Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Vaginal Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources
PubMed1990

Malignant fibrous primary histiocytoma of the recto-vaginal septum.

Considering the different localizations of malignant fibrous histiocytomas (MFH), that of the recto-vaginal septum is extremely rare. The present report describes a case, probably the first in literature, characterized by a storiform-pleomorphic histological type, treated with posterior exenteration and adjuvant chemotherapy. The Authors stress the still controversial histogenetic problem, as well as those related to a correct therapeutic approach.

Combined Modality Therapy↗
PubMed2006

Perineal cellulitis and persistent vaginal erosion after transobturator tape (Obtape)--case report and review of the literature.

Transobturator sub-urethral tapes are emerging as one of the surgical options for the management of urodynamic stress incontinence. Though with relatively less risk of injury to the bladder, a different approach as well as the different characteristics of the tape material mean a variety of complications like obturator abscess, obturator haematoma, retro-pubic haematoma, and perineal cellulitis. In this paper, we describe a case of perineal cellulitis following the insertion of a transobturator tape (Obtape). Though cellulitis was managed conservatively with intravenous antibiotics, the patient was found to have vaginal extrusion of the tape. Vaginal erosion was initially managed with resuturing of the vaginal wall. Persistent erosion unfortunately necessitated complete tape removal. The patient later had another sub-urethral procedure after 3 months. Perineal cellulitis is rare after transobturator tape procedures. In the literature, only two cases have been described so far. Though vaginal erosion can be managed conservatively, we recommend the complete removal of the tape when an infection is proven or suspected.

Cellulitis↗
PubMed2004

Primary malignant mixed mullerian tumor of the vagina immunohistochemically confirmed.

CASE REPORT: We report the case of a 74-year old woman who presented with an ulcerated mass of the vagina. Histology of the tumor showed malignant mixed mullerian tumor (MMMT) with squamous and spindle cell stromal components, associated with high-grade vaginal intraepithelial neoplasia (VaIN 3). Immunohistochemical study of the neoplasm revealed that the malignant stromal tumor was a high-grade leiomyosarcoma. Despite the multimodal therapeutic approach, the patient died within 11 months. CONCLUSION: The vagina is a rare site of presentation of primary MMMTs and the present case is the second one immunohistochemically confirmed.

Aged↗
PubMed2006

How common are tape erosions? A comparison of two versions of the transobturator tension-free vaginal tape procedure.

OBJECTIVE: To compare two transobturator suburethral tapes (Obtape, Mentor-Porges and TVT-O, Gynaecare, Johnson and Johnson) used in the management of urodynamic stress incontinence (USI), for tape erosion (vaginal/urethral) rates, clinical presentation, management and outcome. PATIENTS AND METHODS: We retrospectively studied women who underwent a transobturator suburethral tension-free vaginal tape (TVT) procedure for managing USI in a tertiary referral centre in the West of Scotland over a 36-month period. In our department, the transobturator approach has been the first-choice approach for TVTs since July 2003. Two types of tapes were mainly used, Obtape and TVT-O, and the choice of tape was primarily decided by the surgeons' preference. RESULTS: In all, 316 women had a transobturator tape procedure, of which 96 were associated with another procedure; 112 women had TVT-O using the 'inside-out' technique and 204 had the 'outside-in' technique. Of the latter, 192 had Obtape, four had Obtryx (Boston Scientific) and eight had Monarc (American Medical Systems Inc.) tapes. Sixteen women developed vaginal tape erosion, and significantly more were in the Obtape group than in the TVT-O group (7.29% vs 1.78%, P = 0.038). The patients' age, body mass index, previous vaginal surgery and concomitant vaginal surgery were not significant risk factors for erosions. The time between surgery and diagnosis of erosion was 1-45 weeks, with only one patient being asymptomatic; all others presented with clinical symptoms such as vaginal bleeding, discharge and dyspareunia. Thirteen patients were continent at presentation and 10 of these remained continent after surgical management. In the TVT-O group the erosions were in the lateral vaginal wall, while in the Obtape group the erosions were in the form of central tape extrusion secondary to defective vaginal wall healing. CONCLUSION: There were significantly more vaginal tape erosions in the Obtape group than in the TVT-O group. No cases of urethral erosions were identified.

Chi-Square Distribution↗
PubMed1982

Primary surgical treatment in one hundred ninety-five cases of stage IB carcinoma of the cervix.

Stage IB carcinoma of the cervix may be treated primarily by either radiotherapy of operation. A primary surgical approach was used in 95 patients for the following indications: young age with desire to retain ovarian function (124), pelvic inflammatory disease (33), pregnant or post partum (15), refusal of radiotherapy (11), anatomic problems contraindicating radiotherapy (10), undiagnosed pelvic mass (seven), verrucous tumor (three), mucus-secreting tumor (two), syphilis (one), and previous radiotherapy for Hodgkin's disease (one). Twelve patients had two indications. The surgical procedures were radical abdominal hysterectomy and pelvic lymph node dissection (191) and Schauta-Amreich (radical vaginal) hysterectomy (4). Fourteen patients had serious postoperative complications. The uncorrected 5-year survival rate (95.1% follow-up) was 91.1%. The rationale for recommending a primary surgical approach to selected patients with Stage IB cervical carcinoma is presented.

Adolescent↗
PubMed2003

Multiple leiomyomas of the vagina in a premenopausal woman.

CASE REPORT: A 32-year-old multiparous woman was seen for a history of dyspareunia and vaginal pain. She presented with two firm masses on the lower-medium left lateral wall of the vagina. Transvaginal ultrasonography showed two spherical smooth-walled masses, respectively of 33 and 35 mm in diameter. A transvaginal approach was used to remove the two tumors en bloc. CONCLUSION: Histologically, the tumors were leiomyomas.

Adult↗
PubMed1982

Isolated atherosclerotic aneurysms of the internal iliac arteries: report of two cases and review of literature.

Isolated arteriosclerotic aneurysms of the internal iliac artery are uncommon, with an incidence approaching 0.4%. Although the symptoms invariably involve the genitourinary or gastrointestinal systems, the aneurysms may be found during abdominal, rectal, or vaginal examinations. The 75% mortality associated with the rupture of an internal iliac aneurysm mandates for early surgery for these aneurysms. Operation may consist of ligation of the internal iliac artery, excision of the aneurysm, or an obliterative endoaneurysmorrhaphy. While the operative mortality has average 33.3%, there were no operative deaths in this series.

Aged↗
PubMed1988

Behavioral action of estrogen in male hamsters: effect of the aromatase inhibitor, 1,4,6-androstatriene-3,17-dione (ATD).

This study examines three independent behavioral variables known to be activated by testosterone in the male hamster; namely, the tendency to approach the female, the tendency to leave the female, and the amount of sniffing directed to her. Both intact and testosterone-maintained castrated male hamsters were given the aromatase inhibitor 1,4,6-androstatriene-3,17-dione (ATD) in subcutaneous, Silastic capsules. In intact males, there was an ATD dose-dependent increase in the tendency to leave the female and a decrease in the amount of olfactory investigation. The tendency of the male to approach the female was unaffected. The higher doses of ATD also abolished the ability of males to discriminate between females using vaginal odor cues. These results were confirmed in castrated males whose behavior was maintained at the intact level by testosterone implants. In addition, in both intact and castrated males, estradiol or diethylstilbestrol was able to reverse the behavioral changes induced by ATD. Our results indicate that estrogen produced by aromatization of testosterone activates behavior. We conclude that estrogen, by influencing some, but not all, components of masculine behavior, has a specific role in modulating male-female interactions.

Androstatrienes↗
PubMed1984

Male hamster copulatory responses to a high molecular weight fraction of vaginal discharge: effects of vomeronasal organ removal.

The importance of the vomeronasal (accessory olfactory) system for the copulatory responses of male hamsters to a high molecular weight fraction (HMF) of vaginal discharge was assessed in animals that had their vomeronasal organs (VNO) removed. These organs were extirpated bilaterally using an oral approach through the palate so as to eliminate the peripheral afferents to the accessory olfactory bulb (AOB) with minimal or no damage to the main olfactory system. The selective peripheral deafferentation procedure was verified by applying horseradish peroxidase intranasally following intraperitoneal injections of epinephrine to facilitate the vomeronasal pumping mechanism that draws fluids into the VNO. Heavy, bilateral anterograde labeling was evident in the olfactory nerve afferents within the main olfactory bulb of males that had their VNO removed and of animals that received sham surgery. Sham-operated males also had heavy, bilateral labeling in the vomeronasal nerve afferents within the AOB, whereas no such labeling occurred among animals with bilateral removal of the VNO. In sham-operated animals, both the HMF and the unfractionated discharge significantly increased the incidence of intromission attempts toward anesthetized males (surrogate females) whose hindquarters were scented with these stimuli. The unfractionated discharge also produced a significant elevation of overt copulatory behavior in males with selective peripheral deafferentation of the vomeronasal system, whereas the HMF did not facilitate copulatory behavior in these animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Clinical intervention framework for a sexual complaint of the perimenopause.

Integrative systems therapy, a sexual therapy model, can be used by the nurse-midwife in evaluating and managing symptomatic complaints that may lead to sexual problems. Vaginal dryness, commonly experienced by many perimenopausal women, is one of many presenting complaints that will benefit from such a systemic approach to investigation and treatment.

Female↗
PubMed2004

Conservative treatment of diffuse uterine leiomyomatosis.

OBJECTIVE: To describe the conservative treatment of diffuse uterine leiomyomatosis. DESIGN: Descriptive study. SETTING: Tertiary care centers. PATIENT(S): Three premenopausal women with diffuse uterine leiomyomatosis associated to persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus. INTERVENTION(S): Preoperative ultrasound showed symmetrically enlarged uteri with innumerable, poorly defined and small-sized (0.5-3 cm) myomas involving all the myometrium. An "extreme" myomectomy was performed in two cases, including the removal of a large portion of corporal myometrium. One patient was treated only medically with GnRH analogues (GnRH-a). MAIN OUTCOME MEASURE(S): Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome. RESULT(S): Regular menses were restored in both patients who underwent surgery: one had no pregnancy desire and the other was not able to conceive after two IVF-ETs. The patient treated with GnRH-a conceived spontaneously as soon as medical treatment was discontinued; at 34 gestational weeks, an emergency cesarean section followed by hysterectomy was performed for vaginal bleeding and a healthy 2,400-g baby was born. CONCLUSION(S): Our experience supports the idea that a conservative approach to uterine leiomyomatosis may result in restoration of normal cycles and eventually in the birth of a viable fetus.

Adult↗
PubMed2006

Cultivation-independent assessment of the bacterial diversity of breast milk among healthy women.

Breast milk has been shown to be an excellent and continuous source of commensal and potentially probiotic bacteria to the infant gut. Our aim was to evaluate the dominant bacteria existing in breast milk of healthy women and the potential role of transit through the vagina in the acquisition of breast milk microbiota using the 16S rRNA amplified gene approach. Samples of breast milk were aseptically collected, at day 7 after delivery, from five mothers whose neonates were born by vaginal delivery and from five others who had had their babies by programmed elective cesarean section. All mothers were healthy, had a full-term pregnancy and breastfed their infants. DNA extracted from biological samples was used as a template for PCR amplification of 16S rRNA gene sequences with universal bacterial primers; then the PCR products were analyzed by denaturing gradient gel electrophoresis (DGGE); finally, clone libraries of 16S rRNA gene sequences from 4 mothers (2 from each group) were constructed. PCR DGGE patterns and clone libraries suggest that each woman had a specific bacterial pattern in her breast milk, and confirm, at the molecular level, that breast milk of healthy women is a source of commensal bacteria to the infant gut. They also reinforce recent molecular studies which have shown that lactic acid bacteria colonization is not significantly related to the delivery method.

Bacteria↗
PubMed1997

Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome.

OBJECTIVE: To enhance cost-effective management of uterine cancer by predicting the likelihood of extrauterine disease and survival on the basis of preoperative parameters. METHODS: A retrospective review of preoperative CA 125 levels from 210 women with endometrial carcinoma was performed. The relationship of preoperative CA 125 levels to various preoperative and postoperative histopathologic factors was investigated. RESULTS: Elevated CA 125 (greater than 35 U/mL) correlated (P < .05) with higher stage, higher grade, increased depth of myometrial invasion, positive cytology, pelvic or para-aortic lymph node metastases, and reduced actuarial survival (P < .001). Multivariate analysis of preoperative factors showed that an elevated CA 125 level was the most important predictor for poor survival (P < .001). Moreover, a preoperative CA 125 level greater than 65 U/mL was the most significant predictor of extrauterine disease and carried a 6.5-fold higher risk (95% confidence interval 2.5, 17.1). A logistic model to predict extrauterine disease was developed. The model has a sensitivity of 62%, specificity of 91%, positive predictive value of 69%, and negative predictive value of 88%. CONCLUSION: A CA 125 level should be included as part of the preoperative workup for all patients with uterine cancer. Patients with a preoperative CA 125 level less than or equal to 20 U/mL should be considered as candidates for vaginal hysterectomy unless unfavorable histology or a high-grade (grade II or III) tumor is present. In our series, this approach would have eliminated 24% of the abdominal staging procedures, with a risk of less than 3% for extrauterine disease, while lowering treatment-related morbidity and cutting costs in the treatment of this common female cancer.

Adult↗
PubMed2005

[Urinary complications in sub-urethral sling procedures].

INTRODUCTION: Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS: The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS: Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.

Equipment Failure↗
PubMed1992

The role of transvaginal sonography in the early detection of congenital heart disease.

The antenatal diagnosis of congenital heart disease by fetal echocardiography is rarely achieved before 18-20 weeks' gestation. Transvaginal sonography allows examination of fetal anatomy at earlier gestations than the transabdominal approach. In a screening study of 270 low-risk women between 8 and 14 weeks' gestation using a 5 MHz vaginal transducer, it was possible to obtain adequate four-chamber views in over 70% from 12 weeks. In a second study of 32 women at high risk of congenital heart disease scanned between 14 and 15 weeks' gestation, satisfactory views were obtained transvaginally in 21 women. Seven of the remainder had normal cardiac anatomy confirmed by transabdominal scanning. In three of the four where normal cardiac anatomy could not be demonstrated by either transvaginal or transabdominal scanning, severe congenital heart disease was diagnosed and later confirmed. It is unlikely that transvaginal sonography will replace abdominal scanning for the screening of low-risk pregnancies, but it is a valuable addition to the early examination of those women identified as being at high risk of congenital heart disease.

Journal Article↗
PubMed2004

Treatment of myomas by laparoscopic and laparotomic myomectomy and laparoscopic hysterectomy.

The objective of this study was to evaluate the benefits, feasibility and limitations of laparoscopic myomectomy. It was a retrospective review (Canadian Task Force Classification II-2) at a university-based primary treatment centre for endoscopic surgery. The 216 evaluated patients were treated at the Department of Obstetrics and Gynaecology, University of Kiel, between January 1998 and November 2000. Of 216 patients with myomas, 178 (83%) underwent laparoscopic myomectomy, 27 (12%) laparoscopic hysterectomy and 11 (5%) laparotomic myomectomy. The study reviewed the indications and surgical techniques and evaluated the benefits and limitations of laparoscopic myomectomy. Nine patients were selected for Classic Intrafascial Supracervical Hysterectomy (CISH) and 18 for Laparoscopic Assisted Vaginal Hysterectomy (LAVH), i.e. 12% of the patients were selected for laparoscopic hysterectomy. In an additional 11 (5%) patients the laparoscopic approach was difficult because of the location of the myoma and the procedure converted to a laparotomic myomectomy. A total of 178 patients (83%) was treated by laparoscopic myomectomy. The mean hospital stay was three days. No serious complications occurred. Two patients suffered a uterine wound bleeding which was corrected and one patient an abdominal hematoma. Since this study mainly focuses on laparoscopic myomectomies (83%), hysteroscopic myomectomies were evaluated in a separate study. At our institution laparoscopic myomectomy is the first-step treatment for patients with myomatous uteri. Only a small percentage of patients had to undergo a laparotomy (5%) and for 27 patients (12%) hysterectomy proved to be the treatment of choice.

Journal Article↗
PubMed1995

Laparoscopic surgery in pregnancy: report on two cases.

Laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) are well-established surgical procedures. Although pregnancy initially was considered a contraindication to laparoscopic surgical procedures, successful reports of LC and LA during pregnancy have appeared in the surgical literature. Two cases are presented in this report, one LC and one LA, both in second-trimester pregnancies. Both pregnancies contained undisturbed and ended with spontaneous vaginal delivery of healthy infants. Laparoscopic surgery in pregnant patients is feasible and provides a reasonable alternative to the standard surgical approach.

Adult↗
PubMed2004

Brain abscess complicating pregnancy.

Brain abscess is a potentially life-threatening complication that is only rarely associated with pregnancy. Although predispositions such as a preexisting infection, foreign body, or immunosuppression are often present, up to 30% of individuals could have no risk factors. Presenting symptoms are often nonspecific but suggestive of a central nervous system process and include headache, seizures, mental status changes, and focal neurologic deficits. Cranial imaging by computed tomography (CT) or magnetic resonance imaging (MRI) can suggest the diagnosis of abscess. Diagnosis is confirmed by aspiration of purulent material. Treatment involves antibiotics, often with surgical drainage. Vaginal delivery at term appears to be safe. Care of the affected gravida, including time and route of delivery, should be approached by a team representing perinatology, neurosurgery, infectious disease, and anesthesiology.

Biopsy, Needle↗