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At least 1,207 records · Page 67Linked to original sources
PubMed1987

A role for aromatizable androgens in female rat puberty.

The function that aromatizable androgens may have in female puberty is unclear. The present experiments were undertaken to examine, using a quantitative approach, the role that physiological levels of these androgens may play in determining the timing of vaginal opening and first ovulation in female rats. Serum androstenedione (delta 4) levels increased markedly between Postnatal Days 4 and 8, remained elevated through Day 16, and declined thereafter to remain at about 100 pg/ml throughout juvenile development (Days 20-32). Serum testosterone (T) also increased, though less prominently after Postnatal Day 4. Maximal values were found at Day 12 (about 150 pg/ml); thereafter, T levels decreased to intermediate values (about 100 pg/ml), which were maintained during juvenile days. Serum dehydroepiandrosterone (DHA) remained undetectable throughout prepubertal development. At puberty, serum delta 4 increased 2.5-fold, but only at the time of the preovulatory luteinizing hormone (LH) surge. In contrast, T levels increased significantly 2-fold on the early proestrous-2 phase of puberty, 3.5-fold on the morning of first proestrus, and 9-fold at the time of the LH surge. Serum DHA remained undetectable. Implantation of Silastic capsules containing T at 2 or 6 mg/ml oil into juvenile 28-day-old rats resulted in serum T levels similar to those found on early proestrous 2 (about 150-180 pg/ml) and at 1300 h of first proestrus (ca. 300-400 pg/ml), respectively. Both treatments induced precocious vaginal opening, but failed to advance first ovulation. About 50% of the T-implanted rats had ambiguous estrous-type vaginal cytology preceding the day of first diestrus, and failed to show corpora lutea at this time.(ABSTRACT TRUNCATED AT 250 WORDS)

Androgens↗
PubMed2006

Five cases of tape erosion after transobturator surgery for urinary incontinence.

BACKGROUND: Before introducing the transobturator tape into our practice we undertook 52 transobturator tape procedures. The transobturator tape procedures were undertaken with an "outside-in" approach, using nonwoven polypropylene mesh with average pore size of 50 mum. CASES: Five cases of vaginal erosions have been identified, 1 complicated by a groin abscess. All cases required further procedures to trim (n = 3), resect (n = 1) or remove (n = 1) the tape. One woman had a tension-free vaginal tape procedure. To date, 3 women remain incontinent. CONCLUSION: Possible reasons for the complications include 1) surgical inexperience (unlikely, given that we have undertaken more than 2000 tension-free vaginal tape procedures without similar complication rates); 2) inherent susceptibility of the "hammock" position of the transobturator tape; or 3) the nonwoven polypropylene tape with mesh size of 50 microm itself may predispose to erosion or abscess.

Adult↗
PubMed1978

The incarcerated intrauterine device.

Complete embedding or incarceration of the IUD is likely to cause difficulty at removal. Attempts at vaginal removal with 'heavy' instrumentation are hazardous and should be abandoned in favour of an abdominal approach. A trial demonstrating the superiority of the latter approach is described. The characteristics of patients with an incarcerated loop make concomitant tubal ligation possible in most instances.

Female↗
PubMed1985

Blood velocities in the uterine artery in humans during labour.

Blood velocities in the uterine arteries were measured during labour in humans, by means of the pulsed ultrasound Doppler velocity meter (UNIDOP). The uterine arteries were approached through the abdominal wall at the lateral border of the uterus and through the lateral vaginal fornix. At a depth of 0.5-1.5 cm from the lateral vaginal fornix there were three different arteries in each woman. One of these arteries had similar velocity spectra to the uterine artery as measured through the abdominal wall higher up along the uterus, and the velocities were in the same range. The mean velocities were high and the velocities in diastole were high compared to those in systole. During uterine contractions the velocities were reduced during diastole, reducing mean velocities by 20-40% as measured through the vagina and by 50-60% when measured higher up through the abdominal wall. A second artery, which we believe is a branch of the uterine artery traversing the myometrium, had lower mean velocities and a greater difference between systole and diastole. During contractions the velocities were reduced by 100%. A third artery, which we believe is the descending branch of the uterine artery, supplying the cervix and vagina, had the lowest mean velocities, with backflow during diastole. During contractions the velocities increased 100-140%.

Arteries↗
PubMedDate not supplied

[McKusick-Kaufman syndrome: diagnostic and therapeutic problems].

Mc Kusick-Kaufman Syndrome (SMK) is an autosomal recessive multiple malformation Syndrome characterized by hydrometrocolpos and polydactyly. This Syndrome is more frequent in females, whose parents are first-degree cousins (frequency 1:8 liveborn). We describe two cases of SMK: a male and a female. Patients were siblings and their parents were first cousins. The first child presented postaxial hexadactily, of the hands and feet, cardiovascular malformation and Arnold-Chiari II malformation. The baby died on the 17th day of life, for neurosurgical complications. Second baby, in which a prenatal ultrasonography showed a large cystic dilatation in the pelvis, presented with urinary hydrometrocolpos associated with persistent urogenital sinus (UGS) and polydactyly. The patient was temporary treated with intermittent vaginal catheterization. At age of 6 months she underwent reconstructive surgery via the anterior sagittal transanorectal approach (ASTRA), previous creation of a colostomy. Thirty-two months of the operation, the patient is continent for stool and urine and the vagina looks normal.

Abnormalities, Multiple↗
PubMed2003

Transvaginal uterine artery ligation in a woman with uterine leiomyomas. A case report.

BACKGROUND: Uterine artery embolization by interventional radiologic techniques is an effective and widely used modality in the management of uterine leiomyomas. Anatomically, uterine arteries can be approached transvaginally with an appropriate surgical technique. In this report, we describe a novel, minimally invasive vaginal technique that also occluded the uterine arteries successfully. CASE: A 45-year-old woman with symptomatic leiomyomas decided to undergo a vaginal hysterectomy. During the procedure, Doppler ultrasonography demonstrated the cessation of blood flow after dissection and ligation of uterine arteries bilaterally without cutting the uterosacral and cardinal ligaments. CONCLUSION: Transvaginal ligation of the uterine arteries is possible. If validated by further clinical investigation, this minimally invasive gynecologic technique could be useful in selected cases of uterine leiomyomas.

Arteries↗
PubMed1996

Laparoscopy vs. laparotomy for gynecologic procedures. Impact on resident training.

OBJECTIVE: To compare laparoscopic approaches to traditional ones for operative procedures. STUDY DESIGN: Operating residents collected data on all abdominal, vaginal and laparoscopic vaginal hysterectomies, myomectomies, cystectomies/oophorectomies and ectopics between December 1, 1992, and July 31, 1993. Statistical analysis included Student's t test for interval data and chi (2)/Fisher's exact test for categorical data. RESULTS: Leiomyomas were the major indications for all three types of hysterectomy. Patients selected for vaginal hysterectomy had significantly higher parity and older age than those scheduled for abdominal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Abdominal hysterectomy uteri were larger than those using vaginal or LAVH procedures. LAVH procedures were significantly longer when failed laparoscopic procedures were excluded. Abdominal hysterectomy patients used twice as much morphine as vaginal and LAVH patients, and the length of stay was longer. LAVH was significantly more expensive than vaginal hysterectomy. There was no difference in operating time for nonhysterectomy cases, but the cost and length of stay were less for laparoscopy. CONCLUSION: Laparoscopy can be advantageous for certain procedures but has little advantage for hysterectomy and may make fewer vaginal hysterectomies available for resident education since the patients selected for LAVH and total vaginal hysterectomy are more similar to each other than to patients selected for total abdominal hysterectomy.

Adult↗
PubMed1988

Multimodal approach to screening for ovarian cancer.

1010 postmenopausal women were recruited for an ovarian cancer screening programme incorporating serum CA-125 measurement and vaginal examination as initial tests and real-time ultrasonography as a secondary procedure in selected cases. The normal range for serum CA-125 in postmenopausal women was established. The specificity for ovarian cancer of serum CA-125 measurement and vaginal examination were 97.0% and 97.3%, respectively. The combinations of serum CA-125 measurement with ultrasound and vaginal examination with ultrasound achieved specificities of 99.8% and 99.0%, respectively. 100% specificity was achieved by serum CA-125 measurement with vaginal examination and by the combination of all three tests. The findings indicate that no individual screening test has acceptable specificity for ovarian cancer in postmenopausal women. However, the combination of CA-125 measurement with ultrasound did achieve acceptable specificity and offers the most hope of a specific and sensitive method for early detection.

Aged↗
PubMed2000

The role of laparoscopic surgery in the management of endometrial cancer.

OBJECTIVE: To assess the place of laparoscopically assisted vaginal hysterectomy in the treatment of endometrial cancer. DESIGN: A retrospective uncontrolled case series. SETTING: Gynaecological Oncology Department, Queen Elizabeth Hospital, Gateshead. POPULATION: Women with endometrial cancer referred to this centre from August 1992 to August 1997. MAIN OUTCOME MEASURES: Success of laparoscopically assisted vaginal hysterectomy, operative morbidity, and the length of hospital stay. RESULTS: Laparoscopically assisted vaginal hysterectomy was successful in 35 of 40 women (88%). Five women required laparotomy. Two women sustained injury to the inferior epigastric vessels. One sustained injury to the small intestine requiring later laparotomy and three women required a blood transfusion. The mean hospital stay was 3 x 3 days (SD 1 x 5). Three women died of the disease within one year of their operation. CONCLUSION: Laparoscopically assisted vaginal hysterectomy is a feasible treatment for endometrial cancer. It can be performed successfully in high risk population who are medically unfit and overweight. However, a larger randomised study is required to assess the morbidity compared with the traditional open approach.

Endometrial Neoplasms↗
PubMed1994

Laparoscopic Assisted Vaginal Metroplasty

This presentation describes for the first time the successful performance of a laparoscopic-assisted vaginal metroplasty in a habitual aborter patient with a bicornuate uterus. A combined single puncture laparoscopy and operative colpotomy approach was used. Most symptomatic septate uteri can be treated by operative hysteroscopy. However, the correction of a symptomatic bicornuate uterus still requires abdominal metroplasty. The patient was 24 years old with four early midtrimester miscarriages. Habitual abortion work-up was normal except for a bicornuate uterus. A septate uterus with two distinct cavities, one uterine corpus and an indentation in the mid-fundal area was diagnosed by hysterosalpingogram and laparoscopy. The operating time was 2 hours and blood loss 150 ml. The patient was discharged at 48 hours and had an uneventful postoperative period. She is currently 28 weeks pregnant. This case presentation indicates that assisted vaginal metroplasty is an attractive minimally invasive surgical alternative to traditional laparotomy.

Journal Article↗
PubMed1999

Hysterotomy by a colpotomy approach for treatment of foetal mummification in a cow.

A 7-year-old Brahman cow was diagnosed as suffering from chronic foetal mummification of unknown aetiology, concurrent cystic ovarian disease, prolapse of the 2nd cervical ring and chronic cervicitis. Repeated treatment with prostaglandin F2alpha and oestrogen failed to resolve the mummification. A hysterotomy was performed via an incision in the dorsolateral vaginal wall. Good exposure of the uterine horn was achieved and mild post-operative complications were observed. Colpotomy can be regarded as an alternative surgical approach to the moderately enlarged bovine uterus.

Animals↗
PubMed1999

[Hysterectomy--a time for reappraisal].

Hysterectomy is the most common non-pregnancy-related surgical procedure performed worlwide. The objective of our study was to investigate the hysterectomy by age, indication and surgical method employed during 1994-1998 in Department of Obstetrics and gynecology of Higher Medical Institute-Plovdiv, Bulgaria. During the period 1352 hysterectomies are performed. The most common indication was uterine myoma--50.3%. The most frequently the removal of the uterus is made at the age of 45-49. The low percentage of vaginal hysterectomies has been noticed--4.6%, as well as the comparatively frequent removal of the ovaries along with hysterectomy for benign diseases. A thorough analysis has been made in order to reduce the unnecessary hysterectomies, to choose the right approach and extend of the operation.

Bulgaria↗
PubMed2003

Laparoscopy for the treatment of women with endometrial cancer.

OBJECTIVE: To evaluate the use of a laparoscopic approach for the management of endometrial cancer. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. SUBJECTS AND METHODS: Individual medical records of patients with preoperative histological diagnosis of endometrial carcinoma from January 2000 to December 2001 were reviewed and the data analysed. MAIN OUTCOME MEASURES: Success of laparoscopic-assisted surgical staging, intra-operative and postoperative morbidity, and length of hospital stay. RESULTS: Laparoscopic surgery was successful for 93.3% (28 of 30) patients. Two patients were converted to laparotomy. The mean operating time was 102 minutes (standard deviation, 16 minutes) and the mean operative blood loss was 280 mL (standard deviation, 137 mL). The mean hospital stay was 5 days (standard deviation, 2.3 days). The intra-operative and postoperative complication rate was 16.7%, including vaginal tear, injury to the inferior epigastric vessel, lymphocyst, and pulmonary embolism. CONCLUSION: This study illustrated that a laparoscopic approach is feasible for endometrial cancer surgery and may be considered as the primary treatment modality in skilled hands. This approach should be offered to women with endometrial cancer without contraindications for laparoscopic surgery if experienced endoscopic surgeons are available. Prophylaxis for venous thromboembolism and the use of retroperitoneal drainage may be helpful in decreasing the perioperative morbidity.

Abdominal Abscess↗
PubMed1999

Epidural analgesia for labour and delivery in a parturient with congenital hypertrophic obstructive cardiomyopathy.

We report a parturient delivering vaginally at term with symptomatic congenital hypertrophic obstructive cardiomyopathy. Epidural analgesia was used during labour and delivery and is likely to have made a useful contribution to the successful outcome. Although controversial, reported use of epidural analgesia during labour for hypertrophic obstructive cardiomyopathy parturients has been generally positive. A multi-disciplinary team approach, early anaesthetic assessment and a carefully managed epidural catheter inserted in early labour can optimize analgesia and minimize the stresses of labour and vaginal delivery provided the risks of reduced preload and afterload are minimized.

Adult↗
PubMedDate not supplied

Continuing education: Comprehensive menopausal assessment: an approach to managing vasomotor and urogenital symptoms in breast cancer survivors.

PURPOSE/OBJECTIVES: To describe the development and implementation of a comprehensive menopausal assessment (CMA) and intervention program for women with a history of breast cancer. DATA SOURCES: Published articles selected from computerized databases, conference proceedings, bibliographies of pertinent articles and books, and lay publications. DATA SYNTHESIS: The CMA program consisted of a structured, comprehensive assessment of three symptoms (hot flashes, vaginal dryness, and stress urinary incontinence) and an individualized plan of education, counseling, nonestrogen treatments, psychosocial support, referrals, and follow-up. CONCLUSIONS: A structured approach to evaluating and managing vasomotor and urogenital symptoms with, for example, the CMA, may help breast cancer survivors with severe symptoms more effectively manage these symptoms than "usual care." IMPLICATIONS FOR NURSING: Nurses providing care for women with a history of breast cancer can incorporate the key elements of the CMA program into their practice to facilitate more effective management of three common menopausal symptoms that often are undertreated in this patient population.

Administration, Topical↗
PubMed2003

Outcomes study: A comparison of cure rates in 695 patients undergoing sacrospinous ligament fixation alone and with other site-specific procedures--a 16-year study.

OBJECTIVE: The study was undertaken to compare the results of vaginal fixation from a time when sacrospinous ligament fixation (SSLF) was performed solely or with minimal repair of other defects with the results of SSLF when site-specific defect approaches were performed. STUDY DESIGN: Six hundred ninety-five patients underwent an SSLF over a 16-year period. From 1985 through 1990, minimal attention was paid to other sites because the SSLF appeared to correct all vaginal tract defects (group A = 173). From 1991 through 1994, we realized that our attempts were failing. An anterior and posterior colporrhaphy, and a high ligation of any cul-de-sac were performed when appropriate (group B = 221). From 1995 through 2000, site-specific repairs of all defects were used to care for these patients with prolapse (group C = 301). RESULTS: The anatomic cure rates for the SSLF (when evaluating only the vaginal apex) were calculated for vault fixation. When site-specific repairs were used and all sites repaired anatomically (group C), cure predominated. The chi(2) calculations for group A compared with group B and group B compared with group C were performed. CONCLUSION: The SSLF technique is still a good option for apical prolapse, does not have to distort the vaginal axis, and is to be used in conjunction with other site-specific repairs.

Adult↗
PubMed2005

Transhepatic ultrasound-guided cardiac catheterization in the fetal lamb: a new approach for cardiac interventions in fetuses.

BACKGROUND: Percutaneous transventricular and fetoscopic umbilical catheterization have been applied to animal and human fetuses. These methods have a high rate of failure and complications. Here, we propose an alternative route for anterograde echocardiography-guided cardiac catheterization through a transhepatic approach of the intra-abdominal vessels in the fetal lamb. METHODS AND RESULTS: After exteriorization of the uterus in 12 pregnant ewes between 118 to 122 days' gestation, a 4F sheath mounted over a 1.2-mm needle was placed into the intra-abdominal portion of the umbilical vein (n=2) and into the subdiaphragmatic portion of the inferior vena cava via a transhepatic approach (n=10) under ultrasound guidance. In the first 2 animals using a transumbilical approach, it was impossible to reach the heart through the ductus venosus. In the next 10 animals, using a conventional technique, echocardiography-guided catheterization of the 4 chambers was performed in the all fetuses, atrial or ventricular pacing in 6 fetuses, and ballooning of the pulmonary valve in 9 of 10 fetuses. Among the 10 fetuses catheterized through the transhepatic approach, 2 were euthanized immediately after the procedure to evaluate intraperitoneal bleeding (23 and 29 mL, respectively), and 3 died after the procedure (1 of major bleeding and 2 deaths related to balloon catheter manipulation). Finally, 5 were delivered vaginally after an uneventful pregnancy, and autopsy at day 5 did not show significant liver, vascular, or cardiac injury. CONCLUSIONS: Echocardiography-guided fetal cardiac catheterization through a transhepatic approach is feasible and provides an interesting alternative approach for human fetal cardiac interventions.

Animals↗