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PubMed1997

Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma.

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries re-anastomosed.

Anastomosis, Surgical↗
PubMed2025

Genome-wide analysis of Enterococcus faecalis genes that facilitate interspecies competition with Lactobacillus crispatus.

Enterococci are opportunistic pathogens notorious for causing a variety of infections. While both Enterococcus faecalis and Lactobacillus crispatus are commensal residents of the vaginal tract, the molecular mechanisms that enable E. faecalis to take advantage of a vaginal biome with lower counts of lactobacilli to colonize the vaginal tract and induce aerobic vaginitis remain unknown. Here, we show that L. crispatus eradicates E. faecalis in a contact-independent manner. Using transposon sequencing to identify E. faecalis OG1RF transposon (Tn) mutants that are either under-represented or over-represented when co-cultured with L. crispatus, we found that Tn mutants with disruption in the dltABCD operon, that encodes the proteins responsible for the D-alanylation of teichoic acids, and OG1RF_11697 encoding for an uncharacterized hypothetical protein are more susceptible to killing by L. crispatus. Inversely, Tn mutants with disruption in ldh1, which encodes for L-lactate dehydrogenase, are more resistant to L. crispatus killing. Using the Galleria mellonella infection model, we show that co-injection of L. crispatus with E. faecalis OG1RF enhances larvae survival while this L. crispatus-mediated protection was lost in larvae co-infected with either L. crispatus and E. faecalisΔldh1 or Δldh1Δldh2 strains. Last, using RNA sequencing to identify E. faecalis genes that are differently expressed in the presence of L. crispatus, we found major changes in the expression of genes associated with glycerophospholipid metabolism, central metabolism, and general stress responses. The findings in this study provide insights into how E. faecalis mitigate assaults by L. crispatus.IMPORTANCEEnterococcus faecalis is an opportunistic pathogen notorious for causing a multitude of infections. As vaginal commensals, E. faecalis must interact with Lactobacillus crispatus, but how E. faecalis overcomes or mitigate assaults by L. crispatus killing remains unknown. We show that L. crispatus eradicates E. faecalis temporally in a contact-independent manner. Using high-throughput molecular approaches, we identified genetic determinants that enable E. faecalis to compete with L. crispatus. This study represents an important first step for the identification of adaptive genetic traits required for enterococci to tolerate assaults by lactobacilli.

Enterococcus faecalis↗
PubMed2004

Mucosal drug delivery: membranes, methodologies, and applications.

In recent years, extensive research into novel forms of drug delivery has suggested that mucosal approaches offer a promising therapeutic alternative, especially for systemically acting drugs. Transmucosal drug delivery offers many benefits, including noninvasive administration, convenience, rapid onset, as well as elimination of hepatic first-pass metabolism. The investigated absorptive surfaces consist of the nasal, buccal, ocular, vaginal, and rectal mucosae. Among these, the nasal and buccal routes have proved the most promising to date. The bioavailability achieved mainly depends upon the pathophysiological state of the mucosa and the properties of both the drug and delivery systems. Various agents can increase the efficacy of transmucosal drug delivery. These include cyclodextrins, bile salts, surfactants, fusidic acid derivatives, microspheres, liposomes, and bioadhesive agents. The mechanisms of action, effectiveness, and toxicity profiles of these enhancers have been investigated extensively in both animal and human models.

Absorption↗
PubMedDate not supplied

Care of women infected with the human immunodeficiency virus.

OBJECTIVE: --To review current knowledge regarding human immunodeficiency virus (HIV) infection in women and to derive from that data standards of care. DATA SOURCES: --Selective review of pertinent articles addressing cervical disease, pelvic inflammatory disease, sexually transmitted diseases, contraception, and pregnancy in HIV-infected women. A computer-assisted search was used to identify relevant articles on pharmacokinetics of drugs in women and oral contraceptive--drug interactions. DATA EXTRACTION: --Pertinent data were abstracted from case-control, cohort studies, clinical trials, and pharmacokinetic studies. DATA SYNTHESIS: --Few studies have been performed to define the clinical course of HIV infection in women. Gender-specific manifestations, such as cervical neoplasia, pelvic inflammatory disease, and vaginal moniliasis, appear to pursue a more aggressive course in HIV-infected women. Little is known about the pharmacokinetics of drugs for HIV and related infections. Oral contraceptives may alter the metabolism of some drugs used in HIV-infected women. An approach to the routine treatment of HIV-infected women is summarized. CONCLUSIONS: --Little is currently known regarding the natural course of HIV infection in women. Women infected with HIV should be followed up frequently with specific attention paid to the reproductive system. Additional studies should be conducted to determine the impact of HIV on gender-specific diseases.

Contraception↗
PubMed1996

Sarcoma botryoides of the uterine endocervix: long-term results of conservative surgery.

Sarcoma botryoides, a variant of embryonal rhabdomyosarcoma, is the most common neoplasm of the lower genital tract in girls under 16 years of age. This neoplasm more frequently has a vaginal location in patients younger than 4 years, whereas a cervical location has its peak incidence in the second decade. Although the recommended therapy has been radical surgery alone or combined with other modalities, the use of neoadjuvant chemotherapy has changed the surgical approach to one employing a less radical procedure such as a simple hysterectomy or local excision. We present the case of a 12-year-old girl diagnosed with an embryonal rhabdomyosarcoma of the endocervix who received vincristine-Adriamycin-cyclophosphamide combination chemotherapy followed by a simple hysterectomy. The patient exhibits no evidence of disease 8 years after the initial diagnosis.

Adult↗
PubMed2006

Microbicide preference among young women in California.

BACKGROUND: Microbicides for HIV/sexually transmitted infection (STI) prevention are still in development. Microbicide acceptability studies have thus focused on soliciting input from individuals about hypothetical products using traditional epidemiological and behavioral research methodologies. Here, we integrate a well-established market research method, conjoint analysis, with more traditional epidemiological and behavioral research to examine potential users' preferences for different microbicide formulations. METHODS: Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then, young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. The main outcome measures were intentions for different microbicide formulations, inferred preferences for microbicide characteristics, and self-reported risk factors for HIV, other STIs, and pregnancy. RESULTS: Risk of STIs and unwanted pregnancies is a concern within this population. Participants' responses suggest that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter (OTC), (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. CONCLUSIONS: Our findings help illustrate microbicide product preferences and demand among young women in California, and the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and nonuse is critical.

Administration, Intravaginal↗
PubMed2003

The management of VBAC at term: a survey of Canadian obstetricians.

OBJECTIVE: To determine the current practice patterns of Canadian obstetricians towards pregnant women at term, with intact membranes, who have had a previous Caesarean delivery. STUDY DESIGN: A questionnaire was developed in French and English, pretested, and mailed to all obstetricians registered with the Canadian Medical Directory. Two reminders were sent out at 3-week intervals. Respondents identities were kept anonymous. RESULTS: Of 1497 questionnaires sent out, 750 (50%) were returned. Of these 750 respondents, 102 were no longer working in obstetrics and 47 did not manage women with prior uterine incisions in labour, thus leaving 601 respondents (80% of all respondents) who did manage pregnant women in labour with previous Caesarean scars eligible for the analysis. Whereas 91% of these 601 respondents always counsel prospective vaginal birth after Caesarean (VBAC) candidates regarding the risk of uterine rupture, 9% never, or only occasionally, do so. Of these 601 respondents, 16% would use ultrasound assessment of lower uterine segment thickness to consider patients for VBAC, and 25% percent would use prostaglandins to induce labour in women who have had a previous Caesarean. CONCLUSION: There is considerable disparity in the approach of Canadian obstetricians to the management of women with a previous Caesarean delivery scar who come to term without the spontaneous onset of labour, including appropriateness of inducing labour. A large, multicentre, prospective, randomized controlled trial of large numbers of women would help to determine the safety of VBAC and induction of labour in the setting of a uterine scar.

Adult↗
PubMed1989

The significance and scope of reproductive tract infections among Third World women.

Due to biomedical, behavioral and societal factors, reproductive tract infections are widespread in the Third World. Without early diagnosis and accurate therapy, their complications severely compromise women's health, fertility and productivity; infant health and survival; and the effectiveness of family planning programs. Clinicians and public health planners can address these treatable syndromes through research and services in socially acceptable settings including family planning, prenatal and MCH clinics. Specific approaches are discussed.

Abortion, Induced↗
PubMed1980

Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience.

The difficult problem of a vesicovaginal fistula originally was cured surgically by Sims in 1849. During the last 25 years at UCLA and affiliated hospitals 68 patients have been treated by urologic surgeons for fistulas between the vagina and the urinary tract: 21 ureterovaginal and 47 vesicovaginal and urethrovaginal fistulas. The ureterovaginal fistulas often were complex and patients presented the most challenging diagnostic problem. However, they usually were repaired successfully by simple ureteroneocystostomy. Vesicovaginal and urethrovaginal fistulas were repaired transvaginally in 24 cases, with 70 per cent success at the first attempt and 92 per cent success with 2 attempts. Transabdominal or combined approaches were less successful. Only 58 per cent of the cases were closed at first attempt. The transvaginal approach required less operating time, and resulted in less blood loss and shorter hospital stays than the transabdominal approach and will be described in detail.

Adult↗
PubMed1990

Tumor markers in gynecologic neoplasms.

The applications of tumor markers and steroid receptors in gynecologic neoplasms are described. The value of immunohistologic techniques in the histogenetic assessment of gynecologic neoplasms is examined. Approaches to the diagnosis of similar-appearing lesions are presented.

Biomarkers, Tumor↗
PubMed1990

Rationale for anti-AIDS chemotherapy directed at HIV-1 infected dendritic cells in seropositive individuals prior to the appearance of ARC and AIDS.

An approach to anti-AIDS chemotherapy is presented from the point of view of treating seropositive individuals by eliminating the infected dendritic cells that are the in vivo target of HIV-1. Special attention is given to the treatment of Langerhans (dendritic) cells in the skin and epithelia that are infected in vivo by HIV and are involved in the development of the symptoms leading to AIDS and ARC. Since HIV is released through the cervical and vaginal epithelia in seropositive women, it is suggested that combined local treatment of vaginal epithelium with steroids that inactivate dendritic cells and azidothymidine (AZT) that inhibits HIV-1 replication might prevent virus dissemination. Abrogation of HIV-1 transmission will help to prevent its spread throughout the heterosexual population. Thus a new rationale for anti-AIDS treatment is presented, namely selective elimination of HIV-1 infected dendritic cells in the skin and epithelia of infected individuals before the appearance of ARC or AIDS. Subsequent restoration of dendritic cells in HIV-1-infected persons (and in AIDS patients) by means of orally administered retinoids in combination with an antiviral drug might be a useful approach to prevent or delay AIDS.

AIDS-Related Complex↗
PubMed1993

Transvesical and transvaginal reparation in urinary vaginal fistulas.

Thirty-two cases of urinary vaginal fistulas treated surgically at our Department between 1985 and 1991 have been reviewed retrospectively. There were 26 cases of vesicovaginal fistulas, 1 case of urethrovaginal fistula and 5 cases of ureterovaginal fistulas. Gynaecological surgery was the leading cause of the fistulas (24/32). Eight cases of vesicovaginal fistulas and 1 case of urethrovaginal fistula were repaired transvaginally, with 88.8 per cent success. Seventeen cases of vesicovaginal fistulas were repaired by suprapubic transvesical approach, with 88 per cent success at the first attempt and 94 per cent success at 2 attempts. One patient with vesicovaginal fistula underwent ureterosigmoidostomy. Ureterovaginal fistulas were repaired successfully by simple ureteroneocystostomy in 4 cases and 1 case of ureterovaginal fistula required ureteric substitution with a Boari bladder flap.

Adolescent↗
PubMed1993

Laparoscopically assisted surgical staging (LASS) of endometrial cancer.

We report 59 patients who were considered candidates for laparoscopically assisted surgical staging (LASS) to manage their clinical stage I adenocarcinoma of the endometrium. Their ages ranged from 40 to 85 years, with a mean of 69; their weights ranged from 102 to 267 pounds, with a mean of 153 pounds. Patients with intraperitoneal disease were taken off study. Laparoscopic pelvic and para-aortic lymphadenectomies were performed based on the grade of the tumor and the depth of myometrial invasion. Six patients were discovered to have intraperitoneal disease. Of the remaining 53 patients, 29 underwent lymphadenectomy, 1 of whom had positive para-aortic nodes. Of the 24 patients who did not have laparoscopic lymphadenectomy, 2 should have, according to the study criteria; however, obesity precluded this from being performed. Eight patients had grade 3 lesions; of these, 4 lesions had metastasized. The remaining 3 patients with metastatic disease had grade 2 lesions. Complications were related to the laparoscopically assisted vaginal hysterectomy and resulted in two laparotomies: one for a transected ureter and the other for a cystotomy. Estimated blood loss was < 200 cc and the average hospital stay was 2.9 days. We feel that LASS is an attractive alternative to the traditional surgical approach in patients with stage I endometrial carcinoma.

Adenocarcinoma↗
PubMed1982

Transabdominal cervicoisthmic cerclage for the management of repetitive abortion and premature delivery.

The indications for a transabdominal approach for cervicoisthmic cerclage (TCIC) included traumatic laceration, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage, and advanced cervical effacement with intact membranes. The frequency of all cerclage procedures was 1 in 260 deliveries; one TCIC was performed for each six vaginal procedures in the period from 1966 to 1980. A 0.5-cm Mersilene band was applied at the level of the anatomical internal os in an avascular space between branches of the uterine artery. Prior to this operation, the 16 patients had had 55 pregnancies (excluding first-trimester abortions) and had experienced 42 fetal losses (24% salvage rate). After TCIC, 22 pregnancies in 16 patients resulted in 19 term births, two premature births with favorable outcomes, and one fetal loss (95% salvage rate; chi 2 = 46.5, P less than 0.001). All infants were delivered by cesarean section. Postoperative morbidity and the incidence of premature labor or rupture of the membranes were low. Transabdominal cerclage is effective in selected patients with poor obstetric histories that show anatomically defective cervices, or when marked effacement has precluded high vaginal placement of the cerclage.

Abortion, Habitual↗
PubMed1996

Laparoscopic urethral sling for treatment of intrinsic sphincter deficiency.

The surgical treatment of intrinsic sphincter deficiency, or Type III genuine stress urinary incontinence, has traditionally been accomplished by sling cystourethropexy, the placement of an artificial urinary sphincter, or periurethral injection. We developed a laparoscopic approach for the performance of a sling cystourethropexy as an alternative to the open approach and herein describe our experience. We have found that a laparoscopic sling cystourethropexy is feasible, but at the present time, we have been unable to demonstrate any significant advantages to the patient in terms of decreased cost or convalescence compared with the open vaginal sling cystourethropexy.

Female↗
PubMed2003

Laparoscopic repair of vaginal vault prolapse.

PURPOSE OF REVIEW: Currently, the two laparoscopic techniques available and described in the literature for the treatment of vaginal vault prolapse are uterosacral ligament vault suspension and sacrocolpopexy. These two techniques are opposing each other fundamentally. While the first is reconstructive, the second is essentially palliative. RECENT FINDINGS: In both methods the surgeon starts with the identification and dissection of the pubocervical and rectovaginal fascia. In the first technique however, the new vaginal vault, made by re approximation of the two fasciae, is attached to the uterosacral complex, while in the second one, each fascia is suspended from the sacral promontorium, using a mesh. In review of the existing literature, it seems that the palliative surgical approach is more successful in the long term, giving a cure rate of approximately 92%, probably as it involves using mesh instead of the native tissue. SUMMARY: In this article we discuss the laparoscopic techniques available currently, analyse their results, discuss their differences and compare them with other non-laparoscopic techniques. Finally, we discuss the different options described, and offer some guidelines for the future of laparoscopic treatment of pelvic prolapse.

Female↗