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Biomedical subjects

M F Paraiso

Publications and source records attributed to M F Paraiso.

9 recordsLinked to original sources
PubMed2001

Outcome of sphincteroplasty combined with surgery for urinary incontinence and pelvic organ prolapse.

PURPOSE: This is the first reported prospective study comparing outcome and cost in patients undergoing sphincteroplasty for anal incontinence vs. sphincteroplasty performed in combination with one or more procedures for urinary incontinence and/or pelvic organ prolapse. METHODS: We analyzed 44 patients with fecal incontinence who underwent anal sphincter repair alone (20 patients) or in combination with procedures for urinary incontinence or pelvic organ prolapse (24 patients). Information regarding risk factors for fecal incontinence, the degree of incontinence, and the extent that incontinence limited social, physical, and sexual activity was prospectively obtained from questionnaires. Clinic chart reviews and follow-up telephone interviews provided additional data. A cohort of case-matched patients who underwent only urogynecologic procedures was compared retrospectively for operative time, hospital cost, length of stay, and postoperative complications. RESULTS: There were no major complications in any group. The functional outcomes, physical, social, and sexual activity were similar in all three groups. Twenty-two of 24 patients who underwent the combined procedures were glad that they had both procedures concomitantly. CONCLUSION: Combination pelvic floor surgery provides good outcomes and is cost effective. This approach should be offered to women with concurrent problems of fecal and urinary incontinence and/or pelvic organ prolapse.

Anal Canal↗
PubMed1999

Laparoscopic surgery for enterocele, vaginal apex prolapse and rectocele.

Laparoscopy has been applied to all aspects of gynecologic surgery, but few investigators have reported the repair of vaginal apex prolapse, enterocele and rectocele via the laparoscopic route. This article reviews the indications, anatomy, operative technique, clinical results and complications of laparoscopic culdeplasty, enterocele repair, posterior repair, sacral colpopexy and vaginal vault-uterosacral ligament suspension.

Female↗
PubMed1999

Laparoscopic surgery for genuine stress incontinence.

Laparoscopic Burch colposuspension has rapidly become one of the primary surgical treatment options for genuine stress incontinence. The procedure has been modified by some investigators because of technical difficulty with laparoscopic suturing, but should be identical to the conventional open Burch procedure. This article reviews the indications, operative technique, clinical results, complications and learning curve for laparoscopic retropubic surgical procedures.

Clinical Competence↗
PubMed1999

Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy.

OBJECTIVE: We compared operative time, length of hospital stay, postoperative recovery, return to work, and costs for women undergoing laparoscopically assisted vaginal hysterectomy or abdominal hysterectomy. STUDY DESIGN: A prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy (n = 24) versus abdominal hysterectomy (n = 24) was carried out in a tertiary care setting. The main outcome variables were operative time, length of hospital stay, and return to work. Secondary outcomes were postoperative pain and return to normal activity as determined by weekly visual analog scales and daily diary. Hospital costs were calculated. RESULTS: The laparoscopically assisted vaginal hysterectomy group had longer operative times (median and quartiles, laparoscopically assisted vaginal hysterectomy 180 [139, 225] minutes vs abdominal hysterectomy 130 [97, 155] minutes), lower requirements for postoperative intravenous analgesia (patient-controlled analgesia pump, median and quartiles: laparoscopically assisted vaginal hysterectomy 22.1 [15.9, 23.5] hours, abdominal hysterectomy 36.7 [26.2, 45.0] hours), shorter length of hospital stay (median and quartiles, laparoscopically assisted vaginal hysterectomy 1.5 [1.0, 2.3] days, abdominal hysterectomy 2.5 [1.5, 2.5] days), and quicker return to work (Kaplan-Meier analysis, P =.03). Both procedures had similar hospital costs (P =.21). CONCLUSION: Laparoscopically assisted vaginal hysterectomy appears to allow patients a more rapid postoperative recovery and an earlier return to work with hospital costs similar to those of abdominal hysterectomy.

Adult↗
PubMed1998

Staple pull-out strength in an animal model of Cooper's ligament.

STUDY OBJECTIVE: To understand the effect of staple number, orientation, and configuration on pull-out strength in an animal model of Cooper's ligament, and compare it with force to knot failure or suture breakage. DESIGN: Comparative study (Canadian Task Force classification I). SETTING: Ethicon Endo-Surgery Institute, Cincinnati, Ohio. SUBJECTS: Fibrous connective tissues from bovine ischia were the tissue model. INTERVENTION: Specimens were fixed in a cement-plaster compound and mounted in a tensiometer. Endoscopic staples were used to hold a loop of 0-braided polyester suture to the tissue. MEASUREMENTS AND MAIN RESULTS: The suture loop was pulled perpendicularly away from tissue at a constant rate of 2.1 mm/second and peak force to staple pull-out was recorded. Two staple orientations and four staple configurations were studied. Tests were applied in a factorial arrangement. Ten-millimeter stitches of 0-braided polyester suture in the model were also tested. Maximum force to staple pull-out depended on staple number, orientation, and configuration. Peak force required to remove two staples was significantly higher than that to remove one. Spacing between two staples was less important. Pull-out strength was significantly higher when staples were placed parallel to tissue fibers. Stitches placed perpendicular to fibers failed at the knot or by suture breakage with a mean force approximately two times the peak force to remove two staples. CONCLUSION: Two staples placed 2 to 5 mm apart parallel to tissue fibers resulted in the greatest pull-out strength of studied configurations.

Animals↗
PubMed1996

Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction.

OBJECTIVE: Our purpose was to evaluate the efficacy and consequences of sacrospinous ligament suspension and pelvic reconstruction. STUDY DESIGN: Patients who underwent sacrospinous ligament suspension between 1978 and 1991 were evaluated from follow-up visits, telephone interviews, questionnaires, and chart reviews. Before and after operation, vaginal support was graded in three segments. Postoperative visceral and sexual function was evaluated. RESULTS: Mean length of follow-up for 243 patients was 73.6 months. Of these, 102 (42.0%) had a support defect in at least one segment; anterior, posterior, and apical defects were found in 91 (37.4%), 33 (13.6%), and 20 (8.2%) patients, respectively. A clinically significant defect was defined as a symptomatic first-degree or any second-or third-degree prolapse. Defect-free survival rates at 1, 5, and 10 years were 88.3%, 79.7%, and 51.9%, respectively. Eleven patients (4.5%) underwent subsequent pelvic reconstruction. CONCLUSION: Sacrospinous ligament suspension and pelvic reconstruction are effective for vaginal apex support, but vaginal prolapse recurs with time, most commonly in the anterior segment.

Adult↗
PubMed1996

Comparison between Centcor CA 125 and CA 125 II assays.

Second generation CA 125 assays are expected to replace the original CA 125 assays soon. This study compares the Centcor CA 125 II and the original Centcor CA 125 assays in 50 women: 34 with gynecologic cancers, 5 with benign conditions and 11 healthy. The serum values obtained by both assays were not statistically different and showed high correlation especially for values < 300 U/ml. Two patients who had false elevation of CA 125 by the original assay secondary to human antimouse antibody had normal values by the CA 125 II assay. It is concluded that CA 125 serum values obtained by the Centcor CA 125 II assay correlate well with the values obtained by the original Centcor CA 125 assay especially for values < 300 U/ml and are less likely to show elevated false positive results secondary to human antimouse antibody.

Adult↗
PubMed1994

Evaluation of the endocervical Cytobrush and Cervex-Brush in pregnant women.

OBJECTIVE: To compare, in pregnant women, the endocervical cell yield of the Cytobrush Cell Collector and the Cervex-Brush Cell Sampler with the standard cotton swab, and to determine the incidence of serious adverse events associated with the collection techniques. METHODS: In a randomized, controlled clinical trial, 352 pregnant women undergoing initial obstetric evaluation were randomly assigned to either the cotton swab and modified Ayers spatula, Cytobrush and modified Ayers spatula, or Cervex-Brush. The cytopathology laboratory, blinded to the Papanicolaou smear method, screened the smears using the Bethesda System guidelines. Statistical analyses were performed using the Pearson chi 2 and analysis of variance tests. RESULTS: There was an increased detection of endocervical cells in pregnant patients with both the Cytobrush and modified Ayers spatula (90.7%) and the Cervex-Brush (83.3%) methods, compared with the cotton swab and modified Ayers spatula (70.8%) (P = .0001 and P = .0233, respectively). There was no statistically significant difference between the Cytobrush-spatula and Cervex-Brush groups (P = .0956). Although there were more bloody Papanicolaou smears in the study groups, this was neither clinically nor statistically significant because all the samples were interpretable and repeat samples due to bloody specimens were not required. There were no serious adverse events associated with the study group methods. CONCLUSION: Performance of Papanicolaou smears using the Cytobrush and modified Ayers spatula and with the Cervex-Brush improved Papanicolaou smear adequacy as compared with the cotton swab and modified Ayers spatula. Despite an increased incidence of spotting following collection, these techniques were not associated with an increase in serious adverse events. Based on the cost per item and a clinically significant increase in endocervical cell yield, we recommend the Cytobrush and modified Ayers spatula for cytologic screening in pregnant women.

Adult↗