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At least 1,351 records · Page 75Linked to original sources
PubMed2005

Vaginal bleeding complicating portal hypertension: a particular entity - report of two cases and review of the literature.

Vaginal haemorrhage arising from varices is an exceptional complication of portal hypertension. Two cases successfully treated by transjugular intrahepatic portosystemic stent shunt are presented here. Both these patients previously had a total hysterectomy as did three out of four cases reported in the literature. Clinicians should be aware of 'vaginal bleeding' in the context of both hysterectomy and chronic liver disease in order to adopt the correct diagnostic and therapeutic approach. Definitive treatment can be obtained only if the underlying portal hypertension is adequately taken into consideration.

Female↗
PubMed2005

Characterization of microbial communities found in the human vagina by analysis of terminal restriction fragment length polymorphisms of 16S rRNA genes.

To define and monitor the structure of microbial communities found in the human vagina, a cultivation-independent approach based on analyses of terminal restriction fragment length polymorphisms (T-RFLP) of 16S rRNA genes was developed and validated. Sixteen bacterial strains commonly found in the human vagina were used to construct model communities that were subsequently used to develop efficient means for the isolation of genomic DNA and an optimal strategy for T-RFLP analyses. The various genera in the model community could best be resolved by digesting amplicons made using bacterial primers 8f and 926r with HaeIII; fewer strains could be resolved using other primer-enzyme combinations, and no combination successfully distinguished certain species of the same genus. To demonstrate the utility of the approach, samples from five women that had been collected over a 2-month period were analyzed. Differences and similarities among the vaginal microbial communities of the women were readily apparent. The T-RFLP data suggest that the communities of three women were dominated by a single phylotype, most likely species of Lactobacillus. In contrast, the communities of two other women included numerically abundant populations that differed from Lactobacillus strains whose 16S rRNA genes had been previously determined. The T-RFLP profiles of samples from all the women were largely invariant over time, indicating that the kinds and abundances of the numerically dominant populations were relatively stable throughout two menstrual cycles. These findings show that T-RFLP of 16S rRNA genes can be used to compare vaginal microbial communities and gain information about the numerically dominant populations that are present.

Base Sequence↗
PubMed2000

[A case of epithelioid leiomyoma (leiomyoblastoma) of the urethra].

A 25-year-old woman was admitted to our hospital because of a painless, slow growing mass arising from the external genitalia. The mass had been developing for a few years. She did not have difficulty voiding nor was there hematuria. Magnetic resonance imaging revealed a well-circumscribed, 4 cm, solid tumor between the urethra and the anterior vaginal wall. After needle biopsy confirmed a benign tumor arising from the smooth muscle, the tumor was removed by a transvaginal approach. The histopathological diagnosis was epithelioid leiomyoma (leiomyoblastoma), which often occurs in the stomach or uterus, but seldom around the urethra. The patient has remained well without recurrence for 20 months after surgery.

Adult↗
PubMed2000

[Laparoscopic retropubic colposuspension (Burch procedure). Techniques and continence results].

INTRODUCTION: Laparoscopy allows to perform Burch colposuspension in case of genuine urinary stress incontinence but this approach must not lead to reduced success rates. OBJECTIVE: The aim of this study was to describe laparoscopic Burch techniques and evaluate urinary continence and satisfaction rates. MATERIALS AND METHODS: Clinical and urodynamic data were reviewed for 48 consecutive patients operated on from May 1993 to June 1999. The methods for entering the space of Retzius and performing the colposuspension were analyzed. The continence and satisfaction rates were evaluated with a questionnaire. RESULTS: The operative technique we are now using is the extraperitoneal approach with an umbilical trocar site. A non-absorbable mesh is fixed to the Cooper's ligament and to the vaginal fascia. With a mean follow-up of 41 months, the satisfaction rate is 76.8% with a cure rate of 37.3% and an improvement rate of 41.8%. CONCLUSION: Long term results with laparoscopic Burch colposuspension are relatively good but a bit lower than those published with traditional open technique. The effects of the learning curve with an evolving technique are to be considered when analyzing the results.

Colposcopy↗
PubMed1993

[Modern methods of early diagnosis and treatment of ectopic-oviduct pregnancy].

Medical documentation of 80 women operated on because of ectopic pregnancy between the years 1991-1992 was analyzed. Methods of early diagnosis and ways of surgical approaches were discussed. Authors of this article give priority to controlling beta sub-unit HCG acc. to Romero, to ultrasonographic vaginal probe examination and to diagnostic laparoscopy. Early surgical intervention increases the chances to maintain woman's fertility. All procedures on women with ectopic--oviduct pregnancy should be sparing, depending on the ward equipment and personnel training and should be performed by the means of operative laparoscopy method.

Adult↗
PubMed1995

[Immunohistochemical localization of estrogen receptors in vesicovaginal fascia among female patients with stress incontinence--preliminary report].

Using monoclonal antibody assay technique 29 kD domain of estrogen receptor was found and partially quantitated by means of histological score in fibroblasts from vesico-vaginal fascia obtained during surgical procedure in incontinent women. This is an important proof that estrogen supplementation therapy is a reasonable approach in women affected by urinary stress incontinence.

Adult↗
PubMed2001

[Paravaginal abscess in pregnancy].

Paravaginal abscess in pregnancy. We report the diagnosis and treatment of an infected Gartner's duct cyst during pregnancy. The patient presented with lower abdominal pain, fever (38.5 degrees C) and an elevated C-reactive Protein level. Pelvic examination revealed a painful paravaginal mass. Sonography was not able to detect the cranial border of the tumor. Magnetic resonance imaging (MRI) revealed fluid accumulation laterodorsal to the vagina without evidence of a connection with the retroperitoneal space. An infected Gartner's duct cyst with consecutive abscess formation along the mesonephric duct system, was diagnosed. Following transvaginal drainage, the remainder of the pregnancy was uneventful and the patient was delivered vaginally at 40 + 5 weeks without complications. - The rare clinical finding of a paravaginal abscess in pregnancy was treated without termination of the pregnancy. Preoperative planning of the surgical approach using MRI can be easier for pelvic processes extending out of the pelvis than using ultrasound and is less painful for the patient.

Abdominal Abscess↗
PubMed1994

[Personal observations concerning surgical treatment of urinary stress incontinence in women].

Own observations concerning surgical treatment of urinary stress incontinence based upon the clinical follow-up of 82 treated women are presented. Depending on the method of surgical treatment, patients with urinary stress incontinence have been divided into 3 groups: I group-(42 women), where retropubic colpo-uretero-pexy has been performed following the rules previously suggested by Tanagho, Sprogis et al., with 92.8% of positive result, II group-(34 women), where Mieszczerski or Fothergill type of surgery has been performed, with 88.2% of positive results, and III group-(6 women), where vaginal vault has been suspended to the musculo-fascial flap, with positive results in all treated patients. The obtained results suggest that in every case of urinary stress incontinence the conservative approach should be the primary strategy of treatment. Analysis of the results revealed that retropubic colpo-uretero-pexy was an effective surgical method of urinary stress incontinence treatment in women with no cystocele and with proper uterine statics. In patients with correct uterine statics but with coexisting cystocoele, even of a minor grade, retropubical kolpouretropexy should be joined with the surgery from a vaginal access.

Adult↗
PubMed1994

Use of transvaginal ultrasound in diagnosing the etiology of menometrorrhagia.

Forty-five women with a chief complaint of abnormal vaginal bleeding from a few days' duration (spotting) to three to six months of bleeding (average, 4.5 months) were evaluated using a standard clinical approach followed by transvaginal ultrasound (US). Serum estradiol (E2), progesterone and/or endometrial biopsy was used to further clarify the etiology of the bleeding and confirm the clinical or ultrasound diagnosis. Anatomic findings were present in 31% of patients by US examination as compared to only 9% by clinical evaluation. An additional 9% of patients had polycystic ovary disease. Of the 16% of study patients on oral contraceptives with a clinical diagnosis of breakthrough bleeding, 33% had anatomic findings associated with the bleeding on US. The ultrasound image of the endometrium predicted the endometrial biopsy findings in all three patients with postmenopausal bleeding. In the remaining patients with a diagnosis of dysfunctional uterine bleeding (DUB) (a diagnosis usually made clinically by excluding other etiologies), US was helpful in excluding many patients with anatomic findings not detected by physical examination and in evaluating the endometrium, helping differentiate anovulatory from ovulatory DUB. US was helpful in predicting the hormonal and histologic endometrial status of the patients. Patients with more severe and prolonged DUB had low serum E2 with US findings of a single-line endometrium (consistent with low serum E2 and anovulation). US can be a valuable aid in evaluating women presenting with a complaint of abnormal vaginal bleeding by demonstrating anatomic findings frequently not discernible on pelvic examination, such as small cysts and leiomyomas and even endometrial carcinoma, and in evaluating the endometrium in terms of its thickness and, indirectly, the endometrial histology and the ovulatory and hormonal status of the patient. US can also be of value in confirming some diagnoses that are generally made clinically by exclusion, such as breakthrough bleeding from oral contraceptive use and DUB.

Adolescent↗
PubMedDate not supplied

Impact of collaborative management and early admission in labor on method of delivery.

OBJECTIVE: This study compared the effects of early admission in labor and perinatal care provider on delivery method. Higher spontaneous vaginal delivery rates for certified nurse midwives as compared with physicians have been reported in observational studies and randomized clinical trials. Certified nurse midwives, with their more expectant approach to labor management, would be expected to admit women later in labor than obstetricians. METHODS: Prospective cohort study of 2,196 low-risk pregnancies, with singleton, vertex infants admitted in spontaneous labor. Independent and joint effects of perinatal care provider and cervical dilation at admission on delivery method were evaluated. Confounding was addressed using restriction and multiple regression. RESULTS: Fewer (23.4%) women in collaborative care were admitted in early labor (< 4 cm cervical dilation) than women managed by obstetricians (95% CI = -27.6 to -19.2). Obstetrician care had 9% to 30% fewer spontaneous vaginal deliveries. Women admitted early in labor also had 6% to 34% fewer spontaneous vaginal deliveries. Evaluation of joint effects suggested that interaction between obstetrician provider and earlier admission increased the risk of operative delivery. CONCLUSION: Later admission in labor (at 4 cm or greater cervical dilation) and management of perinatal care by certified nurse midwives in collaboration with obstetricians increased the rate of spontaneous vaginal delivery in low-risk women.

Adult↗
PubMed1976

A new approach to patients with suspected anaerobic postpartum pelvic infections. Transabdominal uterine aspiration for culture and metronidazole for treatment.

Oral metronidazole was given as therapy in 25 women with the clinical diagnosis of a postpartum anaerobic soft tissue pelvic infection following a vaginal delivery. There was a good clinical response in 80 per cent of these women. No anaerobic organisms resistant to metronidazole were recovered in the treatment failures. Different specimen collection techniques were evaluated, with anaerobes recovered in 4 per cent of the blood cultures, 26.3 per cent of the transabdominal endometrial aspirations, and 88 per cent of the transcervical endometrial samples. The aerobic recovery of organisms was 4 per cent from blood cultures, 15.8 per cent from transabdominal endometrial aspirations, and 96 per cent from the transcervical approach. The significance of these findings is discussed.

Abdomen↗
PubMed1999

[Tissue damage in alternative types of hysterectomy: prospective study].

OBJECTIVE: To assess and compare tissue damage during alternative hysterectomies. DESIGN: Prospective clinical study. SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measured in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. RESULTS: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively). CONCLUSION: Clinical experience and metabolic changes indicate that the tissue damage and perioperative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

Adult↗
PubMed1990

Laparoscopic management of stage I ovarian cancer. A case report.

A woman with stage I ovarian cancer refused traditional treatment and was managed laparoscopically. Both ovaries were removed intact via a culdotomy incision. Vaginal hysterectomy, omentectomy and laparoscopic lymphadenectomy followed. With the increasing frequency of laparoscopic oophorectomy, it clearly seems prudent to remove ovaries intact through the cul-de-sac whenever ovarian pathology is in doubt. Although the laparoscopic approach is as yet unproven, it is an alternative for a select group of well-informed women with borderline or low-grade ovarian malignancy.

Female↗
PubMed1998

The outpatient Closed Burch-M.M. procedure for treatment of genuine stress urinary incontinence with no laparotomy or laparoscopy by newly invented bladder saver device.

Objective: To identify a more effective, less invasive surgical technique and tool for treatment of genuine stress urinary incontinence. The new outpatient procedure is one of the most effective ways to treat the patient without sacrificing safety and outcome.Method: The Closed Burch Procedure is a retropubic, trocar and ligature carrier suspension by newly invented bladder saver device that is a major solution to the problem of female genuine stress incontinence. As originally described by Dr. John C. Burch in 1961, the operation entails use of the vaginal wall as an endogenous suburethral sling. The vagina is elevated bilaterally at the urethrovesical junction, thus repositioning the proximal urethra within the abdominal cavity toward Cooper ligament by permanent sutures.Result: After confirmation of diagnosis, 11 patients underwent the new outpatient procedure. The new approach showed no failure of technique or any major complications. It also showed no postoperative urinary retention, no recurrence of stress urinary incontinence up to this time, no wound infection, no hematoma, no rejection of sutures, no nerve damage, no osteitis, and no vaginal enervation.Conclusion: The new outpatient Closed Burch technique is an effective treatment for genuine stress incontinence. The procedure is outpatient with logical anatomical restoration. It is fast and can be done under local anesthesia for some patients.Complications are minimum to none. There is no urinary retention, no self-catheterization, and no major or expensive system needed. The procedure has shown very impressive results.

Journal Article↗