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At least 1,063 records · Page 59Linked to original sources
PubMed2005

Tissue reactions of 5 sling materials and tissue material detachment strength of 4 synthetic mesh materials in a rabbit model.

PURPOSE: We evaluated tissue reactions to 5 sling materials used in tension-free vaginal tape (TVT), intravaginal slingplasty (IVS), polypropylene mesh hernia repair, the suprapubic approach to suburethral polypropylene tape (SPARC) and cadaveric fascia lata procedures. We also compared the mesh-to-tissue attachment strength of 4 sling mesh materials (TVT, IVS, surgical polypropylene mesh and SPARC) at on days 2, 7, 15 and 30 after implantation. MATERIALS AND METHODS: A total of 20 female New Zealand White rabbits were randomized to group 1-2 days, group 2-7 days, group 3-15 days and group 4-30 days. After the rabbits were anesthetized an 8 cm midline incision was made for rectus muscle access, and 0.5 x 1 cm pieces of TVT, IVS, SPARC, surgical polypropylene mesh and cadaveric fascia lata were sewn to the rectus muscle with direct contact. At the same time 4 subfascial tunnels in the medial surface of the upper extremities were prepared, and 1.0 x 0.5 cm strips of TVT, IVS, SPARC and polypropylene mesh were implanted in each tunnel. On days 2, 7, 15 and 30 after implantation mechanical testing was performed to define tissue detachment strength. The strips of 5 sling materials were then harvested with the surrounding tissue. Specimens were studied by light microscopy. RESULTS: Mean detachment strength, that is the minimum weight needed to move the mesh, of the synthetic meshes from days 2 to 30 were 291.6 to 2,390.0 gm for TVT, 178.4 to 2,160.0 gm for SPARC, 188.4 to 1,850.0 gm for hernia mesh and 92.8 to 1,510.0 gm for IVS (at all data points TVT vs IVS p < 0.05). Light microscopy revealed a quite uniform tissue reaction with a sign of marked acute inflammation in and around the mesh fibers on days 2 and 7 after implantation. All meshes showed stable fibrosis and muscle infiltration on day 30. CONCLUSIONS: All 5 synthetic sling materials produce similar tissue reactions beginning soon after implantation. Cadaveric fascia lata persisted in tissue with remarkable perifascial fibrosis at day 30. When comparing the 4 polypropylene mesh materials; the attachment capacity of TVT was superior and that of IVS was the least of the 4. TVT was statistically better than IVS at all data points. SPARC and hernia mesh provided results similar to those of TVT.

Animals↗
PubMed1999

'Pharmacist only' medicines.

While there is a global trend to switch medicines from prescription to non-prescription status, Australia has created a unique schedule of 'pharmacist only medicines' (POM). Such medicines may provide consumers with greater choice and control of health care decisions. However, the impact of these actions has not been evaluated. Public health concerns including the appropriate use of medicines, awareness and equity of access to POM, and access to information on POM are discussed using antifungal vaginal products as an example. The National Medicines Policy advocates a partnership approach to achieve improved health outcomes by the quality use of medicines, however currently no data on POM are available. Recommendations include changes to legislation, public health data collection and the provision of quality information including pharmaceutical and non-pharmaceutical interventions.

Drug Costs↗
PubMed1997

Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis.

OBJECTIVE: To evaluate the safety and effectiveness of a policy of trial of labour for women with a previous caesarean section, delivering in hospitals in sub-Saharan Africa. DESIGN: A meta-analysis of 17 published reports. SETTING: Hospitals located in sub-Saharan Africa. MAIN OUTCOME MEASURES: The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical conditions were computed using an approach equivalent to a random effects model. RESULTS: The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI 63-75%). Maternal mortality among all women with a previous caesarean section was 1.9/1000 (95% CI 0-4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95% CI 1.0-3.2). Criteria used to select women for a trial of labour appeared to have a limited impact on the probability of vaginal delivery. CONCLUSIONS: In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.

Africa South of the Sahara↗
PubMed1976

Management of Postoperative Abscess Following Gynecologic Surgery.

Forty-nine postoperative abscesses were encountered following 1600 major pelvic procedures. Abdominal and vaginal procedures were complicated by abscess formation in 0.7% and 4% of cases, respectively. The average time between surgery and recognition of the pelvic abscess was 18 days. A positive correlation between surgery performed during the luteal phase and abscess formation was noted. Fifty-five percent of pelvic abscesses treated by primary vaginal drainage required eventful laparotomy for final eradiction of disease. An aggressive approach to abscess management is felt to be justified in this disease entity.

Abscess↗
PubMed2006

Surgery for vaginal prolapse: a review.

This article reviews clinical trials of surgery for the repair of apical vaginal prolapse. The procedures include those from the abdominal, laparoscopic and transvaginal approach. When considering new surgical devices or procedures, it is essential to be aware of clinical data. The use of tension-free tape devices for apical support is promising, but a large trial is needed to demonstrate its efficacy and safety.

Adult↗
PubMed1991

[Antifertility effect of the implant containing 16-methylene-17 alpha-acetoxy-19-norprogesterone (ST-1435)].

The silastic capsules containing ST-1435 (0.5, 1, 2, 4, 6 or 8 mg) showed "burst effect" with a peak value of 4-15 micrograms.h-1 after incubation in vitro. A constant release rate was gradually approached within 1-2 wk. After the capsules were subcutaneous implanted or vaginally administrated, the rats manifested diestrus within 24-48 h. The normal estrus cycles and fertility were restored as soon as the release rate of implants decreased to 10 micrograms.d-1 in vitro. ST-1435 did not inhibit the superovulation induced by PMSG and HCG in immature female rats, but blocked the ovulation induced by LHRH in mature rats.

Animals↗
PubMed1988

Hysteroscopic management of mullerian fusion defects.

Operative hysteroscopy for mullerian fusion defects in properly selected cases and in experienced hands is a safe and effective method of management of uterine septal defects associated with recurrent pregnancy losses. For the patient, it is a more acceptable alternative because it avoids laparotomy, a lengthy hospital stay, and blood transfusions. Medical costs are reduced compared with more traditional approaches. While providing the same level of success, this technique makes a vaginal delivery possible.

Endoscopes↗
PubMed1987

Management of the selected term breech presentation: assessment of the risks of selected vaginal delivery versus cesarean section for all cases.

In this study, the concepts of decision theory have been applied to a clinical obstetric controversy--the management of the selected mature breech presentation. We have reviewed in detail the literature published since 1974 and estimated the probabilities of various outcomes after different treatment strategies. We conclude that a policy of selected vaginal delivery will result in four perinatal deaths for every 1000 patients delivered. A similar probability of neurologic handicap, at least until discharge from hospital, can also be attributed to this method of delivery. These unfavorable outcomes were reported less frequently in more recent reports covering the years since 1974. In these cases, the probability of fetal death due to a trial of vaginal delivery is approximately two in 1000. Cesarean section rates have risen, however, and 18-40% of trials of labor for breech presentation now result in "emergency" cesarean section. Decision analysis has demonstrated that a policy of elective cesarean section for all cases would not necessarily increase maternal mortality and morbidity. Thus the greater dangers of emergency compared with nonelective surgery may abolish the advantages of attempting a vaginal delivery. Depending on the relative dangers of elective and emergency cesarean section, planned delivery becomes the safer option when 16-30% of trials of vaginal breech delivery are unsuccessful. The strength and limitations of this probabilistic approach to the breech presentation are discussed in detail.

Adult↗
PubMed1993

[The current treatment of genital endometriosis].

Three therapeutic strategies are available in treating genital endometriosis (GE): medical treatment only, surgical treatment only and a combination of both, i.e. medical and surgical treatment. The author reviews the combined approach to different forms of GE, namely: cervical, ovarian, tubal, adenomyosis, retrocervical, vaginal and perineal. The common problems in decision making are: the age of the patient and her reproductive function, the localization, spread and stage of the lesion, the possible coexisting inflammatory process and its sequellae, the endometrial hyperplasia and the destructive changes of the uterus and ovaries. Hormonal drugs of choice are the anti-gonadotropin danazol and the GnRH analogues. Introduction of argon, CO2 and YAG lasers proved effective in treating certain forms of GE. Therapy results depend on the severity and spread of the process, on resection volume and completeness, on full scale hormonal therapy as well as on rehabilitation. Close follow-up, including ultrasound examination every 3 months, should be provided for immediate detection of possible side effects and complications.

Adult↗
PubMed1998

[New markers of the risk of preterm delivery].

Preterm births account for 5.9% of all deliveries in France, a proportion that has not changed noticeably over the past 30 years. Neither risk scores nor systematic digital vaginal examinations at prenatal consultations have helped to diminish the incidence of prematurity. Because an indispensable prerequisite to reducing this incidence is better identification of the patients at risk, new approaches towards this end have been proposed in recent years. Various studies have shown that fetal fibronectin in cervico-vaginal secretions between 23 and 36 weeks' gestation can be used to identify, among patients with uterine contractions and clinically observable modifications of the cervix, a subgroup of women at very high risk of preterm delivery. Systematic assays for fetal fibronectin among low-risk women are not, however, valuable, because of both the low prevalence of preterm delivery in such a population and the poor positive predictive value. Transvaginal ultrasound of the cervix furnishes an objective and noninvasive method for ascertaining cervical status. Various studies have shown that, among patients presenting signs of preterm labor, the risk of preterm birth is higher when the cervical length, measured with ultrasound, is less than a given cut-off point (the good predictive values of which have been ascertained). Transvaginal ultrasound is also useful among the general population. Measurement of cervical length thus ought to be incorporated into the routine ultrasound performed in this population. Moreover, in addition to cervical shortening, other abnormal ultrasound findings independently associated with an increased risk of preterm delivery include the following: dilatation of the internal os, wedging, funneling (protrusion of amniotic membranes into the cervix), dynamic changes in the degree of dilation of the cervical canal (opening of the internal os or protrusion of membranes) observed, either spontaneously during contractions or after pressure on the fundus. Because fibronectin assays and cervical ultrasound allow patients at risk of true preterm labor to be identified earlier and more accurately, they should improve the chances that tocolytic treatment will succeed. They also ought to reduce the iatrogenic disorders related to prevention of preterm birth (excessive tocolysis and extended hospitalizations) without raising the incidence of such births.

Cervix Mucus↗
PubMedDate not supplied

Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer.

The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach. From July 1996 to July 1998, 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney, Australia. Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy (LAVH) and bilateral salpingo-oophrectomy (BSO) plus minus laparoscopic pelvic lymphadenectomy (LPLA), while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy (TAH) and BSO plus minus pelvic lymphadenectomy (PLA). The main outcomes studied were operative time, blood loss, blood transfusion, intraoperative complications, postoperative complications, duration of hospital stay, and number of lymph nodes obtained. In conclusion, laparoscopic treatment of endometrial cancer is safe in the hands of experienced operators with minimal intraoperative and postoperative complications. This procedure is associated with significantly less blood loss and shorter hospitalization; however, it is associated with significantly longer operating time. Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach.

Abdomen↗
PubMed1985

Sarcomas of the vagina and uterus: the Intergroup Rhabdomyosarcoma Study.

During a 12-year period (1972-1984), 43 patients with sarcomas of the female genital tract were admitted to the Intergroup Rhabdomyosarcoma Study (IRS), including 31 with primary tumors of the vagina; and 12 with tumors of the uterus, including the cervix. Thirty-four of these can be evaluated on the basis of periods of observation from 18 months to 12 years. Primary tumors of the uterus were a distinct group, distinguished from those arising in the vagina by patient age-range and probably by prognosis, as well as site. Patients with vaginal tumors, with a mean age of 1.8 years, responded to a multimodality approach employing combinations of chemotherapy (vincristine sulfate and actinomycin D, or the aforementioned two drugs with cyclophosphamide +/- doxorubicin hydrochloride), irradiation, and/or surgery, with only one tumor-related death, among 24 evaluable patients. In contrast, among the patients with primary uterine tumors, in which the mean age was greater than 14 years, four of ten evaluable patients died secondary to tumor relapse or progression.

Adolescent↗
PubMed2001

The classic approach to diagnosis of vulvovaginitis: a critical analysis.

OBJECTIVE: To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on the combined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis. METHODS: Women presenting consecutively to the women's health center with vaginal discharge were interviewed and examined for assessment of the quantity and color of the discharge. One drop of the material was then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examined microscopically. The clinical diagnosis was based on the results of these assessments. Gram stain and cultures of the discharge were sent to the microbiology laboratory. RESULTS: One hundred and fifty-three women with vaginal discharge with a clinical diagnosis of vulvovaginitis participated in the study. Fifty-five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis (kappa agreement = 18%). According to the laboratory, the principal infectious micro-organism causing the vulvovaginitis was Candida species. Candida infection was associated with pH levels of less than 4.5 (p < 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35-9.5, positive predictive value 68.4%). The whiff test was positive in only a small percentage of bacterial vaginosis (BV) (p = not significant (NS)). Clue cells were documented in 53.3% of patients with a laboratory diagnosis of BV (p < 0.02, positive predictive value 26.7%). CONCLUSIONS: The current approach to the diagnosis of vulvovaginitis should be further studied. The classical and time-consuming assessments were shown not to be reliable diagnostic measures.

Animals↗
PubMed1998

[Laparoscopic assisted transvaginal hysterectomy].

OBJECTIVE: To evaluate the indication, technical procedure and the clinical value of laparoscopic assisted trans vaginal hysterectomy (LAVH). METHODS: Ninety-eight patients suffered from various kinds of benign gynecological diseases underwent LAVH from Feb. 1995 to Feb. 1997. The mean age was 52 years (range 38-66), preoperative examination findings were 38 cases of normal uterine size, 60 of uterine enlargement (44 less than 12 week gestational size and 16 larger). Among these patients, 29 cases had a history of lower abdominal laparotomy. RESULTS: 2 out of the 98 cases were switched to laparotomy (2.0%). Mean operation time of LAVH was 106 min (range 60-240 min). The amount of blood loss was approximately 50-150 ml during operation, and the average hospitalization was 6 days. CONCLUSION: Laparoscopic assisted vaginal hysterectomy expands the indication of transvaginal hysterectomy, and avoids laparotomy and lessens injuries, shortens the hospitalization. It is a promising approach of hysterectomy and should be used widely.

Adult↗
PubMed1992

Prevention of group B streptococcal infection.

Group B streptococci continue to be major perinatal pathogens, both for mothers and their infants, and are associated with significant morbidity, mortality, and its attendant cost to society. Approaches to prevention are directed toward either eliminating exposure to the organism or enhancing host resistance, that is, chemoprophylaxis and immunoprophylaxis. Intrapartum chemoprophylaxis has been shown to effectively interrupt vertical transmission of group B streptococci from the genitally colonized mother to the infant and to decrease the incidence of both maternal and early-onset neonatal group B streptococcal disease. To avoid unnecessarily exposing large numbers of colonized women to antibiotics, only those with defined risk factors should be selected for intrapartum chemoprophylaxis. This regimen is ampicillin given intravenously, 2 g initially at onset of labor or rupture of membranes, followed by 1 g every 4 hours until delivery. Risk factors include premature onset of labor or rupture of membranes before 37 weeks' gestation, rupture of membranes of more than 12 hours, intrapartum fever, group B streptococcal bacteriuria, or having previously delivered an infant with group B streptococcal disease. Detection of anogenital colonization is accomplished either by culture late in the second or early in the third trimester or by intrapartum group B streptococcal antigen testing of vaginal swabs from those previously culture-negative or not cultured. Although this approach combines the advantages of several proposed strategies, it will still miss those cases of group B streptococcal disease developing in the absence of discernible risk factors. Intrapartum prophylaxis does not prevent late-onset group B streptococcal disease. Prenatal and postnatal chemoprophylaxis have not been shown to be effective. Symptomatic infants born to mothers given chemoprophylaxis should be evaluated for neonatal sepsis and treated accordingly. This approach is also suggested for asymptomatic premature infants, those whose mothers have not received adequate prophylaxis or have previously delivered infants with group B streptococcal disease, and for twin siblings of infants developing group B streptococcal disease. Successful implementation of this approach may be limited by the availability and sensitivity of the rapid antigen test used. Immunoprophylaxis, and active immunization in particular, is the most promising method of preventing perinatal group B streptococcal disease in mothers and their infants, including late-onset disease. Immunization of pregnant women with type III polysaccharide vaccine has resulted in adequate provision of functional antibody to the infants born to responders.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacterial Vaccines↗