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PubMed1998

Responses to stress and novelty in adult rats born vaginally, by cesarean section or by cesarean section with acute anoxia.

The aim of this study was to test the hypothesis that alterations in birth conditions, specifically vaginal birth vs. birth by Cesarean section (C-section) vs. birth by C-section with an added period of acute global anoxia, produces long-term differences in behavioral responses to stress or novelty in the rat at adulthood. In comparison to animals born by rapid C-section alone, animals born by C-section with 10 or 15 min of added anoxia were significantly more immobile during forced swim stress administered for 6 trials over several weeks. In a step-down passive avoidance task, there were no group differences in acquisition or retention of the avoidance response. However, when initially placed in the passive avoidance apparatus before delivery of shock, animals born by C-section with 15 min of anoxia required significantly more pretrials to step down from the wooden platform, than did vaginally born or C-sectioned animals. No group differences were observed on measures of exploratory behavior in an elevated plus-maze or of approach behavior either to food or to a novel object in an open field. These findings suggest that birth conditions which include a degree of perinatal hypoxia can contribute to variability in selective responses to stress and novelty in the adult rat.

Acute Disease↗
PubMed1984

Ultrasound diagnosis and perinatal management of fetal genito-urinary abnormalities.

Approximately 50% of fetal abdominal masses originate in the urinary system and those recognizable ultrasonically include renal dysplasia, renal agenesis and obstruction of the lower excretory channels. Fetal renal anomalies may be discovered co-incidentally during the course of sonographic evaluation of uterine size-dates discrepancy, because they are commonly associated with fetal growth retardation and/or oligohydramnios, or during a planned sonographic follow-up of pregnancies in patients who are at risk of recurrence of such anomalies. The sonographic demonstration of renal anomalies under these circumstances may allow for elective termination of pregnancy, may modify the obstetric management and/or facilitate pediatric and surgical care of the newborn. In the collaboration study at three ultrasonic centers there were 81 cases of genito-urinary tract anomalies detected antenatally in a five years period. Among the detected anomalies there were 30 hydronephrotic fetuses, 12 with multicystic disease, 15 with Potter's syndrome, 10 with polycystic kidney, 9 with Prune Belly syndrome, 4 with isolated renal cysts and 1 with an ovarian cyst. Perinatal management of the fetus with urinary tract abnormalities greatly depends on the accuracy of the diagnosis. It would be justifiable to suggest that an inexperienced observer should not make the final diagnosis. He could be of great help, if one kept a high index of suspicion in patients with a significant family history of oligohydramnios and of unexplained abnormal cystic structures in the fetal abdomen and seek the help of a special referral center where experience in related cases is concentrated. Once an accurate diagnosis is made, various alternatives are open to the obstetrician. This is primarily dependent upon the type and degree of the abnormality. Unilateral multicystic kidney and hydronephrosis due to obstruction above the level of the urethra appear to be compatible with extrauterine life and should be approached accordingly. If there is massive enlargement of the fetal abdomen, elective cesarean delivery should be considered to prevent the dystocia which may occur with vaginal delivery and to prevent further damage of these vital organs. If bilateral renal agenesis, bilateral multicystic kidneys, or bilateral infantile polycystic kidneys are demonstrated early in gestation, the obstetrician and parents may choose to terminate the pregnancy because these conditions are not compatible with extrauterine life.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Multiple↗
PubMed2005

Prevalence and risk factors for vaginal candidiasis among women seeking primary care for genital infections in Dar es Salaam, Tanzania.

OBJECTIVE: To determine the prevalence and risk factors for vaginal candidiasis (VC) among women seeking primary care for genital infections. DESIGN: Cross-sectional study. SETTING: Ilala Municipal Hospital in Dar es Salaam, Tanzania. SUBJECTS: Four hundred and sixty four women presenting with complaints of genital infections. RESULTS: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritus, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. The prevalencies of VC, bacterial vaginosis, HIV, T vaginalis, N. gonorrhoeae and syphilis were 45%, 48.4%, 22%, 93%, 1.5% and 4.3%, respectively. The occurrence of VC was positively associated with HIV, (OR = 1.81, 95% CI (1.0-2.67), bacterial vaginosis; (OR = 2.6, 95% CI (1.7-3.9), genital pruritus; (OR = 1.8 1, 95% CI (1.2-2.7) genital discharge; (OR = 1.867, 95% (1.28-2.73) and negatively with T. vaginalis (OR = 0.27, 95% CI (0.12 - 0.6), occupation (OR = 0.65, 95% CI (0.35-0.86)) and with education (OR = 0.43, 95% CI (0.11-0.73). There were increased but non-significant odds for VC in patients with syphilis (OR = 1.6 95% CI (0.6-4.3) and venereal warts (OR = 2.5 95% CI (0.92-6.8) VC was not associated with N. gonorrhoeae, genital ulcers, age at first intercourse, number of sexual partners, marital status or antibiotic usage. CONCLUSION: The high prevalence of vaginal candidiasis among women with genital infections should be taken into account when updating policies concerning syndromic management of sexually transmitted diseases. More gender specific approach to syndromic management of sexually transmitted infections in females should be considered.

Adult↗
PubMed2005

[Sexual and reproductive health--specific problems in adolescence].

The specificity of adolescent gynecology is uncontested and asks for a specific knowledge and approach. Even if the symptoms remain the same, differential diagnostic and therapeutic approach will be different, depending on the state of development (early puberty, late adolescence), during which they occur. The ignorance of specific pathologies (utero-vaginal malformation, ovarian pathologies related to the menstrual cycle) and therefore inadequate or retarded medical treatment might be the source of unnecessary sequellae. There are now many possibilities to acquire or improve one's knowledge and skills in this particular domain of gynecology. The medico-legal situation as well differs in many points from that of the adult.

Adolescent↗
PubMed1991

[Surgical treatment of urinary stress incontinence in women].

32 women with genuine stress urinary incontinence were operated on via the transvaginal approach during 1989-1990. They ranged in age from 27-72 years, with a mean of 55.7. In 26, in addition to the urine leakage, vaginal wall prolapse of various degrees was diagnosed. 6 underwent Raz modified Pereyra bladder neck suspension, 26 had Raz 4-corner bladder and bladder neck suspension, and in 17 rectocele and perineal repair were also performed. 2 with uterine prolapse also underwent vaginal hysterectomy. At follow-up 2-12 months later 29 of the 32 were completely cured of stress incontinence (90.6%). In 7 urge incontinence persisted in various degrees, and 3 had developed urge incontinence de novo. All but 1 of them responded favorably to anticholinergic medication. There were postoperative complications in 5 (15.6%), including wound infection that required removal of Prolene sutures in 2, urethrovaginal fistula requiring reoperation in 1, perioperative myocardial infarction in 1, and in 1 voiding dysfunction initially treated with self-intermittent catheterization, but later cured by removal of a pair of Prolene sutures.

Adult↗
PubMed1983

Problems in the management of sexually transmitted diseases in South Africa.

On the subcontinent sexually transmitted diseases present considerable diagnostic and therapeutic problems. With the recognition of vast numbers of non-gonococcal and chancroid infections, penicillin therapy is no longer adequate. This article outlines an approach to the management of urethritis and genital ulcer disease, giving suitable guidelines for the treatment of these 'disease syndromes'. The management of sexually transmitted vaginal discharges is also discussed, and the relevance of the rapidly performed 'wet mount' in the diagnosis of those discharges arising from the vaginal wall is stressed.

Acute Disease↗
PubMed1993

Problems in the treatment of urinary infections caused by Streptococcus agalactiae.

Authors have investigated the therapeutic problems in urinary infections caused by Streptococcus agalactiae in men and nonpregnant women. It is obvious from the literature that this problem has been considered mainly in pregnant women. On the basis of 86 patients (67 women and 19 men aged 14 to 81 years) it was established that the in vitro sensitivity of this Streptococcus was high (above 95%) to ampicillin, augmentin, cephalothin, lincomycin, chloramphenicol and erythromycin and 100% to rifampicin. For a successful treatment it is of great importance to establish the presence or lack of reservoirs of this infection (vagina, urethra, gastrointestinal tract). Mono- and combined antibiotic therapy was applied, as well as local treatment with vaginal lavages. Successful treatment is guaranteed by a thorough examination, identification of infection foci, including those outside the urinary system and choice of adequate individual approach to the patient. These variants are presented in detail.

Adolescent↗
PubMed2001

Outcome of surgical intervention for rectoneovaginal fistulas in Mayer-Rokitansky-Kuester-Hauser syndrome.

Creation of a neovagina to treat vaginal atresia or aplasia in Mayer-Rokitansky-Kuester-Hauser syndrome must always be followed by long-term application of dilators to avoid shrinkage. However, rectoneovaginal fistulas are caused by chronic alteration and consecutive necrosis of the posterior neovaginal wall. We evaluated retrospectively the postoperative outcome of rectal wall and neovaginal reconstruction using a standardized surgical technique in an exclusive collection of women. Eight women with a mean age of 28 years (range 22-31 years) were treated for rectoneovaginal fistulas in our clinic. Preoperatively, proctoscopy, sphincter manometry, endoluminal rectal ultrasonography, and colonoscopy were performed; and regular postoperative follow-up by digital examination and rectoscopy were obligate. The standard surgical procedure via a perineal approach included fistulectomy and closure of the mucosa and rectal wall followed by a levatorplasty. All but one woman had a temporary colostomy. After 2 weeks the patients were allowed to wear vaginal dilators of a smaller size. Within the mean follow-up period of 20 months, reintervention was necessary twice because of late fistula relapse detected by proctoscopy, barium enema, and subjective symptoms. Morbidity was 25% (n = 2) due to secondary superficial wound healing or urinary tract infection. The average time of the hospital stay was 13 days (10-14 days). One patient complained of vaginal shrinkage and underwent local estrogen therapy with a good functional result 3 months later. Proper fistulectomy and surgical reconstruction with interpositioning of well perfused muscle layers achieved good functional outcome with an acceptable number of minor morbidities. Local estrogen treatment is helpful for avoiding scarification and decreasing the neovaginal size.

Adult↗
PubMed2002

Vaginal microbicides.

The focus of this review will be to highlight articles from 2000 and up to August 2001 that demonstrate the challenges in the evaluation of candidate microbicides, and the ways in which investigators have approached these challenges.

Administration, Intravaginal↗
PubMed1986

A simplified approach to Shirodkar cerclage procedure.

The success of the Shirodkar cerclage procedure described herein lies in the use of the medium curve White tonsil forceps. The use of this curved tonsil clamp allows compression of the vaginal mucosa laterally, thereby making it relatively simple to place the Mersilene band accurately submucosally and avoiding blind advancement of an aneurysm needle.

Cervix Uteri↗
PubMed1981

Genital tract infection with Chlamydia trachomatis in prepubertal children.

Oculogenital strains of Chlamydia trachomatis are important causes of a wide range of genital tract infections in adults, but their recognized role in pediatric infections has been limited to neonatal inclusion conjunctivitis and interstitial pneumonia. We examined 23 prepubertal children with nongonococcal urethritis and vaginitis, and 31 with gonococcal anogenital infection. C. trachomatis was not found in 12 males and 11 females with nongonococcal urethritis or vaginitis. Nine of 33 episodes (27%) of gonorrhea were complicated by concurrent or subsequent chlamydial infection, including postgonococcal urethritis, vulvovaginitis, and asymptomatic anogenital colonization. C. trachomatis complicates gonococcal genital infections in prepubertal children at an incidence comparable to that seen in adults. The diagnostic and therapeutic approach to a prepubertal child with postgonococcal genital discharge should include consideration of this pathogen.

Age Factors↗
PubMed2000

Vulvovaginal soft tissue tumours: update and review.

Differences in biological behaviour make familiarity with (and accurate diagnosis of) vulvovaginal soft tissue tumours essential. Since ancillary studies such as immunoperoxidase staining and electron microscopy may not always be helpful in their distinction, one must often rely on morphological features to distinguish between different tumour types. This is particularly pertinent with regard to the relatively site-specific stromal tumours of this region. The purpose of this review article is to reacquaint the reader with these specific types of vulvovaginal soft tissue tumour, particularly focusing upon the salient morphological features that help in their distinction, as well as to review their clinical aspects and pathogenesis. The following soft tissue lesions are described: fibroepithelial stromal polyp, cellular angiofibroma, angiomyofibroblastoma, superficial angiomyxoma and aggressive angiomyxoma. Because of continued difficulty in predicting their behaviour, a discussion of vulvar smooth muscle tumours is also included, with a particular focus upon a practical approach to their diagnosis.

Diagnosis, Differential↗
PubMed2004

The significance of human papillomavirus infection detected by cervical cytology among women infected with the human immunodeficiency virus.

Human immunodeficiency virus (HIV) infection is a risk factor for both human papillomavirus infection (HPV) and cervical squamous intraepithelial lesions (SIL). This study was undertaken to determine the prevalence of underlying SIL among women with a cytological diagnosis of HPV infection alone. Of 160 women, the overall prevalence of HIV infection and SIL was 41.9% and 36.9%, respectively. Biopsy which confirmed SIL of any grade was demonstrated in 49.3% and 28% of HIV-infected and HIV-non-infected women. However, for individual grade of SIL, there was no statistical significant difference among the HIV-infected and HIV-non-infected groups. Although the finding of a cytological diagnosis of HPV among HIV-non-infected women is usually managed conservatively, the finding of a high rate of underlying SIL among HIV-infected women may argue against such a conservative approach.

Adult↗
PubMed2004

Recurrent extraperitoneal low grade leiomyosarcoma with unusual localization.

Primary extragenital leiomyosarcoma is rarely found in pelvic localization. A 33-year-old multiparous woman who had recurrent low-grade leiomyosarcoma presented with the complaints of dyspareunia, pelvic pain and gait disturbance. Her past medical history revealed she had been subjected to maximal excision of a paravaginal mass by using vaginal and suprapubic transverse incision three years before. The pathology report showed that she had leiomyoma. Three years after the initial surgery, a paravaginal fixed mass was observed at the initial tumor bed and removed by the perineal approach. The histological examination of the specimen revealed a low grade leiomyosarcoma. She was discharged from hospital without any complications.

Adult↗
PubMed2001

Diagnosis and management of vulvar and vaginal intraepithelial neoplasia.

Vulvar intraepithelial neoplasia and VAIN present unique challenges to the practicing gynecologist. VIN may produce distressing symptoms and undergo malignant conversion. A high index of suspicion and liberal use of biopsy are required to make the diagnosis. The approach to therapy for VIN has been reviewed. Treatment should be tailored to each individual patient and may include a period of expectant observation. Variations and combinations are used whenever necessary to preserve normal function and anatomy. Frequent surveillance is a must because recurrence rates are high, especially with multifocal disease in young women. Although VAIN accounts for less than 0.5% of lower genital tract neoplasia, the frequency of its detection is increasing, especially in younger patients. These lesions are most commonly found in the upper third of the vagina and are often multifocal in nature. The close proximity of the upper vagina to the rectum, bladder, and ureters makes treatment difficult. The occult invasion rate may be as high as 28%, and a wide variety of therapies are available. As is true for VIN, recurrence is not uncommon.

Administration, Topical↗
PubMed1976

Station of the fetal presenting part. VI. Arrest of descent in nulliparas.

The specific labor aberration of arrest of descent was investigated in 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxytocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases in which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.

Adult↗
PubMed2000

[Burch laparoscopic colposuspension. Results of 30-month follow-up].

UNLABELLED: Burch colpo-suspension, which is the present gold standard for treatment of stress urinary incontinence, may be performed laparoscopically. STUDY AIM: The aim of this retrospective study was to report the results of laparoscopic Burch colpo-suspension with a 30-month follow-up and to assess the reason for the unsuccessful results. PATIENTS AND METHOD: From 1990 to 1999, 118 patients (mean age: 46 years) were operated on for stress urinary incontinence with laparoscopic colpo-suspension. Urinary incontinence was classified grade 1 (6%), 2 (67%) and 3 (27%). The Burch colpo-suspension was performed through extraperitoneal approach in 51% and transperitoneal in 49%. A genital prolapse was associated in 31% of the patients and treated with sacropexy. A subtotal hysterectomy was performed in 25% of the patients and a vaginal hysterectomy in 46%. RESULTS: Global morbidity rate was 19%, including four cases of bladder injury. With a 30-month follow-up, 76/118 (64.4%) had no more urinary incontinence. Parity, age, previous pelvic surgery, detrusor instability and low urethral closure pressure were not predictive of recurrent stress urinary incontinence after treatment. Associated sacropexy was only correlated with a high risk of failure (P = 0.04). Patients with hysterectomy had significantly better results (72% vs 41.9%) (P = 0.05). Trans- and extraperitoneal techniques had similar results (P = 0.7). CONCLUSION: With a 30-month follow-up, 64.4% of the patients had satisfactory results with strictly no more stress urinary incontinence. There was no significant difference between the trans- and the extraperitoneal approach. Sacropexy was only associated with a higher rate of failure.

Adult↗