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At least 1,189 records · Page 66Linked to original sources
PubMed1996

Non-gay-identifying men who have sex with men: formative research results from Seattle, Washington.

Non-gay-identifying men who have sex with men are at risk for human immunodeficiency virus (HIV) infection. To understand these men and to develop interventions to reduce their HIV risks, the authors interviewed staff at agencies that serve non-gay-identifying men who have sex with men, business people who interact with them, and the men themselves. Interviews were augmented with focus groups of non-gay-identifying men who have sex with men and field observations at sites identified as places where they meet to negotiate or have sex. These qualitative data suggested 73 possible groups, which were consolidated into 16 broader "sectors," and then formally ranked by level of HIV risk, ease of access to the sector, psychosocial risks, and influence of other local interventions or research activities. The authors identified six priority groups of non-gay-identifying men who have sex with men (and sites where members of these groups could be approached): hustlers, closeted men, experimenters, incarcerated or formerly incarcerated men, men of color, and heterosexually identified bisexuals. Masturbation and oral sex were reportedly common, but anal and vaginal sex were also noted; condom use was rarely reported. Risk behaviors among non-gay-identifying men who have sex with men persist for a variety of reasons and may require a variety of intervention approaches.

Adolescent↗
PubMed1984

Hydrometrocolpos in neonate due to distal vaginal atresia.

Hydrocolpos is the result of vaginal obstruction and can become an emergency in the newborn period. The treatment of imperforate hymen is well defined, but the treatment of vaginal atresia is more complex. We encountered two cases of hydrocolpos secondary to distal vaginal atresia, that were operated on in the first days of life. One baby had distal atresia without persistance of urogenital sinus. Surgery combining abdominal perineal approaches and a posterior vaginoplasty was carried out. The second baby had hydrocolpos with persistance of urogenital sinus. Drainage through the sinus was unsuccessful because the baby developed sepsis by trapping urine in the uterus. Finally an abdominoperineal vaginal pull-through was successfully done. The embryology and literature are reviewed. The classification, indications and surgical technique are discussed.

Female↗
PubMed1995

Bovine vaginal antibody responses to immunoaffinity-purified surface antigen of Tritrichomonas foetus.

Bovine trichomoniasis is a prevalent sexually transmitted disease of cattle caused by the protozoan Tritrichomonas foetus. Currently, diagnosis is most often made by culture. In order to provide a faster immunodiagnostic approach, a specific enzyme-linked immunosorbent assay (ELISA) was investigated. A protective surface antigen (TF1.17 antigen) of T. foetus was immunoaffinity purified and used in an ELISA to detect antibodies in vaginal mucus from heifers inoculated with T. foetus. In preliminary studies, antibodies of the immunoglobulin A (IgA) isotype were detected in mucus from all experimentally infected heifers which were tested at 6 weeks postinoculation, whereas IgG1 and IgG2 were not. In addition, IgA responses detected in postinoculation samples were all greater than those detected in preinoculation samples, unlike those detected by a whole-cell antigen ELISA. For these two reasons, IgA antibodies appeared to be useful diagnostically. Further investigation of IgA antibodies used vaginal mucus collected weekly from heifers inoculated intravaginally with 10(2), 10(4), or 10(6) T. foetus organisms. Heifers with positive cultures for T. foetus had similar IgA responses to TF1.17 antigen over the 10 weeks of infection regardless of the initial inoculum dose. This indicates that if the dose is sufficient to establish infection, the magnitude and duration of the immune response are no longer dependent on dose. All of the infected animals receiving all dosages responded with high absorbance values in the IgA anti-TF1.17 antigen ELISA by 6 weeks postinoculation, and all absorbance values remained high at 10 weeks. To determine the duration of the IgA response, four other heifers inoculated with 7 x 10(6) T. foetus organisms were studied through 24 weeks postinoculation. IgA antibody responses to TF1.17 antigen were still high at 24 weeks, even though some heifers cleared the infection several weeks earlier. These results indicate that experimentally infected heifers produced detectable long-lasting IgA responses to TF1.17 antigen in vaginal mucus, which may be useful in a herd test for the diagnosis of bovine trichomoniasis.

Animals↗
PubMed1999

[Carcinoma of the vagina].

In our study we present the cases with vaginal cancer treated in the gynaecological clinic of the National Oncological Centre in Sofia for the period from 1989 till 1998. Most of the women were with squamous cell carcinoma of the vagina. Twenty seven patients were examined--19 of them were operated, 18 patients received radiotherapy and 2 chemotherapy. The tumors that were localized in the upper 2/3 of the vagina were operated by radical hysterectomy a modo Wertheim-Meigs and extirpation of the vagina. When the tumor was localized in the lower third of the vagina we performed additionally radical vulvectomy and bilateral inguinofemoral lymph-node dissection. For more advanced cancers we did exenteration anterior and posterior. When there was no possibility for surgical approach or for radiotherapy we did chemotherapy with 5-Fu, methotrexate, cyclophosphamide and vincristin. The prognosis for the vaginal cancers is not good, in 25-30% of the patients survive 5 years. As a whole we assess that we are having the same results, as well as survival rate like other western clinics.

Carcinoma↗
PubMed2000

Bowel perforation caused by an endoscopic stapler used during laparoscopically assisted vaginal hysterectomy. A case report.

BACKGROUND: A commonly cited concern regarding laparoscopic hysterectomy is that the risks and complications associated with the procedure may be greater than those associated with more-traditional hysterectomy techniques. Among the potential risks that are unique to this approach are injuries caused by laparoscopic instrumentation. The events described below constitute the first known case of a postoperative bowel perforation caused indirectly by an automatic stapler used during a laparoscopically assisted vaginal hysterectomy (LAVH). CASE: A 52-year-old, African American woman underwent an uncomplicated LAVH, bilateral salpingo-oophorectomy and anterior repair in January 1995. Approximately nine months later, the patient began experiencing abdominal pain during a trip to Europe. Her condition progressively deteriorated to the point that an emergency landing in Iceland was required during her flight home. The patient was found to have a bowel obstruction and underwent a laparotomy and bowel resection. An open staple from the endoscopic stapler that was used at the time of LAVH was found to have caused the bowel perforation, which eventually resulted in adhesion formation and obstruction. CONCLUSION: Every effort should be made to remove loose staples from the operative field prior to termination of a laparoscopic procedure.

Female↗
PubMed2001

[Sling-plasty in therapy of female urinary incontinence].

Traditionally, women with type III stress incontinence (intrinsic sphincter deficiency) are treated with sling procedures, which have undergone multiple modifications during the last 90 years regarding surgical approach, sling course, and materials. The latest variation of the established sling concept is the tension-free vaginal tape (TVT) procedure. The choice of sling material influences the postoperative complication rate and reveals a conflict between unrestricted availability (alloplastic material) and optimal tissue compatibility (autologous material). Although valid information about the surgical outcome of sling procedures is rare, at least some evidence-based conclusions may be drawn from the meta-analysis of the published data: sling procedures and colposuspensions are more efficient and more durable than needle suspensions or anterior repairs in the treatment of female stress incontinence. The complication profile does not show a significant difference between slings and colposuspensions. The lack of long-term results for the TVT procedure precludes any definite assessment of this innovation. In any case, to meet the patient's interests, no surgical approach for correction of stress incontinence should be undertaken without complete diagnostic evaluation of the problem.

Adult↗
PubMed1994

Laparoscopically Assisted Vaginal Hysterectomy (LAVH) in a Community Hospital: An Initial Experience

A total of 44 procedures were begun as LAVH with 41 (93%) completed and 3 (7%) attempted but converted to an open approach. Indications were: Leiomyata uteri, 21 (48%); menometrorrhagia, 10 (23%); Uterine prolapse, 6 (14%); endometriosis, 6 (14%); and 1 cervical carcinoma. Four complications occurred. One intraoperative large bowel perforation associated with extensive adhesions occurred and perforation was converted into an abdominal hysterectomy. The perforation was repaired primarily. The 3 remaining complications were delayed vaginal cuff bleeding, one of which required return to the operating room on post-operative day 25 for suturing of the vaginal cuff. The average length of stay was 3 days (range 2-8). The author reviewed the general experience of introducing this new procedure into a community hospital and concluded that LAVH is efficacious and can be safely introduced into a community hospital setting.

Journal Article↗
PubMed2006

Supratrigonal VVF repair by modified O'Connor's technique: an experience of 26 cases.

OBJECTIVE: To report the technical modifications of O'Connor's procedure and their outcome in 26 supratrigonal vesico vaginal fistulae. MATERIALS AND METHODS: Twenty-six cases of supratrigonal VVF (17 primary, 9 recurrent) were operated using the described modifications. It consisted of approaching the bladder transperitoneally, without dissecting the retropubic space, making a short sagittal or parasagittal cystotomy in between stay sutures, liberal use of bladder rotation flaps instead of midline closure, using single layer, continuous, closely placed, interlocking stitches for bladder as well as vaginal approximation and universal use of vascularised tissue interposition. RESULTS: Mean fistula size was 2.8 cm (range 1.0 to 3.7). Mean operative time was 104 minutes, and blood loss was insignificant. Three patients required ureteroneocystostomy. All patients were dry after 2-3 weeks of suprapubic and per urethral catheter drainage. One patient persisted with stress urinary incontinence. No patient on follow up complained of features suggestive of prolonged ileus, peritonitis or adhesive intestinal obstruction. CONCLUSION: Modified O'Connor's repair is safe and achieves excellent functional results. It requires a shorter cystotomy instead of bi-valving of the bladder, thus minimizes tissue trauma, intraoperative blood loss and operating time. It also gives option of tailoring the cystotomy in sagittal or parasagittal line, according to the site and size of the fistula, and thus permits closure of fistula by rotation of bladder flap into the defect without any lateral traction on the bladder edges. Retropubic dissection and drainage of the retropubic space is also not required.

Adolescent↗
PubMed2004

Coexistence of a prolapsed, pedunculated cervical myoma and pregnancy complications: a case report.

BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas arefound in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 x 6 x 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originatedfrom. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choicefor a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of Laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.

Abortion, Induced↗
PubMed1999

Potential preventive strategies and therapies in urinary tract infection.

There are perhaps five strategies either presently advocated or under investigation for prevention of recurrent urinary tract infection (UTI): antibiotics, including natural peptides; functional foods; vaccines; probiotics; and miscellaneous, including avoidance of spermicides and maintenance of good hygiene. It is not possible to state the proportion of patients using antibiotics versus foods such as cranberry or using alternative approaches such as avoidance of spermicides. The majority of women who are referred to specialists will be prescribed long-term, low-dose antibiotics. However, given the magnitude of the problem, it is safe to state that large numbers of women are at least experimenting with alternative remedies such as drinking of cranberry juice or ingestion of herbal remedies with a view to enhancing their immune response. Vaccine development remains a long way from human use and has yet to be developed for organisms other than Escherichia coli. The use of probiotics of restore the normal vaginal flora and provide a competitive bacterial barrier to pathogens is close to becoming available as an alternative preventive approach. The next decade should see the introduction of new methods for reduction of the high incidence of UTI and better management of recurring urogenital infections.

Anti-Bacterial Agents↗
PubMed1993

Vaginal hysterectomy with repair of enterocele, cystocele, and rectocele.

There are several equally effective but different operative procedures to correct uterine procidentia; the technique and operative approach must be chosen according to the specific needs of the patient. The surgeon must be able to dissect, identify, resect, and approximate the appropriate supporting structures. To preserve a functional vagina in a patient with complete procidentia, the surgeon must have a full understanding of the principles of pelvic support. If a functional vagina is unimportant, then a tight, coned-down vagina (one finger in depth and diameter) offers the best long-term results.

Female↗
PubMed2001

[Vaginal hysterectomy in nulliparous women: indications and limitations].

OBJECTIVE: The aim of our study was to determine whether nulliparity is a limiting factor for vaginal hysterectomy performed for benign lesions. PATIENTS AND METHODS: We conducted a prospective study in 1604 patients who underwent hysterectomy for a benign lesion between 1991 and 1998. We studied a subgroup of this population constituted by 128 nulliparous women, i.e. 8% of the patients. RESULTS: Vaginal hysterectomy was performed at first intention in 54.7% of the cases, after laparoscopic preparation in 14%, and by first intention laparotomy in 31.3% for each type of approach we compared: history of pelvic surgery, duration of the operation, final weight of the uterus, peroperative complications, association or not with adnexectomy in patients aged 45 years or older, frequency of a reduction procedure in the vaginal group and duration of hospitalization. CONCLUSION: Nulliparity is not a contraindication for vaginal hysterectomy which can be proposed as a first intention procedure, sometimes in association with laparoscopic preparation in case of prior pelvic surgery or concomitant adnexal disorders.

Contraindications↗
PubMed1994

Improved method for needle electromyography of the urethral sphincter in women.

Needle electromyography (EMG) of the urethral sphincter using the periurethral approach is a procedure which most women find painful and their discomfort can restrict the usefulness of the test. A new technique has been devised using a transvaginal approach. The patient lies in the left lateral position and using a Sims speculum the posterior vaginal wall is retracted. The urethral sphincter can be easily seen and palpated, assisting correct electrode placement. This new technique is much less uncomfortable and highly satisfactory EMG recordings are obtained.

Electromyography↗
PubMed1998

Recurrence of stress incontinence after vault suspension: can it be prevented?

Management of vault prolapse in a patient who has previously undergone successful colposuspension has not been considered in the literature. The two cases presented highlight the risk of incontinence and illustrate measures that should help to reduce it. The approach aims to reveal potential stress incontinence and to prevent excessive stretching of the upper anterior vaginal wall during surgical correction. Potential stress incontinence is revealed by a cough stress test while reducing the prolapse without a speculum, a 'pessary test' for a few days, and urodynamics both with and without a pessary. Patients with potential incontinence undergo perineal ultrasound to assess bladder neck position. If sacrospinous fixation is used, epidural anesthesia is recommended so as to allow the patient to cough during the procedure to ensure accurate suture placement. When sacrocolpopexy is done, preoperative assessment of the degree of 'safe elevation' ensures accurate suture placement.

Aged↗
PubMed1988

The development of an expert computer system on medical consulation.

In order to master fuzziness and uncertainty in solving human problems, an expert system shell SYSTEM Z-II which can handle both exact and inexact reasoning has been successfully developed. This paper describes how the Z-II system shell works in building a medical consultation expert system which accepts fuzzy human concepts and uncertain factors. This expert system ABVAB in the domain of "Abnormal Vaginal Bleeding" is described to demonstrate the power and flexibility of such system. The methods of approach in the development and testing of this system are presented together with the results.

Diagnosis, Computer-Assisted↗
PubMed1996

Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy.

OBJECTIVE: The purpose of this study was to incorporate a wide range of operative laparoscopic techniques to complete a type III radical hysterectomy with aortic and pelvic lymphadenectomy. STUDY DESIGN: A type III radical hysterectomy with bilateral aortic and pelvic lymph node dissection was separated into eight component parts: (1) right and left aortic lymphadenectomy, (2) right and left pelvic lymphadenectomy, (3) development of the paravesical and pararectal spaces, (4) ureteral dissection, (5) ligation and dissection of the uterine artery, (6) development of the vesicouterine and rectovaginal spaces, (7) resection of the parametria, and (8) resection of the upper vagina. The adequacy of the component parts was determined and documented on video. RESULTS: Complete aortic and pelvic lymphadenectomy and a type III radical hysterectomy were performed by operative laparoscopy. Argon beam coagulation and countertraction facilitated pelvic and aortic lymph node dissection, including removal of nodal tissue lateral to the iliac vessels. Ureteral dissection with resection of the cervicovesical fascia ("the tunnel") was completed with right-angle dissectors, vascular clips, and argon-beam coagulation. Resection of the cardinal and ureterosacral ligaments was successful by use of Endo-GIA stapling instruments (United States Surgical Corporation, Norwalk, Ct.). CONCLUSION: A complete pelvic and aortic lymphadenectomy and type III radical hysterectomy were performed laparoscopically. This approach could potentially decrease morbidity historically associated with radical hysterectomy and lymphadenectomy performed either abdominally or vaginally. Only prospective randomized trails will allow for the evaluation of potential benefits associated with this surgical technique.

Adult↗