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At least 1,261 records · Page 70Linked to original sources
PubMed2005

Randomized comparison of vaginal and rectal measurement of intra-abdominal pressure during subtracted dual-channel cystometry.

OBJECTIVES: To compare the rectal (Prec) and vaginal (Pvag) measurement of intra-abdominal pressure during cystometry in women by assessment of patient acceptability and cystometrogram quality control. METHODS: Of 136 consecutive women undergoing cystometrography, 100 were randomized to measurement of Prec or Pvag. The patients' experience was measured using visual analogue scales of anticipated and actual discomfort and embarrassment before and after the procedure. The setup time was recorded, and quality control was assessed by the number of catheter events (pressure lines falling out, requiring flushing, or repositioning), and quality of the cough signal. RESULTS: A total of 136 consecutive patients were approached. Of those eligible, 50 were randomized to Prec and 50 to Pvag; 23 women declined randomization because of preference for a vaginal line. Overall, 81 line events occurred in 29 women with a vaginal line and 117 occurred in 34 women with a rectal line. No difference was found in patient acceptability nor in trace quality for the two routes. Despite catheter repositioning and flushing, only 13% of traces showed optimum trace quality throughout the entire investigation; the cough signal quality was worse after provocation, during voiding, and in women with prolapse. CONCLUSIONS: A significant proportion of patients undergoing cystometry expressed a preference for the vaginal line. The quality of output from cystometry was limited by the conditions of the investigation rather than the method of intra-abdominal pressure measurement.

Abdomen↗
PubMed1998

[Gameprost, sulproston and dinoproston for induced abortion in the 15th-24th week of pregnancy].

In a randomized, prospective study at the Dept. of Obstetrics and Gynecology of the University Hospital of Giessen 4 different ways of inducing abortions with prostaglandins were tested between the 15th and 24th week of gestation. The aim of the study was to determine the best approach to inducing abortion in order to minimize the psychological and physical stress to the patient. Subjects randomized to the first two groups got a single cervical installation of either 0.5 mg Dinoprostongel (Prepidil, N = 22) or 0.5 mg Sulprostongel (Nalador, N = 21). Six hours later, i.v. infusion with Sulproston (8.3 micrograms/min) was started and continued until the abortion was complete. Patients randomized to the third and fourth group received either 0.5 mg Dinoprostongel intracervically (N = 15) or 1 mg Gemeprost vaginal suppositories (Cergem, N = 21) every 6 hours until the cervix was 1-2 cm dilated. Subsequently the patients received an i.v. infusion with Sulproston until the abortion was complete. In the first group with intracervical application of Sulproston the total time until abortion was 17.8 h +/- 7.8 h. This was shorter than following a single application of Dinoprostongel (22.5 h +/- 14.7 h). Although there was a five hours difference, the between-group differences were not statistically different because of a wide range in values following Dinoproston treatment. This range could not be explained by the age of the mother, week of gestation or parity. In the group receiving multiple intracervical applications of Dinoproston the time till expulsion was twice as long as that after multiple vaginal suppositories of Gemeprost (33.8 h +/- 13.9 h vs. 15.6 +/- 6.0 h, p < 0.01). The time span until a cervical dilatation of 1-2 cm was 27.0 h +/- 13.7 h in the group with repeated Dinoproston application. This period of time was more than twice the time span seen in the group with repeated Gemeprost application (12.5 h +/- 4.2 h, p < 0.01). On the average four treatments with intracervical Dinoprostongel were required while the average with Gemeprost vaginal suppositories was two to achieve a cervical dilatation of 1-2 cm. Furthermore in 7 of 21 cases treatment with Gemeprost achieved the expulsion of the fetus without Sulproston infusion (11.4 h +/- 5.2 h). Comparing single versus repetitive prostaglandin application we could demonstrate that the duration of Sulproston infusion was cut in half after repeated therapy with Gemeprost. We conclude that repetitive application of Gemeprost vaginal suppositories decreases the time to abortion and subject discomfort tremendously. The application of Gemeprost suppositories provides the easiest and most efficient therapeutic approach for both patients and staff. Furthermore the regiment that provided the best results was also the most cost-effective (range 180,-DM to 317,- DM per case).

Abortifacient Agents, Nonsteroidal↗
PubMed1999

[Indications from the laparoscopic approach in pediatric urological surgery: our experience in 49 patients].

OBJECTIVES: To analyse the diagnostic and therapeutic potential of video-assisted laparoscopy in the urology paediatric pathology. We had analysed its indications and results, to measure in disminution of morbidity and hospital stay. PATIENTS AND METHODS: We are treated in our section of Paediatric Urology 49 patients during the period of June 1995 and December 1998, performing 51 laparoscopics procedures. The mean age was 8 years (2-16 years ago). The laparoscopic indications were diagnostic in 33 patients: intra-abdominal testes (n = 16), renal biopsy (n = 17), and terapeuthics in 16 patients (17 laparoscopics procedures): varicoceltomy (n = 7), orchiectomy (n = 1), closure peritoneal-vaginal duct (n = 2), retroperitoneal nephrectomy (n = 6), marsupilazation and omentoplastic in giant lymphocel renal post-transplantation (n = 2). RESULTS: The laparoscopic approach were effective in 100% of diagnostic procedures and 93.4% of therapeuticm procedures. Conversion in 2 cases were necessary to make renal biopsy (n = 1). We hadn't have postoperatives complications and the indices of intraoperative morbidity was of 2.4%. The mean hospital stay was 1.4 days. CONCLUSIONS: We believe that exist indications clinically stabilised of laparoscopic approach--diagnostic and therapeutic--in paediatric urology. There are others indications that its are consider anecdotal in the present but in immediately future these indications will be valid.

Adolescent↗
PubMed2001

[Laparoscopic neovaginoplasty--a modification of the Vecchietti operation].

OBJECTIVE: To asses laparoscopic approach to neovaginoplasty. DESIGN: Retrospective clinical study. SETTING: Department of Gynecology and Obstetrics, 2nd Medical Faculty of Charles University. METHODS: Vecchietti's neovaginoplasty is considered to be the most advantageous technique of creating neovagina in vaginal agenesis, because of low perioperational morbidity and quicker recovery. Authors describe own modification of laparoscopic procedure based on designed equipment of themselves. RESULTS: Study evaluates 17 cases of laparoscopic procedures, which are compared with classical laparotomic approach we were experienced in past. Time of surgery was shorter (48 min vs. 66 min) and blood loss was lower (15 ml vs. 50-100 ml) in laparoscopic procedure. Number of complications was lower in this procedure too. There was no difference in length of hospital stay and size of neovagina. CONCLUSION: Laparoscopic modification is safe procedure and comparable with classic operation as regards surgical effect. Both types of procedures are determined for workplaces with experience in special reconstructive surgery and follow-up.

Adolescent↗
PubMed1978

Vaginal cystectomy.

The technique of vaginal cystectomy is described in 2 patients. These patients were particularly suited for vaginal cystectomy because severe lower abdominal scarring from previous multiple abdominal operations would have made the standard suprapubic approach difficult.

Adult↗
PubMed1991

Reverse hysterocolposigmoidectomy (RHCS) for resection of panpelvic tumors.

Lateral retroperitoneal approaches to abdominopelvic masses are commonly employed; the reverse hysterocolposigmoidectomy (RCHS) in addition utilizes transabdominal entry of the vaginal and rectovaginal spaces to provide medial access to the uterosacral and cardinal ligaments as well expose a tumor-free segment of the rectosigmoid for en bloc resection of panpelvic tumors. Thirty-one patients underwent reverse hysterocolpectomy for extensive, symptomatic pelvic malignancies. All patients had complete resection of pelvic tumor, and there were no perioperative deaths. Sigmoid resection was required in 25 patients with 22 primary reanastomosis and 3 end colostomies performed. In 6 patients, vaginal entry facilitated tumor resection while sparing the rectosigmoid. Average operative blood loss was 2677 cc. Early postoperative morbidity (1-30 days) occurred in 13 patients; febrile morbidity (6 patients) was the common complication. Late morbidity (1-6 months) was seen in 10 patients, including 1 fatal pulmonary embolism at 5 months. Subsequent therapy was tolerated well. Mean survival/follow-up is 15.7 months (range, 1 to 49 months). Seventeen patients are alive, seven patients without evidence of disease (average 13.4 months), and ten patients are alive with disease (average follow-up, 28.3 months). Thirteen patients are dead of disease or complication (average survival, 13.7 months). We conclude that RHCS facilitates resection of extensive pelvic tumors with acceptable morbidity.

Adult↗
PubMed2005

Estrogens and progestins: background and history, trends in use, and guidelines and regimens approved by the US Food and Drug Administration.

The US Food and Drug Administration (FDA) approved marketing of diethylstilbestrol in 1941 and conjugated equine estrogens (CEE) in 1942 for treatment of menopausal symptoms. Estrogen sales doubled and tripled in the mid-1960s to mid-1970s, until 1975, when reports of increased endometrial cancer in estrogen users resulted in a dramatic decline. Estrogen use increased again, with evidence of protective effects of progestins on estrogen-induced endometrial changes, combined with a 1982 report that Premarin (conjugated estrogen tablets; Wyeth Pharmaceuticals, Philadelphia, PA) retained bone mass and a 1984 National Institutes of Health (NIH) Consensus Conference on Osteoporosis statement that estrogens were the most effective means for preventing bone loss. Despite conflicting reports in 1985 regarding the relation between estrogens and coronary heart disease (CHD), many published observations of reduced CHD risk in estrogen users--reinforced by clinical trial findings in 1995 of favorable lipoprotein changes in women assigned to CEE with or without a progestin--promoted increased use through the 1990s. By 2001, approximately 15 million US women were using estrogen therapy, with or without progestins. The 2002 Women's Health Initiative (WHI) report of greater harm than benefit of combined CEE plus a progestin resulted in a precipitous decrease in estrogen and progestin use and a serious reevaluation of menopausal hormone therapy, as well as increased interest in alternative approaches to managing menopausal symptoms, including use of "bioidentical" hormones. FDA guidelines regarding treatment indications for vasomotor symptoms, vaginal atrophy, and osteoporosis prevention have resulted in approval of several estrogen (and progestin) formulations, doses, and routes of administration, thereby providing many options for women who seek conventional therapy.

Drug Approval↗
PubMed1996

The role of colpocleisis with urethral lengthening in transsexual phalloplasty.

OBJECTIVE: Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented. STUDY DESIGN: Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vaginal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment. RESULTS: Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible. CONCLUSION: Extending the urethra during colpocleisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.

Female↗
PubMed1995

Advantages of laparoscopic supra-cervical hysterectomy.

The development of minimally invasive hysterectomy in gynaecology is clearly an exciting one, but these procedures need to be validated in prospective studies. If laparoscopic hysterectomy proves to be safe and more effective than abdominal hysterectomy, then it will definitely become established as a validated procedure in gynaecology. There are an increasing number of surgical options for women with menstrual problems-hysterectomy: abdominal, vaginal, laparoscopic, total, supra-cervical, Doderlein, with or without oophorectomy, or endometrial ablation or resection. One particular approach will not be suitable for all women and the choice needs to be individualized according to the particular clinical situation and to some extent patient choice. The true benefits of the supra-cervical approach are yet to be shown, but this may be the way that laparoscopic hysterectomy will develop in the future.

Female↗
PubMed2005

Polymerase chain reaction detection of Y chromosome sequences in vaginal fluid: preliminary studies of a potential biomarker for sexual behavior.

BACKGROUND: Self-reported measures of sexual behavior are subject to nontrivial reporting biases. OBJECTIVE: The objective of this study was to develop a behavioral biomarker of recent sexual activity among females that is inexpensive, easily administered, and can be used in low sexually transmitted disease prevalence populations. METHODS: We developed a polymerase chain reaction (PCR) assay to detect Y chromosome (Yc) fragments. The Yc primers were developed against a 200-basepair (bp) microsatellite repeat sequence, which is unique to the male genome. A standard PCR technique was used. Assay sensitivity was determined quantitatively using donated semen samples. To assess longevity of detectability, we recruited female subjects in monogamous relationships. Seventeen subjects had unprotected intercourse followed by 3 weeks of abstinence from vaginal intercourse. Self-administered vaginal swabs (SAVS) were collected every other day. In addition to the swabs, subjects kept daily sexual diaries. Swabs were processed by semiquantitative PCR, and Yc decay curves were determined for each subject. The half-life of Yc in vaginal fluid was calculated on the collection of individual decay curves by a random-effects regression model approach. RESULTS: The sensitivity of our Yc-PCR assay was determined to be 5 copies of Yc. In the longevity studies, Yc was detectable in SAVS up to 15 postcoital days (PCD). Mean Yc DNA concentration in SAVS eluate followed an exponential decay pattern for each subject. Mean concentrations were 66.7 ng/mL at PCD-1, 20.6 ng/mL at PCD-7, and 4.5 ng/mL at PCD-15. The estimated half-life for Yc clearance was 3.83 days. CONCLUSION: The swab-based Yc-DNA PCR assay can detect coitus in women for a 2-week retrospective period. This can be used to validate sexual behavior-reporting and condom use in women and promises to be a useful tool in sexual behavior research.

Adult↗
PubMed1992

The characteristics of the second stage of labour in 25,069 singleton deliveries in the North West Thames Health Region, 1988.

OBJECTIVE: To define the contemporary characteristics of the second stage of labour in one Health Region. DESIGN: Retrospective analysis of a regional obstetric database. SETTING: Seventeen maternity units in the North West Thames Health Region. SUBJECTS: Selected from 36,727 consecutive singleton deliveries in 1988. The analysis was confined to the 25,069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour. MAIN OUTCOME MEASURES: Second stage duration, obstetric intervention and maternal and fetal morbidity. RESULTS: The duration of the second stage and the use of operative intervention were strongly negatively associated with parity and positively associated with the use of epidural analgesia. Maternal age, fetal birthweight and maternal height were also independently associated with the duration of the second stage. There were small but significant differences in the characteristics of women using epidural analgesia and those using alternative methods of pain relief. Parous women using epidural analgesia behaved in a similar manner to nulliparae without epidurals. Despite the longer second stages observed in women using epidural analgesia there appeared to be no significant increase in fetal morbidity. Within the region the epidural rate in individual units positively correlated with the overall forceps rate, the rate of caesarean section in the second stage of labour and the duration of the second stage. CONCLUSIONS: In our study the duration of the second stage in women not using epidural analgesia was similar to previous findings, but in those using epidural analgesia, the duration of the second stage was longer than has been reported previously, possibly reflecting a more conservative approach to operative intervention. Survival analysis indicates that in multiparae not using epidural analgesia the likelihood of spontaneous vaginal delivery after 1 h in the second stage was low, but in those multiparae using epidural analgesia and in all nulliparae there was no clear cut-off point for expectation of spontaneous delivery in the near future; they continue to give birth at a steady rate over several hours. While maternal and fetal conditions are satisfactory, intervention should be based on the rate of progress rather than the elapsed time since full cervical dilatation.

Adult↗
PubMed2006

A review of transdermal hormonal contraception : focus on the ethinylestradiol/norelgestromin contraceptive patch.

Imperfect use of contraceptive methods notably increases the likelihood of pregnancy. One means of improving user adherence with hormonal contraception is to minimize the dosing schedule. Two forms of hormonal contraceptive have currently achieved this goal: the transdermal patch and the vaginal ring. The first and only transdermal contraceptive patch to receive worldwide regulatory approval (ethinylestradiol/norelgestromin) is a convenient approach to contraception that has a similar efficacy to oral contraceptives (OCs), but with the benefit of once-weekly administration. In addition, transdermal delivery of contraceptive hormones eliminates variability in gastrointestinal absorption, avoids hepatic first-pass metabolism, and prevents the peaks and troughs in serum concentrations that are seen with OCs. Norelgestromin, the progestin contained in the patch, is the active metabolite of norgestimate and is structurally related to 19-nortestosterone. Norgestimate and norelgestromin mimic the physiologic effects of progesterone at the progesterone receptor; however, norelgestromin has negligible direct or indirect androgenic activity, suggesting that it may be suitable for women with disorders related to androgen excess (such as hirsutism, acne, and lipid disorders).Contraceptive effectiveness is usually a function of the efficacy of a contraceptive in combination with compliance with its dosing regimen. The efficacy of the contraceptive patch has been clearly demonstrated in three phase III trials, two of which were randomized comparisons with an OC. The likelihood of pregnancy was similar between these contraceptive methods; however, compliance with the patch was notably better, particularly in younger women. The safety and tolerability profile of the patch was similar to that of the OC. A cost-effectiveness analysis has suggested that the contraceptive patch is more cost effective than the OC, due to decreased costs related to unwanted pregnancy.

Contraception↗
PubMed1992

[Beta interferon therapy of HPV infections of the female genital tract].

The aim of the study was to evaluate the incidence of cervical and vaginal lesions due to Papilloma virus before and after beta-interferon therapy. Clinical symptoms and the therapeutic approach are described, whereas drug efficacy was assessed on a long-term basis. The study of 19 cases, brought to the Author's attention over an eight-year period (1984-91) confirms previously published reports: the use of interferon shows a good level of tolerability without complications and undeniable efficacy following surgical treatment.

Adult↗
PubMed2004

Pelosi minilaparotomy hysterectomy: a non-endoscopic minimally invasive alternative to laparoscopy and laparotomy.

T he authors' technique of minilaparotomy hysterotomy is a new modality that combines the technical benefits of conventional laparotomy with the minimally invasive convalescent and cosmetic advantages of laparoscopic surgery. For patients in whom vaginal hysterectomy is considered contraindicated, this procedure offers an effective and safe minimal access alternative. This redesigned minilaparotomy approach relies on traditional open techniques and experience instrumentation that avoid the cost of expensive equipment, long learning curve, and prolonged operating time associated with laparoscopic surgery, as well as the convalescent disadvantages of a standard laparotomy.

Female↗
PubMed1990

Examination of the second-trimester fetus with severe oligohydramnios using transvaginal scanning.

Transvaginal sonographic transducers have permitted better resolution of the pelvic structures than previously possible. The presenting fetal part may be difficult to image transabdominally when lodged deep in the lower uterine segment. In particular, second-trimester fetuses associated with severe oligohydramnios present a challenge to the sonologist because of both the lack of amniotic fluid and the deep and curled fetal position in the maternal pelvis. Two cases are reported of second-trimester oligohydramnios in which the fetal abnormalities were visible only with the vaginal probe. The vaginal scan permitted a definitive diagnosis of Potter syndrome not possible with the poorer resolution of the transabdominal approach. I conclude that transvaginal scanning should be considered in patients with unexplained severe oligohydramnios because the resolution of the fetal anatomy is greatly enhanced.

Abnormalities, Multiple↗
PubMed1986

Laser ablation of hymenal fissures.

Four patients presented with linear ulcers (hymenal fissures) that had not responded to conventional local therapy or oral antibiotics. These sexually active women had experienced dyspareunia for 8-24 months. Cultures for venereal agents were negative. One patient had two linear ulcers, and the others had only one; all the ulcers were restricted to the hymenal ring at either the 4 or 8 o'clock position. The lesions usually were obscured when the hymen was collapsed, but they were obvious when the ring was expanded. The lesions varied in length from 0.5 to 2 cm and were very shallow, generally 1 mm deep. The ulcers were linear streaks that could be stretched to 3-4 mm wide. Laser ablation of the lesions to a depth of at least 5 mm resulted in complete resolution of the ulcer in two cases. A third patient had almost complete resolution of the lesion after two laser treatments. The fourth patient failed treatment and refused additional treatment. The underlying nature of this recalcitrant condition may be as much an enigma as that of the anal fissure. Laser treatment seems the best approach at present.

Adult↗