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PubMed1994

Pathology of the vulva and vagina.

Extensive clinical, epidemiologic and pathologic research published in the past year has enhanced our understanding of the pathogenesis and natural history of human papillomavirus induced female genital tract lesions, and refined diagnostic and therapeutic modalities in management of these patients. Current experience with vulvar intraepithelial neoplasia as well as diagnosis and treatment of squamous cell carcinoma of the vagina and vulva are discussed. Advanced imaging techniques and immunohistochemical studies are employed in diagnosis and classification of less common neoplasms. New antibiotics and potent topical steroids are available for treatment of inflammatory vulvovaginitis, particularly in cases of recurrent candidiasis and lichen sclerosus. Persistent or resistant vulvovaginitis may benefit from an interdisciplinary approach to diagnosis and treatment.

Female↗
PubMed1991

Clinical approach to infertility in the cycling bitch.

The majority of "infertile" bitches presented to the practitioner are victims of mismanagement. Careful evaluation of reproductive history, physical examination, and vaginal cytologic evaluation permit conception in these patients. Measurement of serum progesterone levels can help establish occurrence and timing of ovulation. Diagnosing true reproductive problems may require a minimum data base, guarded cultures, vaginoscopy, vaginography, ultrasound, and ultimately laparotomy for uterine biopsy and culture. The majority of these diagnostic procedures are readily available for the interested practitioner.

Animals↗
PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. IV. Bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

A multicentred clinical trial was conducted in 12 countries to assess the contraceptive efficacy and side effects of a low-dose levonorgestrel-releasing vaginal ring. Contraceptive efficacy and side effects, expulsions and removals, and the relation between pregnancy rate and admission body weight of the women have been reported previously. The effect of ring use on vaginal bleeding patterns as observed from daily menstrual diaries kept by the women is the object of this paper. A total of 1005 women were fitted with the ring and 702 of them provided a menstrual diary suitable for analysis. The description of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition the longest bleeding/spotting episode and longest bleeding/spotting-free interval are calculated over the entire diary length. Half of the ring users have vaginal bleeding patterns similar to normal untreated patterns. A quarter experience irregular bleeding, 10% have prolonged cycles and 10% have shortened cycles. Over one year of continuous use, there appears to be no significant trend in these patterns. Users with the worst bleeding patterns tend to discontinue first during the clinical trial and are influenced by their more recent experience of vaginal bleeding irregularities. Life-table analysis of discontinuation rates gives an underestimation of the true incidence of bleeding irregularities. Some comments are made on the limitations of the methods of analysis of menstrual diaries.

Clinical Trials as Topic↗
PubMed2005

Laparoscopic vesicovaginal fistula repair with robotic reconstruction.

INTRODUCTION: To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time. A vesicovaginal fistula developed several weeks later, and she was referred for repair. The location of the fistula was deemed amenable to repair using a robot-assisted laparoscopic approach. TECHNICAL CONSIDERATIONS: The total operative time was 280 minutes, including placement of ureteral catheters and repositioning. The estimated blood loss was 50 mL. The fistula was repaired using robot-assisted laparoscopic techniques without complications, and the patient went home on the second postoperative day. The Foley catheter was removed 2 weeks postoperatively. The patient continued to void normally without recurrence at 16 weeks of follow-up. CONCLUSIONS: Laparoscopic repair of vesicovaginal fistulas has not gained widespread acceptance owing to its technical difficulty. We describe a minimally invasive laparoscopic approach using the DaVinci robotic system to repair a vesicovaginal fistula.

Adult↗
PubMedDate not supplied

Vaginal malignant melanoma: a case report and literature review.

Vaginal melanomas are rare genital malignancies occurring mainly in the 6th and 7th decades of life. In general, they have a worse prognosis than cutaneous melanomas. In the past, various treatment modalities have been recommended including radical pelvic surgery. However, the prognosis is poor in spite of such radical approaches. More recently, more conservative treatment in the form of wide local excision combined with adjuvant chemotherapy, high-dose radiotherapy, and immunotherapy seem to have promising results. We describe a patient with vaginal malignant melanoma treated with conservative local excision as well as adjuvant radiotherapy, chemotherapy, and interferon.

Combined Modality Therapy↗
PubMed2001

[Colposuspension in treatment of female stress incontinence].

Colposuspension has emerged as the "golden standard" for the surgical treatment of female urinary incontinence. With a lateral and tangential approach for the placement of the sutures, the rate of obstructed micturition and de novo urgency is low. Success rates of 85% for primary and 70-75% for recurrent incontinence can be achieved. In competition with the tension-free vaginal tape (TVT) procedure, colposuspension will remain the first choice for all laparotomies necessitated by other pathologies, in cases of paravaginal herniation as the cause of prolapse, and in women with unstable bladders caused by anatomical defects. The endoscopic approach has not yet gained general acceptance.

Female↗
PubMed2005

A minimally invasive technique for harvesting autologous fascia lata for pubo-vaginal sling suspension.

OBJECTIVE: To access donor site morbidity associated with harvesting of autologous fascia lata for pubo-vaginal sling suspension in treating stress urinary incontinence. METHODS: A retrospective study was performed of 25 female patients who underwent pubo-vaginal sling suspension for stress urinary incontinence. Autologous fascia lata strip was harvested in all patients with a minimally invasive approach using a fascial stripper. Demographic, intraoperative, and immediate postoperative data were recorded to determine the incidence of complications. Follow-up data was reviewed for documentation of long-term complications. RESULTS: Adequate length of fascia lata was harvested in all of our patients. Ten patients required a single 2 cm incision just above lateral femoral epicondyle to harvest fascia lata. Twelve patients needed two incisions and remaining three required three incisions. There were no intraoperative complications. There was no incidence of wound related infection or hematoma in the immediate post-operative period. On follow-up no patient had bothersome problems pertaining to the site of graft harvesting. CONCLUSIONS: Harvesting fascia lata with fascial stripper is a minimally invasive which is easy to learn and provides an excellent fascial strip with minimal morbidity.

Fascia Lata↗
PubMed1990

Oral administration of RU 486 and 9-methylene PGE2 for termination of early pregnancy.

It has been shown that the antiprogestin RU 486 increases the sensitivity of the early pregnant human uterus to the stimulatory action of prostaglandin E analogues administered vaginally or intramuscularly. To examine if RU 486 also increases uterine sensitivity to a PGE analogue given orally, two investigative approaches were used in the present study: 1) direct registration of uterine contractions before and after administration of 9-methylene PGE2 in untreated and RU-486-treated early pregnant women; and 2) an efficacy trial involving treatment of pregnant women (amenorrhea of 49 days or less) with 25 mg RU 486 twice daily for three or four days followed by 2.5, 5.0 or 10 mg 9-methylene PGE2, or 600 mg RU486 followed by 10 mg 9-methylene PGE2 administered on day 3 and 4. The results showed that oral 9-methylene PGE2 had a clear stimulatory effect on uterine contractility which was further increased by pretreatment with RU 486. Following 2.5, 5.0 or 10.0 mg 9-methylene PGE2, the frequency of complete abortion was the same, or approximately 80%. The success rate is higher than that generally reported for RU 486 treatment alone. If 600 mg RU 486 was complemented with 10 mg 9-methylene PGE2 administered on both days 3 and 4, the frequency of complete abortion increased to 95%. Side effects were of a mild nature and generally occurred following administration of 9-methylene PGE2. The results of the present study indicate that a combined treatment based on oral administration of both the antiprogestin and the prostaglandin analogue can be developed into a highly effective and simple method to terminate early pregnancy.

16,16-Dimethylprostaglandin E2↗
PubMed1989

[Transvaginal pulsed Doppler measurement of flow velocities in pelvic vessels following cycle stimulation].

The availability of pulsed Doppler probes has made it possible to sample signals at a chosen depth and thus to detect the flow in any selected deep vessel. Pulsed Doppler signal processing combined with real-time imaging, the so-called "duplex" method, is now also available for transvaginal transducers. The advantage of endosonographic ultrasound investigation is the possibility of using higher frequencies leading to a better resolution of anatomical structures of the small pelvis. Therefore this method allows the precise localisation of a deep vessel and the positioning of the Doppler sample volume within it. The transvaginal approach enables one to position the transducer close to the artery for better measurements. For our study we used a vaginal probe with 7.5 MHz with a pulsed Doppler equipment linked to a Combison 320 (Kretztechnik, Zipf, Austria). The integrated pulsed Doppler is not attached at a fixed angle but can be moved in the whole sector of 240 degrees. We investigated, if during follicle phase of the cycle changes of the pelvic blood flow velocity could be observed. 14 patients undergoing in vitro fertilization for sterility reasons participated in our study. We performed daily measurements of the blood-flow velocity of the ovarian artery and the internal iliac artery from cycle day 8 until the day of induction of ovulation. During cycle stimulation the observed decrease of the A/B ratio was dependent on cycle day and number of follicles. We found a decrease of the A/B ratio in the ovarian artery from 3.85 in cases with 2 follicles to 2.71 in cases with 5 follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed2004

Chromosomes 6 and 13 harbor genes that regulate pubertal timing in mouse chromosome substitution strains.

Variation in the onset of puberty among inbred strains of mice suggests that quantitative trait loci (QTLs) affect neurological and hormonal aspects of sexual maturation. Taking a novel approach toward identifying factors that regulate the hypothalamic-pituitary-gonadal (HPG) axis, we evaluated pubertal timing [as assessed by vaginal opening (VO)] in two inbred strains of mice, A/J and C57BL/6J (B6), and in a panel of chromosome substitution strains (CSSs) generated from A/J and B6 mice. In each CSS, a single chromosome from A/J has been substituted in a homozygous fashion for the corresponding chromosome in B6, partitioning the A/J genome into 22 strains with a common host (B6) background. VO occurred significantly earlier in A/J compared with B6 mice. Although the majority of the CSSs assessed had a timing of VO that was similar to the progenitor B6 strain, CSSs for chromosomes 6 and 13 each displayed significantly earlier time of VO than B6 mice. F1 (B6 x CSS) mice for chromosomes 6 and 13 displayed phenotypes that were intermediate between the CSS and B6 strains, suggesting that the trait was inherited in a codominant manner. These findings demonstrate that chromosomes 6 and 13 harbor QTLs that control the timing of VO. Identification of the responsible genes may reveal factors that regulate the maturation of the HPG axis and determine the timing of puberty.

Animals↗
PubMed1998

An alternative continuous caudal block with caudad catheterization via lower lumbar interspace in adult patients.

BACKGROUND: Continuous caudal block with caudad catheterization has not yet been mentioned in literatures. We designed a preliminary study to investigate the feasibleness of this technique, spread of contrast medium under fluoroscopy, and its clinical effectiveness. METHODS: Ten patients were subjected to epidural block (caudal) for elective anal or vaginal procedures. The entry of the epidural needle was made at the L4-5 interspace either with midline or paramedian approach. Through an 18 G Touhy needle with its bevel facing caudally an epidural catheter was threaded until a length of 10 cm was beyond the point of entry. The presence or absence of paresthesia during the passage of catheter and the ease with which the catheter was inserted were recorded. After the procedure, the course on which the catheter traversed and the spread of the medicinal substance in the epidural space were visualized and studied fluoroscopically using 1 and 3 ml iohexol (omnipaque 300 mg/ml) as contrast medium respectively. Then the patients were brought to operating rooms for anesthesia and surgery. Sensory anesthetic level and motor blockade were evaluated fifteen min after 11-15 ml of 2% lidocaine had been injected through the epidural catheter. During anesthesia vital signs were closely monitored, and adverse reaction if any was evaluated and managed. RESULTS: The insertion of the epidural catheter was considered easy and caused no paresthesia in nine patients. Catheter insertion encountered moderate resistance and induced paresthesia in one patient. Yet, the catheter was advanced successfully to the expected length. In radiological study with contrast medium, the course of the epidural catheter was not always traceable, while the spread of the contrast medium was clearly identified. Epidural spread occurred in eight patients, left paravertebral spread in one patient, and right retrorectal spread in another one patient. As to clinical assessment, adequate sensory blockade with local anesthetic was gained in 8 patients with well-preserved motor function of the lower limbs. In one patient the caudal block worked well after the withdrawal of the catheter 5 cm in length. Spinal anesthesia was supplemented in one patient due to failure of the caudal block. CONCLUSIONS: Continuous caudal block with caudawise catheterization via lower lumbar interspaces is feasible (eight of 10 patients in this study) with respect to technique and clinical effect. Paravertebral and retrorectal migrations of the catheter may occur in spite of smooth catheterization. Either migration might lead to a failure of caudal block.

Adult↗
PubMed2000

Complex enterocutaneous fistula: closure with rectus abdominis muscle flap.

Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously in less than 30% of cases. Mortality rates in patients with complex enterocutaneous fistulas may reach 60% to 80%. When traditional conservative surgeries of fistulous tract excision, bowel mobilization, and resection with primary end-to-end anastomosis fail, a more aggressive approach is required. The rectus abdominis muscle flap has been extensively studied and used in a wide variety of abdominal, vaginal, and perineal repairs. We report successful closure of complex enterocutaneous fistulas with a rectus abdominis muscle flap in a complicated case.

Cutaneous Fistula↗
PubMed1980

Mangement of dyspareunia secondary to hymenal remnants.

At the Sexual Dysfunction Clinic at Keesler USAF Medical Center, 17 women complaining of dyspareunia with painful hymen and demonstrable vaginismus were managed by surgical removal of hymenal remnants followed by directive sexual therapy and progressive vaginal dilatation. All patients were pain free within 8 weeks of the surgical procedures. It is believed that a combined approach is best to break the cycle of pain, fear, vaginismus, and more pain that these women have established.

Adult↗
PubMed2006

[Management of life-threatening postpartum hemorrhage: indications and technique of arterial embolization].

Pluridisciplinary management of women with postpartum hemorrhage is mandatory in order to precisely assess initial seriousness, to maintain hemodynamic parameters and to confirm the cause of bleeding. Embolization should be offered only after exploration of the uterine cavity, inspection of the vagina, cervix and perineum and failure of uterotonic drugs. Embolization should be carried out in an angiography suite under constant monitoring of the patient by the anesthesiologist. Indications to perform arterial embolization include uterine atony particularly following a vaginal delivery, cervico-uterine hemorrhage, cervicovaginal lacerations (previously repaired or if surgical repair has failed) and vaginal thrombus, particularly in case of associated coagulopathy. Arterial embolization is effective in about 85% of cases. Placenta acccreta can also be successfully managed with arterial embolization as an alternative to hysterectomy. Unilateral femoral approach allows selective study of both internal iliac arteries and branches. Selective embolization of both uterine arteries should be ideally performed. In case of spasm or difficult catheterization, embolization of the anterior division of both internal iliac arteries should be considered. In case of bleeding from the cervico-vaginal region, selective evaluation and embolization of cervicovaginal branches should be performed. In case of failure or recurrence of bleeding, ovarian and round ligament arteries should be evaluated. In most cases, resorbable gelatin sponge pledgets should be used to perform embolization. The use of microcatheters and non resorbable embolization agents should be considered by trained interventional radiologists in case of placenta accreta or vascular lesions. After embolization, the patient should be transferred to the intensive care unit for further observation in order to offer emergent surgical procedure or another session of embolization in case of recurrence of bleeding.

English Abstract↗
PubMed2004

[Management of life-threatening postpartum hemorrhage: indications and technique of arterial embolization].

Pluridisciplinary management of women with postpartum hemorrhage is mandatory in order to precisely assess initial seriousness, to maintain hemodynamic parameters and to confirm the cause of bleeding. Embolization should be offered only after exploration of the uterine cavity, inspection of the vagina, cervix and perineum and failure of uterotonic drugs. Embolization should be carried out in an angiography suite under constant monitoring of the patient by the anesthesiologist. Indications to perform arterial embolization include uterine atony particularly following a vaginal delivery, cervico-uterine hemorrhage, cervicovaginal lacerations (previously repaired or if surgical repair has failed) and vaginal thrombus, particularly in case of associated coagulopathy. Arterial embolization is effective in about 85% of cases. Placenta acccreta can also be successfully managed with arterial embolization as an alternative to hysterectomy. Unilateral femoral approach allows selective study of both internal iliac arteries and branches. Selective embolization of both uterine arteries should be ideally performed. In case of spasm or difficult catheterization, embolization of the anterior division of both internal iliac arteries should be considered. In case of bleeding from the cervico-vaginal region, selective evaluation and embolization of cervicovaginal branches should be performed. In case of failure or recurrence of bleeding, ovarian and round ligament arteries should be evaluated. In most cases, resorbable gelatin sponge pledgets should be used to perform embolization. The use of microcatheters and non resorbable embolization agents should be considered by trained interventional radiologists in case of placenta accreta or vascular lesions. After embolization, the patient should be transferred to the intensive care unit for further observation in order to offer emergent surgical procedure or another session of embolization in case of recurrence of bleeding.

Embolization, Therapeutic↗
PubMed2005

Expression, purification, and characterization of recombinant cyanovirin-N for vaginal anti-HIV microbicide development.

Cyanovirin-N (CV-N) is a prokaryotic protein under development as a topical anti-HIV microbicide, an urgent and necessary approach to prevent HIV transmission in at-risk populations worldwide. We have expressed recombinant CV-N as inclusion bodies in the cytoplasm of Escherichia coli. A purification scheme has been developed that exploits the physicochemical properties of this protein, in particular its stability in a harsh inclusion body purification scheme. Under the conditions developed, this system yields 140 mg of highly purified CV-N per liter of high-density cell culture, which represents a 14-fold increase over the best recombinant CV-N yield reported to date. This purification scheme results in monomeric CV-N as analyzed by SDS-PAGE, isoelectric focusing, and reverse phase- and size exclusion-HPLC. This recombinantly expressed and refolded CV-N binds to gp120 with nanomolar affinity and retains its potent anti-HIV activities in cell-based assays. The expression and purification system described herein provides a better means for the mass production of CV-N for further microbicide development.

Animals↗