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PubMedDate not supplied

[A new vacuum extraction system with a ball joint and detachment warning--in vitro studies and clinical use].

BACKGROUND: The vacuum extractor is used in about 5% of deliveries. It is associated with a lower maternal morbidity than is forceps extraction. On the other hand, cephalhematomas, hyperbilirubinemia and cerebral hemorrhages in the baby are observed more frequently. The sudden detachment of the vacuum extractor with appreciable fluctuations in intracranial pressure in the baby is especially dangerous. In order to improve the conventional Malmström system, we have developed a new vacuum extractor and investigated its handling in vitro and in clinical application. PATIENTS AND METHODS: The essential constructional principle of the new vacuum extractor consists in a pivot lowered by ball bearings and a volume reduction of one third. Moreover, in two-chamber vacuum it is possible to give a warning of sudden detachment. The possible tractional force in kiloponds was determined at various angles (0 degree, 15 degrees, 30 degrees und 45 degrees) comparing the Malmström extractor with the new one and two-chamber system in a standardized apparatus. In addition, the new vacuum extractor was also used clinically in 43 women; besides the obstetric parameters, the handling was also appraised. RESULTS: In the in-vitro experiments, a distinct decrease of the possible tractional force with increasing angles was shown for the Malmström extractor (0 degree--15.7 kp, 15 degrees--12.7 kp, 30 degrees--8.6 kp, 45 degrees--7.3 kp). The values for the new one-chamber system were significantly greater from a tractional angle of 15 degrees (0 degree--15.6 kp, 15 degrees--14.4 kp, 30 degrees--14.0 kp, 45 degrees--13.8). The clinical application of the new vacuum system was unproblematic and confirmed the feasibility of good traction. A very much smaller caput succedaneum was found in the baby. Especially in the training situation, the warning system enables a good surveillance before sudden detachment, but reduces the possible tractional force. CONCLUSIONS: The new vacuum system appears to enable the vaginal surgical delivery to be improved compared to the conventional Malmström extractor. After these promising approaches, a multicenter study was commenced in order to enable better evaluation of their clinical significance.

Equipment Design↗
PubMed2000

Operative hysteroscopy for infertility using normal saline solution and a coaxial bipolar electrode: a pilot study.

The efficacy and safety of a coaxial bipolar electrode surgical system used to treat surgically remediable infertility conditions was investigated. After gaining initial experience with 50 patients with perimenopausal menorrhagia, 40 infertile patients with submucous myomas (n = 12), uterine septum (n = 12), uterine adhesions (n = 11), and uterine hypoplasia (n = 5) were treated. Bipolar electrodes were inserted through a '5' French operating channel of a 5.5 mm hysteroscope without cervical dilatation. Three electrodes were used: ball, twizzle and spring. Power settings ranged from 50 W (desiccation mode) to 200 W (vapour cut mode). Normal saline was used as the distension medium. All the procedures were completed within 30 min using a 1 l bag of normal saline solution. No episodes of cervical laceration, uterine perforation, haemorrhage, fluid overload or thermal injury occurred. Mild cramping, vaginal bleeding and vaginal discharge were common during the first week. No patients were readmitted. This new surgical approach appears to be well tolerated, safe, and is an effective alternative to conventional hysteroscopic surgery in the treatment of intrauterine lesions.

Adult↗
PubMed1995

First trimester embryo reduction: a medical solution to an iatrogenic problem.

The incidence of multiple pregnancies is increasing, mainly as a consequence of the widespread use of various infertility protocols. Since such gestations present a high risk of feto-maternal morbidity and mortality, selective first trimester fetocide remains one of the few reasonable options. We reviewed the literature dealing with the outcome of 804 multiple pregnancies following the use of transcervical, transvaginal or transabdominal approaches. Questions relating to dealing with technical failure, method of fetocide and procedural improvements are examined. In a comparison of the variables: miscarriage, preterm delivery, perinatal and neonatal loss rates, the transvaginal approach fares better, but statistical significance (P < 0.001) is achieved only for preterm delivery. We speculated that this might be attributable to the very early gestational age at which the procedure is usually performed. However, the transabdominal approach offers better results when post-manipulation maternal morbidity is considered, i.e. infection and vaginal bleeding. Since each option offers different advantages and disadvantages, additional experience and larger population samples are required to further clarify this important issue.

Female↗
PubMed2001

Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial.

OBJECTIVE: To compare the results of removing mature teratoma with laparoscopy or without laparoscopy. DESIGN: A prospective, randomised trial. SETTING: Medical centre. PARTICIPANTS: Seventy-nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers. INTERVENTION: Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy. METHODS: Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (n = 37, Group A) or laparoscopic cystectomy via culdotomy opening (n = 42, Group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina. RESULTS: Blood loss in Group A (88 +/- 37 ml) was significantly more than that in Group B (64 +/- 20 ml, P = 0.000). The post-operative recovery times were 20 and 17 hours, respectively (P = 0.030). The rates of successful surgery were 58.6 and 97.6%, respectively (P = 0.002). The spillage rates were 44.8% and 19.0%, respectively (P = 0.006). There were no significant differences in tumour size, patient age, and operative time between groups. CONCLUSION: Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.

Adolescent↗
PubMed1976

The role of postoperative irradiation in the management of stage I adenocarcinoma of the endometrium.

A comparison of treatment protocols for endometrial carcinoma is presented. Valid conclusions regarding optimum approach are virtually precluded because of variability of such factors as clinical staging, incidence of vaginal metastases, patient selection, and histologic grade. While hysterectomy is the established definitive treatement, the superiority of adjuvant irradiation can be demonstrated only by randomized prospective studies.

Adenocarcinoma↗
PubMed2000

Uncomplicated pregnancy: clinical pathway genesis based on the nursing process.

A prospective study of obstetrical patients from enrollment as outpatients until postpartum discharge was formulated at Madigan Army Medical Center. The control group included uncomplicated obstetrical patients from March 1 to August 31, 1994. The study group included uncomplicated obstetrical patients from March 1 to August 31, 1996. Patient satisfaction, identification of barriers to care, recognition of areas to improve quality of care, and cost-consequence analysis were studied. There were 1,042 control patients totaling 2,668 hospital days, with mean hospital stays of 2.56 days per patient (SD = 0.878). The study cohort comprised 1,050 patients with 1,965 hospital days, with a mean of 1.87 hospital days per patient (SD = 1.48). The study cohort demonstrated a statistically significant decrease (p < 0.05) in admission length of stay in the early discharge vaginal delivery gravidas, with cost savings from $3.2 million to $2.4 million. Using an interdisciplinary approach, we were able to elucidate the process necessary to identify critical nodes of patient care and satisfaction while providing significant cost savings.

Cost Savings↗
PubMed1979

[Gartner's duct carcinoma of vagina in pregnancy - case report (author's transl)].

Reported in this paper is a mesonephroid carcinoma in the vagina of a primigravida, 27 years of age, in the 27th or 28th week of pregnancy. The carcionoma originated from Gartner's duct and is characterised by typical papillary structures. Such carcionoma quite often cannot be morphologically differentiated from metamesonephroid carcionomas which originate from Mueller's epithelium to occur on the same site. Both tumour forms are rather often be considered an entity in relevant literature. The development of that carcinoma during gravidity is considered accidental. - Included in the therapeutic approach were Caesarean section, radical hysterectomy, including radical adnexectomy and removal of a 5-cm vaginal collar, removal of the Douglas peritoneum because of visible intraperitoneal metastasation, and extensive lymphonodectomy, all in one session. - Biaxial telecobalt pendulum irradiation followed postsurgically, the focal dose being 7,000 rd. No sign of recurrence has been recordable from follow-up checks and clinical examinations, one year from surgery.

Adnexa Uteri↗
PubMedDate not supplied

Effect of TSAA-291 on male reproductive tract and fertility of the rat.

Adult male rats were injected with TSAA-291 (16 beta-ethyl-17 beta-hydroxyestr-4-en-3-one), a steroidal antiandrogen, daily for 30 days at two doses, viz., 10.0 and 25.0 mg/kg. The treatment caused a dose-dependent reduction in the weights of testis, epididymis, and other accessory sex glands. In the animals that received the high dose, 50% of the rats showed spermatogenic arrest in about 20% of the seminiferous tubules and Leydig cell morphology was normal. The levels of glycerylphosphorylcholine and sialic acid were significantly reduced in the cauda epididymis of all the treated rats. There was a reduction in the number of motile spermatozoa in the cauda epididymis of rats treated with high dose of the antiandrogen. This was accompanied by a reduced number of females exhibiting spermatozoa in their vaginal smears. A combination treatment of the antiandrogen and androgen appears to be a promising approach for fertility regulation in the male.

Androgen Antagonists↗
PubMed1993

[Endoscopy of the preperitoneal interstitium--a new approach for colposuspension].

The successful use of fibrin sealant in Colposuspensive surgery has been proved in long-term follow-up studies, avoiding disadvantages and risk of the suture technique. We introduce a new technique allowing us to perform colposuspension by minimal invasive surgery. By endoscopic approach of the pre-peritoneal interstice (Retziiscopy), a correct preparation of urinary bladder, urethra, vaginal fascia and Cavum Retzii is possible. Following preparation, colposuspension by means of fibrin sealant can be performed.

Female↗
PubMedDate not supplied

[Colonization by group B hemolytic streptococcus in pregnancy. Note of prevention and therapy of the materno-neonatal infection. Casuistics].

As several international studies show, the knowledge of the wide clinical spectrum of perinatal group B streptococcal infection, particularly of the early and of the late-onset neonatal diseases in GBS carrier mothers, is basically important for medical diagnosis. Risk factors analysis further determines both the diagnosis and the maternal intrapartum chemoprophylaxis. The considerable rate of neonatal disease without risk factors and its possible serious and fatal consequences bring to tendentially non selective prevention approaches that must consider the local background. At Merate Hospital, in a 3 years time, vaginal and rectal specimens for GBS cultures were obtained from 1766 pregnant women either at the 32nd or at the 36th week of gestation and regularly at the labor. 376 women (21.29 percent) resulted GBS carriers; the maternal-fetal contamination rate was 15.42 percent (58/376) i.e. 32.6 per 1000 live births (58/1769). Intrapartum chemoprophylaxis was carried out with i.v. erytromycin, i.v. or i.m. cephalosporins, i.v. ampicillin and per os amoxicillin (which gave the most interesting results). In infants born to mothers who received an antibiotic therapy at labor as compared with those who received no treatment, GBS neonatal colonization was present in 31 of 286 (10.8 percent) versus 27 of 90 (30 percent; P < 0.001); heavy colonization was observed in 10 of 286 (3.4 percent) versus 15 of 90 (16.6 percent; P < 0.001) and early-onset neonatal disease (both symptomatic and asymptomatic) occurred in none of 286 versus 4 of 90 (4.44 percent; P = 0.0031). Perinatal risk factors (no-screened mothers, labor at 36th week of gestation, prolonged membrane rupture) were present only in 1 of 4 GBS infected infants (25 percent). Intrapartum therapy both in carriers and in no-screened women significantly reduced GBS neonatal colonization, particularly the heavy one and, consequently, the early-onset neonatal group B streptococcal disease.

Adult↗
PubMed1996

Controversies: premature rupture of membranes at term--no advantage of delaying induction > 24 hours.

Results from randomised trials with formal randomisation indicate no evidence of benefits in terms of cesarean delivery of maternal/neonatal infectious morbidity by awaiting spontaneous onset of labor for more than 24 hours in women with term PROM. An overnight policy of management seems to be an attractive alternative to other management protocols. Women with prelabor rupture of membranes await stimulation of labor with oxytocin till next morning if admitted before midnight. A majority of the women may go into spontaneous labor with an excellent prospect of having a vaginal delivery. Particularly the nulliparous woman with poor cervical score could benefit from such an approach. Although prostaglandins in theory should be an useful adjunct agent to oxytocin, particularly in the nulliparous woman with unripe cervix, convincing evidence of the efficacy of the drug is still lacking. Well-conducted and randomised studies to evaluate the role of prostaglandins in nulliparous women with PROM are required.

Dinoprostone↗
PubMed1999

Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival.

OBJECTIVES: Our goal was to evaluate the morbidity, recurrence, and survival of patients with clinical stage I endometrial cancer treated by laparoscopic lymphadenectomy with vaginal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy. STUDY DESIGN: This article is a retrospective review of records for 56 patients. The mean follow-up among those alive at last contact was 2.4 years (range, 32 days-5.2 years). Staging according to the International Federation of Gynecology and Obstetrics (1988) was as follows: I, 45 (80.4%); II, 3 (5.4%); III, 6 (10.7%); and IV, 2 (3.6%). RESULTS: Intraoperative complications occurred in 4 patients (7.1%). Transformation to laparotomy was necessary in 7 patients. Postoperative complications were observed in 9 patients (16.1%). Pelvic irradiation was administered postoperatively to 11 patients (19.6%). Among the 45 patients with surgical stage I disease, the 3-year recurrence rate was 2.5% and the 3-year cause-specific survival was 96.0%. CONCLUSIONS: Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy provided 3-year survival and recurrence rates similar to those of the traditional abdominal approach.

Adult↗
PubMed1994

Pudendal enterocele with bladder involvement.

A 72-year-old diabetic women presented with a large left labial mass following multiple prior vaginal surgeries to correct vaginal vault prolapse, including two failed right-sided sacrospinalis fixation procedures and a near total colpocleisis. After failure of conservative management, a translabial repair of this pudendal hernia containing bladder was performed. Return of the labial mass 9 months later prompted a more extensive abdominal approach. To close the defect in the urogenital diaphragm and prevent its recurrence, an absorbable mesh was used. Then, to prevent enterocele recurrence, vaginal vault suspension to the sacral promontory and closure of the Douglas pouch were performed. A review of the literature is presented, with an analysis of risk factors and corrective surgical techniques.

Aged↗
PubMed1991

Recurrent vaginitis.

Recurrent vulvo-vaginitis is indeed a difficult problem with both a physical and psycho-sexual impact on the patient. A thorough and caring approach is important to help patients through a demanding time. Future hopes lie in the refinement of better tolerated oral imidazoles and the research into the immunology of candidiasis.

Female↗
PubMed2005

Pelvic lymphadenectomy for cervical cancer: extraperitoneal versus laparoscopic approach.

OBJECTIVE: To compare the extraperitoneal versus the laparoscopic technique in performing pelvic lymphadenectomy in a series of patients undergoing a radical vaginal hysterectomy for locally advanced cervical cancer. STUDY DESIGN: Retrospective study with 42 patients undergoing a radical vaginal hysterectomy for cervical cancer. Patients from group A (20 patients) had a laparoscopic lymph node dissection and patients belonging to group B (22 patients) had an extraperitoneal lymphadenectomy. Historical data, clinical and surgical characteristics, perioperative and post-operative complications were analyzed. Follow-up was conducted according to the oncologic requirements. RESULTS: No significant difference was observed between the two groups in terms of blood loss, post-operative pain, transfusions, hospital stay and post-operative hematomas. The extraperitoneal group (group B) significantly showed a reduced operating time, a greater number of nodes removed (p<0.05). The only lymphocyst occurred in group B. CONCLUSIONS: Extraperitoneal pelvic lymphadenectomy can be considered an adequate technique to complement radical vaginal operations for cervical cancer.

Female↗
PubMed1999

Selective estrogen receptor modulators: a controversial approach for managing postmenopausal health.

Hormone replacement therapy (HRT) is considered the standard of care for managing the acute (e.g., hot flashes, vaginal dryness) and long-term (e.g., increased risk of cardiovascular disease, osteoporosis) sequelae of menopause. A group of synthetic nonsteroidal compounds, which act on the estrogen receptor, have been promoted for use as an alternative to hormonal therapy for postmenopausal women. Originally called antiestrogens because of their ability to antagonize the action of estrogen, these compounds possess both agonist and antagonist properties of estrogen action. They are now referred to as selective estrogen receptor modulators (SERMs). This article reviews the mechanism of action and the efficacy and safety data for SERMs currently used for clinical purposes. These data may indicate why the use of SERMs is a controversial alternative to HRT.

Cardiovascular Diseases↗
PubMed2004

Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods.

The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the aetiology of these diseases. Common wisdom is that lactobacilli dominate the normal vaginal microflora of post-pubertal women. However, this conclusion is based on methods that require cultivation of microbial populations; an approach that is known to yield a biased and incomplete assessment of microbial community structure. In this study cultivation-independent methods were used to analyse samples collected from the mid-vagina of five normal healthy Caucasian women between the ages of 28 and 44. Total microbial community DNA was isolated following resuspension of microbial cells from vaginal swabs. To identify the constituent numerically dominant populations in each community 16S rRNA gene libraries were prepared following PCR amplification using the 8f and 926r primers. From each library, the DNA sequences of approximately 200 16S rRNA clones were determined and subjected to phylogenetic analyses. The diversity and kinds of organisms that comprise the vaginal microbial community varied among women. Species of Lactobacillus appeared to dominate the communities in four of the five women. However, the community of one woman was dominated by Atopobium sp., whereas a second woman had appreciable numbers of Megasphaera sp., Atopobium sp. and Leptotrichia sp., none of which have previously been shown to be common members of the vaginal ecosystem. Of the women whose communities were dominated by lactobacilli, there were two distinct clusters, each of which consisted of a single species. One class consisted of two women with genetically divergent clones that were related to Lactobacillus crispatus, whereas the second group of two women had clones of Lactobacillus iners that were highly related to a single phylotype. These surprising results suggest that culture-independent methods can provide new insights into the diversity of bacterial species found in the human vagina, and this information could prove to be pivotal in understanding risk factors for various infectious diseases.

Actinobacteria↗