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At least 1,621 records · Page 90Linked to original sources
PubMed1978

Hyperprolactinemia-induced precocious puberty in the female rat: ovarian site of action.

Hyperprolactinemia induced in immature female rats by chronic treatment with sulpiride, a dopaminergic receptor blocker, resulted in advancement of the onset of puberty. While serum PRL levels increased promptly after initiation of the treatment and remained elevated throughout the entire period studied (day 22 to first diestrus after vaginal opening), gonadotropin levels did not appear to be altered and increased abruptly only at the time of the first preovulatory surge. Except for a decrease during the first diestrus, serum TSH and GH were not consistently altered by sulpiride. After 5 days of treatment, serum progesterone levels, but not those of androgens, were increased in hyperprolactinemic (HP) rats. Uterine weight, taken as an index of estrogen secretion, was unambiguously increased in HP rats, the first significant difference being observed 5 days after initiation of the sulpiride treatment (day 27). Ovarian estrogen and progesterone responsiveness of normal animals to gonadotropins, as determined by in vitro release of the steroids after incubation with hCG, increased with age. The response was dramatically enhanced in HP rats, its magnitude increasing markedly as the animals approached puberty. Androgen response to hCG was, however, similar in HP and control rats. In vitro release of adrenal progesterone, but not that of estrogen or androgens, was slightly enhanced in HP rats. When sulpiride treatment was terminated on the first day of diestrus after vaginal opening, the animals continued to show estrous cycles. By contrast, maintenance of the treatment for several days after vaginal opening resulted in a condition of constant diestrus. The results suggest that one of the mechanisms by which PRL induces precocious puberty in the female rat is by sensitizing the ovaries to the low circulating gonadotropin levels observed during the prepubertal period. In addition, PRL also seems to stimulate progesterone secretion by the adrenal glands.

Androgens↗
PubMedDate not supplied

[Laparoscopic hysterectomy in the surgical treatment of gynecological malignant and premalignant diseases].

INTRODUCTION: Laparoscopic hysterectomy (LH) is a safe surgical approach that offers patients a faster recovery. However, its use in malignant or premalignant gynecological lesions is not well established. The objective of the present study was to show the feasibility of LH in a tertiary cancer center. MATERIAL AND METHODS: We conducted a descriptive analysis of patients with histologically proven malignant or premalignant uterine lesions who underwent to LH. Surgical time, bleeding complications, and hospital stay were evaluated. RESULTS: Twenty-five patients were included with a mean age of 45 years. Ten LH (40%) with or without salpingo-oophorectomy for premalignant or preinvasive malignant lesions were done, five surgical staging procedures for endometrial cancer (20%) and seven radical hysterectomies for cervical cancer (28%). In three patients, conversion from laparotomy (12%) was necessary for operative complications (two cases) or technical problems (one case). Mean operative time for the entire group was 207 min, mean bleeding 204 mL and mean hospital stay was 2.5 days. Postoperative complications were present in two patients, hematoma in the vaginal cupola (one case) and temporary bladder dysfunction (one case). CONCLUSIONS: In the present trial we described our initial experience in LH for the treatment of malignant and premalignant gynecologic diseases. Our results suggest that it is a safe and feasible surgical approach. Long-term surveillance studies are necessary for the evaluation of recurrence patterns and overall survival.

Adult↗
PubMed1976

Persistent brow presentation: a new approach to management.

When the fetal vertex is extended on the spinal column and the brow becomes the presenting part, it is termed "brow presentation." Persistent brow presentation occurs when there is no spontaneous conversion after the onset of active labor. Since there is a risk in the vaginal delivery of such fetuses, it should not be attempted where there is known maternal disease or evidence of acute or chronic intrauterine fetal distress. During labor, cesarean section is indicated if there is cephalopelvic disproportion, if the fetal head is not in the frontoanterior position, if there is abnormal labor, or if there is evidence of fetal distress. Continuous lumbar epidural anesthesia should be given, and only manual conversion is used. The fetus is monitored continuously.

Anesthesia, Epidural↗
PubMed2006

The management of severe vaginal obstruction from genital chronic graft-versus-host disease: diagnosis, surgical technique and follow-up.

AIM: Chronic graft-versus-host disease (GVHD) is one of the most important systemic late-onset complications of haematopoietic stem cell transplantation. Gynaecological manifestations are considered relatively rare, and involve lower genital tract skin and mucosa, causing vulvar scarring, vaginal stenosis, affecting the patients' sexual life, and leading to more serious complications as haematocolpos, haematometra and abscesses. Genital GVHD can be treated with topical therapy when mild to moderate disease is present. Surgery is indicated in advanced and complicated cases to restore normal anatomy. The aim of this study is to propose a standard approach for the management of such condition when medical therapy is not effective. METHODS: From May 2000 to January 2002, 8 patients suffering from genital chronic GVHD were operated in our institution. We describe clinical and sonographic presurgical assessment, simple or ultrasonographic guided surgical technique, postsurgical treatment and follow-up. RESULTS: Surgery was completely successful in restoring genital anatomy in all the cases. Mean follow-up was of 17 months (6 to 38 months). Two patients early discontinued the postsurgical treatment. At 1 month complete vaginal patency was found in 6 cases, weak partial adhesions in 1 case, while 1 patient refused follow-up. Eventually, complete vaginal patency was maintained in 2 cases, and partial adhesions were found in 5 cases. CONCLUSIONS: The combined use of clinical examination and endosonography provides a precise assessment of the level of the obstruction. The surgical technique here described is feasible and successful in restoring normal anatomy, while long term results seem related to the compliance towards the postsurgical treatment.

Adult↗
PubMed2004

[Abdominal management of rectocele and elytrocele: place of the laparoscopic approach].

AIM OF THE STUDY: To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele. PATIENTS AND METHODS: Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series. RESULTS: The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients. CONCLUSION: The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.

Adult↗
PubMedDate not supplied

The place of sling operations in treating genital prolapse in young women.

A review of 260 cases of genital prolapse in women less than 35 years of age is presented. Thirty-six percent of the women were less than 25 years old, and 73.5% were less than 30 years. Until 1965, a total of 85 patients had undergone either Manchester operations or simple colporrhaphies after a conventional method of treatment. Since then, a different surgical approach was elected, and patients were divided into four groups according to the severity of their conditions and the types of operation required. The abdominal sling operation was performed on 110 patients, and the vaginal sling operation was performed on 18 women. Other patients had Manchester operations or simple colporrhaphies,

Abdomen↗
PubMed2001

Outlet Dysfunction Constipation.

The diagnosis of outlet dysfunction constipation in patients with idiopathic constipation that responds poorly or not at all to conservative measures, such as fiber supplements, fluids, and stimulant laxatives, is based upon diagnostic testing. These tests include colonic transit of radio-opaque markers, anorectal manometry or electromyography, barium defecography, and expulsion of a water-filled balloon. The literature suggests that conditions such as pelvic floor dyssynergia exist but may be over-diagnosed as a laboratory artifact. In our laboratory, we screen patients with balloon expulsion studies, and then test for dyssynergia only if the result of the balloon expulsion test is abnormal. In my opinion, anal sphincter electromyogram and manometry are equivalent in establishing the diagnosis. Barium defecography is helpful in making a diagnosis of a rectocele, but I prefer to document that vaginal pressure on the rectocele significantly improves rectal evacuation. Manometry also helps to establish the presence of megarectum, hypotonia, and weak expulsion efforts. Conceptually, biofeedback training, which incorporates simulated defecation, is the most logical approach to pelvic floor dyssynergia. It incurs no risk and benefits 60% to 80% of patients. The drawbacks are the time-intensive nature of the therapy and the short-term costs, which are offset if there is sustained benefit. There is no evidence that biofeedback is helpful in children with constipation. Habit training has established benefits, but recurrences are frequent and long-term reinforcement is helpful to maintain success. Laxatives and enemas are adjunctive therapies in both habit training and biofeedback. Surgery is effective in those uncommon patients with physiologically significant rectoceles, but surgical division of the puborectalis muscle is risky and unproven. Likewise, botulinum toxin injection into the puborectalis is unproven, but the effects are rarely permanent should incontinence occur. Diagnostic measures and therapeutic success are enhanced when patients are seen in centers experienced with the evaluation of these disorders.

Journal Article↗
PubMed1990

Evaluation of different surgical approaches in the treatment of endometrial cancer at FIGO stage I.

From January 1, 1970 to December 31, 1979, 425 cases of endometrial carcinoma, FIGO stage I, were treated at the First Department of Obstetrics and Gynecology, University of Milan. Three different surgical approaches were used: total abdominal hysterectomy with bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy was performed in 245 women, total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy in 100, and vaginal hysterectomy with bilateral salpingo-oophorectomy in 80. Five-year survival was evaluated as a function of risk factors (histological grade, depth of myometrial invasion, metastatic nodes) in the three groups of patients, and we conclude that lymphadenectomy is useful for prognostic purposes but does not confer a therapeutic benefit.

Adult↗
PubMed2004

Surgical management of cloacal malformations: a review of 339 patients.

BACKGROUND/PURPOSE: The aim of this study was to describe lessons learned from the authors' series of patients with cloaca and convey the improved understanding and surgical treatment of the condition's wide spectrum of complexity. METHODS: The medical records of 339 patients with cloaca operated on by the authors were retrospectively reviewed. RESULTS: A total of 265 patients underwent primary operations, and 74 were secondary. All patients were approached posterior sagittally; 111 of them also required a laparotomy. The average length of the common channel was 4.7 cm for patients that required a laparotomy and 2.3 cm for those that did not. Vaginal reconstruction involved a vaginal pull-through in 196 patients, a vaginal flap in 38, vaginal switch in 30, and vaginal replacement in 75 (36 with rectum, 31 with ileum, and 8 with colon). One hundred twenty-two patients underwent a total urogenital mobilization. Complications included vaginal stricture or atresia in 17, urethral strictures in 6, and urethro-vaginal fistula in 19, all of which occurred before the introduction of the total urogenital mobilization. A total of 54% of all evaluated patients were continent of urine and 24% remain dry with intermittent catheterization through their native urethra and 22% through a Mitrofanoff-type of conduit. Seventy-eight percent of the patients with a common channel longer than 3 cm require intermittent catheterization compared with 28% when their common channel was shorter than 3 cm. Sixty percent of all cases have voluntary bowel movements (28% of them never soiled, and 72% soiled occasionally). Forty percent are fecally incontinent but remain clean when subjected to a bowel management program. Forty-eight patients born at other institutions with hydrocolpos were not treated correctly during the neonatal period. The surgeons failed to drain the dilated vaginas, which interfered with the drainage of the ureters and provoked urinary tract infections, pyocolpos, and/or vaginal perforation. In 24 patients, the colostomy was created too distally, and it interfered with the pull-through. Twenty-three patients suffered from colostomy prolapse. All of these patients required a colostomy, revision before the main repair. Thirty-six patients underwent reoperation because they had a persistent urogenital sinus after an operation done at another institution, and 38 patients underwent reoperation because they suffered from atresia or stenosis of the vagina or urethra. The series was divided into 2 distinct groups of patients: group A were those with a common channel shorter than 3 cm (62%) and group B had a common channel longer than 3 cm (38%). CONCLUSIONS: The separation of these groups has important therapeutic and prognostic implications. Group A patients can be repaired posterior sagittally with a reproducible, relatively short operation. Because they represent the majority of patients, we believe that most well-trained pediatric surgeons can repair these type of malformations, and the prognosis is good. Group B patients (those with a common channel longer than 3 cm), usually require a laparotomy and have a much higher incidence of associated urologic problems. The surgeons who repair these malformations require special training in urology, and the operations are prolonged, technically demanding, and the functional results are not as good as in group A. It is extremely important to establish an accurate neonatal diagnosis, drain the hydrocolpos when present, and create an adequate, totally diverting colostomy, leaving enough distal colon available for the pull-through and fixing the colon to avoid prolapse. A correct diagnosis will allow the surgeon to repair the entire defect and avoid a persistent urogenital sinus. Cloacas comprise a spectrum of defects requiring a complex array of surgical decisions. The length of the common channel is an important determinant of the potential for urinary control, and predicts the extent of surgical repair.

Cloaca↗
PubMed2003

Laparoscopic two-team slings for women with stress urinary incontinence.

STUDY OBJECTIVE: To review long-term success and complication rates of laparoscopic two-team sling procedures in women with stress urinary incontinence or mixed incontinence confirmed by urodynamic testing and cystoscopy. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Tertiary urogynecology unit at a university-affiliated teaching hospital. PATIENTS: One hundred seventy-five women. INTERVENTIONS: Laparoscopic two-team sling procedure. MEASUREMENTS AND MAIN RESULTS: The extraperitoneal approach to the space of Retzius was accomplished using a balloon device, and the intraperitoneal approach involved a transverse incision through the anterior parietal peritoneum 6 cm above the symphysis. A 1.5- to 2.0-cm wide strip of polypropylene mesh was inserted through a vertical incision along the anterior vaginal wall, perforating the urogenital diaphragm under laparoscopic guidance. The mesh was sutured to Cooper's ligaments bilaterally with 0 polypropylene sutures. Mean operating time was 80.1 +/- 30.0 minutes, mean estimated blood loss was 160 +/- 146 ml, and mean hospital stay was 2.4 +/- 1.2 days. Patients were followed at 6 weeks, 6 months, 1 year, and yearly (mean 17.8 mo, range 1-5 yrs). CONCLUSION: Laparoscopic two-team sling procedures can be performed safely in women with recurrent stress incontinence and those with risk factors for failure of retropubic urethropexy. Long-term success rates are excellent (91.1%) with few complications.

Female↗
PubMed1991

Screening for fetal anomalies during the first trimester of pregnancy: transvaginal versus transabdominal sonography.

Ultrasound is a sensitive tool for the diagnosis of fetal anomalies during the prenatal period. Most knowledge about the ultrasound images of such anomalies is based on abdominal scanning during the second trimester of pregnancy. The value of transvaginal sonography for evaluating fetal anomalies and a comparison with transabdominal sonography in the first trimester has, to our knowledge, so far not been studied. During a 12-month period, 800 pregnant women between 9 and 13 weeks of gestation, underwent first a transabdominal scan followed by a transvaginal examination, in order to compare the value of the two techniques. Eight cases of fetal abnormality, including anencephaly, exencephaly, cervical myelomeningocele, cystic hygroma, omphalocele, posterior fossa cyst and syndactyly, were diagnosed by using the transvaginal sonographic approach. The standard abdominal technique failed to detect four of these anomalies, while in the other four only vague and non-specific fetal abnormalities could be demonstrated. All women with normal abdominal and vaginal sonograms in the first trimester were rescreened transabdominally at mid-gestation. Five patients with a variety of fetal anomalies, including hydrocephalus, agenesis of corpus callosum, bilateral ureteropelvic junction obstruction, right heart hypoplasia and tetralogy of Fallot, were identified in the rescreening procedure. One case of ventricular septal defect and coarctation of the aorta was not detected at either of the first or second screening procedures. Our findings show that transvaginal sonography is more sensitive than transabdominal sonography in the detection of first-trimester anomalies. However, since not all fetal anomalies are manifest so early in pregnancy, standard abdominal sonography in the second trimester is still recommended.

Journal Article↗
PubMed1989

Research comparing the dyadic adjustment and sexual functioning concerns of diabetic and nondiabetic women.

The dyadic relationship and sexual functioning concerns of a group of diabetic women and a matched control group of nondiabetic women were compared. There was no statistically significant difference in overall dyadic adjustment between the two groups. Both diabetic and nondiabetic women were moderately well adjusted. However, diabetic women were significantly more concerned than nondiabetic women in the following six specific sexual functioning areas: (a) frequency of feeling sexual repulsion, (b) frequency of difficulty with vaginal lubrication, (c) frequency of difficulty reaching orgasm, (d) impact of genital discomfort, (e) frequency of performance anxiety, and (f) impact of performance anxiety. Therefore, health care professionals need to use the suggested holistic approaches in helping diabetic women overcome these sexual functioning concerns. Finally, the relationship between level of sexual functioning concerns and overall dyadic adjustment was not statistically significant for either group. This finding supports the belief that sexual and marital factors may operate independently.

Adolescent↗
PubMed2006

Diaphragmatic hernias complicating pregnancy.

BACKGROUND: Diaphragmatic hernias complicating pregnancy are not a common problem but they can have catastrophic consequences. They can present to the surgeon as a life-threatening emergency or pose a management dilemma when detected incidentally. In this paper, recommendations for the management of non-hiatal maternal diaphragmatic hernias are made based on our experience and the available published reports. METHODS: The presentation, management and outcomes of a series of three recent cases are described. A review of all other reported cases of diaphragmatic hernias complicating pregnancy was also carried out. RESULTS: All three cases were emergency presentations in the third trimester of pregnancy, resulting from compression of thoracic contents. All cases required emergency laparotomy and one also required thoracotomy. Delivery was by Caesarean section at the time of emergency surgery in two cases and was delayed in the third case. There was one fetal and no maternal deaths. One mother suffered persistent pleural infection. One baby also had a diaphragmatic hernia requiring postnatal repair. Published reports showed only 36 previously reported cases of diaphragmatic hernias identified in pregnancy. There is a consensus that hernias presenting with evidence of strangulation represent a surgical emergency and mandate operative management, irrespective of fetal maturity. Elective management of asymptomatic hernias is more controversial and both conservative and operative approaches have been suggested. CONCLUSION: Diaphragmatic hernias can cause life-threatening complications in pregnancy. Consideration should be given to operative repair in the second trimester if asymptomatic hernias are identified during pregnancy. If vaginal delivery is attempted in the presence of a hernia, this should only be carried out under closely monitored conditions.

Adult↗
PubMed1981

Teflon tape suspension for the control of stress incontinence.

Vaginal surgery for the relief of stress incontinence has a failure rate which is unacceptable. Since 1964 the authors have combined in the management of female urinary disorders. Where surgery was indicated the combined approach was used as the primary procedure. The bladder neck was elevated by a technique of suspension using 2 mm Teflon tape, via the cave of Retzius. It was not a sling. The results of 100 consecutive operations are presented. The team approach has lead to a better understanding and management of all varieties of female bladder problems.

Female↗
PubMed2000

Correlations between antibody immune responses at different mucosal effector sites are controlled by antigen type and dosage.

Monitoring specific secretory immunoglobulin A (IgA) responses in the intestines after mucosal immunization or infection is impeded by the fact that sampling of small intestinal secretions requires invasive methods not feasible for routine diagnostics. Since IgA plasma cells generated after intragastric immunization are known to populate remote mucosal sites as well, secretory IgA responses at other mucosal surfaces may correlate to those in the intestines and could serve as proxy measures for IgA secretion in the gut. To evaluate the practicability of this approach, mice were immunized intragastrically with 0.2, 2, and 20 mg of ovalbumin plus 10 microg of cholera toxin, and the antigen-specific local secretory IgA responses in duodenal, ileal, jejunal, rectal, and vaginal secretions, saliva, urine, and feces, as well as serum IgG and IgA responses were analyzed by enzyme-linked immunosorbent assay. Correlation analysis revealed significant relationships between serum IgG and IgA, urinary IgA, salivary IgA, and secretory IgA in duodenal, jejunal, ileal, and rectal secretions for the 0.2-mg but not for the 20-mg ovalbumin dose. Fecal samples were poor predictors for intestinal antiovalbumin IgA responses, and no correlations could be established for cholera toxin, neither between local anti-cholera toxin levels nor to the antiovalbumin responses. Thus, specific IgA in serum, saliva, or urine can serve as a predictor of the release of specific IgA at intestinal surfaces after intragastric immunization, but the lack of correlations for high ovalbumin doses and for cholera toxin indicates a strong dependency on antigen type and dosage for these relationships.

Animals↗
PubMed1997

[Does it make sense to carry out a Vecchietti intervention pelviscopically?].

The Mayer-Rokitansky-Küster syndrome is the most frequent cause of vaginal aplasia. There are several operations that can correct this malformation; the most important is that of Vecchietti. The rapid development of the laparoscopic know-how in the last years enables a pelviscopic approach of the laparotomic part of the Vecchietti operation. The question remains whether there are real advantages or whether the choice between laparotomy and laparoscopy should depend exclusively on the personal experience of the surgeon.

Adolescent↗