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At least 1,369 records · Page 76Linked to original sources
PubMed2003

Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn's disease: a new cell-based therapy.

BACKGROUND AND AIMS: Rectovaginal fistulas in patients with Crohn's disease are difficult to resolve, and surgical failure is very frequent. Recent studies have shown that adult stem cells extracted from certain tissues, such as adipose tissue, can develop into different tissues, such as muscle. PATIENT AND METHODS: We report here the case of a young patient with Crohn's disease who had a recurrent rectovaginal fistula that was treated by autologous stem-cell transplantation with a lipoaspirate as the source of stem cells. RESULTS: Although Crohn's disease is the worst condition for a surgical approach in cases of rectovaginal fistula, we observed good closure. Since the surgical procedure 3 month ago the patient has not experienced vaginal flatus or fecal incontinence through her vagina. Thus our treatment seems to be effective. CONCLUSION: Cell transplantation to overcome healing problems is a new surgical tool, and careful evaluation of this new modality may provide an opportunity to define a new era in the treatment of surgical challenges associated with healing disorders. Ethical and safety items do not seem to be critical problems using autologous stem cells.

Adult↗
PubMed2003

Two bladders and two vaginas in two planes: one urogenital sinus.

We report 2 cases of persistent urogenital sinus (UGS) with duplication of the bladder and vagina in different planes. Cystoscopy and vaginoscopy were used to diagnose persistent UGS with bladder and vaginal duplication in 2 infants with recurrent urinary tract infection. Surgical repair was done by way of a midline abdominal and perineal approach using tubularized UGS to reconstruct the urethra. Persistent UGS represents a major anomaly; these patients had the added complexity of duplication of the bladder and vagina. In these complex patients, the true anatomy may only become apparent during the surgical reconstruction, necessitating a flexible, individual approach.

Abnormalities, Multiple↗
PubMed2004

[Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh].

OBJECTIVES: To describe, in view of the new standardization, the technique for urogenital prolapse repair using a one-piece synthetic mesh. MATERIALS AND METHODS: The history and development steps through which the Tension free Vaginal Mesh (TVM) technique emerged are described. The use of a mesh was prompted by the 20-30% recurrence rate associated with conventional repair techniques. Selection of the type of mesh is discussed. Non-absorbable synthetic meshes have shown their usefulness in visceral surgery. A list of materials along with their respective advantages and inconveniences is reviewed and particular emphasis is put on both the tolerance and erosion issues, the latter being specific to the vaginal route. The TVM Group selected a one-thread polypropylene mesh, Prolene Soft, which seemed the most appropriate for the transvaginal approach of prolapse surgical repair. The prosthesis and its design rationale are described. Full details are given on the consecutive intervention steps and underlying concepts. RESULTS: The relevant literature is scarce and there is a lack of methodologically sound studies validating the materials and techniques used. After completion of a first step of technique refinement and feasibility assessment involving about 300 surgical interventions, the authors initiated a prospective multicenter study. Clinical outcome assessments using feasibility, complications, and efficacy endpoints will be published after twelve months, three years, and five years of follow-up. CONCLUSION: Fruitful reasoning led to the development of the TVM technique of complete surgical repair of genital prolapse, which uses a synthetic materiel carefully selected after several tests. All surgeons can apply this technique after a short training period.

Female↗
PubMed2004

Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified vascularized pedicled sigmoid.

Between 1995 and 2002, 53 primary sex reassignments in male to female transsexuals were performed at our division. The objective of this procedure is to mimic the female external and part of the internal genitalia both esthetically and functionally. In 11 of the 53 patients, a secondary vaginal lengthening had to be performed due to a short neovagina. This was achieved using a pedicled sigmoid segment, with an open approach in the first 2 patients and using a laparoscopic method in the following 9. This paper focuses on the laparoscopic technique, its benefits and potential complications. Where a primary vaginoplasty, combining inversion of the penile and scrotal skin flaps, yields unsatisfactory functional results, a secondary vaginoplasty using the pedicled sigmoid represents an elegant means to achieve functional improvement. Furthermore, we report a modified surgical approach to the conventional sigmoid transition.

Adult↗
PubMed1999

Prevalence and risk factors of symptoms of pelvic inflammatory disease in a rural community of Jamshoro, Sindh, Pakistan.

OBJECTIVES: (1). To estimate the prevalence of symptoms of pelvic inflammatory disease (PID) in rural Jamshoro, Sindh, (2). To assess specific social and biological risk factors of symptoms of PID. METHODOLOGY: Trained females conducted the interviews using a pre-tested Sindhi questionnaire during a cross-sectional survey carried out in 8 villages of rural Jamshoro, Sindh. Women reporting either lower abdominal pain or vaginal discharge with continuous or intermittent fever during the 6 months prior to interview, were classified as having PID symptoms. RESULTS: We approached 753 ever-married women and successfully interviewed 738 (98%) from July-September 1997. Sixty-five women (9%) had symptoms consistent with PID, and 156 (24%) reported ever using a modern contraceptive. Symptomatic women were 3.6 times more likely to have ever used IUCD/tubal ligation (95% CI, 1.9-6.9), 1.8 times more likely to have married at earlier age (< 15) (95% CI, 1.1-3), and 3 times more likely to be housewives by occupation (95% CI, 10-8.4) as compared to women who did not have PID symptoms. CONCLUSION: Symptoms of PID among tubal ligation/IUCD users may reflect existence of unhygienic conditions during application of procedure, delay in replacement of IUCD and mismatching in the size of IUCD with uterus. The quality of life is affected in women with PID symptoms and may have serious consequences like infertility. These symptoms need thorough evaluation/investigation to gauge the magnitude and nature of the problem and to guide intervention, effective promotion of women's socio-economic status, health education regarding counselling for delaying age at marriage and hygienic/safe use of family planning methods.

Adult↗
PubMed2000

Pelvic prolapse.

PURPOSE: Pelvic prolapse is a common problem affecting women of all ages. We reviewed the pathophysiology, presentation, evaluation and treatment of pelvic prolapse. MATERIALS AND METHODS: We comprehensively reviewed the literature using MEDLINE, resources cited in those peer reviewed articles and abstracts from recent international meetings. RESULTS: Pelvic prolapse involves the herniation of various portions of the vaginal wall. Symptoms vary according to the area of the vagina affected. Proper evaluation is imperative for providing proper treatment. Various surgical approaches to repair have been developed and techniques continue to evolve. CONCLUSIONS: With the increasing involvement of urologists in the treatment of pelvic prolapse it is essential for us to become familiar with the anatomy, and the evaluation and management options available. We provide an overview of the care of patients with pelvic prolapse.

Diagnosis, Differential↗
PubMed2000

A new technique for the creation of a neovagina

Background: There are many described reconstructive techniques for vaginal agenesis including vaginal dilators, skin covered molds, sigmoid grafts, vulval and large muscle flaps all of which aim to produce a vagina of normal axis, secretory capacity and length. We report the laparoscopic approach to Davydov's operation which utilizes peritoneum to line the newly dissected vesicorectal space. Methods: A case report detailing preoperative evaluation, surgical technique and outcome.Results: There were no intraoperative or immediate postoperative complications. The patient was discharged from hospital within 23 hours of surgery. Six month follow up revealed a vagina 7-8 cm in length, lined with squamous epithelium. The patient reports satisfactory sexual intercourse.Conclusion: This technique provides a satisfactory option for the surgical management of vaginal agenesis.

Journal Article↗
PubMed1991

Malignant fibrous histiocytoma of the vagina and vulva successfully treated by combined chemotherapy and radiotherapy.

Combined vaginal and vulvar malignant fibrous histiocytoma has not been reported previously. Radical vulvectomy with node dissection is the currently recommended therapy for a vulvar lesion of this type. We present a case with complete tumor regression after combined chemotherapy and radiotherapy. The surgical approach in our patient was inappropriate due to advanced disease. Follow-up examinations for 6 years after initiation of therapy showed no evidence of local recurrence or distant metastasis. Chemotherapy followed by radiotherapy should be considered as an alternative to surgery in patients with advanced vaginal and vulvar involvement and in patients in whom complex medical problems preclude extensive surgical procedures.

Aged↗
PubMed2001

Transvaginal repair of pouch-vaginal fistula.

BACKGROUND: The results of surgery for ileoanal pouch-vaginal fistula have been disappointing. Intra-anal procedures result in fistula healing in, at best, approximately 50 per cent of patients. A transvaginal approach was developed to achieve direct access to the internal opening, enabling closure without damage to the anal sphincter. METHODS: Fourteen patients were treated between January 1992 and December 1998. All had had restorative proctocolectomy for ulcerative colitis and all were defunctioned. Histological review confirmed the diagnosis in all patients. RESULTS: Median age was 40 (range 25-52) years. Median follow-up was 18 (range 6-60) months. The operation was successful in 11 of the 14 patients, after one attempt in six patients, after two attempts in four, and after three attempts in one patient. The operation failed in three patients, who had a permanent ileostomy. The number of bowel actions in the patients who had successful closure ranged from 2 to 10 (median 6) in 24 h, with no faecal incontinence reported. CONCLUSION: This simple technique achieved healing in 11 of 14 patients. This compares favourably with the poor results in 28 patients treated by other procedures in the same hospital, with certain healing in five and definite failure in 20.

Adult↗
PubMed2005

Methotrexate/misoprostol vs. a more standard approach for termination of pregnancies of undetermined location: a randomized, controlled trial.

OBJECTIVE: To conduct a randomized, controlled trial to compare a group of patients receiving methotrexate intramuscularly on day 1 and vaginal misoprostol on day 5 to terminate a pregnancy of undetermined location with a group in which the diagnosis was established prior to treatment. STUDY DESIGN: We randomized 43 women with a pregnancy of undetermined location to 2 study groups: (1) 1 group received methotrexate/misoprostol, and (2) the other group had a diagnosis established first and then were treated appropriately. The outcomes that were measured for the 2 groups were: (1) hospital admission rate, (2) laparoscopy rate, (3) uterine aspiration rate, (4) patient visits, and (5) interval to end point. RESULTS: The uterine aspiration rate was lower in the methotrexate/misoprostol group (0.0% vs. 77.3%, p<0.0001). The mean number of patient visits in the methotrexate/misoprostol group was higher (3.8 vs. 2.5 visits, p<0.0001), and the mean interval to the end point in the methotrexate/misoprostol group was higher (26.4 days vs. 4.5 days, p<0.0001). CONCLUSION: To terminate pregnancies of undetermined location, empirical methotrexate/misoprostol is associated with a lower uterine aspiration rate but more patient encounters and longer follow-up.

Abortifacient Agents, Nonsteroidal↗
PubMed1987

Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women.

The use of oestrogens in the treatment of genuine stress incontinence was assessed by a double-blind prospective trial in 36 postmenopausal women with genuine stress incontinence who received 3 months of cyclical treatment with either piperazine oestrone sulphate or a matching placebo. Patients were assessed subjectively and objectively before and after treatment by 7-day bladder charts, urethral pressure profiles (UPP), the Urilos nappy test, vaginal cytology and hormone assays (plasma oestrogens and gonadotrophins). There was no statistical difference in the subjective response to treatment between the two groups. After 6 weeks of treatment there was a greater reduction in the number of pad changes/24 h in the oestrogen-treated patients that approached statistical significance but, because of a marked response in the placebo group, this difference was not significant after 3 months of treatment. There were also no significant differences between the two groups with respect to the UPP or Urilos measurements but the vaginal cytology and hormone profiles were significantly affected by oestrogens. In view of the possible risks of oestrogen therapy its use in genuine stress incontinence is limited.

Aged↗
PubMed1995

The diagnosis of preterm labor and the prediction of preterm delivery.

Clinical approaches to the diagnosis of PTL and the prediction of PTD are complicated by the absence of a gold standard for the pathogenic process leading to PTD. There is also substantial overlap between the signs and symptoms of PTL and impending PTD, and the normal processes of pregnancies destined to remain uncomplicated (e.g., our inability to convincingly differentiate PTL from Braxton-Hicks contractions). Our emphasis on the diagnosis of PTL rather than the pathogenic process preceding PTD also results in failure to detect the 50% of spontaneous PTDs in which uterine contractions follow PPROM. Thus, clinical predictors of incipient PTD including cervical change, uterine contractions, vaginal bleeding, risk scoring schemes, and fetal breathing activity, either have poor sensitivity or specificity, or are accurate only at late stages in the pathogenic process. The most promising approaches to the detection of impending PTD are laboratory indices of the putative pathogenic processes including: maternal serum or plasma CRH, salivary E3, serum collagenase and cervicovaginal cytokines, granulocyte elastase, and FFN levels. However, even if these indices prove sensitive, specific, and early predictors of PTD, they will be useful only if more appropriate therapies are found to treat patients. The latter will depend on addressing the primary causes of chorionic-decidual cell activation (e.g., infection, stress, utero-placental ischemia, hemorrhage, endocrinopathies).

Cervix Uteri↗
PubMed1997

Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty.

A 46-year-old Caucasian female underwent vaginal hysterectomy for myoma in another hospital and developed a high rectovaginal fistula 6 weeks later. A diverting-loop colostomy of the sigmoid colon was performed 2 months later. The patient was admitted to our service with persistent high rectovaginal fistula 6 months later. We resected the sigmoid colon and two-thirds of the rectum including the fistula tract using laparoscopic techniques. An intracorporeal anastomosis was accomplished using a double-stapling technique. An omental flap was mobilized and placed between the colorectal anastomosis and the vagina. Except for a subcutaneous wound infection at the former colostomy site, the postoperative course was uneventful. The patient was discharged at the 7th postoperative day and remained free of symptoms. We conclude that laparoscopic resection of high rectovaginal fistula with primary intracorporeal anastomosis is feasible and should be considered in selected cases as an alternative "minimal-invasive" approach to this disease.

Anastomosis, Surgical↗
PubMed1995

Surveillance for recurrent endometrial carcinoma: development of a follow-up scheme.

We examined the method of diagnosis for a group of women who developed recurrent endometrial carcinoma after being rendered clinically disease-free by primary therapy. We then used this information to develop a follow-up protocol that maximizes the chances for detecting recurrence while minimizing surveillance costs. In brief, we evaluated all women with clinical stage I endometrial carcinoma who were treated with curative intent during a 7-year period. Medical records were examined to identify patients who had tumor recurrence diagnosed during follow-up in our clinic. Clinical presentation, time to diagnosis, method of diagnosis, and subsequent outcome were analyzed. This information was used to design a surveillance protocol for further clinical testing. Ninety-six percent of 412 women treated between 1985 and 1992 were clinically disease-free after primary surgery with or without adjuvant treatment. Median follow-up is 64 months. Overall, 44 patients (11%) developed recurrent cancer after a median interval of 14.8 months. Complete follow-up data were available for the 39 patients who had their recurrence diagnosed in our clinic. The cumulative percentages of diagnosed recurrences were 51, 82, and 95% at 12, 24, and 36 months, respectively. Sixteen women (41%) had symptoms that led to the identification of recurrent disease. Recurrences in the 23 asymptomatic women (59%) were diagnosed by physical examination in 13, chest radiograph in 1, serum CA-125 level in 6, vaginal cytology in 1, and computed tomography in 2. Only 1 patient with a grade 1 adenocarcinoma had treatment failure. At the time of analysis, 30 patients with recurrent cancer had died of disease, 6 were alive with disease, and 3 were free of disease. A surveillance scheme consisting of an examination, vaginal cytology, and serum CA-125, combined with immediate evaluation of symptomatic women, could be expected to identify 95% of recurrences. Such an approach, performed at 6- to 12-month intervals for 3 years, could be limited to patients with grade 2-3 adenocarcinomas or variant cell types. However, given the high failure rate of salvage therapy, the prompt detection of recurrence may not convey a survival advantage.

Endometrial Neoplasms↗
PubMed2005

South Asian victims of intimate partner violence more likely than non-victims to report sexual health concerns.

To assess relationships between intimate partner violence (IPV) and sexual health among South Asian women in Boston. Surveys assessed demographics, IPV and sexual and reproductive health outcomes of women in relationships with men (N=208). In-depth interviews explored these issues with women with a history of IPV (N=23). Subjects were majority Indian, non-U.S. citizens, and highly educated. Quantitative data were assessed by logistic regression, qualitative data by a grounded theory approach. About 21.2% of the survey sample reported IPV in the current relationship. These women are 2.6 times as likely to report discolored vaginal discharge in the past year (95% CI=1.27-6.50), 3.1 times as likely to report burning during urination in the past year (95% CI=1.52-6.31) and 3.4 times as likely to report unwanted pregnancy in the current relationship (95% CI=1.33-8.66). Interviewed women described how abuse reduces sexual autonomy, increasing risk for unwanted pregnancy and multiple abortions. Study findings demonstrate the need for increased gynecologic health outreach to abused South Asian women in the U.S.

Adult↗
PubMed1985

The effects of RU486 on the luteal phase of the rhesus monkey.

RU486 is a steroid which possesses great affinity for the progesterone (P) receptor, but which has no P activity. It has been shown to be, as a result, a potent P antagonist. In the present study, we investigated the effect of this compound on the luteal phase of the rhesus monkey. The day of ovulation was diagnosed with a +/- 12 h accuracy, using serial laparoscopies and serum estradiol (E2) determinations, in regularly cycling rhesus monkeys. RU486 was administered by gavage (10 mg daily) in different regimens during the luteal phase: Group 1, days 1-5; Group 2, days 5-9; Group 3, days 9-13; and Groups 4, days 9-13, plus hCG (30, 60, 90, 180 and 360 IU i.m. on days 6-10). RU486 induced vaginal bleeding within 24-72 h after the initial administration in Groups 1-3. Animals of Group 4 presented luteal lengths ranging from 9-12 days. Progesterone concentrations at the onset of vaginal bleeding were 2.1 +/- 0.3, 4.9 +/- 0.6, 2.6 +/- 0.4 and 11.2 +/- 1.5 ng/ml (x +/- SEM) for animals of Groups 1-4, respectively. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), E2 and P levels were not altered during treatment. The availability of a compound such as RU486, that consistently induces vaginal bleeding due to its action at the target level (endometrium) without affecting the hormonal events of the menstrual cycle, opens a new approach to post-coital and interceptive contraception.

Abortifacient Agents, Steroidal↗