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PubMed1992

Experience with vaginal reconstruction utilizing the modified Singapore flap.

Many types of vaginal reconstruction have been described, and we have employed several with varying degrees of success. All we have used seem to have drawbacks. In April 1989 Wee and Joseph from Singapore described a technique using neurovascular pudendal-thigh flaps as islands. Initially we used the procedure as described. Later we modified the approach by releasing the labia majora, allowing them to retract somewhat anteriorly, and rotating the flap into position. This procedure has been used in eight patients, in some instances under the most adverse circumstances in patients who have undergone multiple procedures and heavy irradiation (including intraoperative radiation) besides experiencing postoperative leakage of urine. Though we have had dehiscence and problems with infection and drainage in some of our patients, no flap has failed, contour is exceptionally good, and potential for function is satisfactory. The procedure requires less time and produces better results than any other technique employed by us in the more than 30 vaginal reconstructions we have carried out. The technique will be illustrated and clinical cases will be presented.

Adolescent↗
PubMed2003

[Stress urinary incontinence: an overview on actual surgical trends].

Stress urinary female incontinence (IUS) is an unpleasant symptom describing a loss of urine during physical exertion; genuine stress incontinence (GSI) is a socially unacceptable, involuntary loss of urine in absence of detrusor activity from the urethra associated with sudden cough or strain. The incidence of IUS is less than 10% in reproductive-age women but may approach 10-20% in postmenopausal women. The IUS pathophysiology is connected with two specific mechanisms: the urethral-bladder sliding out of anatomical area involves the normal system of endobladder/intraabdominal pressures, with a loss of urine; the second mechanism involves the damaged urethral sphincteric function, with a reduction of the urethral closure pressure and a urinary loss after minimal physical stimulation. The IUS medical therapy is troublesome and often inefficient, and the only approved effective measures are the surgical procedures, actually reserved for cases of unsuccessful medical therapy; surgical treatments can be classified according to the access as: vaginal, abdominal, associated and complex. They intend to reposition the urethral-bladder sliding in its normal intra-abdominal position, to allow equal transmission of increased intraabdominal pressure to the bladder and the proximal urethra. In the scientific literature there are more than one hundred surgical procedures for IUS correction, but the IUS surgical approach is anyway the actual gold standard therapy.

Adult↗
PubMed1994

Use of a gonadotropin releasing hormone agonist before vaginal surgery for cervical leiomyomas. A report of two cases.

Two cases of cervical myoma were treated with combined medical/surgical therapy using a gonadotropin releasing hormone agonist (GnRH-a) and transvaginal cervical myomectomy. Patients were treated with depot GnRH-a (leuprolide acetate) for two months followed by myomectomy. This approach allowed successful treatment with short hospitalization (< 24 hours). Potential benefits of this regimen include decreased intraoperative blood loss, outpatient management, decreased morbidity, decreased hospital expense and preservation of reproductive potential by avoiding hysterectomy.

Adult↗
PubMed1978

The anti-reproductive pharmacology of LH-RH and agonistic analogues.

LH-RH and three particular ("super") analogues were evaluated for agonistic (ovulation-induction and short-term uterotrophic properties) and postcoital contraceptive activity in rodents. Additionally, LH-RH and/or a representative analogue (D-Ala6-des Gly10-Pro9-LH-RH ethylamide) were tested for postcoital contraceptive/vaginal smear/return to fertility effects, precoital contraceptive activity, and effects on puberty in the immature female. All compounds induced ovulation and uterotrophic effects and terminated pregnancy when administered either pre- or post-implantation. LH-RH and the representative analogue, while terminating pregnancy postcoitally, produced an associated break in the characteristic leucocytic vaginal smear of pregnancy to one of cornification by day 12; at this time mating and insemination were reestablished and all rats carried to normal term. Precoitally, LH-RH administered to nembutalized (but not to unblocked) rats produced a 50% reduction in the pregnancy rate and a 38% decrease in the number of viable pups delivered. In immature rats, the representative analogue delayed puberty (i.e. vaginal canalization) and retarded the growth of the ovaries, uteri, and anterior pituitary gland. The collective data strongly support the concept that LH-RH and agonistic derivatives, in spite of their putative pro-fertility classification, are characteristically antifertility by nature. Since the latter effect appears to be the paradoxically dominant one, it is suggested that LH-RH agonism is synonymous with contraception. Furthermore, such peptides may represent a new potential approach to fertility control.

Animals↗
PubMed1983

Outcome of labor following previous cesarean section.

Four hundred fifty-one patients who had had previous lower segment cesarean section were studied for subsequent pregnancy outcome at the University Teaching Hospital, Lusaka, Zambia. Of 319 who were allowed to go into labor, 63% succeeded in delivering vaginally, while 37% had to undergo repeat intrapartum cesarean delivery. No maternal death occurred. Scar dehiscence occurred in one case only. Parturition in otherwise obstetrically normal patients seems to be safe, and the trial of labor approach is desirable as it results in a lower number of repeat cesarean deliveries.

Adolescent↗
PubMed1999

[Fixation of the prolapse vagina to the sacrotuberal ligament].

OBJECTIVE: To present personal experience in the fixation of the vaginal stump to the sacrotuberal ligament. METHOD: Description of the surgery including modified surgical instruments. RESULTS: 32 surgical procedures were performed during a 4-year period. Two relapses were recorded. DISCUSSION: Various surgical procedures including abdominal approach to the fixation are mentioned, complications and prevention of relapses are discussed. CONCLUSION: The method is appropriate for sexually active patients. It preserves the length, axis and volume of the vagina.

Aged↗
PubMed2000

Use of PCR for the detection of genital Chlamydia trachomatis infection on self-obtained mailed vaginal samples.

BACKGROUND: To determine whether the patient self-obtained and mailed vaginal sample might be used for the detection of genital C. trachomatis infection by the PCR. METHODS: Women with genital symptoms, younger than 35 years of age and sexually active were enrolled. Cervical and urethral samples collected by the physician were tested by PCR and cell culture. Three vaginal samples were collected: the first and second - by the physician and the patient at the time of the visit to the clinic. The third vaginal sample was collected by the patient at home and posted dry to the laboratory. All vaginal samples were PCR-tested, including also the internal control for the detection of the inhibitors. RESULTS: The prevalence of chlamydial infection was 19.2%. C. trachomatis was detected in the cervix of 18.5%, in the urethra of 4.4% and in the vagina of 19.2% of the women, when all vaginal samples were considered. Each separate vaginal sampling detected 88.8% of the C. trachomatis infected women. Nearly 10% of the cervical, 3% of the urethral and 12-19% of the vaginal samples were inhibitory. Inhibitors were destroyed by storage of the samples for five days at +4 degrees C or the dilution at 1:10. CONCLUSIONS: Self-collected and mailed vaginal sample is convenient for the patient and useful for the PCR-testing for genital C. trachomatis infections. Sensitivity of sampling might improve if several consecutive samples were to be collected. This self-sampling approach would help to reach section of the population in which pelvic examination and cervical sampling is not routinely performed.

Adult↗
PubMed2005

[HPV and cancer].

Human papillomavirus (HPV) has been largely demonstrated involved in the pathogenesis of several intraepithelial lesions and cancers. The role of HPV in the carcinogenesis of intraepithelial and invasive anogenital lesions is currently well established, characterized by integrated DNA HPV inside the lesions. HPV genotypes are classified according to their risk of oncogenesis and HPV16 remains the most common and higher oncogenic types. HIV-infected patients have a higher rate of HPV infection with a higher persistence and higher viral loads than general population, which can explain the increasing risk of cancers in such patients. However, independently of HIV infection, HPV infections seems to be strongly associated with several neoplasms, including head and neck, oral, cervical, anal, vulvar, vaginal cancers and probably some lung cancers. Paradoxically, little information about the immunity role and virological factors involved in the occurrence and outcome of HPV epithelial lesions are currently available, leading to more effective and biological approaches, in this HPV infection setting.

Antiretroviral Therapy, Highly Active↗
PubMed1990

Management of pregnancy after major urinary reconstruction.

Major reconstructions of the urinary tract are being performed with increasing frequency. However, published experience concerning pregnancy after urinary reconstruction is limited. Complications in women who have undergone such complex procedures may endanger them or their fetuses and can disrupt the reconstruction or impair renal function. To counsel better those patients who have undergone urinary reconstruction and who desire to bear children, and to develop an approach to the management of their pregnancies, we reviewed the available literature. We found that the incidence of complications was low during pregnancy after a genitourinary reconstruction; the majority of women had an uneventful pregnancy and vaginal delivery. Close observation of renal function and prophylaxis against urinary tract infection during pregnancy are recommended. Elective cesarean is advised for women who have had a reconstruction of the bladder neck or urethra or who have received an artificial urinary sphincter. Urologists and gynecologists must continue to report the outcome of pregnancy in their patients who have undergone reconstruction so that we may develop meaningful data about the incidence of complications.

Female↗
PubMed1983

Trial of labor in patients with multiple previous cesarean sections.

Trial of labor (TOL) in patients with multiple previous low transverse cesarean sections has not been investigated extensively, and information regarding the risks and benefits of this kind of management is largely unavailable. A combined series of patients experienced a TOL after two or more previous cesarean deliveries; the rate of vaginal delivery was 66%, and there was virtually no morbidity. Though a larger number of patients is necessary to document the desirability of a TOL in these circumstances, the evidence available now suggests that this management approach is both reasonable and safe.

Cesarean Section↗
PubMedDate not supplied

Menopause: providing comprehensive care for women in transition.

Knowledge and research on the physiological changes associated with menopause is steadily expanding. A partnership between women and health care providers can contribute to the quality of women's life expectancy which is estimated to be 79.1 years (United States Bureau of Census, 1993). Menopause is a normal phenomena of aging and women experiencing menopause must have access to comprehensive care, including a complete history, thorough physical exam, risk factor and age-appropriate screening, and patient education. Studies confirm women's lack of knowledge concerning menopause and the need for education on bodily changes and approaches to self-care during transition. Decline in the ovarian production of estrogen and the feedback effect of gondatropins leads to an increased follicle-stimulating hormone (FSH) of 40 mlU/mL. Vasomotor flushing, night sweats, vaginal dryness, shortening of the menstrual cycle with heavy flow progressing to longer cycles and scant flow and eventual cessation of menses for a period of 12 consecutive months confirms menopause. A program of screening and education for self-care can enhance women's quality of life.

Adult↗
PubMed1999

Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: case report and review of literature.

OBJECTIVE: Although rare among gestational trophoblastic diseases, the clinical relevance of malignant placental site trophoblastic tumor (PSTT) derives from its potential malignancy associated with early systemic tumor cell dissemination and manifestation of fatal metastases. Because of the low number of cases reported so far worldwide, several treatment strategies have been under consideration, which will be debated following this case report. METHOD: We present the case of a 33-year-old female with PSTT and metastases to the vagina and lung. A 9-month delay in accurate diagnosis was caused by a misinterpretation of her symptoms as signs of a spontaneous abortion. Specialized pathological examination finally led to the diagnosis of PSTT. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by multiple resections of recurrent vaginal disease. After the completion of six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy, hCG titers stayed within the normal range. The patient is without evidence of disease 39 months after primary diagnosis. RESULT: This is the third case of documented long-term remission (>1 year) in metastatic PSTT after combined cryostatic-surgical treatment. CONCLUSION: Since the few previously reported cases with prolonged remission have been treated with the described combined cytostatic-surgical approach consisting of cytoreductive surgery and adjuvant chemotherapy, this approach may be recommended for metastatic PSTT.

Adult↗
PubMed1996

Signs and symptoms of prevalent and incident cases of gonorrhea and genital chlamydial infection among female prostitutes in Kinshasa, Zaire.

Most studies that have examined the clinical features of gonorrhea and chlamydial infection have been based on prevalent cases (cases of undetermined onset). In our investigation, we compared signs and symptoms of incident (new) cases of these infections with those observed in prevalent cases (involving the same women) that were diagnosed at enrollment in a prospective study of female prostitutes in Kinshasa, Zaire. Neisseria gonorrhoeae or Chlamydia trachomatis was present at enrollment in 29.2% (225 of 771) of the women in the study. As they were followed during the study, 509 (66.0%) had at least one episode of gonorrhea or chlamydial infection. No symptom was significantly associated with these infections at enrollment or during follow-up. Clinical signs, such as endocervical mucopus (P < .001) and vaginal discharge (P = .001), were associated with both the prevalent and incident cases. However, none of these signs was simultaneously sensitive and specific for detection of these infections. The frequency of clinical signs was significantly reduced after successful treatment (all P values, < .05). This study shows that a syndromic approach to screening for gonococcal and chlamydial infections in female prostitutes is as problematic for acute incident cases as for prevalent cases. Therefore, there is still an urgent need for simple, cheap, reliable tests that could be used in sexually transmitted disease intervention programs in developing countries.

AIDS-Related Opportunistic Infections↗
PubMed2005

Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach.

Infected pelvic fluid collections are relatively common particularly after abdominal or pelvic surgery or in patients suffering from benign intestinal disease such as diverticulitis, appendicitis, or Crohn's disease. Historically the treatment of pelvic abscess has been either laparotomy with lavage or blind surgical incision and drainage through the rectal or vaginal wall. More recently, computed tomography and ultrasound-guided percutaneous drainage has become the procedure of choice, when feasible, for the treatment of pelvic abscess. However, many deep pelvic collections are not amenable to percutaneous technique. Transrectal or transvaginal ultrasound-guided abscess drainage is a safe and effective method used in the treatment of deep pelvic abscesses. The purpose of this article is to review the techniques, patient selection, pre- and post-procedural care, and monitoring aspects of transrectal or transvaginal ultrasound-guided drainage.

Abscess↗