Follow-up of women treated for cervical precancer: an argument for a more rational approach.
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Adult↗
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Results for “Vaginal Approach”
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[Suburethral bands in women urinary stress incontinence: a review of the various techniques].
With more than 1,000,000 procedures in the world and the good results that have been published (85% recovery rate, low morbidity), Tension free Vaginal Tape (TVT) is now considered the gold standard for the treatment of female urinary stress incontinence. Currently, advances are noticed concerning the material used (monofilament, multifilament or extruded cross-linked polypropylene), the surgical access (ascending or descending retropubic, transobturator approach), and the ancillary instruments. The surgeon's vigilance is essential in selecting the most adapted material and access to obtain good results and the lower morbidity rate.
Equipment Design↗
The bicycle seat stool in the treatment of vaginal agenesis and stenosis.
The Ingram method for creating a neovagina in women with vaginal agenesis or stenosis by using an intermittent pressure technique was performed on 45 patients between 1975 and 1982. Poor patient compliance has been the major drawback of previously reported pressure techniques. To overcome this, the Ingram method employs a unique approach using Lucite dilators and a mobile bicycle seat stool. Extensive nursing participation and a successfully treated former patient used as a motivating role model have significantly contributed to the acceptance of this method. Thirty-seven of the 45 patients were able to experience coitus subsequent to treatment.
Bicycling↗
Arteriogenic erectile impotence.
Organic causes of erectile impotence, including penile arterial insufficiency, is far more frequent than previously assumed. The aim of this review (based on the literature and previous works of the author) is to define arteriogenic erectile impotence, and to describe its pathophysiological and clinical features, the diagnostic approach, differential diagnostic aspects and possible treatment of this type of impotence. Erectile impotence is inability to react to relevant sexual stimulation, with a change in pelvic and penile hemodynamics that will increase the pressure in the cavernous bodies thus enabling vaginal intromission without special precautions; as well as inability to maintain this pressure ordinarily until ejaculation occurs. Arteriogenic erectile impotence is erectile impotence caused by insufficient arterial blood supply to the cavernous bodies regardless of the arterial disease or abnormality responsible for the insufficiency. The normal mechanism of erection is not fully understood. Accumulation of blood under pressure in the cavernous body is brought about by dilation of the arteries to the cavernous spaces and closure of the drainage from the cavernous body. The drainage blockade is active and located just inside the tunica albuginea at the origin of the emissary veins. The mechanism is probably related to the smooth muscles of the cavernous body which become relaxed at the start of erection. Furthermore, passive out-flow restriction probably supporting the active closure when the cavernous body is distended. The autonomic nerves regulating the erection come from Th10-L2 and S2-S4 and pass the pelvic plexus. The target organ neurotransmitters are probably vasoactive intestinal polypeptide and catecholamines. Penile arterial insufficiency can be demonstrated by penile blood pressure measurement either as a simple measurement, or, better, as pelvic steal test and hyperemic stress test. Ultrasonic Doppler pulse curve analysis is another way of demonstrating penile arterial insufficiency. Visualization of the arterial disease causing penile arterial insufficiency requires bilateral selective internal iliac arteriography.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
[Irradiation technic, documentation and individual dosimetry in intracavitary short-term afterloading therapy].
The different techniques and radioisotopes for the intracavitary remote-controlled afterloading therapy of the carcinoma of the cervix are discussed. Single or multi-channel applicators including sector-shielding are characterized. A modified 3-channel-applicator offers beside the well known advantages, the possibility to irradiate a vaginal infiltration and the cervix simultaneously and guarantees a definite distance to rectum and bladder and allows an improved representation on localisation-films. Extended tumor-invasion requires beside the intracavitary therapy an additional percutaneous irradiation. Depending on the theoretical approach, intracavitary or percutaneous therapy is predominant. The complex 3-dimensional intracavitary isodose distribution and the locally different fractionation has to be considered by matching the intracavitary and percutaneous therapy. The biological effect of different fractionations arising from the abrupt intracavitary isodose decrease, enlarged penumbra regions behind wedge-filters or slow decreasing isodoses from moving-field irradiations have to be taken into consideration.
Brachytherapy↗
Ovarian pregnancy: a series of 24 cases.
This study was undertaken to investigate 24 cases of ovarian pregnancy identified by retrospective analysis of 148,734 deliveries at 6 hospitals between 1952 and 1980, and to review pertinent literature. Although ovarian pregnancy is rare, it was shown to occur 4 times more frequently than previously believed--on the order of 1 per 7000 deliveries and slightly less than 3% of all ectopic pregnancies. Awareness of the possibility of ovarian pregnancy and closer histologic examination of surgical specimens are critical factors for increased recognition. The use of intrauterine contraceptive devices was not associated with an absolute increase in occurrence of ovarian pregnancy. More than half the cases involved a history of previous reproductive system pathology or infertility. Clinical presentations of ovarian and tubal pregnancies are similar and differentiation can be made only after microscopic examination of tissue specimens. Even then, diagnosis of primary ovarian pregnancy may be elusive due to increasing tissue destruction and greater use of conservative surgical procedures. When the organized diagnostic approach should be followed. Culdocentesis should be performed whenever hemoperitoneum is suspected. The preferred therapeutic procedure is ovarian cystectomy or ovarian wedge resection. No maternal mortality occurred in any of the cases reviewed. An extremely rare case of ovarian pregnancy following vaginal hysterectomy is presented.
Adolescent↗
Essential thrombocythemia and epidural analgesia in the parturient. Does thromboelastography help?
BACKGROUND AND OBJECTIVES: It is often considered that essential thrombocythemia contraindicates placement of an epidural catheter because of the danger of epidural hematoma. Thromboelastography offers a possible means of determining the appropriateness of epidural analgesia in a patient with this disorder. METHODS: A pregnant woman with essential thrombocythemia and a history of spontaneous abortions was evaluated by thromboelastography at 38 weeks of gestation to determine the safety of using epidural analgesia for labor pain management. On the basis of the thermoelastography findings, the patient was given epidural analgesia with bupivacaine and fentanyl during her labor. RESULTS: The patient experienced good pain relief, delivered a healthy infant vaginally, and suffered no complications. CONCLUSIONS: Thromboelastography may be a useful diagnostic test in determining the suitability of regional techniques for labor analgesia in parturients with essential thrombocythemia. However, success in one patient does not prove the general safety of this approach.
Adult↗
Interdisciplinary approach to the control of cancer of the breast.
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Breast Neoplasms↗
Malignant gynecologic tumors in children: current approaches to treatment.
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Age Factors↗
Solicitation behavior in the estrous female rat: a review.
Data are reviewed concerning the display of solicitation behaviors in the estrous female rat, including precopulatory hopping, darting, and ear wiggling, and the pacing of copulatory contacts through patterns of approach toward and withdrawal from a sexually active male rat. Observations made under semi-natural and laboratory conditions suggest that solicitation behaviors determine the types and amounts of coital stimuli received by the female. Solicitation behaviors as regulators of cervical-vaginal stimulation play a primary role in ensuring the activation of the neuroendocrine reflex are responsible for prolongation of ovarian corpora luteal function. Despite solicitation behaviors' importance for reproductive success, few studies have examined the neural and endocrine mechanisms involved in the display of those aspects of solicitation behavior which influence the patterning of coital stimuli received by the female. The present review suggests that two elements of pacing behavior, the ability to discriminate between varying intensities of coital stimulation and the active patterning of approach/withdrawal which controls receipt of that stimulation, are constituent parts of solicitation behaviors readily amenable to experimental investigation.
Animals↗
Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients.
PURPOSE: The purpose of this pilot study was to evaluate the efficacy of the clitoral therapy device (Eros Therapy) in alleviating sexual dysfunction in irradiated cervical cancer patients. METHODS AND MATERIALS: Eligible patients had a history of cervical cancer treated with radiotherapy and self-reported sexual dysfunction of sexual arousal and/or orgasmic disorders. Patients used the noninvasive, nonpharmacologic clitoral therapy device using a hand-held, battery-powered vacuum to cause clitoral engorgement four times weekly for 3 months during foreplay and self-stimulation. Study instruments included the Female Sexual Function Index, Derogatis Interview for Sexual Functioning, and Dyadic Adjustment Scale. The outcome evaluation was performed at 3 months. RESULTS: Between 2001 and 2002, 15 women were enrolled and 13 completed the study. The median patient age and radiotherapy-enrollment interval was 43.5 years and 2 years, respectively. At baseline, all patients reported symptoms of sexual arousal and/or orgasmic disorders, and some also had sexual desire and pain disorders. At 3 months, statistically significant improvements were seen in all domains tested, including sexual desire, arousal, lubrication, orgasm, sexual satisfaction, and reduced pain. The median Female Sexual Function Index total score increased from 17 to 29.4 (maximal score, 36; p <0.001). The median Derogatis Interview for Sexual Functioning total raw score increased from 46 to 95 (maximal score, 118; p <0.001). At baseline, the Derogatis Interview for Sexual Functioning total T-score corresponded to the bottom 10th percentile of normal sexual functioning. At 3 months, the total T-score placed the patients at the normalcy cutoff. Gynecologic examinations revealed improved mucosal color and moisture and vaginal elasticity and decreased bleeding and ulceration. CONCLUSION: Our results from this pilot study suggest that the clitoral therapy device may alleviate sexual dysfunction in irradiated cervical cancer patients. A randomized, controlled trial is warranted to assess the full benefits of this approach.
Adult↗
[Surgical treatment of rectocele and enterocele: an integrated view of disorders of the posterior vaginal compartment].
Genital prolapse, whether associated or not with urinary, anal or sexual dysfunction, should be evaluated globally to select the appropriate treatment. Rectocele and enterocele are defects of the posterior vaginal compartment, although they can be secondary to abnormalities of the central compartment, since lesions of the perineal raphe and rectovaginal septum can occur in isolation or accompanied by others that also affect the tissues involved in pelvic support. The various surgical approaches to rectocele alone or associated with other defects are reviewed. Likewise, the distinct pathogenic types of enterocele are discussed. Laparoscopic sacrocolpoperineopexy is a promising intervention for the simultaneous correction of defects of the posterior and central compartments. New and better designed studies are required to evaluate the distinct surgical approaches and interventions for genital prolapse.
Digestive System Surgical Procedures↗
Surgically correctable fetal hydrops.
Hydrops fetalis is classically the result of immune mediated intrauterine hemolysis. Increasingly, however, nonimmunologic abnormalities have been associated with fetal anasarca. A number of these are potentially surgically correctable. Four such infants have been treated at the Arkansas Children's Hospital since 1981. Fetal hydrops was detected prenatally in three, as well as lesions which might be corrected. All three were delivered by cesarean section with vigorous resuscitation required. Following stabilization, each underwent operation with excision of an intrathoracic mass (teratoma and leiomyosarcoma) in two and closure of omphalocele in the remaining neonate. A fourth infant was transferred following spontaneous premature vaginal delivery with hydrops and respiratory distress. This was associated with adenomatoid malformation which was subsequently excised. Anasarca and respiratory distress resolved postoperatively in all. With evidence of nonimmune hydrops, a thorough evaluation for surgically correctable lesions is indicated. A planned aggressive approach to delivery, resuscitation and stabilization followed by prompt surgical intervention can improve the morbidity associated with nonimmune hydrops fetalis having surgically correctable malformations.
Cesarean Section↗
A novel two-stage approach for the management of massive pelvic organ prolapse.
A new two-stage surgical procedure to treat massive pelvic organ prolapse in elderly women is described. Four women in whom previous pessary treatment had failed (two of these had also tried and failed the double ring pessary) or was not possible due to poor pelvic muscle tone or enlarged vaginal introitus underwent manual reduction of prolapse, colpoperineorrhaphy and ring pessary insertion in the first stage followed by a vaginal hysterectomy with or without sacrospinous fixation 6 weeks later. All patients had a favourable outcome in terms of improvement of symptoms and satisfaction with the treatment.
Age Factors↗
Cyclic shedding of HIV-1 RNA in cervical secretions during the menstrual cycle.
The association between hormone fluctuations during the menstrual cycle and human immunodeficiency virus type 1 (HIV-1) RNA shedding in cervical and vaginal secretions was examined daily for 17 HIV-1-seropositive women, for the duration of 1 cycle. Serum levels of RNA were evaluated 3 times/week. A marginally significant positive correlation between serum levels of progesterone and serum levels of HIV-1 RNA (P=.04) was observed. Cervical virus levels were significantly correlated with the number of days from the midcycle surge in luteinizing hormone (LH) (P=.008). The lowest levels of cervical HIV-1 RNA were present at the LH surge, and this nadir was followed by an increase in virus levels that reached a maximum before the start of menses. In contrast, there was no significant association between the number of days from the LH surge and the level of HIV-1 RNA in vaginal secretions (P=.4). These data support the hypothesis that the level of HIV-1 RNA in cervical secretions is influenced by the menstrual cycle, and they suggest that the risk of heterosexual transmission of HIV-1 may increase as menses is approached.
Cervix Uteri↗
Management of female genitourinary fistulas: transvesical or transvaginal approach?
PURPOSE: We reviewed 25 female genitourinary fistula repairs performed at our institution from 1993 to 1997. MATERIALS AND METHODS: Our series comprised 7 primary vesicovaginal, 6 recurrent vesicovaginal, 7 complex, 1 ureterovaginal and 4 urethrovaginal fistulas. Postoperative followup ranged from 8 months to 5 years. RESULTS: Overall, 92% of the patients were cured (23 of 25). The 2 failures occurred in patients with a history of pelvic malignancy involving adjuvant therapy. CONCLUSIONS: Complex irradiated vesicovaginal fistulas require staged repairs, often with pedicle flaps. However, primary repair of uncomplicated vesicovaginal fistulas is highly successful. Limited transvesical repair of these fistulas offers reliable success with minimal morbidity and hospital stay comparable to those of the transvaginal approach.
Female↗
Invasive procedures in the female pelvis: value of transabdominal, endovaginal, and endorectal US guidance.
Transabdominal, endovaginal, and endorectal ultrasonographic (US) guidance is indispensable for a multitude of invasive procedures in the female pelvis. Transabdominal uterine US performed with a fluid-filled bladder is appropriate and convenient for guidance of difficult dilation and curettage procedures. Transabdominal intraoperative US can be employed to guide several procedures for which the more expensive intraoperative hysteroscopic procedure is now used. Aspiration of symptomatic ovarian cysts that appear benign at US with an endovaginally guided small-gauge needle is simple and effective. Simple noninfected pelvic fluid collections may be aspirated transvaginally for both diagnosis and therapy by using endovaginal guidance. Endovaginal US demonstrates the anatomic relationships of a pelvic abscess to adjacent structures, allowing safe access for transvaginal drainage. By using an endovaginal transducer with a needle guide, cervical and vaginal cuff masses may be easily sampled. An obstructed uterus may be accessed by puncturing obstructive tissue with a trocar-containing needle guided by an endorectal probe. US guidance for placement of a central brachytherapy tandem is performed via the abdominal approach after the bladder has been distended with sterile water. Endorectal US transducers may be effectively used to guide placement of interstitial brachytherapy needles in pelvic soft-tissue masses.
Biopsy, Needle↗
STD care in Zambia: an evaluation of the guidelines for case management through a syndromic approach.
Clinical diagnosis of STDs is unreliable and therefore constitutes a poor basis for choice of treatment. A syndromic approach has been suggested to increase effectiveness of treatment in resource poor settings. Algorithms for the treatment of STD syndromes were evaluated. A total of 436 patients were followed; cure rates were defined and estimated for genital ulcer disease (GUD), urethral and vaginal discharge. Cure rates for the discharge syndromes were high, 97-98%, for both sexes. The cure rate for GUD was 83% for female and 69% for male patients. A higher prevalence of syphilis in the female study population probably contributed to this. It is likely that a large proportion of the treatment failures were due to decreased susceptibility of Haemophilus ducreyi to trimethoprim-sulpha. The determination of cure rates met with a number of methodological problems. This makes it difficult to evaluate the algorithms as part of routine activities, as suggested earlier by WHO.
Evaluation Studies as Topic↗