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PubMed1989

[Differential approach to cesarean section in current obstetrics].

A survey of cesarean sections performed between 1984 and 1987 has demonstrated a changing pattern of indications for abdominal delivery. An expanded range of indications for cesarean section in cases of breech presentation and maternal gestosis has been shown to reduce significantly perinatal losses. It is demonstrated that indications for vaginal delivery in patients with a uterine scar should be expanded through further search for new methods for the assessment of the scar as well as the improvement of the available ones. Intraoperative administration of antibiotics is a method of choice in preventive antibiotic treatment.

Breech Presentation↗
PubMed2001

Measurement of male and female sexual dysfunction.

Measurement approaches for male and female sexual dysfunction have proliferated in recent years, spurred in large part by the development of new treatments for male and female dysfunction. In the past, physiologic measures of penile tumescence and rigidity in males, and vaginal blood flow in females, played an important role in clinical and research studies. More recently, a variety of brief, self-report measures have been developed for assessing male and female function across a variety of sexual domains (eg, desire, arousal, orgasm, satisfaction). These self-report measures have been shown to have a high degree of reliability and validity, and are sensitive to treatment interventions. Accordingly, they are widely employed in clinical trials. Daily diary or sexual event logs have similarly been developed for this purpose. Self-report measures have been used for clinical screening purposes and for diagnostic assessment of sexual function in a number of studies. Finally, several disease-specific quality of life and treatment satisfaction measures have been developed, which are currently in widespread use in clinical trials of sexual dysfunction.

Female↗
PubMed2006

Sigmoid vaginoplasty: long-term results.

OBJECTIVES: To evaluate the long-term results of sigmoid vaginoplasty for Mayer-Rokitansky-Kuster-Hauser syndrome. The social and psychological acceptance of the procedure is also discussed in terms of a developing country scenario. METHODS: A total of 14 patients with Mayer-Rokitansky-Kuster-Hauser syndrome were treated at our institute from January 1995 to December 2004. Sigmoid vaginoplasty was performed in all patients. The procedure was performed using a combined abdominoperineal approach. Dissection was done between the urethra and rectum to create a bed for the neovaginal colon conduit. A 10-cm segment of sigmoid colon was raised on its vascular pedicle, delivered through the abdominoperineal tunnel, and fixed to the vaginal pit incision. The patient records were reviewed for surgical technique and postoperative complications. Patients underwent a personal interview to assess the postoperative results, social acceptance of the procedure, and sexual satisfaction. RESULTS: The mean patient age at surgery was 16.8 years. The patients who underwent sigmoid vaginoplasty had good cosmetic results without the need for routine dilation or the problem of excessive mucus production. The postoperative morbidity was minimal. During a mean follow-up of 4.1 years, no stenosis or colitis was encountered. The subjective satisfaction rate with the surgical outcomes in all the patients was 8.01 on a scale of 0 to 10 (0, very disappointed to 10, satisfied). CONCLUSIONS: Sigmoid vaginoplasty is an effective treatment for patients with vaginal atresia. Timed vaginal reconstruction in these patients allows for a better quality of life and social acceptance. It also enables the patient to lead a near-normal sexual life, with high satisfaction rates.

Abnormalities, Multiple↗
PubMed2005

[Treatment of chronic anal fissure].

Chronic anal fissure is a common benign anorectal problem in Western countries that substantially impairs the patient's life. Consequently, a rapid and effective solution is required. We reviewed the various treatments for chronic anal fissure described in the literature, with the aim of establishing a therapeutic protocol. We recommend surgical sphincterotomy (preferably open or closed lateral sphincterotomy) as the first therapeutic approach in patients with chronic anal fissure. However, we prefer the use of chemical sphincterotomy (preferably botulinum toxin) in patients aged more than 50 years old and in those with previous incontinence, risk factors for incontinence (previous anal surgery, multiple vaginal births, diabetes, inflammatory bowel disease, etc.), or without anal hypertonia, despite the higher recurrence rate with medical treatments, since this procedure avoids the greater risk of residual incontinence described in the literature with surgical sphincterotomy in this group of patients.

Botulinum Toxins↗
PubMed1989

A new 1-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermaphrodites.

A new 1-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermaphrodites is presented. The technique consists of clitoral reduction with preservation of the neurovascular supply to the glans and vaginal formation by joining the inverted penile skin and the divided distal "urethra" (urogenital sinus) to form a cylinder that is then inserted into the perineum and anastomosed to the true vagina. For high and small vaginas Monfort's transtrigonal approach is suggested. This operation, 4 of which have been performed to date, can be done at any age, and it offers excellent cosmetic and functional results.

Child, Preschool↗
PubMed1990

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

Cervix Uteri↗
PubMed2001

New developments in the treatment of cervical cancer.

Cervical cancer is world-wide the second most frequent cancer found in women and represents 12% of all female malignancies. In fact, it is the most common female cancer in developing countries. There is now sufficient evidence to recommend that women with locally advanced cervical cancer confined to the pelvis receive concurrent pelvic radiation and chemotherapy. New surgical techniques such as laparoscopically assisted radical vaginal hysterectomy and trachelectomy (a fertility-preserving radical operation technique) are being established and have to be evaluated for their long-term safety. Causal treatment by developing multivalent antiviral drugs and vaccines is no longer a pure theoretical approach. Despite these improvements, the early diagnosis by colposcopy and gynaecological cytology remains the safest method to ensure early treatment avoiding death of cervical cancer.

Chemotherapy, Adjuvant↗
PubMed2005

Factors associated with infant feeding practices after hospital discharge.

OBJECTIVE: To assess factors associated with infant feeding practices on the first day at home after hospital discharge. METHODS: A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. RESULTS: Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. CONCLUSIONS: On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

Adolescent↗
PubMed2004

Epoprostenol in pregnant patients with secondary pulmonary hypertension: two case reports and a review of the literature.

Women who present with pulmonary hypertension during gestation have traditionally been persuaded to terminate their pregnancy. Historically, the mortality associated with this group is very high. Certain patients with a secondary cause of pulmonary hypertension are believed to share similar pathophysiology with primary pulmonary hypertension patients. Recently, new treatments have become available that have slowed disease progression. We present the successful treatment of two patients who presented during late gestation with moderate pulmonary hypertension. Both patients were managed with intravenous vasodilators and anticoagulants without complication. Each patient successfully delivered a healthy child via spontaneous vaginal delivery. The review of the historical management of similar patients including new insights into the etiology of pulmonary arterial hypertension is also included. It highlights the complexity involved in managing such patients and the requirement of a multidisiplinary team approach.

Adult↗
PubMed1991

Management of submucous uterine fibroid with buserelin, gemeprost and hysteroscopic resection.

A 19-year-old virgin presented with severe menorrhagia and a haemoglobin level of 76 g/L as a problem of management. A 5 cm diameter submucous fibroid was identified at hysteroscopy and biopsied but was unable to be removed. The luteinising hormone releasing hormone agonist, buserelin, was used in an attempt to produce symptomatic relief. One week after commencing buserelin therapy, severe menorrhagia occurred and the patient was admitted to hospital with a haemoglobin concentration of 24 g/L. Buserelin treatment was continued and no further menstruation occurred over the following year. As the patient was now well, hysteroscopic submucous fibroid resection was contemplated. Due to cervical rigidity in this teenager, a 1 mg gemeprost pessary was inserted into the posterior vaginal fornix three hours before surgery. This allowed an operative hysteroscope to be inserted into the uterus and a fibroid resection to be performed. Menstrual blood loss has been normal for six months after hysteroscopy. A combined medical and surgical approach may avoid hysterectomy in such problem patients.

Adult↗
PubMed2004

Current perspectives on management of urgency using bladder and behavioral training.

Behavioral interventions for overactive bladder (OAB) include bladder training and behavioral training. Bladder training focuses on modifying bladder function by changing voiding habits; a bladder diary is indispensable. Behavioral training focuses on improving voluntary control rather than bladder function. It works through modification of the bladder outlet using methods, such as pelvic floor muscle training and urge suppression strategies to inhibit detrusor (bladder) muscle contraction. Behavioral methods--with biofeedback (which requires instrumentation), verbal feedback during a pelvic examination (using vaginal or anal palpation), or electrical stimulation--appear to be at least as effective in terms of reducing incontinence episodes as currently available drug therapy. However, evidence suggests that combining behavioral and drug therapy may produce better results than either approach alone. More research is needed to elucidate the role of behavioral modification in reducing urgency, frequency, and nocturia.

Behavior Therapy↗
PubMedDate not supplied

[Imperforate anus. Various Belgian epidemiologic data].

Two hundred and ninety cases of congenital anorectal anomalies were collected in a survey of the experience contributed by belgian surgeons over the last ten years (1971-1980). The incidence (1 in every 4,500 live births) and the sex ratio (56% males, 44% females) are similar to accepted figures in white race; this suggests that most of the cases have been included in the survey. The collected series was analysed according to the international classification proposed in 1970. It differs from most reported series 1 degrees in boys by the prevalence (58%) of low, infralevator types and the unusually high frequency of recto-vesical fistulas (versus recto-urethral); 2 degrees in girls, by the very high prevalence (80%) of low types and a relatively heavy incidence of low recto-vaginal fistulas (versus recto-vestibular). These characteristics could be partly related to a lack of accuracy in the diagnostic work-up. Every new case of anorectal anomaly should be accurately described and classified since the choice of surgical approach and the functional result are related to a large extent to the type and the level of the malformation. Use of the international classification is recommended.

Anus, Imperforate↗
PubMed1981

[Prostaglandins in human pregnancy and labor--studies on the levels of PGF2 alpha metabolites and in vitro production of PGE and PGF by uterus and placenta during human pregnancy and labor (author's transl)].

In order to study the relationship between labor and prostaglandin (PG) production, 13,14-dihydro 15-keto-prostaglandin F2 alpha (dhk-PGF2 alpha) in plasma and amniotic fluid and 5 alpha, 7 alpha-dihydroxy 11-keto tetranor-prostane 1,16-dioic acid (the main urinary metabolite of PGF2 alpha [PGF2 alpha MUM]) in urine were measured by radioimmunoassay in 26 patients during pregnancy, labor and puerperium. In vitro PG production was investigated in the myometrium, decidua and amnion, obtained at term from 17 patients (9 before and 8 in labor) in cesarean section and from 7 in vaginal delivery. The radioimmunoassay newly developed for dhk-PGF2 alpha was satisfactory in its accuracy, precision, and sensitivity. During pregnancy, no increase in plasma dhk-PGF2 alpha (ng/ml) and PGF2 alpha MUM excretion (microgram/hour) was detected as delivery approached. But they elevated significantly around parturition (p less than 0.005), and decreased subsequently. A significant elevation of dhk-PGF2 alpha was found in amniotic fluid at delivery (p less than 0.01). PGE production was constant regardless of uterine contraction in three tissues tested, with the amnion showing the highest activity (p less than 0.005). PGF production increased remarkedly in association with uterine contraction in the myometrium and decidua. The myometrium showed the highest activity to produce PGF among three tissues during labor (p less than 0.025). These results indicate that the production of PGF2 alpha is remarkably increased during labor, and the myometrium appears to be the main source of PGF2 alpha.

Amniotic Fluid↗
PubMed2002

Vaginal extraction of the intact specimen following laparoscopic radical nephrectomy.

PURPOSE: We report the detailed technique and results of transvaginal extraction of the intact laparoscopic radical nephrectomy specimen. MATERIALS AND METHODS: Since June 2000, 10 select female patients with a median age of 67 years underwent transvaginal extraction of the intact specimen after laparoscopic radical nephrectomy. In 5 patients open surgery had previously been performed on the uterus, including transabdominal hysterectomy in 2 and cesarean section in 3. Laparoscopic nephrectomy was performed via the transperitoneal and retroperitoneal approach in 5 cases each. After completion of the primary laparoscopic procedure a sponge stick was externally inserted into the sterile prepared vagina and tautly positioned in the posterior fornix. Laparoscopically a transverse posterior colpotomy was created at the apex of the tented up posterior fornix and the drawstring of the entrapped specimen was delivered into the vagina. After laparoscopic exit was completed the patient was placed in the supine lithotomy position. The specimen was extracted intact via the vagina and the posterior colpotomy incision was repaired transvaginally. Patients were mailed a linear scale analog questionnaire to assess various aspects of recovery with responses graded from 0--no pain and/or change to 10--severe pain and/or change. RESULTS: Vaginal extraction was successful in all 10 patients. Median operative time for the vaginal extraction procedure was 35 minutes. Blood loss was minimal. Median tumor size was 3.6 cm. (range 2.4 to 7.4) and median specimen weight was 327 gm. (range 152 to 484). No intraoperative complications occurred. Postoperatively blood spotting via the vagina in 1 patient resolved spontaneously. Postoperative questionnaires revealed excellent patient satisfaction and convalescence. CONCLUSIONS: Vaginal extraction is an efficacious and minimally morbid technique for removing the intact entrapped specimen after laparoscopic radical nephrectomy. It has now become our preferred technique of intact specimen extraction in appropriate female patients.

Adult↗
PubMed1998

Women's preferences for vaginal antimicrobial contraceptives. I. Methodology.

Sexually transmitted diseases, including AIDS, and unplanned pregnancies continue to be a serious worldwide problem. A number of organizations are developing woman-controlled vaginal formulations to prevent these problems. However, little information is available regarding the types of products women prefer even though such knowledge is essential to obtain widespread use. This is the first of several articles that describe the results of a consumer preference study for such vaginal formulations performed in Campinas, São Paulo State, Brazil. Because no published methodology was available, the instruments and interview techniques were developed first and procedures established for the identification and participation of research subjects. After preparation of a questionnaire, a pilot study was performed to evaluate it, to establish the interview technique, and to determine the optimal method for subject recruitment. Based on the results, the approach was selected and applied to 635 subjects from different age and socioeconomic groups. The developed methodology and questionnaire, the advantages and the problems encountered, are presented.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Atypical Papanicolaou smear in pregnancy.

Atypical glandular cells (AGC) in Papanicolaou (Pap) smears can be associated with premalignant and malignant cervical and endometrial lesions. AGC is difficult to diagnose in pregnancy due to confusion with normal cellular changes that accompany graviditas. While guidelines have been established for management of AGC cases in the non-pregnant patient, special considerations are required when this is discovered during a pregnancy. A routine Pap smear performed on a 29-year-old woman being seen for a history of infertility yielded AGC and a high-grade squamous intraepithelial lesion. The patient achieved pregnancy 1 month later. Satisfactory colposcopic exam was performed with cytobrush sampling of the endocervical canal, in addition to 2 exocervical biopsies at 11 weeks gestation. Positive diagnosis of endocervical adenocarcinoma in situ resulted in a risk-informed decision to proceed with a cold knife conization of the cervix. Final pathology showed complete resection of the lesion with negative margins and an additional area of squamous dysplasia (cervical intraepithelial neoplasia, grade II to III). Appropriate follow-up was recommended. AGC found upon Pap smear during a pregnancy can be associated with significant pathology for which an aggressive management approach is warranted.

Adult↗
PubMed1988

Asian approaches in the treatment of trophoblastic disease.

The cure of trophoblastic disease depends on early recognition and appropriate chemotherapy. In many areas in Asia, doctors face the problems of insufficient funds and poor patient compliance with follow-up. In such situations, the maximum returns for the minimum input would consist of: 1. Routine ultrasound diagnosis for irregular vaginal bleeding associated with amenorrhea; 2. In hydatidiform mole, hysterectomy for women above 40 and those who have completed their families; prostaglandin and suction curettage for evacuation; 3. Prophylactic methotrexate-folinic acid, or dactinomycin or 5-FU for high-risk cases; 4. Follow-up by the simplified regimen using hCG test kits; 5. Chemotherapy with hysterectomy for choriocarcinoma, whether localized in the uterus or metastatic: if the uterus is to be conserved, there must be a good reason; 6. Multiagent chemotherapy as first line in all high-risk cases; and 7. In view of the excellent results with 5-FU in China, investigation of this drug elsewhere, initially in metastatic mole.

Asia↗
PubMedDate not supplied

High-dose-rate interstitial brachytherapy for gynecologic malignancies.

PURPOSE: The study aimed to assess the outcome of locally advanced cervical and vaginal cancer treated with high-dose-rate interstitial brachytherapy (HDRB). METHODS AND MATERIALS: Between 1998 and 2004, 16 previously unirradiated patients with locally advanced cervical and vaginal cancer not suitable for intracavitary brachytherapy because of distorted anatomy or extensive vaginal disease were treated with HDRB in combination with external beam radiotherapy. All patients received whole pelvis external beam radiation therapy (EBRT) followed by interstitial implantation. The median whole pelvis external beam dose was 45 Gy (range, 39.6-50.4 Gy) with 11 patients receiving parametrial boost to a median dose of 9 Gy. Twelve (75%) of these patients received chemotherapy concurrent with external beam. All patients received a single HDRB procedure using a modified Syed-Neblett template. A CT scan was performed postimplant for needle placement verification and treatment planning purpose. Dose was prescribed to the tumor volume based on the radiographic and clinical examination. All patients received 18.75 Gy in five fractions delivered twice daily. The median followup was 25 months (6-69 months). RESULTS: Median cumulative biologic effective dose (EBRT+HDRB) to tumor volume was 78.9 Gy10 with the range of 72.5-85.2Gy10. Median cumulative biologic effective dose for the rectum and bladder were 99.4 Gy3 (range, 79.6-107.8 Gy3) and 96.4 Gy3 (range, 78.3-105.3 Gy3), respectively. Complete response was achieved in 13 (81%) patients with 3 patients having persistent disease. Five of these 13 patients developed recurrence at a median time of 14 months (distant in 4 and local and distant in 1). The 5-year actuarial local control and cause-specific survival were 75% and 64%, respectively. In subset analysis, 5-year actuarial local control was 63% for cervical cancer patients and 100% for vaginal cancer patients. No patient had acute Grade 3 or 4 morbidity. Grade 3 or 4 delayed morbidity resulting from treatment occurred in 1 patient with 5-year actuarial rate of 7%. Three patients had late Grade 2 rectal morbidity and 1 patient had Grade 2 small bowel morbidity. CONCLUSIONS: Our series suggests that single interstitial implantation procedure with five fractions of 3.75 Gy each to target volume is an effective and safe fractionation schedule. The integration of imaging modality helps in decreasing dose to the critical organs. Additional patients and followup are ongoing to determine the long-term efficacy of this approach.

Adult↗