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PubMedDate not supplied

[Marfan syndrome and pregnancy. Apropos of 4 cases].

OBJECTIVES: To create a follow-up protocol for pregnant patients with Marfan syndrome. PATIENTS AND METHODS: We retrospectively reviewed the charts of patients who delivered in the Jeanne de Flandre University Hospital between June 1996 and June 1999. Four pregnant patients with Marfan syndrome were identified. RESULTS: Three of these patients had Bentall procedure. One of them had vaginal delivery and the two others underwent cesarean section. One of these two patients developed aortic valve thrombus at 14 weeks of amenorrhea. The fourth patient did not have surgery and had two vaginal deliveries. DISCUSSION: According to our results and after reviewing literature pregnant patients with Marfan syndrome were divided into two groups. The 1st group was comprised of patients who underwent Bentall procedure. The 2nd one was comprised of patients who did not undergo any surgical procedure. The possibility of vaginal delivery for patients who underwent Bentall procedure (one case) and the interest of Propanolol and anticoagulant treatment are emphasized. CONCLUSION: The multivariant approach of pregnant patients with Marfan syndrome is stressed out with special reference to the potential complications of this syndrome such as aortic dissection and to the problems related to the anticoagulant treatment.

Adult↗
PubMed1978

Sexually transmitted diseases. Advances in management.

We have briefly presented practical approaches to the management of the most common disorders caused by sexually transmitted pathogens, including pelvic inflammatory disease, urethritis in men, genital lesions, vaginal discharge, and syphilis. Guidelines for the management of gonorrhea may change if penicillin-resistant strains become more prevalent. Areas which require further research include the treatment of genital herpes and the prevention of recurrences, the treatment of nonspecific vaginitis, and definition of the importance of metronidazole toxicity.

Anti-Bacterial Agents↗
PubMed2002

Embolization versus myomectomy versus hysterectomy: which is best, when?

Uterine fibroids are the commonest tumour affecting the female reproductive tract. In many instances they are asymptomatic, but in some women there does appear to be an association with heavy menstrual blood loss and, possibly, subfertility. Classically, treatment has been surgical with hysterectomy the most common approach for women who have completed their fertility and myomectomy for those who wish to conceive. The surgery can be carried out laparoscopically, vaginally and abdominally, although all routes are associated with an appreciable rate of morbidity. Myomectomy can also be achieved hysteroscopically. Hysterectomy is associated with a high rate of satisfaction and is likely to relieve menstrual problems in virtually all women. The success of myomectomy is less certain since no randomized trials against expectant management have ever been carried out. In addition, myomectomy may lead to adhesion formation within the abdominal cavity, which may impair fertility further. Since myomectomy is not the ideal answer, other treatments for fibroids are being sought. Medical treatment may be useful in specific instances and for the short-term, but does not lead to a cure. Consequently, other modalities are being developed, one of which is uterine artery embolization. This procedure involves occluding the vessels using either foam or coils. The normal myometrium rapidly develops a new blood supply from collateral circulations, whereas the fibroids do not. The procedure leads to fibroid shrinkage of approximately 30-50% and appears to lead to relief of fibroid-associated symptoms, although it is too early to determine the effect on fertility. However, it is associated with significant complications and requires further evaluation before being accepted as a useful alternative to surgical therapy in the management of women with uterine fibroids.

Embolization, Therapeutic↗
PubMed2005

Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia.

BACKGROUND: Several surgical techniques have been described for the treatment of patients with vaginal agenesis. The simplest intervention that gives good sexual results should be the surgical technique of choice. METHODS: We report anatomic and functional outcome in 28 women after vaginoplasty using laparoscopic Davydov operation. This surgery includes three steps: two laparoscopic and one perineal. The patient then has to use a mould or a vaginal dilatator for 1 month. The functional outcome was assessed by a brief and valid self-report questionnaire evaluating female sexual life (Female Sexual Function Index, FSFI). A control group was recruited to compare the results. RESULTS: Two intra-operative bladder and ureteric injuries were repaired without sequels. Two post-operative complications were observed: one abdominal migration of the mould, which was treated successfully with the laparoscope, and one vesico-vaginal fistula. No patient was lost to follow-up. The anatomical result was judged to be satisfactory (>6 cm) in 26 of the 28 patients: the mean vaginal length was 7.2 +/- 1.5 cm. Among the 28 operated women, 19 had a good or very good result. No statistical difference was found between our operated patients and French controls in all six domains of the FSFI. CONCLUSIONS: Laparoscopic Davydov may be considered a good option for the surgical treatment of women presenting vaginal agenesis. This technique offers advantages such as: short operating time and hospital stay, no particular instrumentation required and no external scars. Sexuality approaches so-called 'normal sexuality'.

Abnormalities, Multiple↗
PubMed2004

The influence of testing context and clinical rotation order on students' OSCE performance.

PURPOSE: To investigate the influence of testing context and rotation order on third-year medical student performance on a common objective structured clinical examination (OSCE) station in both obstetrics-gynecology (ob-gyn) and psychiatry rotations. METHOD: Archival OSCE performance data (in the form of a 25-item binary content checklist) from one class of third-year medical students (n = 141) at Saint Louis University (2002-03) were aggregated and analyzed. RESULTS: Despite the fact that the station was identical in both OSCEs, students were, in general, less likely to inquire about ob-gyn issues on the psychiatry OSCE and less likely to inquire about psychiatric issues on the ob-gyn OSCE, regardless of order of rotation. Order did have a positive effect on some results, such that students were more likely to mention menopause and vaginal dryness on the psychiatry OSCE if they had already had the ob-gyn rotation. CONCLUSION: The testing context may influence student approaches to patients in ways that bias their collection and interpretation of information. OSCE evaluations may better approximate true clinical context and complexity by presenting case scenarios that reflect a broader range of diagnostic possibilities than those limited to the recently completed rotation.

Adult↗
PubMedDate not supplied

Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study.

OBJECTIVE: To determine the safety and efficacy of an oral soy isoflavone extract for relief of menopausal hot flushes. DESIGN: This was a double-blind, randomized, parallel group, outpatient, multicenter (15 sites) study. A total of 177 postmenopausal women (mean age = 55 years) who were experiencing five or more hot flushes per day were randomized to receive either soy isoflavone extract (total of 50 mg genistin and daidzin per day) or placebo. Physical examinations and endometrial and biochemical evaluations were performed upon admission and completion. Body weight, symptoms, and safety were evaluated at all visits. RESULTS: Relief of vasomotor symptoms was observed in both groups. Decreases in the incidence and severity of hot flushes occurred as soon as 2 weeks in the soy group, whereas the placebo group experienced no relief for the first 4 weeks. Differences between evaluable subjects in both groups were statistically significant over 6 weeks (p = 0.03). Over 12 weeks, between-group differences approached significance (p = 0.08). Endometrial thickness evaluated by ultrasound, lipoproteins, bone markers, sex hormone-binding globulin and follicle-stimulating hormone, and vaginal cytology did not change in either group. CONCLUSIONS: Soy isoflavone extract was effective in reducing frequency and severity of flushes and did not stimulate the endometrium. Soy isoflavone extracts provide an attractive addition to the choices available for relief of hot flushes.

Double-Blind Method↗
PubMed1993

Use of a Colapinto needle in US-guided transvaginal drainage of pelvic abscesses.

The ultrasound-guided transvaginal approach offers a direct, nonsurgical means for drainage of deep pelvic abscesses. It is often difficult, however, to place drainage catheters through the vaginal wall by using routine Seldinger technique. The authors describe four recent drainage procedures facilitated through use of a Colapinto needle as a dilator. In two cases, the Colapinto needle also served as a stiffening cannula for the passage of a fascial dilator.

Abscess↗
PubMed2000

Vaginal-rectal colonization with group A streptococci in late pregnancy.

OBJECTIVE: To determine the vaginal-rectal colonization rate with group A streptococci in late pregnancy. METHODS: All patients delivering at a northern New England hospital over a 38 month period had 35-37 week vaginal-rectal swabs cultured for group A and group B streptococci, using selective media and slide agglutination. RESULTS: Six thousand nine hundred forty-four screening cultures were obtained. Among these 1,393 were positive for group B streptococci and 2 for group A streptococci, yielding colonization rates of 20.1% and 0.03%, respectively. CONCLUSIONS: Vaginal-rectal colonization with group A streptococci is rare, arguing against the need for establishing group A streptococcal screening programs in pregnancy. An approach for managing this uncommon finding is presented.

Agglutination↗
PubMed1998

Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

Adult↗
PubMedDate not supplied

Treatment of menorrhagia by radiofrequency heating.

A new technique is described for the treatment of menorrhagia by heating the whole of the endometrial cavity of the uterus. A capacitively coupled probe at 27.12 MHz is inserted into the uterine cavity, which causes the basilis layer to be raised to approximately 50-55 degrees C whilst the rest of the pelvic contents remain at approximately normal (body) temperature. A major advantage of the method is that no special hysteroscopic skills are required, unlike the two other techniques currently used for endometrial ablation: the Nd-Yag laser or the hysteroresectoscopic loop. Also no toxic flushing/distension fluids are necessary, as are required for all hysteroscopic surgery. The method, however, does require the application of a large amount of RF power to the probe and so care must be taken to position the probe correctly in order to prevent any serious complications. Of 32 patients given a single treatment at a power level of 550 W for 20 min, the 'success rate' was 84% with 31% becoming amenhorrhoiec and 53% showing significant reduction in menstrual bleeding. However, retreatment is possible and by this means, combined with improved treatment techniques, an even higher success rate could be achieved. In two of the earlier patients treated at 550 W a fistula was produced at the anterior vaginal wall which had to be surgically repaired. The probe was subsequently modified, since when this problem has not recurred. This new treatment approach offers an alternative to hysterectomy in the treatment of menorrhagia and may offer a number of significant advantages over methods currently used for endometrial ablation.

Adult↗
PubMed2003

Management of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. A case report.

BACKGROUND: Uterus didelphys with obstructed hemivagina presents with a pelvic mass often inappropriately approached by laparotomy. CASE: An adolescent female was evaluated for dysmenorrhea, a pelvic mass and a double uterus. Transvaginal resection of the oblique vaginal septum was performed, with relief of symptoms and subsequent conception. CONCLUSION: This entity should be considered to prevent misdiagnosis and unnecessary abdominal surgery.

Abnormalities, Multiple↗
PubMed1988

[Ureterotransversopyelostomy and unilateral nephrostomy as supravesical urinary diversion in vesico-vagino-rectal fistula and incurable bladder cancers].

The use of a transversal uretero-pyelostomy as an alternative to other forms of supravesical urinary diversion is described in a patient suffering from incurable bladder cancer and in another patient with combined bladder-vaginal-rectal fistula, colostomy and radiogenic contracted urinary bladder. The operation is less severe to the patient and a transperitoneal or a retroperitoneal approach is possible. This type of urinary diversion should be included in the operative armamentarium of the urologist in selected cases because of the quality of patient's life is improved markedly.

Aged↗
PubMed1980

[Recovery of human oocytes (author's transl)].

Oocyte recovery was attempted on 62 women, with laparoscopy being applied to 46 and surgical treatment to 16. The attempts were successful in 56 per cent of them, with 61 oocytes being recovered. Twenty per cent of these were pre-ovulatory, 52 per cent non-ovulatory, and 28 per cent degenerated. The amount of oocytes recovered by laparoscopy was 25 per cent below that obtained from surgery. Possible variants of oocyte recovery are discussed. --Follicular puncture can be undertaken in concomitance with gynaecological operations, by the vaginal or abdominal routes. Less difficulty is implied in puncturing the extirpated ovary. Uterus or tube washing and ovarian extirpation are other possible approaches. Ovarian implantation and perfusion may be considered theoretical approaches to oocyte recovery. Laparoscopy or colpotomy are believed to be, possibly, the most promising approaches to oocyte transplantation, which may become relevant in the long run.

Adult↗
PubMed2004

Trans vaginal tape readjustment after unsuccessful tension-free vaginal tape operation.

AIMS: This study is aimed at evaluating a new surgical technique to deal with tension-free vaginal tape (TVT) failure. The TVT operation, described by Ulmsten in 1995, is based on a mid urethral Prolene tape support. TVT is accepted as an easy-to-learn and safe minimal invasive surgical technique. Yet, as with other surgical methods for correction of female urinary stress incontinence, therapeutic failures occur with TVT also. MATERIALS AND METHODS: Described here is a new approach for addressing this issue. Out of 344 women who underwent TVT and who were followed for up to 55 months, four (1.2%) requested to be reoperated on the grounds of a diagnosis of operative failure. These four women were treated by trans vaginal readjustment of the tape. RESULTS: Three out of the four reoperated patients reported subjective continence, subsequently confirmed clinically. The fourth patient, although suffering residual minor urinary leakage, declined further interventions. CONCLUSIONS: The readjustment technique seems effective, easy, and safe for the treatment of failed TVT operations. More experience is needed prior to suggesting this technique as a recommended approach.

Adult↗
PubMed1985

Surgery of pelvic renal ectopia: a new approach.

We present 5 patients with ectopic pelvic kidneys who underwent surgery for associated disorders. In addition, the kidneys were repositioned to a higher location where they are less likely to interfere with vaginal delivery at a later date. Ectopic kidneys are mobile, and the vessels and ureters have sufficient length to allow for their repositioning.

Child, Preschool↗
PubMed2006

Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery.

Female pelvic floor dysfunction is integral to the woman's role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery. Available epidemiologic data on pelvic floor dysfunction suggest that there may be substantial opportunities for the primary prevention of pelvic organ prolapse at delivery. Although definitive recommendations await further epidemiologic studies of the potential risk and benefits of obstetric practice change, it is hoped that this discussion will provide a novel, quantitative framework for the assessment of pelvic floor dysfunction prevention opportunities.

Cesarean Section↗
PubMed2001

Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women.

OBJECTIVE: To study the survival, rates and patterns of recurrence, and perioperative morbidity in medically compromised women with endometrial cancer treated by primary vaginal hysterectomy. METHODS: Fifty-one patients with endometrial cancer treated initially by vaginal hysterectomy between 1977 and 1999 were identified at the University of California, Irvine Medical Center and affiliated hospitals. Data were retrieved from hospital and office records. Statistical analysis, including Kaplan-Meier methods, was performed and the disease-specific survival rates were estimated. This study has 80% power to demonstrate a greater than 20% improvement in 5-year survival over historical controls. RESULTS: Fifty-one women with uterine carcinoma clinically confined to the uterus underwent primary vaginal hysterectomy with (n = 26) or without (n = 25) salpingo-oophorectomy. Eighty-four percent were obese with a body mass index greater than 27. Additional risk factors for surgical complications included hypertension (57%), diabetes mellitus (27%), and cardiovascular disease (18%). One-third of patients had three or more risk factors. Surgical morbidity included one episode of acute hemorrhage necessitating transfusion and abdominal exploration. Blood transfusions were given to four additional patients. There were no perioperative deaths. Five women recurred and expired at a median of 13 months (range 3--53 months) after surgery. The 3- and 5-year disease-specific survival rates were 91.4% and 88.0%, respectively. CONCLUSION: Vaginal hysterectomy for the initial treatment of early-stage endometrial cancer is associated with a high rate of cure and minimal morbidity. Thus, it may be considered a reasonable alternative to the abdominal approach in medically compromised women.

Adult↗
PubMed1990

[The association of uterine lipoma and cancer of the endometrium. Diagnostic and etiopathogenic approach].

Uterine lipoma (UL) is a rare tumor frequently presenting as leiomyolipoma. Even more uncommon is the association of UL and endometrial carcinoma (EC) for which only two cases have been reported. We present the case of a 73 years old female of French origin complaining of vaginal bleeding. Initial examination under general anesthesia found a 13 cm length uterine cavity with a large tumor located in the anterior wall. After curettage, the histopathologic analysis diagnosed a moderately differentiated adenocarcinoma of the endometrium. Patient work-up showed no evidence of extension outside the uterus (stage Ib). Treatment consisted of pelvic and iliac lymph node external irradiation with subsequent vaginal intracavitary irradiation followed, 6 weeks later, by total extra-fascial hysterectomy without lymph node dissection. Pathologic examination found a small EC with limited infiltration of the myometrium (stage Ia) associated with a 10 x 9 x 7 cm yellowish fibrolipoma type tumor without smooth muscle pattern. First described by Lobstein in 1816, UL are uncommon and casually diagnosed. The association with EC is rare and without evident relationship. Ultrasound (US) and computed tomographic (CT) appearances allow a diagnostic approach. US show a highly echogenic central tumor with a thin moderately echoic rim. CT appearance of UL is a central, well delimited fat-density tumor. The etiopathogenesis of UL is unclear, attributed to a possible leiomyoma evolution for Willen or a myometrial cell metaplasia for Brandfass.

Adenocarcinoma↗