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PubMed1990

The sexually sadistic criminal and his offenses.

This is an uncontrolled, descriptive study of 30 sexually sadistic criminals. All were men, and all intentionally tortured their victims in order to arouse themselves. Their crimes often involved careful planning, the selection of strangers as victims, approaching the victim under a pretext, participation of a partner, beating victims, restraining victims and holding them captive, sexual bondage, anal rape, forced fellatio, vaginal rape, foreign object penetration, telling victims to speak particular words in a degrading manner, murder or serial killings (most often by strangulation), concealing victims' corpses, recording offenses, and keeping personal items belonging to victims.

Criminal Psychology↗
PubMedDate not supplied

Terconazole--a new antifungal agent for vulvovaginal candidiasis.

Terconazole is a new broad-spectrum antifungal agent for the treatment of vulvovaginal candidiasis. Instead of an imidazole structure, terconazole contains a triazole ring, a structure developed specifically to improve antifungal activity. Clinical studies of this antifungal agent have involved 5,500 women worldwide and a number of terconazole formulations, including 80-mg vaginal suppositories and 0.4% vaginal cream. The highlights of several large, major studies are discussed in this review article. In European studies, mycologic cure rates for terconazole regimens approached or exceeded 90%. Speed of action was rapid, and relapse rates were low. In double-blind, multicenter studies conducted in the United States, clinical cure rates for 0.4% terconazole cream ranged from 86% to 96% and microbiologic cure rates from 77% to 91% at 8 to 10 days after therapy. Most patients remained free of positive signs and symptoms and microbiologic evidence of infection at 30 to 35 days posttherapy. Symptomatic relief tended to be more rapid for patients treated with 0.4% terconazole cream than for those treated with 2.0% miconazole nitrate cream. In US studies of 80-mg terconazole suppositories, clinical cure rates 8 to 10 days after therapy were between 89% and 92%, and microbiologic cure rates were between 80% and 85%. Relapse rates were also low with this form of therapy. No statistically significant differences were found between three days of treatment with 80-mg terconazole suppositories and seven days of treatment with 100-mg miconazole nitrate suppositories. This research demonstrates that terconazole is a fast-acting, highly effective, well-tolerated therapy for vulvovaginal candidiasis.

Antifungal Agents↗
PubMedDate not supplied

Genital prolapse in a preterm female infant.

Genital prolapse in the female infant during the neonatal period is relatively rare and is usually associated with anomalies of the central nervous system. A case of vaginal prolapse in a small-for-gestational-age preterm female infant, without any associated nervous system anomalies, is presented. The clinical presentation, diagnostic approach, management, and outcome of the case are discussed with reference to a review of the literature.

Female↗
PubMed1996

[Vaginal colonization of Streptococcus B in pregnancy].

In the last few years the importance of GBS as the cause of serious neonatal sepsis has become more evident. The number of cases of this infection clearly exceeds the number of other congenital infections, for which antenatal screening is performed. Asymptomatic colonization of the genital tract of the pregnant woman has the most important role in transmission of GBS and several risk factors are connected to neonatal infection. In order to assess the epidemiological situation in Tuscany, 5079 pregnant women have been recruited by the Obstetrical Department of 16 Hospitals and evaluated for the vaginal colonization by GBS. 3654 couples mother-neonate have also been studied to ascertain the transmission of this germ to the neonate. A vaginal swab was collected at the admission to the Hospital at delivery-time and swabs from several sites of the neonate were obtained just after birth. A blood-agar culture and a latex agglutination test were employed to detect the GBS. GBS was present in 6.6% of the vaginal cultures, with a wide variation in colonization rates. 2.2% of the neonates were positive. The transmission of GBS from the positive mother to the neonate occurred in 20% of the cases. Furthermore one positive neonate out of three was born from a negative mother. No correlation between GBS positivity and preterm delivery was found. The rates of prevalence of GBS in our population, both mother and neonates, suggest a situation that can no longer be neglected. Our data are probably underestimated because of the low sensibility of the culture method. A preventive strategy has to be employed to avoid serious neonatal sepsis. An antenatal screening that provides a vaginal culture at the 36th week of gestation and a chemoprophylaxis intra-partum in the positive cases appears to be the most effective approach.

Female↗
PubMed2000

Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients.

BACKGROUND: Cervical carcinoma occurs frequently in young women who would like to preserve their childbearing potential. For those with early stage invasive lesions, the authors designed and performed radical trachelectomy, a surgical procedure that preserves the functions of the uterus. METHODS: Radical trachelectomy combines laparoscopic (for pelvic lymphadenectomy) and transvaginal approaches. Between April 1987 and December 1996, 56 patients were scheduled for this procedure, and 47 underwent it. The charts of these patients were retrospectively reviewed for medical and obstetric history, characteristics and complications of surgical procedures, pathologic findings, postoperative obstetric results, and cancer recurrences. RESULTS: The mean durations of the laparoscopic and vaginal steps of the procedure were 62 and 67 minutes, respectively. One intraoperative complication (cystotomy) and seven postoperative complications (drainage of pelvic collection) were observed. The pathologic tumor classification was International Union Against Cancer (UICC) pT1a1 (International Federation of Gynecology and Obstetrics [FIGO] Stage pIA1) in 5 cases, UICC pT1a2 (FIGO Stage pIA2) in 13 cases, UICC pT1b (FIGO Stage pIB) in 25 cases, UICC pT2a (FIGO Stage pIA2) in 1 case, and UICC pT2b (FIGO pIIB) in 3 cases. The mean follow-up was 52 months. Two recurrences (4%) were observed (one lateropelvic and one distant), and one patient died of disease progression. Despite a 25% rate of late miscarriages, 13 normal children were born after radical trachelectomy. CONCLUSIONS: In young patients affected by early invasive cervical carcinoma, radical trachelectomy does not appear to increase the rate of recurrence. It carries a relative risk of infertility and late miscarriage but makes it possible for some patients to become pregnant and give birth to normal newborns. Thus, it seems reasonable to offer this procedure in selected cases, provided that each patient is fully informed and the surgeon properly trained.

Abortion, Spontaneous↗
PubMed1981

Clinical, cytological and biological study of the intra-vaginal administration of oestriol (Ortho-Gynest) in post-menopausal patients.

Although some well-defined conditions require a replacement oestrogen therapy, local trophic disorders associated with the decrease of oestriol concentrations after surgical castration or menopause are corrected in a very satisfactory way by local oestrogen therapy. An initial treatment with 0.5 mg oestriol per day for 3 wk followed by a 4-wk maintenance therapy of 2 pessaries per week (2 x 0.5 mg) brings about a clinical cure and normalization of the maturation index in more than 95% of the 48 patients with surgical or natural menopause who received this treatment. The authors insist on the efficacy of this therapeutic approach.

Administration, Topical↗
PubMed2000

[Vestigial retrorectal cyst in adults].

STUDY AIM: The aim of this retrospective study was to report three cases of retrorectal vestigial cyst in adults. PATIENTS AND METHOD: From 1977 to 1999 retrorectal vestigial cyst (RVC) was diagnosed in our department in three women who were 28, 57 and 53 years of age, respectively. RVC was revealed by either pain (n = 2) that occurred in one case in a pregnant woman, or acute intestinal obstruction (n = 1). The patients were operated on using a perineal approach in two cases and an abdominal approach in one case. RESULTS: One epidermoid cyst and two mixed cysts without any sign of malignancy were observed. Postoperative follow-up was simple in two patients, while complications occurred in the third one via an uretero-vaginal fistula which required uretero-vesical reimplantation. The first two patients, reviewed after a 1-year follow-up, had no functional trouble and no sign of recurrence. CONCLUSION: Retrorectal vestigial cysts are very rare tumors with a risk for degeneration. Computerized tomography on nuclear magnetic resonance and endorectal ultrasonography allow detection of their structure and topography and help guide their surgical approach. In the absence of malignancy, wide excision, if possible without opening of the cystic wall, leads to good results.

Acute Disease↗
PubMed1978

The spectrum of alleged rape.

A prospective series of 110 alleged rape victims from July through November 1974 at Denver General Hospital is presented. The victims and assailants are characterized. The laboratory established proof of recent coitus in 68%. Four-fifths of the victims presented within 12 hours of the alleged incident. The analysis of ABO vaginal antigens appears to be promising for assailant identification. Follow-up by appointment in this group was successful in only 5%. Only a minority of cases led to arrest and criminal proceedings. Suggestions are made for alternative approaches to victims based on new developments in forensic laboratory procedures.

ABO Blood-Group System↗
PubMed2003

Pelvic floor nerve conduction studies: establishing clinically relevant normative data.

OBJECTIVE: The purpose of this study was to establish data for normative distributions for pudendal and perineal nerve compound muscle action potential data in healthy women across a wide age range and varied history of vaginal deliveries. STUDY DESIGN: We studied 42 continent women, aged 20 to 67 years, including 29% nulliparous women with a disposable St. Mark's electrode to stimulate the pudendal nerve at the ischial spine by a transvaginal approach. The pudendal terminal motor latency and amplitude were detected with the use of surface patch electrodes overlying the external anal sphincter; the perineal responses were measured with the use of a surface ring electrode at the proximal urethra. RESULTS: None of the data were distributed normally and required the use of negative inverse and cube root transformations to create a normal distribution. Clinical correlations were found with advancing age and vaginal delivery. CONCLUSION: The collection of these data allows for the definition of normal limits and begins the study of clinically important variables on test results and clinical outcomes.

Action Potentials↗
PubMed1979

Current approaches to the diagnosis, treatment, and reporting of trichomoniasis and candidosis.

The current approach to the management of trichomoniasis and candidosis in sexually transmitted disease (STD) clinics in England and Wales is described. Microscopy alone was used in the diagnosis of trichomoniasis in 44% of clinics and of candidosis in 35% of clinics. Oral metronidazole was used for the treatment of trichomoniasis in women in 92% of clinics. Vaginal pessaries containing nystatin or clotrimazole were routinely used to treat candidosis in 95% of clinics. Male sexual contacts of female patients with candidosis and trichomoniasis were invited to attend for examination in 88% of clinics. Physicians in 81% of clinics prescribed treatment on epidemiological grounds for male contacts of female patients with trichomoniasis. A more uniform approach to the diagnostic categories used for the quarterly returns for cases treated epidemiologically is recommended.

Candidiasis, Vulvovaginal↗
PubMed1989

Colpovesical neck suspension for the correction of female stress urinary incontinence.

A new surgical approach for the correction of female urinary stress incontinence has been devised. The retropubic space is entered through a dome-shaped incision in the vaginal vestibule. The bulbocavernosus muscles are separated from the urethra and the layers of the genitourinary diaphragm are opened beginning behind the symphysis pubis. The retropubic cavity is exposed and the junction of the vesical neck and vagina is identified. Double helical bites with 2-zero polypropylene sutures are taken from each side of the junction. The 2 ends of the sutures are brought ventrally with a suture carrier through a small incision just above the symphysis pubis in the midline and tied. This procedure moves the bladder neck forward and upward to the desired level by observing movement of the bladder neck through the vestibule. Of 20 patients treated 17 are fully continent and 3 remain much improved after 2 years.

Adult↗
PubMedDate not supplied

Recently approved and experimental methods of contraception.

The U.S. Food and Drug Administration has recently approved two new contraceptive methods, and others are nearing approval. In addition, several innovative approaches to contraception are under investigation. This paper details the latest information on the following methods: Paragard Copper T 380A intrauterine device, cervical cap, NORPLANT, vaginal pouch, long-acting injectables, hormonal vaginal ring, transdermal patch, experimental male methods, inhibin, and contraceptive vaccines.

Contraception↗
PubMed1999

Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh.

BACKGROUND: In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. We investigated the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection. METHODS: During a 5-month period, we investigated all women complaining of abnormal vaginal discharge and seeking care at maternal and child health/family-planning centres in Matlab, Bangladesh, for the presence of laboratory-diagnosed reproductive-tract infections and STIs. Syndromic diagnoses made by trained health-care workers were compared with laboratory diagnosis of infection. We then calculated the costs of treating women by means of the recommended WHO algorithm and an adapted algorithm incorporating use of a speculum and simple diagnostic tests. FINDINGS: The prevalence of endogenous infections among 320 women seen was 30%. Cervical infections (Neisseria gonorrhoeae and Chlamydia trachomatis) were found in only three women. The WHO algorithm had a high sensitivity (100%) but a low specificity (zero for bacterial vaginosis, candida, and Trichomonas vaginalis). The speculum-based algorithm had a low sensitivity (between zero and 59%) but a higher specificity (79-97%). Between 36% and 87% of costs would have been spent on uninfected women. INTERPRETATION: The high rate of overtreatment in the population studied carries both financial and social costs--the latter in potentially exposing women misdiagnosed as having an STI to threats of domestic disruption or even violence. We make recommendations for management programmes in areas of low STI prevalence and low income.

Adolescent↗
PubMed2001

Urinary stress incontinence in obese women: tension-free vaginal tape is the answer.

OBJECTIVE: To determine the effectiveness of the tension-free vaginal tape (TVT) in obese women with genuine stress incontinence (GSI), in whom obesity is often considered a relative contraindication to surgical treatment by traditional approaches, e.g. Burch colposuspension and slings (which are difficult and carry increased morbidity) or injectable agents (which although simple, are unpredictable and expensive). PATIENTS AND METHODS: Data on 242 consecutive women with urodynamically proven GSI were collected prospectively. The women were subdivided into three groups with a body mass index (BMI) of < 25, 25-29 and >or=30; obesity was defined as a BMI of >or=30. All procedures were performed under spinal anaesthesia. The King's validated quality of life (QoL) questionnaires (version 7) were completed before and 6 months after surgery. The subjective results were defined as a cure, significant improvement or failure. RESULTS: Almost 90% of the obese women with GSI were cured, while the remaining 10% noted a considerable improvement in their symptoms. There was no significant difference in cure rates among the three groups. There was a highly significant (P < 0.001) improvement in QoL in all groups. CONCLUSION: The TVT is at least as effective in obese women as in those with a lower BMI. The TVT is a simple and minimally invasive procedure, with low morbidity even in the obese group. TVT can be offered confidently to all obese women with GSI.

Adult↗
PubMed1999

Outpatient vaginal cuff brachytherapy for endometrial cancer.

Petereit DG, Tannehill SP, Grosen EA, Hartenbach EM, Schink JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. The objective of this study was to determine the efficacy and complications of postoperative high-dose-rate (HDR) vaginal-cuff brachytherapy (VCB) in patients with endometrial carcinoma. Between August 1989 to September 1997, 191 patients were treated postoperatively after a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) with outpatient adjuvant HDR VCB for low-risk endometrial cancer (IB-84%, grade 1 or 2-96%). Patients were treated with 2 HDR fractions, delivered one week apart while under conscious sedation (16.2 Gy X 2 to the vaginal surface). All clinical endpoints were calculated using the Kaplan Meier method. The median time in the brachytherapy suite was 60 min in which no acute complications were observed. The 30-day morbidity and mortality rates were both 0%. With a median follow-up of 38 months (12-82 months), the 4-year survival, relapse-free survival, and vaginal-control rates were 95%, 98%, and 100%, respectively. One patient developed a colo-vaginal fistula at 5 years. Adjuvant HDR VCB in 2 outpatient insertions produced 100% vaginal control rates with minimal morbidity. The advantages of high dose-rate compared to low dose-rate vaginal brachytherapy include patient convenience, markedly shorter treatment times (1 h per insertion), and reduction in the cost and potential morbidity of hospitalization. HDR brachytherapy approach is a cost-effective alternative to either low-dose-rate brachytherapy or whole pelvic radiotherapy in carefully selected patients.

Journal Article↗
PubMed1999

Laparoscopic hysterectomy.

The first laparoscopic hysterectomy using only laparoscopic techniques was performed around 10 years ago by Harry Reich. Such total laparoscopic hysterectomy (TLH) approach is surgically elegant but technically difficult. A number of alternative laparoscopic techniques to perform all or some of the hysterectomy have since been introduced to simplify the surgical technique but retain the major advantages of the approach, which is to avoid the use of a large laparotomy wound. The advantages of this approach have been well documented, but so far the laparoscopic route has been little used by the general gynecologic surgical community. Although it has been possible in some units to reduce the laparotomy rate for hysterectomy to 10%, there is evidence from the United Kingdom and the United States that still more than 70% of all hysterectomies are still being performed by the laparotomy approach. This chapter seeks to explain why this should be so and how appropriate training and acquisition of the necessary skills in operative laparoscopy and vaginal surgery can be achieved to ensure that all patients who may benefit by avoiding a laparotomy incision are given the opportunity to do so.

Costs and Cost Analysis↗