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PubMed1983

Ten-year survival in 290 patients with endometrial cancer: prognostic factors and therapeutic approach.

Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III) patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high-risk patients. Ten-year survival, determined by the life-table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P less than 0.001); deep myometrial invasion (P less than 0.001); poorly differentiated histological grade (P = 0.11); lack of resection of the upper vagina (P = 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high-risk patients.

Adult↗
PubMed2004

[Genital infections in women, in community practice. Comparison of two studies, 1987 and 2002].

One thousand eight hundred and thirty-six clinical and biological cervico-vaginal flora samples from genital infections in women observed in community practice in 1987 were compared to 368 samples collected in 2001. The diagnosis of sexually transmitted infection (STI) was rarely made. Nonetheless, examining these samples made it possible either to prescribe a specific treatment for a confirmed infection (chlamydia, trichonomiasis, candidiasis, gonococci, vaginosis), or to modify a long-term treatment that was often ineffective and sometimes badly tolerated. Not all vulvar itching, associated or not with pelvic pain, is caused by mycosis. Treatment based on a syndromic approach was often ineffective, because clinical symptoms, whether isolated or associated, even when they were suggestive of an etiology, presented only a minor positive predictive value (the PPV for the association ichting + pelvic pain was only 10% for chlamydia, but 45% for candidiasis). The diagnosis of vaginosis, suggested for the past 10 years as an improvement in the diagnosis of vulvo-vaginitis, was made in only 13% of the cases. The only significant difference in our two studies was a lower number of cases of gonococci, chlamydiae, and ureaplasms in 2001, the settings having remained identical, except for a lower number of patients in 2001.

Adolescent↗
PubMed1994

Low cost, patient acceptable, local analgesia approach to gynaecological outpatient surgery. A review of 817 consecutive procedures.

UNLABELLED: The objective of this study was to evaluate safety, cost effectiveness and patient acceptability, of performing a wide variety of gynaecological procedures, including endometrial resections, in a clinic using only local analgesia. Eight hundred and seventeen consecutive gynaecological procedures were performed under local analgesia only, with no sedation, including endometrial resections, cone biopsies, terminations of pregnancy, hysteroscopies, and local vaginal and plastic vulval procedures, as well as many combined procedures (figure 1) in a day-surgery ward annexe in the Department of Gynaecology, St John's District General Hospital, Chelmsford Essex. The main outcome measures were patient acceptability, safety and encountered side-effects of procedures performed under local analgesia as well as evaluation of cost-effectiveness and reduction in theatre waiting list times. A high degree of safety and patient acceptability was achieved, with other considerable benefits being short waiting times and much quicker recovery. The only complications were from the endometrial resection group, with only 8 (3.6%) of these requiring intravenous sedation intraoperatively, and 6 (2.7%) requiring overnight admission. No transfers to theatre during any procedure occurred. Savings per procedure, in cost and in patient's time, were very considerable. CONCLUSION: The local analgesia approach for a wide variety of gynaecological procedures in a combined outpatient theatre is safe and is highly acceptable to patients. There are also considerable benefits in cost and patient convenience, with a reduction in operating list waiting time, which in the current economic climate are worth considering.

Ambulatory Surgical Procedures↗
PubMed2001

Gram stain versus culture in the diagnosis of vulvovaginal candidiasis.

We evaluated Gram stain as a rapid diagnostic method for vulvovaginal candidiasis (VVC). Vaginal swabs were taken from 100 pregnant women and subjected to Gram stain and culture; 39% were diagnosed as having VVC (29% had symptomatic VVC and 10% had asymptomatic VVC). Candida albicans was isolated from 94.9% of all cultures while other Candida species were isolated from 5.1% of cases. Multigravidae were significantly more affected than primigravidae. Gram stain is a valuable method in rapid accurate diagnosis of symptomatic VVC and even superior to culture as it demonstrates the invasive forms of the yeast. However, its low sensitivity could restrict its use in routine practice. A combination of culture and Gram stain is the ideal approach for the diagnosis of VVC.

Adolescent↗
PubMed1992

Conservative management of placental abruption complicated by severe clotting disorders.

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.

Abruptio Placentae↗
PubMed2001

Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair.

OBJECTIVES: To evaluate the anatomic and functional results of transperitoneal-transvesical repair of simple and complex vesicovaginal fistulas (VVFs). METHODS: Between 1978 and 1995, 30 VVFs in 28 patients (mean age 44.6 years, range 21 to 80) were treated by way of a transperitoneal-transvesical approach. VVFs were secondary to hysterectomy in 67.8% of cases; 46.7% of VVFs were considered complex fistulas. Fifty percent of the VVFs were retrotrigonal and 40% were trigonal. A flap was interposed in 70% of cases. The vaginal fistula orifice was left open in 66% of cases, and 33% of VVFs required ureteral reimplantation. The mean duration of bladder drainage was 15.8 days (range 6 to 42), and the mean follow-up was 30 months (range 23 days to 14.6 years). The anatomic and functional results were evaluated by physical examination, cystoscopy, and a self-assessment questionnaire. Success was defined as the disappearance of the fistula. RESULTS: The overall success rate was 85% (24 of 28). The success rate was 87.5% for simple VVFs, 71% for complex VVFs, 93% for retrotrigonal VVFs, 66% for cervicotrigonal VVFs, and 80% for fistulas requiring ureteral reimplantation. Postoperative voiding disorders were reported in 38% of patients. CONCLUSIONS: Transperitoneal-transvesical repair of simple and complex VVFs remains the reference treatment for a disease that has become rare in countries with a well-developed healthcare system, but that is disabling and poorly tolerated by patients after the treatment of another disease.

Adult↗
PubMedDate not supplied

Delayed contact hypersensitivity in the vagina and skin of the guinea pig.

A new method was developed to permit the contact of haptens exclusively with the vaginal mucosal surfaces of the guinea pig. The method described has some unique characteristics that make it potentially useful, not only for studies of the immune response but also for other areas of toxicologic concern. Utilizing this approach it was demonstrated that delayed contact hypersensitivity was as readily produced in the vagina as it was in the skin. Grossly, the vaginas of sensitized animals appeared normal when challenged with a non-irritating concentration of hapten but, histologically, a perivascular lymphocytic cuffing, that is the hallmark of the delayed hypersensitivity response, was demonstrated.

Animals↗
PubMed2002

Herbal medicines for sexually transmitted diseases and AIDS.

Sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) are gaining significant importance at present due to rapid spread of the diseases, high cost of treatment, and the increased risk of transmission of other STDs and AIDS. Current therapies available for symptomatic treatment of STDs and AIDS are quite expensive beyond the reach of common man and are associated with emergence of drug resistance. Many patients of STDs and AIDS are seeking help from alternative systems of medicines such as Unani, Chinese, Ayurvedic, naturopathy, and homeopathy. Since a long time, medicinal plants have been used for the treatment of many infectious diseases without any scientific evidence. At present there is more emphasis on determining the scientific evidence and rationalization of the use of these preparations. Research is in progress to identify plants and their active principles possessing activity against sexually transmitted pathogens including human immunodeficiency virus (HIV) with an objective of providing an effective approach for prevention of transmission and treatment of these diseases. In the present review, plants reported to possess activity or used in traditional systems of medicine for prevention and treatment of STDs including AIDS, herbal formulations for vaginal application, and topical microbicides from herbal origin, have been discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Influence of DNA encoding cytokines on systemic and mucosal immunity following genetic vaccination against herpes simplex virus.

The aim of our investigation was to improve the effectiveness of DNA vaccines against herpes simplex virus (HSV) infection. We chose coimmunization with DNA encoding cytokines known to emphasize components of immune defense that best correlate with immune protection. These include interferon-producing T and NK cells and the IgG2a isotype immunoglobulin. Our results show that the coadministration of plasmid DNA encoding IL-12 or IL-18 along with glycoprotein B (gB) DNA improves immune induction. Recipients of the coimmunization procedure had elevated humoral as well as IFN-gamma-producing T cell responses and showed greater resistance to vaginal challenge with a lethal dose of HSV-1. The adjuvant effects were observed when the vaccines were administered either systemically or mucosally. By most assays, the adjuvant effect of IL-18 was superior to IL-12, although gB DNA plus IL-18 failed to induce levels of immunity achieved by UV-inactivated HSV immunization. Mucosal immunization proved as an effective means of inducing systemic immunity, but was less effective than the systemic route for inducing protection from vaginal challenge. Our results also demonstrated that protection from such challenges was mainly a property of IFN-gamma. Thus, immunized IFN-gamma-/- mice remained susceptible to challenges even while generating readily measurable immune responses. The approach of using DNA vaccines combined with DNA encoding cytokines holds promise and represents a potentially useful approach for vaccines.

Administration, Intranasal↗
PubMed2001

Emergency management of the nonviable intrauterine pregnancy.

Fetal death early in gestation is common. Patients in the first trimester of pregnancy with abdominal pain or vaginal bleeding often present to the emergency department for care. Over the past 20 years, the technology available to confirm or exclude the diagnosis of a nonviable pregnancy has improved dramatically. These improvements have altered the diagnostic approach to these patients and have lead to a change in the terminology used to categorize the pregnancy status. In addition, the therapeutic options available to manage patients with a confirmed nonviable pregnancy have expanded greatly. In this article, we re-evaluate the classification scheme used to categorize patients with first trimester pain or bleeding given the improved technology that is available to the emergency physician today. We discuss the role of ultrasound and biochemical markers in confirming or excluding the diagnosis of a nonviable pregnancy. Finally, we review the therapeutic options, including expectant, surgical as well as medical management that are available once the diagnosis of a nonviable intrauterine pregnancy has been confirmed.

Abdominal Pain↗
PubMed2004

Laparoscopy-assisted transvaginal total exenteration for locally advanced cervical cancer with bladder invasion after radiotherapy.

When invasive cervical cancer involves the urinary bladder or rectum, exenteration can be curative treatment. However, this operation, particularly by an open approach, carries significant morbidity, both physically and psychologically. Laparoscopic surgery has been documented to be a reasonable alternative to the open counterpart for a variety of pelvic operative procedures, including such advanced procedures as laparoscopy-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and laparoscopy radical hysterectomy. With improving surgical technology and increasing surgical experience, exenteration is a logical extension of current laparoscopic practice. However, it raises skepticism regarding the feasibility and justification for the complicated surgery. We herein describe our experience in a patient undergoing total exenteration assisted by laparoscopic technology for advanced recurrent cervical cancer after extensive radiotherapy. Transperitoneal laparoscopic total exenteration with ureterosigmoidstomy and end-sigmoidostomy was accomplished in 6 hours. The whole specimen was removed en bloc transvaginally. The patient tolerated the procedure well. The only complication was a wound infection 50 days postoperatively that was controlled with debridement and antibiotics. No episodes of pyelonephritis occurred. After 1 year of follow-up, the patient is free of cancer by imaging studies and lives without associated morbidity of this extensive palliative operation except the care of the sigmoid colostomy.

Aged↗
PubMed1989

Tocolysis during cervical ripening with vaginal PGE2.

Forty-two primigravidae with unripe cervices (modified Bishop score less than or equal to 5) were pretreated with 8 mg of oral salbutamol 30 min before vaginal administration of 5 mg of PGE2. The proportion of patients in established labour after treatment (19%) was markedly less than results reported previously and cervical improvement occurred in 86% of the non-labouring patients. The improved outcome of labour associated with the prior administration of PGE2 when the cervix is unripe, including reduced induction-to-delivery intervals and higher rates of vaginal delivery was maintained. Apart from some minor side-effects, there were no adverse effects noted as a direct consequence of the tocolytic; blood loss was not increased, although one patient suffered an intrapartum abruption. This approach allows a greater control of induced uterine activity and timing of delivery which may be of particular importance in women with suspected placental insufficiency.

Administration, Intravaginal↗
PubMed1995

Predictors of neonatal encephalopathy in full-term infants.

OBJECTIVE: Preliminary investigation of the contribution of adverse antepartum and intrapartum factors to neonatal encephalopathy in singleton neonates born full term. DESIGN: Matched case-control study based on incidence density sampling of controls. SETTING: Two major teaching hospitals (one paediatric and one obstetric) and three peripheral maternity hospitals in Perth, Western Australia (population 1.2 million). SUBJECTS: 89 cases, all the full term singleton neonates born during an eight month period in 1992 who fulfilled one or more of six criteria during the first week of life (seizures, abnormal conscious state, persistent hypertonia or hypotonia, and feeding or respiratory difficulties of central origin). One full term control infant without neonatal encephalopathy was matched to each case by sex, hospital of delivery, time of day and day of the week of birth, and maternal health insurance status. MAIN OUTCOME MEASURES: Odds ratio estimates of relative risk of neonatal encephalopathy associated with antepartum and intrapartum factors. RESULTS: Estimated incidence of moderate or severe encephalopathy in first week of life was 3.75 per 1000 full term live births. Thirteen cases and no controls had evidence suggestive of important intrapartum hypoxia, and in only five of these cases was the neurological condition at birth attributed to events during the intrapartum period. Univariate conditional logistic regression analysis identified significant differences between cases and controls for maternal vaginal bleeding in pregnancy, maternal thyroxine treatment, congenital abnormalities, induction of labour, interval from membrane rupture to delivery, maternal pyrexia in labour, augmentation of labour, abnormal intrapartum cardiotocograms, and meconium in labour. Family history of convulsions also approached significance. CONCLUSIONS: Our preliminary results suggest that intrapartum hypoxia, according to currently used criteria, was not the cause of neonatal encephalopathy in most cases in this population. Our findings suggest that many aetiologies of neonatal encephalopathy originate in the antepartum period.

Brain Diseases↗
PubMed2006

Role of minimally invasive surgery in gynecologic cancers.

The role of minimally invasive surgery in the management of gynecologic cancers continues to expand. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy has emerged as a safe, reasonable option for women with early-stage cervical cancer desiring fertility preservation. Similarly, laparoscopically assisted radical vaginal hysterectomy has been systematically described, is feasible, and can be offered to women with early-stage cervical cancer who do not desire future childbearing. In the treatment of early-stage endometrial cancer, the surgical approach of laparoscopic hysterectomy, peritoneal washings, and pelvic and para-aortic lymph node dissection, with or without an omentectomy, is being compared with the same surgery performed via laparotomy in the cooperative Gynecologic Oncology Group LAP 2 study, which has completed accrual, and appears to be a reasonable surgical option. In ovarian cancer, minimally invasive surgery has been incorporated to manage early-stage, advanced-stage, and recurrent disease, as well as second-look procedures. Hand-assisted laparoscopy has also recently been described in managing larger volume primary and recurrent gynecologic cancers. Extraperitoneal laparoscopy for para-aortic and pelvic lymph node dissections has been shown to yield adequate nodal counts and to be safe and feasible in the management of gynecologic cancers.

Female↗
PubMed2006

Right ectopic gestation following in vitro fertilisation: case report.

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure. A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an "evacuation" one-week prior to this episode due to an initial diagnosis of an incomplete abortion. No chorionic villi were reported on histology. The repeat serum BhCG was 777 mimicro/l and at laparoscopy a right unruptured ampullary ectopic gestation (4 cms in size) was evident. A right linear salpingostomy was subsequently performed laparoscopically. Histology confirmed the presence of tubal chorionic villi. The laparoscopic management of ectopic pregnancies is now regarded as the gold standard in many centres in the world. In this patient the ectopic pregnancy resulted following an intra-uterine zygote transfer, and was managed successfully.

Abdominal Pain↗
PubMed1990

[Reinforced colposuspension (modified Cukier's operation). Immediate results, complications, indications].

In order to avoid mean term failures of colposuspension and short term obstructive complications of sling procedure, the author present a technique of urethropexy combining the two principles: reinforced colposuspension. A series of 67 consecutive procedures is subdivided in 45 stress incontinence and 22 incontinence with prolapse simultaneously treated by spinofixation. Continence is obtained in 97.6% and 91% respectively. Severe obstruction is observed in 3%, all of the first group. There is no infection due to this combined approach. The closure pressure remains similar or increases in 75% of the cases. Compared to others colposuspensions, this technique offers a conceptual advantage, without added morbidity. It is especially indicated when the closure pressure is low, the vaginal wall is weak, or when combined with a spinofixation.

Aged↗
PubMed1996

Transvaginal ultrasonography in nonpregnant and postmenopausal women.

Compared with transabdominal pelvic ultrasonography, transvaginal ultrasonography provides improved resolution for visualization of female pelvic organs, with less artifact. Transvaginal ultrasonography has superseded the transabdominal approach in many situations. Identification of uterine and adnexal masses can be facilitated with use of transvaginal ultrasonography. Transvaginal ultrasonography is also useful in the evaluation of pelvic pain and suspected pelvic inflammatory disease. Postmenopausal patients with vaginal bleeding or a palpable ovary can be triaged on the basis of transvaginal ultrasonographic findings, avoiding invasive diagnostic procedures in selected patients. Screening average-risk patients for ovarian cancer is not an accepted indication for transvaginal ultrasonography at this time.

Diagnosis, Differential↗
PubMed1998

Severe coital injury after Frank's creation of a neovagina.

A neovagina was created by the Frank's dilatation method in a girl with vaginal agenesis. At the first coital attempt complete laceration of the cul de sac with copious bleeding occurred. Daily application of estrogen cream was the only therapy until complete healing after four weeks. Possible causes and therapeutic approaches are discussed.

Adult↗