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At least 19 recordsLinked to original sources

[Shielded vaginal applicators for line-shaped 192Ir sources for use in the irradiation of cervix cancer].

The possibility is investigated to use shielded vaginal applicators for "line-shaped" 192Ir-sources to irradiate cervical carcinoma. Using segment-shaped absorbers of heavy metal the dose can be reduced in ventro-dorsal direction in area of rectum and bladder with irradiation of cervical carcinoma up to a factor of 2 in dependence of rectum and bladder position. Selecting a suitable source position and source standing time a dose reduction can be realized in cranial direction up to two centimetres from the portio.

Brachytherapy↗

Dose distributions produced by a shielded vaginal cylinder using a high-activity iridium-192 source.

Algorithms commonly used to compute the dose distribution around a 192Ir source do not calculate the dose by summing the primary and scatter dose components. Thus if the scatter component is reduced significantly by the insertion of a shield into a vaginal cylinder, the algorithm may overestimate the dose delivered to the tumor volume. This problem was investigated by measuring the relative dose around a 2.5 cm diameter shielded vaginal cylinder in a water phantom by use of a 0.147 cm3 thimble ionization chamber. Measurements were made with the cylinder unshielded and with 0.8 cm thick 90 degrees, 180 degrees, and 270 degrees tungsten shields inserted. A reduction in dose was observed on the unshielded side of the cylinder which increased with distance from the source and with the angle subtended by the shield. This reduction did not exceed 2% within 1 cm from the surface of the cylinder with any shield. However, the reduction in dose increased linearly to 3%, 5%, and 15% at a distance of 10 cm from the source with the 90 degrees, 180 degrees, and 270 degrees shields, respectively. On the shielded side of the cylinder, the dose at the surface is reduced to about 13% of its value without the shield; however, this percentage increases with distance reaching a maximum 2-4 cm from the cylinder. The maximum values obtained with the 90 degrees, 180 degrees, and 270 degrees shields were 23%, 17%, and 16%, respectively.

Algorithms↗

On the validity of the superposition principle in dose calculations for intracavitary implants with shielded vaginal colpostats.

Intracavitary vaginal applicators typically incorporate internal shielding to reduce dose to the bladder and rectum. While dose distributions about a single colpostat have been extensively measured and calculated, these studies neglect dosimetric perturbations arising from the contralateral colpostat or the intrauterine tandem. Dosimetric effects of inhomogeneities in brachytherapy is essential for both dose-based implant optimization as well as for a comparison with alternate modalities, such as intensity modulated radiation therapy. We have used Monte Carlo calculations to model dose distributions about both a Fletcher-Suit-Delclos (FSD) low dose-rate system and the microSelectron high dose-rate remote afterloading system. We have evaluated errors, relative to a Monte Carlo simulation based upon a complete applicator system, in superposition calculations based upon both precalculated single shielded applicator dose distributions as well as single unshielded source dose distributions. Errors were largely dominated by the primary photon attenuation, and were largest behind the shields and tandem. For the FSD applicators, applicator superposition showed differences ranging from a mean of 2.6% at high doses (>Manchester Point A dose) to 4.3% at low doses (<Manchester Point A dose) compared to the full geometry simulation. Source-only superposition yielded errors higher than 10% throughout the dose range. For the HDR applicator system, applicator superposition-induced errors ranging from 3.6%-6.3% at high and low doses, respectively. Source superposition caused errors of 5%-11%. These results indicate that precalculated applicator-based dose distributions can provide an excellent approximation of a full geometry Monte Carlo dose calculation for gynecological implants.

Biophysical Phenomena↗

Dose distributions produced by shielded applicators using 241Am for intracavitary irradiation of tumors in the vagina.

Dosimetric characteristics of shielded vaginal applicators containing encapsulated 241Am sources are investigated in this work. Encapsulated 241Am sources emit primarily 60-keV photons which are more effectively shielded by thin layers of high atomic number materials than the 662-keV photons from 137Cs sources. With 241Am, it is possible to achieve almost unidirectional irradiation of localized vaginal tumors. The drastic decrease in irradiation volume on the contralateral side (uninvolved with tumor) is observed to decrease dose by up to 20%, even in the forward direction (unshielded side toward the tumor) of the applicator. A possible explanation for the observed effects of shields in both the forward and backward directions is the reduction of scattered photon fluence due to absorption of photons in the lead shield via photoelectric effect. Current theoretical models do not include this perturbation effect caused by shields on brachytherapy applicators.

Americium↗

Incidence of perceived and actual face shield contamination during vaginal and cesarean delivery.

OBJECTIVE: The purpose of this study was to determine the rate of potential contamination or splashes to the face of obstetricians during vaginal and cesarean delivery. STUDY DESIGN: Clear plastic face shields were worn during 50 consecutive vaginal and 50 consecutive cesarean deliveries. The face shields were then analyzed for evidence of contamination, and rates of contamination were compared. RESULTS: The contamination rate of the face shields was 50% during cesarean deliveries and 32% during vaginal deliveries. Ninety-two percent of the contaminated face shields were undetected by physicians at the time of cesarean delivery and 50% were undetected at the time of the vaginal delivery. CONCLUSIONS: Obstetricians commonly receive blood or amniotic fluid splashes to the face during deliveries and should wear protective eyeglasses or face shields during all deliveries to minimize the risk of exposure to potentially infectious blood and body fluids.

Amniotic Fluid↗

Prevention of vaginal trichomoniasis by compliant use of the female condom.

BACKGROUND: Several case-control studies suggest that the male condom protects women against some sexually transmitted diseases. The female condom is the first barrier device under the woman's control that may be effective in the prevention of sexually transmitted diseases. GOAL OF THIS STUDY: To determine if appropriate use of the female condom decreased the rate of recurrent vaginal trichomoniasis in previously diagnosed and treated women. STUDY DESIGN: One hundred and four sexually active women with vaginal trichomoniasis were treated with metronidazole and assigned to a group using the female condom or a control group during a 45-day period of continued sexual activity. Fifty women served as controls, and 54 women were assigned to use the female condom. RESULTS: Only 20 women used the female condom each time they had sexual intercourse. Reinfection with trichomonas occurred in 7/50 (14%) controls, in 5/34 (14.7%) noncompliant users, and in 0/20 compliant users of the female condom. CONCLUSION: The compliant use of the female condom is effective in preventing recurrent vaginal trichomoniasis.

Adult↗

New condoms for men and women, diaphragms, cervical caps, and spermicides: overcoming barriers to barriers and spermicides.

Barriers and spermicides are being developed for the prevention of unwanted pregnancy and sexually transmitted infection. The inconvenience of current methods limits their acceptability and leads to higher user failure rates. New methods, such as female condoms, nonlatex male condoms, and new cervical caps are being developed: the Reality (Wisconsin Pharmacal, Jackson, WI) polyurethane vaginal pouch has already received conditional Food and Drug Administration approval for use in the United States. The material used in a Food and Drug Administration-approved nonallergenic glove is being tested for its effectiveness as a condom. In addition, the Fem Cap, a cervical cap that had a life table probability of failure within 1 year of 4.8%, is expected to be available within the next 2 years. It is important for clinicians to be informed of new options becoming available for those patients who may be good candidates for these barrier methods.

Contraceptive Devices↗

Contraception for midlife women.

Women wish to continue to be sexually active long after their desire to bear children. The risks associated with unintended pregnancy easily can be avoided by providing women with information about, and access to, contraceptives that are safe and effective. Because fertility naturally declines with age, different contraceptives may be more suitable for women toward the end of their reproductive years than were appropriate at periods of peak fertility. This article discusses the risks and benefits of various contraceptives for midlife women and the implications of this information on nursing practice.

Adult↗

Treatment of female urethral carcinoma in medically inoperable patients using external beam irradiation and high dose rate intracavitary brachytherapy.

PURPOSE: We developed and present our experience with high dose rate brachytherapy for treatment of carcinoma of the urethra in medically inoperable women. MATERIALS AND METHODS: Since 1991, 4 women with localized urethral cancer, medically unable to undergo resection or interstitial implantation, were treated with external beam and high dose rate intracavitary implantation rather than external beam irradiation alone. The fractionated implants were delivered with a high dose rate remote afterloader using a shielded vaginal applicator and modified urethral catheter. The urethral catheter was inserted through the lumen of a 20F Foley tube to improve depth dose. Homogeneous dose distribution was achieved and customized to the individual patient. RESULTS: All high dose rate brachytherapy treatments were given at the clinic without use of sedation or anesthesia. Treatment was well tolerated, and all patients maintained voluntary urinary function and local control at 12 to 55 months after therapy. Chronic morbidity due to urethral, bladder, vaginal or rectal injury, including urethral stenosis, necrosis or fistula, was not noted. Isodose distributions were compared among this technique, interstitial implantation and external beam radiotherapy alone. CONCLUSIONS: Although we prefer interstitial implantation as the boost technique for women with urethral cancer, high dose rate brachytherapy is a reasonable option for medically inoperable patients. This outpatient treatment is well tolerated, preserves voluntary urinary function and enhances quality of life.

Aged↗

The female condom. A pilot study of the acceptability of a new female barrier method.

The best available prevention against sexually transmitted diseases is limited to a consistent and correct use of a condom by the male. A new barrier method has been developed for the female. As it can be inserted into the vagina before sexual intercourse starts, and as it covers the entrance of the vagina, the opening of the urethra and the root of the penis, it is presumed to give a high degree of protection against sexually transmitted diseases and unwanted pregnancy. The preliminary results concerning acceptability are promising, and further investigations concerning acceptability and efficacy are in progress or completed in several countries. The method should be regarded as one aspect in the pattern of protection, particularly suitable for females with sexual risk behavior.

Adult↗