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PubMed2005

Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh.

PURPOSE: We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure for the surgical treatment of stress urinary incontinence in women. MATERIALS AND METHODS: A total of 65 patients diagnosed with stress urinary incontinence underwent a transobturator suburethral tape procedure with a fusion welded, nonwoven, nonknitted polypropylene mesh, with or without a central silicone coated section, at our institution. All women were followed and if vaginal erosion was diagnosed, cystoscopy and vaginoscopy were performed, the mesh was partially or completely removed and, if necessary, posterior cough test and urodynamic study were performed. RESULTS: Of the 65 patients 9 (13.8%) were diagnosed with vaginal erosion at the vaginal incision during a relatively long postoperative period (mean 290 days). All presented with vaginal discharge and 1 had a severe complication (obturator abscess). Complete mesh removal was necessary in 8 patients and only 2 (22%) had recurrent stress urinary incontinence. CONCLUSIONS: A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).

Adult↗
PubMed1995

Blues and depression during early puerperium: home versus hospital deliveries.

OBJECTIVE: To investigate whether women who give birth at home are less prone to mood disturbances during the early puerperium than those who give birth in hospital. DESIGN: A prospective study of 303 pregnant women who registered for antenatal care. SETTING: The antenatal clinic at St Joseph's Hospital, Veldhoven, The Netherlands, and five antenatal consultation programmes of local midwives working in the surrounding region. SUBJECTS: Three hundred and eighty-two consecutive caucasian women registering for antenatal care were approached. Of these, 303 consented to participate and 293 completed the study. MAIN OUTCOME MEASURE: The predictor variable was the way in which the women gave birth: spontaneous vaginal parturition at home or in hospital as follows: spontaneously; vaginal parturition after stimulation with medication; vaginal parturition with forceps/vacuum extraction; or caesarean section. The outcome variables were blues and depression. The occurrence of blues was assessed at 4 weeks postpartum, using Pitt's criteria. The occurrence of depression was assessed at 4 weeks postpartum using the Research Diagnostic Criteria. The possible confounding effects of a set of obstetrical and psycho-social variables relating to the early puerperium were investigated using logistic regression analysis. RESULTS: Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium. CONCLUSIONS: Women who gave birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.

Affective Disorders, Psychotic↗
PubMedDate not supplied

Bilateral hydronephrosis caused by vaginal prolapse.

INTRODUCTION: Even though it is uncommon, uterine prolapse can cause compression of ureters and bilateral hydronephrosis, predisposing to arterial hypertension and renal failure. Hydronephrosis consequent to cystocele and to vaginal prolapse is even rarer. CASE REPORT: This paper reports on a 59 year-old patient, Caucasian, obese and hysterectomized who presented complete vaginal prolapse with bilateral hydronephrosis and slight alteration in serum urea and creatinine. Patient underwent correction of vaginal prolapse by endoscopic suspension technique with improvement of hydronephrosis and normalization of renal function. This work emphasizes the rarity of such case and the requirement of surgical approach.

Journal Article↗
PubMed1993

The case. What should Leah be told?

Fearing that his 18-year-old daughter will value her fertility more than her life, an Orthodox Jewish father implores physicians not to seek her informed consent for surgery for vaginal cancer.

Adolescent↗
PubMed2001

Novel routes of insulin delivery for patients with type 1 or type 2 diabetes.

Subcutaneous insulin has been used to treat diabetes since the 1920s; however, despite a number of different formulations, intensive insulin therapy with multiple daily injections has not gained widespread clinical acceptance. Attempts to find effective, well-tolerated, nonenteral routes for delivering insulin began in the 1920s, and, over the years, have included ocular, buccal, rectal, vaginal, oral, nasal and uterine delivery systems. Until recently, many researchers believed that insulin delivered noninvasively was associated with too low a bioavailability to offer a realistic clinical approach. However, a growing body of evidence suggests that inhaled insulin is an effective, well-tolerated, noninvasive alternative to subcutaneous regular insulin. Critically, inhaled insulin shows a more physiological insulin profile than that seen with conventional insulin. Further studies are needed to confirm long-term efficacy and pulmonary safety, to compare the different approaches, and to characterize better their relative places in practice. As a result of the recognition of the importance of tighter control of glycaemia and the growing number of patients with type 2 diabetes who receive insulin, inhaled insulin could become an increasingly integral part of managing diabetes.

Administration, Inhalation↗
PubMed1989

Artificially induced menstrual cycle with natural estradiol and progesterone.

In order to study the feasibility and efficacy of using natural 17 beta-estradiol (E2) and progesterone (P) to induce endometrial changes, a group of patients with history of premature ovarian failure and bilateral oophorectomy, also interested in the embryo transfer program with donor ovum, were given transdermal E2 (Estraderm, Ciba Pharmaceutical Co., Summit, NJ), and vaginal progesterone suppositories. Serial serum E2, P, follicle-stimulating hormone, and luteinizing hormone were determined by radioimmunoassays. The dosages of E2 and P were adjusted according to the levels of E2 and P so that their changes could follow the same pattern as that of a normal spontaneous menstrual cycle. Serial ultrasonic evaluation of the endometrium and endometrial biopsy during the late luteal phase also was performed. Preliminary data indicated that transdermal E2 patches and vaginal P suppositories, while being as effective in inducing endometrial development for the embryo transfer procedure with donor ovum as synthetic steroids, can also provide a more physiologic approach that may conveniently and safely be extended into the second trimester of pregnancy.

Administration, Cutaneous↗
PubMed1988

Antibiotic usage in pelvic infections. An overview.

Postoperative soft-tissue pelvic infections in women most commonly are polymicrobial and mixed aerobic and anaerobic. Antibiotic prophylaxis has been advocated to reduce the risk of postcesarean endometritis and post-vaginal hysterectomy pelvic infection. The use of antibiotic prophylaxis has a tendency to select for resistant bacteria, and many of those bacteria produce beta-lactamase. A new approach to the treatment of those infections is to employ beta-lactamase inhibitors in conjunction with a broad-spectrum antibiotic, such as ticarcillin disodium plus clavulanate potassium (Timentin).

Anti-Bacterial Agents↗
PubMed1985

Uterus duplex with a unilaterally imperforate vagina--diagnosis and treatment. Report of two cases and review of the literature.

Severe cyclic dysmenorrhoea in a young woman with a unilateral abdominopelvic mass terminating in a purpuric bulge in the lateral vaginal wall, and resulting in renal agenesis ipsilateral to the pelvic mass, suggests uterus didelphys with unilaterally imperforate vagina. A report of two cases, their diagnostic and therapeutic approach and review of the literature are presented.

Abnormalities, Multiple↗
PubMed1998

Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature.

OBJECTIVE: To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature. QUALITY OF EVIDENCE: Scientific articles were identified by searching MEDLINE, CINAHL, and HEALTH databases from 1966 to mid-1997 for English-language articles. More than 200 references were reviewed; 85 were selected for citation based on specific reference to alternative medicine for symptoms commonly attributed to menopause (e.g., hot flashes), to the effects of changing estrogen levels (e.g., irregular menses, vaginal dryness), and to reported side effects of the treatments. MAIN FINDINGS: The scientific literature was categorized under the headings nutritional supplements, herbal remedies, homeopathic remedies, and physical approaches. Some scientific evidence of the safety and efficacy of alternative treatments during menopause was uncovered, with the strongest evidence emerging in favour of phytoestrogens, which occur in high concentrations as isoflavones in soy products. CONCLUSIONS: In available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to estrogen deficiency and for possible protective effects on bones and the cardiovascular system. Randomized controlled trials, standardization of dosage, and accurate safety and efficacy labeling are required to ensure proper use of alternative remedies.

Complementary Therapies↗
PubMed2005

Alcohol or traditional methods versus natural drying for newborn's cord care.

This is a quasi-experimental study that aimed to compare the use of alcohol and traditional methods for newborn's cord care with a no-treatment approach, natural drying. The study also aimed to identify the factors associated with the occurrence of cord infection and time of cord separation. A convenient sample of 70 women with vaginal delivery, full-term and healthy babies was selected from postpartum departments of two university hospitals in Alexandria and Minia. A specially designed interview schedule was developed and utilized to collect data. Swabs were taken from the newborns' umbilical stumps on zero and 3rd day of birth to detect bacterial colonization. Follow-up was carried-out at home to assess methods used for cord care, babies' hygiene, cord infection and time of cord separation. The study revealed that traditional methods of cord care were used by women with higher mean age (30.8 +/- 7.8 years), from Minia (100%) or rural areas (71.4%), while alcohol and natural drying were used by women with lower mean age (27.7 +/- 4.8 and 24.8 +/- 6.5 years) respectively, from Alexandria (76% and 100%) respectively or urban areas (56% and 64.7%) respectively. Alcohol was used for male babies (76%), while traditional methods and natural drying were used for female babies (71.4% & 64.7%) respectively. Incidence of cord infection was significantly lower among natural drying group (35.3%), and no signs of systemic infection were observed among them. Rate of increase of bacterial colonization (from 0-3rd day of birth) was significantly higher in alcohol group (44%). It was relatively similar with presence or absence of cord infection (33.3 & 32.1) respectively. Mean time of cord separation was longer among alcohol group (6.4 +/- 2.4 days), as compared with natural drying group (4.7 +/- 1.9 days) and traditional methods group (3.4 +/- 0.7 days). Bathing baby while cord was attached was carried-out by all women of alcohol and natural drying groups, compared to only 28.6% of traditional methods group. Breast-feeding was significantly related to less incidence of cord infection (P= 0.008) and shorter time of cord separation (P= 0.002). Incidence of cord infection was significantly related to using cloth diaper (P= 0.015), using dry method for skin care (X(2) 2= 7.2917), giving tub bath (X(1)2 = 4.1788) and delaying the bath to the 7th day of birth (P= 0.050). Time of cord separation was significantly shorter with closed cord dressing (X(2)2= 20.4028), in Minia, during spring, among male babies (X(2)2= 15.0352), and in rural areas (X(2)2 = 9.7608). It was significantly longer with bathing the baby while cord was attached (X(2)2 = 27.9354), giving 2-3 baths/week or delaying the bath to the 7th day of birth (P= 0.049) and with using cloth diaper (P= 0.0467). So, moving from an intervention to a non- intervention, particularly in a healthy population should be applied to the healthy naturalistic approach to care advocated in nursing. Also, only through continuing efforts done to examine our assumptions about historic health care routines, will we be able to demonstrate evidence-based practice and to advance nursing care.

Adult↗
PubMed1996

Simultaneous laparoscopic cholecystectomy and laparoscopically assisted vaginal hysteroadnexectomy.

As a consequence of the wide applications of operative laparoscopy and thoracoscopy, simultaneous surgical procedures have been carried out endoscopically. We report a 51-year-old woman treated by simultaneous laparoscopic cholecystectomy and celioscopically assisted vaginal hysteroadnexectomy for hydropic calculous gallbladder, uterine myomas, and bilateral ovarian policystosis. These procedures were carried out using six abdominal trocar sites, and the gallbladder was removed through the colpotomic access. The patient had an uncomplicated postoperative course and was discharged on postoperative day 5. In our opinion, the multidisciplinary laparoscopic approach, with the original technical solutions, represents an effective, minimally invasive method of treatment that gives new perspective about the indications and the treatment of similar cases.

Cholecystectomy, Laparoscopic↗
PubMed1987

Cervical cytology: a general practice audit.

The UK cervical cytology programme has not had a significant impact on the disease. Reasons for this are discussed, and in particular the role of the primary care physician. One method of increasing awareness and improving performance is peer group audit. Such an initiative was taken by the Vale of Trent faculty of the Royal College of General Practitioners. Of the 240 members 140 (58%) responded to a questionnaire about smear policy and organization. Seventy-six practices, which included 101 members (42%) reviewed a sample of 100 records of women aged 35-64 years. Performance was estimated by noting the number in each sample who had never had a smear taken and the number who had had a smear taken in the last five years. Wide variations in performance were found, little of which could be explained by the variables measured. Practices with an active call system produced slightly higher coverage rates. The value of such an audit is discussed and suggestions made for facilitating this approach.

Adult↗
PubMed1998

Endoscopic lymphadenectomy and LAVH in the treatment of endometrial cancer.

This article describes the results of two and half years experience in laparoscopic treatment of patients with endometrial cancer stage I and II. Between January 1994 and October 1996, 25 patients were treated by laparoscopy procedures. All of them had performed LAVH and pelvic lymphadenectomy. The technique of the laparoscopic procedure was accurately described. No operative complications were observed and blood loss did not exceed 250 ml. In 7 patients (27.8%) nodal metastases were found. Mean 14 (range 7-25) lymph nodes were removed. After surgery some patients required radiotherapy. Up to now all patients are free of disease. We believe that laparoscopic assisted surgical staging of stage I and II endometrial cancer is an attractive alternative to the traditional surgical laparotomy approach.

Adenocarcinoma↗
PubMed2003

Primary small cell carcinoma of the vagina.

BACKGROUND: Primary vaginal small cell carcinoma is extremely rare, with a total number reported in English-language journals to date of 23. Most patients die of the disease within 2 years of diagnosis from metastatic disease. CASE: A 69-year-old woman presented with vaginal spotting while on Premarin. She was subsequently diagnosed with Stage I (T1N0M0) small cell carcinoma of the vagina. She underwent concurrent chemoradiation and then brachytherapy for persistent disease. Due to residual disease after the brachytherapy, surgical resection was planned but aborted because of metastatic disease. CONCLUSIONS: Of the three reported cases treated with concurrent chemoradiation, ours is the first case reported with persistent local disease after therapy. Extrapolating from the available clinical trials from lung carcinoma, concurrent chemoradiation as a primary treatment approach should still be considered.

Aged↗
PubMed1981

Experimental simulation of neuroendocrine dynamics at periparturient periods--a synthetic approach to pregnancy maintenance, parturition and lactation by programmed infusion of sex steroids in ovariectomized rats.

The blood levels of progesterone (P) and estradiol (E2) were artificially controlled in rats ovariectomized on days 19-20 of pregnancy (day 1: sperm in vaginal smears) by 48-168 h intravenous infusions according to 15 different temporally variable programs. The predominance of P infused in various curves for longer than 72 h, caused postmature deliveries on days 24-26 accompanying difficulties in labor and the lack of lactation, although changes in E2 levels antagonistically accelerated the timing of delivery. The most successful delivery and subsequent lactation were induced by an infusion of total amount of 1.5 mg P for 48 h (days 19-21) at a linearly decreasing rate in combination with an infusion of a total amount of 875 ng E2 for 72 h (days 19-22) at a slowly increasing rate, reaching a plateau in the morning of day 21 and rapidly decreasing to nil after that. Spontaneous delivery occurred on day 22 with a normal range of labor duration and no incidence of stillbirth. No further supply of sex steroids was required for the maintenance of lactation. Blood levels of prolactin shortly after delivery were much higher in these lactating ovariectomized rats than in non-lactating animals. The neuroendocrine dynamics at periparturient periods, which triggers the termination of pregnancy and then the induction of parturition and lactation, is discussed in relation to the results of these simulation experiments.

Animals↗
PubMed2002

Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage.

OBJECTIVE: To describe a novel, effective, and minimally invasive surgical technique for avoiding excess blood loss and hysterectomy in intractable postpartum hemorrhage. Previously described techniques-uterine artery ligation at various levels, hypogastric (internal iliac) artery ligation, uterine compression-all require an abdominal approach. METHODS: This procedure, which is quickly learned, is performable in the delivery room with minimal preparation, with or without bladder retraction. A 2-cm horizontal incision is made in the anterior cervix 1 cm beneath the estimated vaginocervical fold and the bladder reflected in the natural plane. Firm but gentle downward traction on the uterus to the contralateral side of the intended ligature maximizes cephalad and lateral access, permitting bilateral uterine artery ligation from laterally under direct vision and/or indirect transcervical palpation. RESULTS: Between November 1997 and June 2001, 13 women with intractable postpartum hemorrhage chose the vaginal route over laparotomy as a uterus-preserving procedure. Hysterectomy proved necessary in only one case (8%) because of placenta percreta. One woman has since delivered a healthy term infant by cesarean, and uterine vascularization was unimpaired. CONCLUSION: The vaginal route offers a novel, simple, effective, and minimally invasive technique for treating intractable puerperal hemorrhage by uterine artery ligation. Timely intervention avoids hysterectomy and consumption coagulopathy and preserves reproductive potential.

Arteries↗
PubMed2002

Reducing cesarean delivery rates in managed care organizations.

BACKGROUND: A national consensus has emerged that cesarean delivery (CD) rates are excessive. OBJECTIVES: To review the subject of CD delivery and to discuss options for reducing CD delivery rates in managed care organizations (MCOs) from the current rate of approximately 22% to a rate of 10% to 15% in 5 years, as proposed by the World Health Organization. STUDY DESIGN AND METHODS: Literature review. RESULTS: Contracted physicians could be provided with evidence-based clinical practice guidelines for CD as well as data on acuity-adjusted physician-specific CD rates within the MCO and could be offered supplementary fees for performing vaginal deliveries after a previous CD. Administrators and physician leaders of contracted hospitals could also be asked to adopt written criteria for lack of progress in labor, to review all indications for CD for all cases, to encourage use of vaginal delivery after a previous CD, and to require a second opinion for performing all except emergency CDs. Members of MCOs who become pregnant could be mailed an educational pamphlet that encourages vaginal delivery rather than CD. CONCLUSIONS: To facilitate dissemination of information, MCOs should report their experience in implementing, monitoring, and evaluating the effectiveness and outcomes of programs to reduce CD delivery rates. The MCO objective would be to lower CD rates without alienating physicians or attempting to impose a regimented approach that would offend and be counterproductive for consumers.

Cesarean Section↗