone and gemeprost: a review of 956 cases.

The treatment outcomes of 956 women undergoing second trimester termination of pregnancy with mifepristone and gemeprost were studied. The median gestational age was 16 weeks (range: 12-24 weeks). All women were treated with 200 mg mifepristone orally, followed 36 h later with 1 mg vaginal gemeprost administered every 6 h to a maximum of 4 doses in the first 24 h. A second course of 1 mg vaginal gemeprost was given 3-hourly in the next 12 h, if abortion had not occurred. Overall, 96.4% and 98.8% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 7.8 h (range: 0.5-109.9 h). The induction-abortion interval was longer in nulliparous women and women with a gestation age 17 weeks or above. Surgical evacuation of the uterus was performed in 11.5% of women for incomplete abortion or retained placenta. More multiparous women (16.7%) required surgical evacuation of uterus than did nulliparous women (7.3%; p <0.001). Ten (0.1%) women failed to abort with gemeprost and required other methods for abortion. In conclusion, a combination of mifepristone and gemeprost is a safe, effective, and noninvasive method of medical abortion for second trimester pregnancy.

Abortifacient Agents, Nonsteroidal↗