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Vaginal cuff dehiscence after vaginal cuff brachytherapy for uterine cancer. A case report  

PubMed Central

Vaginal cuff dehiscence is a rare, but potentially serious complication after total hysterectomy. We report a case of vaginal cuff dehiscence after vaginal cuff brachytherapy. A 62 year old female underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and was found to have International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB endometrioid adenocarcinoma of the uterus. The patient was referred for adjuvant vaginal cuff brachytherapy. During the radiation treatment simulation, a computerized tomography (CT) of the pelvis showed abnormal position of the vaginal cylinder. She was found to have vaginal cuff dehiscence that required immediate surgical repair. Vaginal cuff dehiscence triggered by vaginal cuff brachytherapy is very rare with only one case report in the literature.

Cattaneo, Richard; Bellon, Maria



Optimisation techniques in vaginal cuff brachytherapy.  


The aim of this study was to explore whether an in-house dosimetry protocol and optimisation method are able to produce a homogeneous dose distribution in the target volume, and how often optimisation is required in vaginal cuff brachytherapy. Treatment planning was carried out for 109 fractions in 33 patients who underwent high dose rate iridium-192 (Ir(192)) brachytherapy using Fletcher ovoids. Dose prescription and normalisation were performed to catheter-oriented lateral dose points (dps) within a range of 90-110% of the prescribed dose. The in-house vaginal apex point (Vk), alternative vaginal apex point (Vk'), International Commission on Radiation Units and Measurements (ICRU) rectal point (Rg) and bladder point (Bl) doses were calculated. Time-position optimisations were made considering dps, Vk and Rg doses. Keeping the Vk dose higher than 95% and the Rg dose less than 85% of the prescribed dose was intended. Target dose homogeneity, optimisation frequency and the relationship between prescribed dose, Vk, Vk', Rg and ovoid diameter were investigated. The mean target dose was 99+/-7.4% of the prescription dose. Optimisation was required in 92 out of 109 (83%) fractions. Ovoid diameter had a significant effect on Rg (p = 0.002), Vk (p = 0.018), Vk' (p = 0.034), minimum dps (p = 0.021) and maximum dps (p<0.001). Rg, Vk and Vk' doses with 2.5 cm diameter ovoids were significantly higher than with 2 cm and 1.5 cm ovoids. Catheter-oriented dose point normalisation provided a homogeneous dose distribution with a 99+/-7.4% mean dose within the target volume, requiring time-position optimisation. PMID:19470571

Tuncel, N; Garipagaoglu, M; Kizildag, A U; Andic, F; Toy, A



Vaginal cuff dehiscence after intracavitary brachytherapy for endometrial cancer  

PubMed Central

We describe 2 unusual cases of vaginal dehiscence after intracavitary brachytherapy performed following robotic laparoscopic hysterectomy (RLH) along with their management. This unusual complication, which may be more common because of the robotic procedures, can be prevented by careful examination and possible delay of the onset of brachytherapy, if indicated. Our report reviews techniques of avoiding this complication and suggests that these complications should be discussed with the patients.

Shah, Karan; Potkul, Ronald



Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation  

SciTech Connect

Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average ({+-} standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 {+-} 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 {+-} 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 {+-} 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

Ma, Daniel J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Michaletz-Lorenz, Martha [Department of Education and Training, Elekta, Maryland Heights, MO (United States); Goddu, S. Murty [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W., E-mail: [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)



Vaginal cuff dehiscence with adnexal mass evisceration after abdominal hysterectomy  

PubMed Central

INTRODUCTION More commonly, a vaginal cuff dehiscence is a complication of robotic or laparoscopic hysterectomy while dehiscence is less commonly observed following total abdominal or vaginal hysterectomies. PRESENTATION OF CASE Three years after an uncomplicated total abdominal hysterectomy for fibroid uterus, a 50 year old female with a known, large adnexal mass presented with vaginal cuff dehiscence and prolapse of the adnexal mass through the vaginal cuff. DISCUSSION We discuss surgical risk factors including route of hysterectomy, method of colpotomy and vaginal cuff closure as contributing factors for vaginal cuff dehiscence in our patient. CONCLUSION Any large pelvic mass that may potentially exert pressure necrosis on the vaginal cuff, even remote from hysterectomy may result a vaginal cuff dehiscence. Emergent surgical intervention is warranted.

Nguyen, My-Linh T.; Anyikam, Adanna L.; Paolucci, Michele



Effects of Electrosurgery and Vaginal Closure Technique on Postoperative Vaginal Cuff Dehiscence  

PubMed Central

Background and Objectives: The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. Methods: From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure—laparoscopically in the TLH group and vaginally in the LAVH group. Results: Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). Conclusion: It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique.

Kesterson, Joshua; Davies, Matthew; Green, Janis; Penezic, Lindsey; Vargas, Roberto; Harkins, Gerald



American Brachytherapy Society survey regarding practice patterns of postoperative irradiation for endometrial cancer: Current status of vaginal brachytherapy  

Microsoft Academic Search

Purpose: To survey the current postoperative recommendations for radiotherapy (RT) in patients with endometrial cancer, with an emphasis on vaginal brachytherapy (VBT). Methods and Materials: In August 2003, a 32-item questionnaire was mailed to a random sample of 2396 members of the American Society for Therapeutic Radiology and Oncology and the American Brachytherapy Society. The sample excluded members-in-training, physicists, and

William. Small; Beth Erickson; Francis M. A. Kwakwa



Optimized Dose Distribution of Gammamed Plus Vaginal Cylinders  

Microsoft Academic Search

Endometrial carcinoma is the most common malignancy arising in the female genital tract. Intracavitary vaginal cuff irradiation may be given alone or with external beam irradiation in patients determined to be at risk for locoregional recurrence. Vaginal cylinders are often used to deliver a brachytherapy dose to the vaginal apex and upper vagina or the entire vaginal surface in the

Sanjay S. Supe; T. K. Bijina; C. Varatharaj; B. Shwetha; T. Arunkumar; S. Sathiyan; K. M. Ganesh; M. Ravikumar



Two cases of post-coital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted laparoscopic hysterectomy  

PubMed Central

INTRODUCTION Vaginal cuff dehiscence following robotic surgery is uncommon. Published reports of vaginal cuff dehiscence following robotic surgery are increasing, but the true incidence is unknown. PRESENTATION OF CASE Case 1. A 45 year old female had sexual intercourse and presented with a vaginal cuff dehiscence complicated by small bowel evisceration 4 months after RA-TLH. Case 2. A 44 year old female had sexual intercourse and presented with a vaginal cuff dehiscence with small bowel evisceration 6 weeks after RA-TLH. DISCUSSION We discuss the rate of vaginal cuff dehiscence by mode of hysterectomy, surgical and non-surgical risk factors that may contribute to vaginal cuff dehiscence, and proposed preventative methods at the time of RA-TLH to reduce this complication. CONCLUSION Vaginal cuff dehiscence with associated evisceration of intraabdominal contents is a potentially severe complication of hysterectomy. We recommend counseling patients who undergo RA-TLH to abstain from vaginal intercourse for a minimum of 8–12 weeks.

Nguyen, My-Linh T.; Kapoor, Monica; Pradhan, Tana S.; Pua, Tarah L.; Tedjarati, Sean S.



High-dose-rate postoperative vaginal cuff irradiation alone for stage Ib and Ic endometrial cancer  

Microsoft Academic Search

Purpose: To evaluate the effectiveness of postoperative high-dose-rate (HDR) vaginal cuff irradiation alone (1500 cGy in 3 fractions) in patients with Stage Ib and Ic endometrial cancer.Methods and Materials: This is a retrospective review of 102 patients with Stage Ib and Ic endometrial cancer treated with a hysterectomy and postoperative HDR intracavitary therapy alone during the period of 1\\/1\\/90–12\\/31\\/96. Each

John M Anderson; Baldassarre Stea; Alton V Hallum; Edward Rogoff; Joel Childers



Image-Based 3D Treatment Planning for Vaginal Cylinder Brachytherapy: Dosimetric Effects of Bladder Filling on Organs at Risk  

SciTech Connect

Purpose: To investigate the dosimetric effects of bladder filling on organs at risk (OARs) using three-dimensional image-based treatment planning for vaginal cylinder brachytherapy. Methods and Materials: Twelve patients with endometrial or cervical cancer underwent postoperative high-dose rate vaginal cylinder brachytherapy. For three-dimensional planning, patients were simulated by computed tomography with an indwelling catheter in place (empty bladder) and with 180 mL of sterile water instilled into the bladder (full bladder). The bladder, rectum, sigmoid, and small bowel (OARs) were contoured, and a prescription dose was generated for 10 to 35 Gy in 2 to 5 fractions at the surface or at 5 mm depth. For each OAR, the volume dose was defined by use of two different criteria: the minimum dose value in a 2.0-cc volume receiving the highest dose (D{sub 2cc}) and the dose received by 50% of the OAR volume (D{sub 50%}). International Commission on Radiation Units and Measurements (ICRU) bladder and rectum point doses were calculated for comparison. The cylinder-to-bowel distance was measured using the shortest distance from the cylinder apex to the contoured sigmoid or small bowel. Statistical analyses were performed with paired t tests. Results: Mean bladder and rectum D{sub 2cc} values were lower than their respective ICRU doses. However, differences between D{sub 2cc} and ICRU doses were small. Empty vs. full bladder did not significantly affect the mean cylinder-to-bowel distance (0.72 vs. 0.92 cm, p = 0.08). In contrast, bladder distention had appreciable effects on bladder and small bowel volume dosimetry. With a full bladder, the mean small bowel D{sub 2cc} significantly decreased from 677 to 408 cGy (p = 0.004); the mean bladder D{sub 2cc} did not increase significantly (1,179 cGy vs. 1,246 cGy, p = 0.11). Bladder distention decreased the mean D{sub 50%} for both the bladder (441 vs. 279 cGy, p = 0.001) and the small bowel (168 vs. 132 cGy, p = 0.001). Rectum and sigmoid volume doses were not affected by bladder filling. Conclusions: In high-dose rate vaginal cylinder brachytherapy, treatment with a distended bladder preferentially reduces high dose to the small bowel around the vaginal cuff without a significant change in dose to the bladder, rectum, or sigmoid.

Hung, Jennifer; Shen Sui; De Los Santos, Jennifer F. [Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, AL (United States); Kim, Robert Y., E-mail: [Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, AL (United States)



Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer  

SciTech Connect

Purpose To determine the efficacy and complications of adjuvant vaginal high-dose-rate brachytherapy alone for patients with Stage I endometrial cancer in whom complete surgical staging had been performed. Methods and Materials Between April 1998 and March 2004, 100 patients with Stage I endometrial cancer underwent surgical staging (total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic {+-} paraaortic nodal sampling) and postoperative vaginal high-dose-rate brachytherapy at our institution. The total dose was 2100 cGy in three fractions. Results With a median follow-up of 23 months (range 2-62), no pelvic or vaginal recurrences developed. All patients underwent pelvic dissection, and 42% underwent paraaortic nodal dissection. A median of 29.5 pelvic nodes (range 1-67) was removed (84% had >10 pelvic nodes removed). Most patients (73%) had endometrioid (or unspecified) adenocarcinoma, 16% had papillary serous carcinoma, and 11% had other histologic types. The International Federation of Gynecology and Obstetrics stage and grade was Stage IA, grade III in 5; Stage IB, grade I, II, or III in 6, 27, or 20, respectively; and Stage IC, grade I, II, or III in 13, 17, or 10, respectively. The Common Toxicity Criteria (version 2.0) complications were mild (Grade 1-2) and consisted primarily of vaginal mucosal changes, temporary urinary irritation, and temporary diarrhea. Conclusion Adjuvant vaginal high-dose-rate brachytherapy alone may be a safe and effective alternative to pelvic external beam radiotherapy for surgical Stage I endometrial cancer.

Solhjem, Matthew C. [Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN (United States)]. E-mail:; Petersen, Ivy A. [Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN (United States); Haddock, Michael G. [Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN (United States)



Adjuvant vaginal brachytherapy as a part of management in early endometrial cancer  

PubMed Central

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years.

Wojcieszek, Piotr; Bialas, Brygida



A Novel Low Dose Fractionation Regimen for Adjuvant Vaginal Brachytherapy in Early Stage Endometrial Cancer  

PubMed Central

Purpose To evaluate local control, survival and toxicity in patients with early-stage endometrioid adenocarcinoma of the uterus treated with adjuvant high-dose-rate (HDR) vaginal brachytherapy (VB) alone using a novel low dose regimen Methods We reviewed records of 414 patients with stage IA to stage II endometrial adenocarcinoma treated with VB alone from 2005 to 2011. Of these, 157 patients with endometrioid histology received 24 Gy in 6 fractions of HDR vaginal cylinder brachytherapy and constitute the study population. Dose was prescribed at the cylinder surface and delivered twice weekly in the post-operative setting. Local control and survival rates were calculated by the Kaplan-Meier method. Results All 157 patients completed the prescribed course of VB. Median follow-up time was 22.8 months (range, 1.5–76.5). Two patients developed vaginal recurrence, one in the periurethral region below the field and one in the fornix after treatment with a 2.5-cm cylinder. Three patients developed regional recurrence in the para-aortic region. Two patients developed distant metastasis (lung and carcinomatosis). The 2-year rate of vaginal control was 98.6%, locoregional control was 97.9% and disease-free survival was 96.8%. The 2-year overall survival rate was 98.7%. No Grade 2 or higher vaginal, gastrointestinal, genitourinary or skin long-term toxicity was reported for any patient. Conclusion Vaginal brachytherapy alone in early-stage endometrial cancer provides excellent results in terms of locoregional control and disease-free survival. The fractionation scheme of 24 Gy in 6 fractions prescribed to the cylinder surface was well-tolerated with minimal late toxicity.

Townamchai, Kanokpis; Lee, Larissa; Viswanathan, Akila N.



A novel method for vaginal cylinder treatment planning: a seamless transition to 3D brachytherapy  

PubMed Central

Purpose Standard treatment plan libraries are often used to ensure a quick turn-around time for vaginal cylinder treatments. Recently there is increasing interest in transitioning from conventional 2D radiograph based brachytherapy to 3D image based brachytherapy, which has resulted in a substantial increase in treatment planning time and decrease in patient through-put. We describe a novel technique that significantly reduces the treatment planning time for CT-based vaginal cylinder brachytherapy. Material and methods Oncentra MasterPlan TPS allows multiple sets of data points to be classified as applicator points which has been harnessed in this method. The method relies on two hard anchor points: the first dwell position in a catheter and an applicator configuration specific dwell position as the plan origin and a soft anchor point beyond the last active dwell position to define the axis of the catheter. The spatial location of various data points on the applicator's surface and at 5 mm depth are stored in an Excel file that can easily be transferred into a patient CT data set using window operations and then used for treatment planning. The remainder of the treatment planning process remains unaffected. Results The treatment plans generated on the Oncentra MasterPlan TPS using this novel method yielded results comparable to those generated on the Plato TPS using a standard treatment plan library in terms of treatment times, dwell weights and dwell times for a given optimization method and normalization points. Less than 2% difference was noticed between the treatment times generated between both systems. Using the above method, the entire planning process, including CT importing, catheter reconstruction, multiple data point definition, optimization and dose prescription, can be completed in ~5–10 minutes. Conclusion The proposed method allows a smooth and efficient transition to 3D CT based vaginal cylinder brachytherapy planning.

Wu, Vincent; Wang, Zhou; Patil, Sachin



Modified Fletcher's 3-channel brachytherapy system with vaginal line source loading versus uterine tandem and vaginal cylinder system in Stage IIIA cervical cancer  

Microsoft Academic Search

Purpose: The uterine tandem with open-ended vaginal cylinder is the most commonly used brachytherapy system for Federation Internationale de Gynecologie et d'Obstetrique (FIGO) Stage IIIA cervix cancer at the National Cancer Centre, Singapore. Without the 3-channel ovoid system, the dose to the parametrium is often compromised. In this study, a vaginal cylinder that could potentially be incorporated with the 3-channel

JSH Low; KB Ng



Vulval and Vaginal Rhabdomyosarcoma in Children: Update and Reappraisal of Institut Gustave Roussy Brachytherapy Experience  

SciTech Connect

Purpose: To report the Institut Gustave Roussy brachytherapy (BT) experience in the management of vulval and vaginal rhabdomyosarcoma with special emphasis on long-term outcome. Patients and Methods: Between 1971 and 2005, the data concerning 39 girls who had undergone BT as a part of their treatment were retrospectively analyzed. Of the 39 girls, 20 had been treated before 1990, when the BT volume encompassed the initial tumor extension. After 1990, only residual disease was included in the BT volume. Side effects were classified using the Common Terminology Criteria for Adverse Events, version 3.0. Results: The median age was 16.3 months at diagnosis. Vaginal or vulvar rhabdomyosarcoma was diagnosed in 26 and 6 patients, respectively. The median follow-up was 8.4 years. The 5-year overall survival rate was 91%. Of the 39 patients, 6 developed a relapse. Of the 20 patients treated before 1990, 6 experienced Grade 1-2 renal/genitourinary function symptoms and 75% developed sequelae, in the form of vaginal or urethral sclerosis or stenosis. Four patients received follow-up treatment for psychological disorders. Of the 19 patients treated after 1990, 2 developed acute side effects, with maximal Grade 1-2 renal/genitourinary function symptoms, and 20% developed vaginal or urethral sclerosis or stenosis. Two cases of psychological disturbances were also documented. Conclusion: Reducing the BT volume coverage, better indications for surgery, and more efficient chemotherapy, all combined within a multidisciplinary approach, tended to improve results in terms of both survival and long-term sequelae.

Magne, Nicolas [Department of Radiotherapy, Brachytherapy Unit, Institut Gustave Roussy, Villejuif (France); Oberlin, Odile [Department of Pediatric Medical Oncology, Institut Gustave Roussy, Villejuif (France); Martelli, Helene [Department of Pediatric Surgery, Hopital du Kremlin-Bicetre, Bicetre (France); Gerbaulet, Alain; Chassagne, Daniel [Department of Radiotherapy, Brachytherapy Unit, Institut Gustave Roussy, Villejuif (France); Haie-Meder, Christine [Department of Radiotherapy, Brachytherapy Unit, Institut Gustave Roussy, Villejuif (France)], E-mail:



High Dose-Rate Intracavitary Brachytherapy for Cervical Carcinomas With Lower Vaginal Infiltration  

SciTech Connect

Purpose: This report presents the clinical applications of an automated treatment-planning program of high-dose-rate intracavitary brachytherapy (HDR-ICBT) for advanced uterine cervical cancer infiltrating the parametrium and the lower vagina. Methods and Materials: We adopted HDR-ICBT under optimized dose distribution for 22 cervical cancer patients with tumor infiltration of the lower half of the vagina. All patients had squamous cell carcinoma with International Federation of Gynecology and Obstetrics clinical stages IIB-IVA. After whole pelvic external beam irradiation with a median dose of 30.6 Gy, a conventional ICBT was applied as 'pear-shaped' isodose curve. Then 3-4 more sessions per week of this new method of ICBT were performed. With a simple determination of the treatment volume, the cervix-parametrium, and the lower vagina were covered automatically and simultaneously by this program, that was designated as 'utero-vaginal brachytherapy'. The mean follow-up period was 87.4 months (range, 51.8-147.9 months). Results: Isodose curve for this program was 'galaxy-shaped'. Five-year local-progression-free survival and overall survival rates were 90.7% and 81.8%, respectively. Among those patients with late complications higher than Grade 2 Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer morbidity score, only one (4.5%) developed severe proctitis. Conclusions: Because of the favorable treatment outcomes, this treatment-planning program with a simplified target-volume based dosimetry was proposed for cervical cancer with lower vaginal infiltration.

Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan)], E-mail:; Kato, Shingo [Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Tabushi, Katsuyoshi; Kutsutani-Nakamura, Yuzuru [Department of Radiation Oncology, Saitama Medical School, Saitama (Japan); Mizuno, Hideyuki [Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Takahashi, Michiko [Department of Gynecology, Saitama Cancer Center, Saitama (Japan); Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Shiromizu, Kenji [Department of Gynecology and Obstetrics, Saitama Medical School, Saitama (Japan); Saito, Yoshihiro [Department of Radiology, Saitama Cancer Center, Saitama (Japan)



Modified Fletcher's 3-channel brachytherapy system with vaginal line source loading versus uterine tandem and vaginal cylinder system in Stage IIIA cervical cancer  

PubMed Central

Purpose The uterine tandem with open-ended vaginal cylinder is the most commonly used brachytherapy system for Federation Internationale de Gynecologie et d'Obstetrique (FIGO) Stage IIIA cervix cancer at the National Cancer Centre, Singapore. Without the 3-channel ovoid system, the dose to the parametrium is often compromised. In this study, a vaginal cylinder that could potentially be incorporated with the 3-channel system was developed, hence addressing the problem of treating both the vaginal disease extension and the parametrium. Methods and materials A hollow cylinder of 3 cm in diameter was incorporated with the Fletcher's 3-channel tandem and ovoid system. Treatment plans were generated with the single tandem line source with a vaginal cylinder applicator and the modified Fletcher's system using the Abacus version 3 brachytherapy treatment planning software. A nominal dose of 5 Gy was prescribed to point H for both plans. The perpendicular distance of the 5 Gy isodose line from the uterine tandem plane at the centre of the ovoid and the vaginal cylinder plane 1 cm below the os guard were then compared. Results The 5 Gy isodose line was 1.7 cm from the uterine tandem source at the location lateral through the centre of the ovoids on the plan with the uterine tandem and vaginal cylinder system as compared to a distance of 3.3 cm using the modified 3-channel Fletcher system. The 5 Gy isodose line was 2 cm lateral to the central source at the vaginal cylinder plane 1 cm below the os guard on the uterine tandem and vaginal cylinder system as compared to a distance of 2.5 cm on the Modified-Fletcher system. This corresponds to an increase of 1.6 cm and 0.5 cm depth of treated parametrium on the uterine tandem plane and vaginal cylinder plane respectively with the modified Fletcher's applicator as compared with the single line source cylinder system. Conclusion As compared with the single uterine tandem and open-ended vaginal cylinder system, an addition of 1.6 cm of the parametrium was covered within the 5Gy isodose on the uterine tandem plane and 0.5 cm on the vaginal cylinder plane with the modified Fletcher's applicator. A feasibility study was started to address the ease of insertion of this modified Fletcher system into patients.

Low, JSH; Ng, KB



Patterns of Failure in Endometrial Carcinoma Stage IB Grade 3 and IC Patients Treated with Postoperative Vaginal Vault Brachytherapy  

Microsoft Academic Search

Objective. The vagina is the most common site of locoregional failure in surgical stage IB, IC, and II (occult) endometrial adenocarcinoma. The objective of this study is to evaluate the therapeutic efficacy of vaginal vault brachytherapy alone for surgical stage I patients with high-risk features.Materials and methods. The study group consists of high-risk stage I patients with either stage IB

M. Chadha; P. J. Nanavati; P. Liu; J. Fanning; A. Jacobs



Sexual Function After Intracavitary Vaginal Brachytherapy for Early-Stage Endometrial Carcinoma  

PubMed Central

Objective To describe the effects of intracavitary brachytherapy (IVB) on sexual function and quality of life of women with early-stage endometrial cancer. Methods Women with International Federation of Gynecology and Obstetrics stage I to stage II endometrial cancer treated surgically with or without IVB were identified and mailed questionnaires. Quality of life and sexual function were measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the cervical cancer disease-specific module. Pertinent data from prior surgery and radiation treatments were abstracted retrospectively. Linear transformation of the survey subscale scores was conducted per European Organization for Research and Treatment of Cancer guidelines. Results Sixteen women in the IVB arm and 53 in the surgery-alone group completed the survey. Of the sexually active patients, 33% of the IVB patients and 42% of the surgery-alone patients felt their vagina was dry during sexual activity (P = 0.804) and 17% versus 20% felt their vagina was short (P = 0.884). Seventeen percent of patients in the IVB group felt their vagina was tight compared to 29% in the surgery-alone group (P = 0.891) and 0% versus 14% of patients reported pain during intercourse (P = 0.808). There was no statistically significant difference in sexual/vaginal functioning, sexual worry, or sexual enjoyment between the 2 groups. Conclusions Although both groups report vaginal changes that may affect sexual function, the patients treated with IVB reported similar outcomes on a sexual function questionnaire compared to patients treated with surgery alone.

Quick, Allison M.; Seamon, Leigh G.; Abdel-Rasoul, Mahmoud; Salani, Ritu; Martin, Douglas



Uncertainties in Assesment of the Vaginal Dose for Intracavitary Brachytherapy of Cervical Cancer using a Tandem-ring Applicator  

SciTech Connect

Purpose: The vagina has not been widely recognized as organ at risk in brachytherapy for cervical cancer. No widely accepted dose parameters are available. This study analyzes the uncertainties in dose reporting for the vaginal wall using tandem-ring applicators. Methods and Materials: Organ wall contours were delineated on axial magnetic resonance (MR) slices to perform dose-volume histogram (DVH) analysis. Different DVH parameters were used in a feasibility study based on 40 magnetic resonance imaging (MRI)-based treatment plans of different cervical cancer patients. Dose to the most irradiated, 0.1 cm{sup 3}, 1 cm{sup 3}, 2 cm{sup 3}, and at defined points on the ring surface and at 5-mm tissue depth were reported. Treatment-planning systems allow different methods of dose point definition. Film dosimetry was used to verify the maximum dose at the surface of the ring applicator in an experimental setup. Results: Dose reporting for the vagina is extremely sensitive to geometrical uncertainties with variations of 25% for 1 mm shifts. Accurate delineation of the vaginal wall is limited by the finite pixel size of MRI and available treatment-planning systems. No significant correlation was found between dose-point and dose-volume parameters. The DVH parameters were often related to noncontiguous volumes and were not able to detect very different situations of spatial dose distributions inside the vaginal wall. Deviations between measured and calculated doses were up to 21%. Conclusions: Reporting either point dose values or DVH parameters for the vaginal wall is based on high inaccuracies because of contouring and geometric positioning. Therefore, the use of prospective dose constraints for individual treatment plans is not to be recommended at present. However, for large patient groups treated within one protocol correlation with vaginal morbidity can be evaluated.

Berger, Daniel [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria)]. E-mail:; Dimopoulos, Johannes [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria); Georg, Petra [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria); Georg, Dietmar [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria); Poetter, Richard [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria); Kirisits, Christian [Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna (Austria)



Dose Reduction Study in Vaginal Balloon Packing Filled With Contrast for HDR Brachytherapy Treatment;HDR; Uterine cervix cancer; Vaginal balloon packing; Contrast; Monte Carlo  

SciTech Connect

Purpose: Vaginal balloon packing is a means to displace organs at risk during high dose rate brachytherapy of the uterine cervix. We tested the hypothesis that contrast-filled vaginal balloon packing reduces radiation dose to organs at risk, such as the bladder and rectum, in comparison to water- or air-filled balloons. Methods and Materials: In a phantom study, semispherical vaginal packing balloons were filled with air, saline solution, and contrast agents. A high dose rate iridium-192 source was placed on the anterior surface of the balloon, and the diode detector was placed on the posterior surface. Dose ratios were taken with each material in the balloon. Monte Carlo (MC) simulations, by use of the MC computer program DOSXYZnrc, were performed to study dose reduction vs. balloon size and contrast material, including commercially available iodine- and gadolinium-based contrast agents. Results: Measured dose ratios on the phantom with the balloon radius of 3.4 cm were 0.922 {+-} 0.002 for contrast/saline solution and 0.808 {+-} 0.001 for contrast/air. The corresponding ratios by MC simulations were 0.895 {+-} 0.010 and 0.781 {+-} 0.010. The iodine concentration in the contrast was 23.3% by weight. The dose reduction of contrast-filled balloon ranges from 6% to 15% compared with water-filled balloon and 11% to 26% compared with air-filled balloon, with a balloon size range between 1.4 and 3.8 cm, and iodine concentration in contrast of 24.9%. The dose reduction was proportional to the contrast agent concentration. The gadolinium-based contrast agents showed less dose reduction because of much lower concentrations in their solutions. Conclusions: The dose to the posterior wall of the bladder and the anterior wall of the rectum can be reduced if the vaginal balloon is filled with contrast agent in comparison to vaginal balloons filled with saline solution or air.

Saini, Amarjit S. [Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States); Zhang, Geoffrey G., E-mail: [Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States); Finkelstein, Steven E.; Biagioli, Matthew C. [Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States)



The dosimetric impact of vaginal balloon-packing on intracavitary high-dose-rate brachytherapy for gynecological cancer  

PubMed Central

Purpose We perform a clinical retrospective study to determine whether a vaginal balloon-packing system provides a dosimetric reduction to organs at risk (OARs) versus traditional gauze packing for gynecological high-dose-rate brachytherapy (HDR-BT). We also test various balloon filling materials for optimizing imaging quality. Material and methods Filling materials for balloon-packing were evaluated based on imaging quality with X-ray, computerized tomography, and magnetic resonance imaging modalities. We then retrospectively reviewed 45 HDR-BT plans of 18 patients performed with gauze packing and 39 plans of 16 patients performed with balloon-packing. Twelve patients received both gauze and balloon-packing. HDR-BT was delivered with an iridium-192 afterloader and a Fletcher-Suit-Declos-style T&O applicator. At each fraction, 3D imaging was obtained. The D2cc values of OARs were calculated, as well as ICRU-defined point doses. Results In the 84 HDR fractions reviewed, vaginal balloon-packing provides statistically equivalent doses to rectum, bladder, and sigmoid compared to gauze packing. On average balloon-packing produced average reductions of 3.3% and 6.9% in the rectal and sigmoid D2cc doses and an increase of 3.2% to the bladder D2cc dose (normalized to prescription dose), although none of these values were statistically significant for the twelve patients who received both gauze and balloon-packing (32 and 40 total fractions, respectively). Conclusions In the 84 HDR fractions analyzed, vaginal balloon-packing is as effective as gauze packing for dose sparing to the rectum, bladder, and sigmoid. A 1: 1 solution of saline and contrast for filling material enables easy contouring for image-guided HDR with minimal artefacts.

Rockey, William M.; Bhatia, Sudershan K.; Jacobson, Geraldine M.





... diagnosed? • How is vaginitis treated? • What is a yeast infection? • What causes yeast infections? • What factors increase the risk of getting a yeast infection? • What are the symptoms of a yeast ...


The use and advantages of a multichannel vaginal cylinder in high-dose-rate brachytherapy  

Microsoft Academic Search

Purpose: This paper describes California Endocurietherapy’s (CET) high-dose-rate (HDR) multichannel cylinder, the rationale for its design, procedure for its insertion, and the dosimetry involved in its use. A study was done that compared the doses achieved using the CET multichannel cylinder to the same cylinder if it only had a central channel.Methods and Materials: The CET multichannel vaginal cylinder was

D. Jeffrey Demanes; Sheila Rege; Rodney R Rodriquez; Kathleen L Schutz; Gillian A Altieri; Thomas Wong



A Monte Carlo dosimetry study of vaginal {sup 192}Ir brachytherapy applications with a shielded cylindrical applicator set  

SciTech Connect

A durable recommendation for brachytherapy treatment planning systems to account for the effect of tissue, applicator and shielding material heterogeneities exists. As different proposed approaches have not been integrated in clinical treatment planning routine yet, currently utilized systems disregard or, most commonly, do not fully account for the aforementioned effects. Therefore, it is of interest to evaluate the efficacy of current treatment planning in clinical applications susceptible to errors due to heterogeneities. In this work the effect of the internal structure as well as the shielding used with a commercially available cylindrical shielded applicator set (Nucletron part no. 084.320) for vaginal and rectum treatments is studied using three-dimensional Monte Carlo simulation for a clinical treatment plan involving seven source dwell positions of the classic microSelectron HDR {sup 192}Ir source. Results are compared to calculations of a treatment planning system (Plato BPS v.14.2.7), which assumes homogeneous water medium and applies a constant, multiplicative transmission factor only at points lying in the shadow of the shield. It is found that the internal structure of the applicator (which includes stainless steel, air and plastic materials) with no shield loaded does not affect the dose distribution relative to homogeneous water. In the unshielded side of the applicator with a 90 deg., 180 deg., or 270 deg. tungsten alloy shield loaded, an overestimation of treatment planning system calculations relative to Monte Carlo results was observed which is both shield and position dependent. While significant (up to 15%) at increased distances, which are not of major clinical importance, this overestimation does not affect dose prescription distances by more than 3%. The inverse effect of approx. 3% dose increase at dose prescription distances is observed for stainless steel shields. Regarding the shielded side of the applicator, it is shown that the default treatment planning system transmission factors for tungsten alloy result in a consistent dose overestimation thus constituting a safe approach given the nature of associated clinical applications. Stainless steel is shown to be an ineffective shielding material with transmission factors reaching up to 0.68 at increased distances irrespective of shield geometry.

Lymperopoulou, G.; Pantelis, E.; Papagiannis, P.; Rozaki-Mavrouli, H.; Sakelliou, L.; Baltas, D.; Karaiskos, P. [Nuclear and Particle Physics Section, Physics Department, University of Athens, Panepistimioupolis, Ilisia, 157 71 Athens (Greece); Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach, 63069 Offenbach, Germany and Department of Electrical and Computer Engineering, National Technical University of Athens, 15773 Zografou, Athens (Greece); Medical Physics Department, Hygeia Hospital, Kiffisias Ave and 4 Erythroy Stavrou, Marousi, 151 23 Athens (Greece)



Effects of prescription depth, cylinder size, treatment length, tip space, and curved end on doses in high-dose-rate vaginal brachytherapy  

SciTech Connect

Purpose: To determine the effects of the prescription depth, cylinder size, treatment length, tip space, and curved end on high-dose-rate vaginal brachytherapy (HDR-VBT) of endometrial cancer. Methods and Materials: Treatment plans were prescribed and optimized based on points at the cylinder surface or at 0.5-cm depth. Cylinder sizes ranging from 2 to 4 cm in diameter, and treatment lengths ranging from 3 to 8 cm were used. Dose points in various depths were precisely defined along the cylinder dome. The given dose and dose uniformity to a depth of interest were measured by the mean dose (MD) and standard deviation (SD), respectively, among the dose points belonging to the depth. Dose fall-off beyond the 0.5 cm treatment depth was determined by the ratio of MD at 0.75-cm depth to MD at 0.5-cm depth. Results: Dose distribution varies significantly with different prescriptions. The surface prescription provides more uniform doses at all depths in the target volume, whereas the 0.5-cm depth prescription creates larger dose variations at the cylinder surface. Dosimetric uncertainty increases significantly (>30%) with shorter tip space. Extreme hot (>150%) and cold spots (<60%) occur if no optimization points were placed at the curved end. Conclusions: Instead of prescribing to a depth of 0.5 cm, increasing the dose per fraction and prescribing to the surface with the exact surface points around the cylinder dome appears to be the optimal approach.

Li Shidong [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States)]. E-mail:; Aref, Ibrahim [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Walker, Eleanor [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States)



Comparison of high-dose-rate and low-dose-rate brachytherapy in the treatment of endometrial carcinoma  

SciTech Connect

Purpose: To compare the outcomes for endometrial carcinoma patients treated with either high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy. Methods and Materials: This study included 1,179 patients divided into LDR (1,004) and HDR groups (175). Patients with International Federation of Gynecology and Obstetrics (FIGO) surgical Stages I-III were included. All patients were treated with postoperative irradiation. In the LDR group, the postoperative dose applied to the vaginal cuff was 60-70 Gy surface doses to the vaginal mucosa. The HDR brachytherapy prescription was 6 fractions of 2 Gy each to a depth of 0.5 cm from the surface of the vaginal mucosa. Overall survival, disease-free survival, local control, and complications were endpoints. Results: For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the LDR group were 70%, 69%, and 81%, respectively. For all stages combined, the overall survival, disease-free survival, and local control at 5 years in the HDR group were 68%, 62%, and 78%, respectively. There were no significant differences in early or late Grade III and IV complications in the HDR or LDR groups. Conclusion: Survival outcomes, pelvic tumor control, and Grade III and IV complications were not significantly different in the LDR brachytherapy group compared with the HDR group.

Fayed, Alaa [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Mutch, David G.; Rader, Janet S.; Gibb, Randall K. [Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)]|[Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Powell, Matthew A. [Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)]|[Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Wright, Jason D. [Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States); El Naqa, Issam [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Zoberi, Imran [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States)]|[Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Grigsby, Perry W. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States)]|[Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)]|[Alvin J. Siteman Cancer Center, St. Louis, MO (United States)]|[Division of Nuclear Medicine, Department of Radiology, Washington University School of Medicine, St. Louis, MO (United States)]. E-mail:



Optimized Dose Distribution of Gammamed Plus Vaginal Cylinders  

SciTech Connect

Endometrial carcinoma is the most common malignancy arising in the female genital tract. Intracavitary vaginal cuff irradiation may be given alone or with external beam irradiation in patients determined to be at risk for locoregional recurrence. Vaginal cylinders are often used to deliver a brachytherapy dose to the vaginal apex and upper vagina or the entire vaginal surface in the management of postoperative endometrial cancer or cervical cancer. The dose distributions of HDR vaginal cylinders must be evaluated carefully, so that clinical experiences with LDR techniques can be used in guiding optimal use of HDR techniques. The aim of this study was to optimize dose distribution for Gammamed plus vaginal cylinders. Placement of dose optimization points was evaluated for its effect on optimized dose distributions. Two different dose optimization point models were used in this study, namely non-apex (dose optimization points only on periphery of cylinder) and apex (dose optimization points on periphery and along the curvature including the apex points). Thirteen dwell positions were used for the HDR dosimetry to obtain a 6-cm active length. Thus 13 optimization points were available at the periphery of the cylinder. The coordinates of the points along the curvature depended on the cylinder diameters and were chosen for each cylinder so that four points were distributed evenly in the curvature portion of the cylinder. Diameter of vaginal cylinders varied from 2.0 to 4.0 cm. Iterative optimization routine was utilized for all optimizations. The effects of various optimization routines (iterative, geometric, equal times) was studied for the 3.0-cm diameter vaginal cylinder. The effect of source travel step size on the optimized dose distributions for vaginal cylinders was also evaluated. All optimizations in this study were carried for dose of 6 Gy at dose optimization points. For both non-apex and apex models of vaginal cylinders, doses for apex point and three dome points were higher for the apex model compared with the non-apex model. Mean doses to the optimization points for both the cylinder models and all the cylinder diameters were 6 Gy, matching with the prescription dose of 6 Gy. Iterative optimization routine resulted in the highest dose to apex point and dome points. The mean dose for optimization point was 6.01 Gy for iterative optimization and was much higher than 5.74 Gy for geometric and equal times routines. Step size of 1 cm gave the highest dose to the apex point. This step size was superior in terms of mean dose to optimization points. Selection of dose optimization points for the derivation of optimized dose distributions for vaginal cylinders affects the dose distributions.

Supe, Sanjay S. [Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka (India)], E-mail:; Bijina, T.K.; Varatharaj, C.; Shwetha, B.; Arunkumar, T.; Sathiyan, S.; Ganesh, K.M.; Ravikumar, M. [Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka (India)



Optimized dose distribution of Gammamed plus vaginal cylinders.  


Endometrial carcinoma is the most common malignancy arising in the female genital tract. Intracavitary vaginal cuff irradiation may be given alone or with external beam irradiation in patients determined to be at risk for locoregional recurrence. Vaginal cylinders are often used to deliver a brachytherapy dose to the vaginal apex and upper vagina or the entire vaginal surface in the management of postoperative endometrial cancer or cervical cancer. The dose distributions of HDR vaginal cylinders must be evaluated carefully, so that clinical experiences with LDR techniques can be used in guiding optimal use of HDR techniques. The aim of this study was to optimize dose distribution for Gammamed plus vaginal cylinders. Placement of dose optimization points was evaluated for its effect on optimized dose distributions. Two different dose optimization point models were used in this study, namely non-apex (dose optimization points only on periphery of cylinder) and apex (dose optimization points on periphery and along the curvature including the apex points). Thirteen dwell positions were used for the HDR dosimetry to obtain a 6-cm active length. Thus 13 optimization points were available at the periphery of the cylinder. The coordinates of the points along the curvature depended on the cylinder diameters and were chosen for each cylinder so that four points were distributed evenly in the curvature portion of the cylinder. Diameter of vaginal cylinders varied from 2.0 to 4.0 cm. Iterative optimization routine was utilized for all optimizations. The effects of various optimization routines (iterative, geometric, equal times) was studied for the 3.0-cm diameter vaginal cylinder. The effect of source travel step size on the optimized dose distributions for vaginal cylinders was also evaluated. All optimizations in this study were carried for dose of 6 Gy at dose optimization points. For both non-apex and apex models of vaginal cylinders, doses for apex point and three dome points were higher for the apex model compared with the non-apex model. Mean doses to the optimization points for both the cylinder models and all the cylinder diameters were 6 Gy, matching with the prescription dose of 6 Gy. Iterative optimization routine resulted in the highest dose to apex point and dome points. The mean dose for optimization point was 6.01 Gy for iterative optimization and was much higher than 5.74 Gy for geometric and equal times routines. Step size of 1 cm gave the highest dose to the apex point. This step size was superior in terms of mean dose to optimization points. Selection of dose optimization points for the derivation of optimized dose distributions for vaginal cylinders affects the dose distributions. PMID:19181251

Supe, Sanjay S; Bijina, T K; Varatharaj, C; Shwetha, B; Arunkumar, T; Sathiyan, S; Ganesh, K M; Ravikumar, M



Rotator Cuff  

Microsoft Academic Search

Over the last 20 yr, the frequency of surgical intervention for rotator cuff tears has risen dramatically. The surgery and\\u000a postoperative rehabilitation has been mostly empirical with little scientific foundation. There is a wide range of pathology\\u000a found in the rotator cuff, particularly the horizontal cleavage tear or delamination, which is frequently observed but rarely\\u000a studied.

Richard O. Evans; Peter J. Hughes; David H. Sonnabend


Comparative dosimetric and radiobiological assessment among a nonstandard RapidArc, standard RapidArc, classical intensity-modulated radiotherapy, and 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecologic cancer  

SciTech Connect

To evaluate a nonstandard RapidArc (RA) modality as alternative to high-dose-rate brachytherapy (HDR-BRT) or IMRT treatments of the vaginal vault in patients with gynecological cancer (GC). Nonstandard (with vaginal applicator) and standard (without vaginal applicator) RapidArc plans for 27 women with GC were developed to compare with HDR-BRT and IMRT. Dosimetric and radiobiological comparison were performed by means of dose-volume histogram and equivalent uniform dose (EUD) for planning target volume (PTV) and organs at risk (OARs). In addition, the integral dose and the overall treatment times were evaluated. RA, as well as IMRT, results in a high uniform dose on PTV compared with HDR-BRT. However, the average of EUD for HDR-BRT was significantly higher than those with RA and IMRT. With respect to the OARs, standard RA was equivalent of IMRT but inferior to HDR-BRT. Furthermore, nonstandard RA was comparable with IMRT for bladder and sigmoid and better than HDR-BRT for the rectum because of a significant reduction of d{sub 2cc}, d{sub 1cc}, and d{sub max} (p < 0.01). Integral doses were always higher than HDR-BRT, although the values were very low. Delivery times were about the same and more than double for HDR-BRT compared with IMRT and RA, respectively. In conclusion, the boost of dose on vaginal vault in patients affected by GC delivered by a nonstandard RA technique was a reasonable alternative to the conventional HDR-BRT because of a reduction of delivery time and rectal dose at substantial comparable doses for the bladder and sigmoid. However HDR-BRT provides better performance in terms of PTV coverage as evidenced by a greater EUD.

Pedicini, Piernicola, E-mail: [Service of Medical Physics, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy); Caivano, Rocchina [Service of Medical Physics, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy); Fiorentino, Alba [U.O. of Radiotherapy, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy); Strigari, Lidia [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Califano, Giorgia [Service of Medical Physics, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy); Barbieri, Viviana; Sanpaolo, Piero; Castaldo, Giovanni [U.O. of Radiotherapy, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy); Benassi, Marcello [Service of Medical Physics, Scientific Institute of Tumors of Romagna IRST, Meldola (Italy); Fusco, Vincenzo [U.O. of Radiotherapy, IRCCS Regional Cancer Hospital (C.R.O.B.), Rionero in Vulture (Italy)



Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse  

Microsoft Academic Search

Objective: The anatomic and functional success of suspension of the vaginal cuff to the proximal uterosacral ligaments is described. Study Design: Forty-six women underwent vaginal site-specific repair of endopelvic fascia defects with suspension of the vaginal cuff to the proximal uterosacral ligaments for pelvic organ prolapse. Outcome measures included operative complications, pelvic organ prolapse quantitation, and assessment of pelvic floor

Matthew D. Barber; Anthony G. Visco; Alison C. Weidner; Cindy L. Amundsen; Richard C. Bump



Vaginal itching  


... and make you more susceptible to infections. Vaginal yeast infection Vaginitis . Vaginitis in girls before puberty is ... If you are sure that you have a yeast infection, try over-the-counter creams or vaginal ...


Vaginal discharge  


... infections and sexually transmitted infections (STIs) Trichomoniasis Vaginal yeast infection ... is never recommended. Use an over-the-counter yeast infection treatment cream or vaginal suppository, if you ...


Radiation therapy for primary vaginal carcinoma  

PubMed Central

Brachytherapy plays a significant role in the management of cervical cancer, but the clinical significance of brachytherapy in the management of vaginal cancer remains to be defined. Thus, a single institutional experience in the treatment of primary invasive vaginal carcinoma was reviewed to define the role of brachytherapy. We retrospectively reviewed the charts of 36 patients with primary vaginal carcinoma who received definitive radiotherapy between 1992 and 2010. The treatment modalities included high-dose-rate intracavitary brachytherapy alone (HDR-ICBT; two patients), external beam radiation therapy alone (EBRT; 14 patients), a combination of EBRT and HDR-ICBT (10 patients), or high-dose-rate interstitial brachytherapy (HDR-ISBT; 10 patients). The median follow-up was 35.2 months. The 2-year local control rate (LCR), disease-free survival (DFS), and overall survival (OS) were 68.8%, 55.3% and 73.9%, respectively. The 2-year LCR for Stage I, II, III and IV was 100%, 87.5%, 51.5% and 0%, respectively (P = 0.007). In subgroup analysis consisting only of T2–T3 disease, the use of HDR-ISBT showed marginal significance for favorable 5-year LCR (88.9% vs 46.9%, P = 0.064). One patient each developed Grade 2 proctitis, Grade 2 cystitis, and a vaginal ulcer. We conclude that brachytherapy can play a central role in radiation therapy for primary vaginal cancer. Combining EBRT and HDR-ISBT for T2–T3 disease resulted in good local control.

Murakami, N.; Kasamatsu, T.; Sumi, M.; Yoshimura, R.; Takahashi, K.; Inaba, K.; Morota, M.; Mayahara, H.; Ito, Y.; Itami, J.



Radiation therapy for primary vaginal carcinoma.  


Brachytherapy plays a significant role in the management of cervical cancer, but the clinical significance of brachytherapy in the management of vaginal cancer remains to be defined. Thus, a single institutional experience in the treatment of primary invasive vaginal carcinoma was reviewed to define the role of brachytherapy. We retrospectively reviewed the charts of 36 patients with primary vaginal carcinoma who received definitive radiotherapy between 1992 and 2010. The treatment modalities included high-dose-rate intracavitary brachytherapy alone (HDR-ICBT; two patients), external beam radiation therapy alone (EBRT; 14 patients), a combination of EBRT and HDR-ICBT (10 patients), or high-dose-rate interstitial brachytherapy (HDR-ISBT; 10 patients). The median follow-up was 35.2 months. The 2-year local control rate (LCR), disease-free survival (DFS), and overall survival (OS) were 68.8%, 55.3% and 73.9%, respectively. The 2-year LCR for Stage I, II, III and IV was 100%, 87.5%, 51.5% and 0%, respectively (P = 0.007). In subgroup analysis consisting only of T2-T3 disease, the use of HDR-ISBT showed marginal significance for favorable 5-year LCR (88.9% vs 46.9%, P = 0.064). One patient each developed Grade 2 proctitis, Grade 2 cystitis, and a vaginal ulcer. We conclude that brachytherapy can play a central role in radiation therapy for primary vaginal cancer. Combining EBRT and HDR-ISBT for T2-T3 disease resulted in good local control. PMID:23559599

Murakami, N; Kasamatsu, T; Sumi, M; Yoshimura, R; Takahashi, K; Inaba, K; Morota, M; Mayahara, H; Ito, Y; Itami, J



Endobronchial cuff pressures.  


In 20 adult patients (18 male) who presented for thoracotomy, the trachea was intubated using Mallinckrodt disposable double-lumen tubes (18 large and two medium). The endobronchial cuff was inflated by a trained operating department assistant using an air-filled syringe. The volume of air and the initial endobronchial cuff pressure were measured. The minimum cuff pressure required to prevent respiratory gas leakage from the isolated lung was measured also and maintained using the Cardiff Cuff Controller. Mean initial cuff pressure was 69.3 (SEM 6.0) mm Hg, whereas the mean minimum cuff pressure was 29.5 (4.0) mm Hg (P < 0.0001). The results suggest that the method described of inflating the endobronchial cuff may lead to overinflation and subsequent excessive pressure on the endobronchial wall. PMID:8318334

Cobley, M; Kidd, J F; Willis, B A; Vaughan, R S



[Brachytherapy training].  


Treatment technique training needs theoretical and practical knowledge allowing proposing the right treatment for the right patient, but also allowing performing the technical gesture in the best conditions for an optimal result with a maximal security. The evolution of the brachytherapy techniques needs the set up of specific theoretical and practical training sessions. The present article focuses on the importance of the brachytherapy training as well as the different means currently available for the young radiation oncologist community for perfecting their education. National and international trainings are presented. The role of the simulation principle in the frame of brachytherapy is also discussed. Even if brachytherapy is not always an easy technique, its efficacy and its medico-economical impact need to be passed down to motivated students with the implementation of relevant educational means. PMID:23402877

Hannoun-Lévi, J-M; Marchesi, V; Peiffert, D



Rotator cuff repair  


Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (" ... Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure may not always return ...


Rotator Cuff Injuries  


... had the torn rotator cuff. Treatment for torn rotator cuff includes: Rest Heat or cold to the sore area Medicines that reduce pain and swelling Electrical stimulation of muscles and nerves Ultrasound Cortisone injection Surgery NIH: National Institute on Arthritis and Musculoskeletal and ...


Serious rotator cuff injuries.  


Usually, serious rotator cuff injuries can be operated upon and a high level of performance can be achieved afer surgery. This is not so for the substantial tears seen in baseball pitchers. However, a damaged rotator cuff can be rehabilitated and can recover from the threatened tear without surgery if detected early enough and given the proper treatment. PMID:9697647

Jobe, F W



Signal strength versus cuff length in nerve cuff electrode recordings  

Microsoft Academic Search

When a nerve cuff electrode is used for the recording of signals from peripheral nerves, cuff dimensions have to be chosen. Traditionally, the peak-to-peak amplitude of the single-fiber action potential (SFAP) is optimized through the choice of cuff diameter and cuff length. In this paper, the dependency of the root-mean-square (RMS) value of the nerve signal on the cuff dimensions

Lotte N. S. Andreasen; Johannes J. Struijk



The Rotator Cuff Functional Index  

Microsoft Academic Search

Background: Despite improvements in the clinical assessment of rotator cuff injuries, shortcomings exist in diagnosing rotator cuff tears.Purpose: To formulate a clinical rotator cuff functional index for predicting rotator cuff tears based on handheld dynamometer measurements for shoulder strength testing and to assess its ability to diagnose a rotator cuff tear.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: Preoperative

Daryl C. Osbahr; George A. C. Murrell



Rotator cuff interval reconstruction.  


Five pairs of cadaveric shoulders underwent posterior and anterior drawer and inferior sulcus tests in five progressive conditions: intact, vented, following opening of the rotator cuff interval, reconstruction of the interval, and transfer of the coracoacromial ligament. The surgical treatments--vented, open rotator cuff interval, reconstruction, and coracoacromial ligament transfer--had an effect compared to the intact shoulders on the inferior stiffness (P = .00002) and on the anteroposterior stiffness (P = .00031). The difference between the stiffness of the reconstructed rotator cuff interval compared to the coracoacromial ligament transfer was significant for loading in the AP direction (P = .006) and for loading in the inferior direction (P = .005). PMID:17134054

Roidis, Nikolaos T; Stennette, Denise; Burkhead, Wayne; Karachalios, Theofilos S; Malizos, Konstantinos N; Itamura, John Minoru



Vaginal Yeast Infections  


... HIV/AIDS Sexually transmitted infections fact sheet Vaginal yeast infections fact sheet What is a vaginal yeast ... on vaginal yeast infections What is a vaginal yeast infection? A vaginal yeast infection is irritation of ...


Rotator cuff exercises  


... torn due to overuse or injury See also: Rotator cuff problems These injuries often lead to pain, weakness, and stiffness when you use your shoulder. A key part in your recovery is starting exercises to make the muscles and ...


Rotator Cuff Injuries  

MedlinePLUS Videos and Cool Tools

... often have rotator cuff injuries, due to the physical nature of their activities. Factors that increase the ... after a good medical history and a thorough physical examination are performed. Tests such as shoulder x- ...


Vaginal Discharge  


... also be on the lookout for symptoms of yeast infections, bacterial vaginosis and trichomoniasis, 3 infections that ... cause changes in your vaginal discharge. Signs of yeast infections White, cottage cheese-like discharge Swelling and ...


Estrogen Vaginal  


... estradiol vaginal ring is also used to treat hot flushes ('hot flashes'; sudden strong feelings of heat and sweating) ... mild soap and warm water. Do not use hot water or boil the applicator. Ask your pharmacist ...


Rotator cuff repair - series (image)  


The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder. These muscles and ... Surgery to repair a torn rotator cuff is usually very successful at ... is less predictable at returning strength to the shoulder. ...


Peritonitis due to a peritoneal vaginal fistula.  


Development of a peritoneal vaginal fistula is rare and presents a unique clinical scenario, since the fistula wall is less likely to spontaneously heal because of the increased intra-abdominal pressure in the abdomen from the peritoneal fluid. Catheter removal and surgical repair of the fistula are required. Early catheter removal contributes to peritoneal membrane preservation. In the case of M.T., the most likely explanation was that the peritoneal fluid was leaking through the vaginal cuff created during the surgical procedure in 2004. Early identification of this problem may have prevented the numerous complications and lengthy hospitalization. Suspicion should be raised in any patient who complains of vaginal leakage or if the passage of "urine" in a previously anuric patient is noted. Early assessment and evaluation along with prompt catheter removal can help reduce complications and preserve the peritoneal membrane. This case also emphasizes that prompt catheter removal is very important in cases of fungal peritonitis. PMID:20462078

Neumann, Joanna Lee; Moran, John


Rotator cuff repair  

Microsoft Academic Search

Rotator cuff surgery is developing at a fast pace, with progress in arthroscopic techniques driving much of its advance. Overall, functional outcomes are satisfactory. Tendon healing, however, is inconsistently obtained. Tendon healing correlates with better outcomes, most notably greater strength. Therefore, the best candidates for surgery are patients with lesions that are likely to heal. Factors associated with healing are

Luc Favard; Guillaume Bacle; Julien Berhouet



Rotator cuff problems  


... of demand on the shoulder. You may need surgery to repair the tendon if the rotator cuff has had a complete tear, or if the symptoms persist despite conservative therapy. Most of the time, arthroscopic surgery can be used. Some large tears require open ...


Rotator Cuff Injuries.  

ERIC Educational Resources Information Center

|Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

Connors, G. Patrick


Off the cuff consultations.  

PubMed Central

Over six months I recorded 198 off the cuff consultations that occurred at social gatherings, at chance meetings, and in medical settings outside my surgery. More men than women made such consultations, roughly two thirds were a request for health information, and just under half of consultations were with other doctors' patients. It seemed that many patients were seeking a second medical opinion.

Weingarten, M A



Rotator Cuff Exercises  


... rotator cuff--the part that helps with circular motion). These exercises should not cause you pain. If you feel any pain, stop exercising. Start again with a lighter weight. Look at the pictures with each exercise so you can use the ...


Arthroscopic surgery for partial rotator cuff tears  

Microsoft Academic Search

Rotator cuff pathology is one of the most common disorders of the shoulder. However, partial rotator cuff tears, treatment, and natural history are still in a state of flux. We believe that partial rotator cuff tears should be treated surgically when the rotator cuff is torn more than 50% of the thickness or when substantial thinning of the rotator cuff

Richard C Lehman; Clayton R Perry



Vaginal Cancer  


... Vaginal cancer treatments are likely to cause side effects that make sexual intimacy more difficult for you and your partner. If treatment makes sex painful or temporarily impossible, try to find new ways of maintaining intimacy. Spending quality time together and having ...


Vaginal Cancer  


... body). There are four types of vaginal cancer: Squamous cell carcinoma. Squamous cell carcinoma is a type of skin cancer that begins in the cells lining the vagina, most often in the area closest to the cervix. Squamous cell cancer makes up 85% to 90% of ...


Histopathology of rotator cuff tears.  


The pathogenesis of rotator cuff tears is multifactorial. Tendon abnormalities of the rotator cuff include alteration of collagen fiber structure, tenocytes, cellularity, and vascularity. Ruptured tendons show marked collagen degeneration and disordered arrangement of collagen fibers. Fibroblast population decreases as the size of the tear in the rotator cuff increases. The larger fibroblast population seen in the smaller tears is also actively proliferating and is part of an active reparative process. Inflammatory cell infiltrate correlates inversely to rotator cuff tear size in the torn supraspinatus tendon samples, with larger tears showing a marked reduction in all cell types. As tear size increase, there is also a progressive decrease in the number of blood vessels. Whether rotator cuff tear heals spontaneously is an important pathologic and clinical question. Histologic changes indicative of repair and inflammation lead to consider biological options in addition to biomechanical treatment of the rotator cuff tears. PMID:21822106

Longo, Umile Giuseppe; Berton, Alessandra; Khan, Wasim S; Maffulli, Nicola; Denaro, Vincenzo



Rotator Cuff and Impingement  

Microsoft Academic Search

Shoulder pain due to trauma or overuse is a common complaint in the populations of athletes in general, with a variety of\\u000a causes that are frequently diffi cult to differentiate by physical examination alone.\\u000a \\u000a MR imaging and ultrasonography are optimal and complementary tools to discriminate different forms of impingement and to localize\\u000a and classify rotator cuff injuries. A native MR

Henk-Jan Van der Woude; Diana G. Franssen-Franken; W. Jaap Willems


Partial Rotator Cuff Ruptures  

Microsoft Academic Search

\\u000a Partial rotator cuff ruptures are not rare and occur mainly in the supraspinatus tendon and may extend to that of infraspinatus,\\u000a but rarely to the tendon of subscapularis. Isolated lesions in the tendons of infraspinatus, teres minor or subscapularis\\u000a are rare. Partial ruptures usually occur before the sixth decade of life and can be a cause of unexplained pain in

Antonio Cartucho


Partial cuff debridement for irreparable defects of the rotator cuff  

Microsoft Academic Search

The treatment of massive rotator cuff tears can pose a difficult problem for the unprepared orthopaedic surgeon.There are many ways to treat massive rotator cuff tears, and one viable option is debridement with acromioplasty. For this form of treatment to be successful, the surgeon must choose his patient carefully. This report will focus on patient selection, biomechanics, and postoperative rehabilitation.

Craig Zeman; Kari M. Babinski; W BURKHEADJR



Vaginal agenesis.  


Vaginal agenesis is not rare. Many ingenious procedures have been devised for its correction; some are simple, and some are complicated. Not enough emphasis has been placed on the emotional aspects when patients with this problem are treated. Proper timing of the operation and selection of the best procedure are discussed. We feel that procedure of choice is the simplest, least dangerous one which will give good results in the individual patient. Rather than using the same routine procedure in each patient, we fitted the treatment to each patient. Our experience, particularly with the simple vulvovaginoplasty technique, is given. Postoperative support and encouragement are needed to have a successful outcome. PMID:1244753

Capraro, V J; Gallego, M B



Revision rotator cuff repair.  


The management of patients with a failed rotator cuff repair is challenging. Revision arthroscopic repairs can be entertained in select patients when realistic outcomes are understood. Complete evaluation of the shoulder is needed to identify and treat potential confounding pain generators. The ability to determine if a recurrent tear is repairable is difficult, because there are no established criteria to make this determination. If a recurrent tear is found to be repairable, the results of the surgery are encouraging, although persistent limitations in shoulder function are common. Strategies to improve the rates of tendon healing should be used and include the use of stronger repair constructs, when possible, and implementation of a slower rehabilitation progression. PMID:23040555

Keener, Jay D



Vaginal-Assisted Laparoscopic Radical Hysterectomy: Rationale, Technique, Results  

PubMed Central

Objective: Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications. Methods: The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumor-adapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin. Results: All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ?pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively. Conclusion: VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with early-stage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.

Gottschalk, Elisabeth; Lanowska, Malgorzata; Chiantera, Vito; Marnitz, Simone; Schneider, Achim; Brink-Spalink, Verena; Hasenbein, Kati



Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis  

Microsoft Academic Search

OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons

G P Riley; R L Harrall; C R Constant; M D Chard; T E Cawston; B L Hazleman



Five-year cure of cervical cancer treated using californium-252 neutron brachytherapy  

Microsoft Academic Search

Female pelvic carcinoma is one of the common malignancies seen at the University of Kentucky Medical Center and often presents in an advanced stage. In 1976, the authors began to test californium-252 neutron brachytherapy (NT) for its efficacy for control of primary and recurrent advanced uterine, cervix, and vaginal cancers. The first protocol used was 5000-5500 rad of whole pelvis

John R. van Nagell; Justine Yoneda; Elvis Donaldson; Michael Hanson; Ann Martin; Leonard C. Wilson; Charles W Coffey; Jose Feola; J. Lawrence Beach



21 CFR 868.5760 - Cuff spreader.  

Code of Federal Regulations, 2013 CFR

...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a...



Evaluation of Intratracheal Cuffs for Aeromedical Evacuation.  

National Technical Information Service (NTIS)

Conventional, low-residual-volume intratracheal cuffs exert possible trachea damaging pressures at ground level and definitely damaging pressures upon ascent to 8,000 ft. Also, these cuffs exert excessively high pressures with decompression to 35,000 ft. ...

D. L. Stoner J. P. Cooke



[Bacterial vaginitis: general overview].  


Bacteria are the most frequently detected agents in women, clinically complaining of vaginal discharge. The studies have shown that the vaginal microflora of women with bacterial vaginitis have altered from Lactobacillus spp. to various anaerobic bacteria. Gardnerella vaginalis is found in vaginal flora of women with bacterial vaginitis as well as in healthy women, while anaerobic bacteria such as Mobiluncus and Prevotella are the causative agents for bacterial vaginosis. For the laboratory diagnosis of bacterial vaginitis, direct microscopy is one of the most commonly used methods, and for this purpose cervicovaginal smears are examined by staining Papanicolaou and Gram stains. Because of the demonstration of bacterial vaginitis in association with the obstetric diseases such as preterm labor and postpartum endometritis, is a risk factor, its importance has increased recently. In this review article, the microorganisms that cause bacterial vaginitis, their biological characteristics, and the diagnostic laboratory methods of infection, have been discussed. PMID:12838684

Demirezen, Sayeste



What Is Vaginal Cancer?  


... cancer There are several types of vaginal cancer. Squamous cell carcinoma About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas . These cancers begin in the squamous cells that ...


Effect of xenon on endotracheal tube cuff  

Microsoft Academic Search

Study Design:To investigate the effect of xenon on the endotracheal tube cuff in comparison to that of nitrous oxide.Design:Prospective, randomized study.Setting:Laboratory in vitro testing of endotracheal tubes.Interventions:Exposure of air-filled endotracheal tube cuffs to xenon or nitrous oxide (79 vol%) mixed with a balance of oxygen (21 vol%) for 3 hours.Measurements:The intra-cuff pressure and gas volume in the cuff were measured

Yoshiki Ishiguro; Hayato Saito; Yoshinori Nakata; Takahisa Goto; Katsuo Terui; Yoshinari Niimi; Shigeho Morita



Autologous blood products in rotator cuff repair.  


We review the management of rotator cuff tears, the mechanism of action of autologous blood products, principally platelet-rich plasma, and the current evidence for effective use of platelet-rich plasma, particularly in relation to the shoulder and chronic rotator cuff tears, for biological augmentation of rotator cuff repair. PMID:21986046

Mei-Dan, Omer; Carmont, Michael R



Rotator Cuff Tear - Surgery versus Rehabilitation  

Microsoft Academic Search

Rotator cuff tears are a common source of shoulder pain. . The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon, rather than injury from sports or trauma. While the information that follows can be used as a guide for all types of rotator cuff tears, it is intended specifically for

Hythem P. Shadid


Comparative histological analysis of anterior vaginal wall in women with pelvic organ prolapse or control subjects. A pilot study  

Microsoft Academic Search

The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse\\u000a (POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with\\u000a POP and eight control subjects operated for hysterectomy without prolapse. Masson’s trichrome stain was used to determine\\u000a the

Wassim Badiou; Guillaume Granier; Philippe-Jean Bousquet; Xavier Monrozies; Pierre Mares; Renaud de Tayrac



[Rupture of the rotator cuff].  


Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation in the shoulder joint. Both the classic technique of open surgery and the arthroscopic technique are employed to reconstruct the rotator cuff. This review tries to answer the question which of both surgical techniques is superior by a review of the literature. The recent literature demonstrates a shorter follow-up period for publications concerning arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results between 68 to 96%, open reconstruction between 77 and 91%. Longevity of reconstructed rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic technique was used. Several authors mentioned size of tear as a major factor influencing longevity. However in patients treated arthroscopically despite rerupture of the rotor cuff patient's satisfaction and clinical outcome is still very good in short-term follow-up. In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique seems to be superior. If large tears occur (two or three tendons) the open surgical technique may be more reliable with regard to longevity of the repair. For the future it seems necessary to obtain long-term results to be able to compare both principles of reconstruction of the rotator cuff. Furthermore these future studies should include quality of life scores as measurements tools besides the already employed parameters as size of the tear, age at surgery, patient satisfaction and outcome scores. PMID:17187328

Wurmig, C


All arthroscopic rotator cuff repairs  

Microsoft Academic Search

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages ofglenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in both

Gary M. Gartsman



Paediatric brachytherapy. II. Brain implantation.  


The case histories of four children with brain tumours, for whom stereotactic brachytherapy was indicated, are presented from the St Bartholomew's Hospital intracranial brachytherapy programme. The recent evolution of the computed-tomography-directed stereotactic technique is described and the uses of different radionuclides (198Au, 192Ir) are discussed. The future of brachytherapy for paediatric brain tumours is debated. PMID:2539219

Thomson, E S; Afshar, F; Plowman, P N



Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs  

Microsoft Academic Search

Background: Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome.Hypothesis: Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in

Steven Klepps; Julie Bishop; Jason Lin; Oren Cahlon; Alyssa Strauss; Patrick Hayes; Evan L. Flatow



Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff  

Microsoft Academic Search

Recently, there has been an increased interest in the normal anatomy of the rotator cuff footprint and the re-establishment of the footprint during rotator cuff repair. Single-row suture anchor techniques have been criticized because of their inability to restore the normal medial-to-lateral width of the rotator cuff footprint. In this report, the authors describe a double-row technique for rotator cuff

Ian K. Y Lo; Stephen S Burkhart



A Novel Device for Intravaginal Electronic Brachytherapy  

SciTech Connect

Purpose: Postoperative intravaginal brachytherapy for endometrial carcinoma is usually performed with {sup 192}Ir high-dose rate (HDR) afterloading. A potential alternative is treatment with a broadband 50kV X-ray point source, the advantage being its low energy and the consequential steep dose gradient. The aim of this study was to create and evaluate a homogeneous cylindrical energy deposition around a newly designed vaginal applicator. Methods and Materials: To create constant isodose layers along the cylindrical plastic vaginal applicator, the source (INTRABEAM system) was moved in steps of 17-19.5 mm outward from the tip of the applicator. Irradiation for a predetermined time was performed at each position. The axial shift was established by a stepping mechanism that was mounted on a table support. The total dose/dose distribution was determined using film dosimetry (Gafchromic EBT) in a 'solid water' phantom. The films were evaluated with Mathematica 5.2 and OmniPro-I'mRT 1.6. The results (dose D0/D5/D10 in 0/5/10 mm tissue depth) were compared with an {sup 192}Ir HDR afterloading plan for multiple sampling points around the applicator. Results: Three different dose distributions with lengths of 3.9-7.3 cm were created. The irradiation time based on the delivery of 5/7 Gy to a 5 mm tissue depth was 19/26 min to 27/38 min. D0/D5/D10 was 150%/100%/67% for electronic brachytherapy and 140%/100%/74% for the afterloading technique. The deviation for repeated measurements in the phantom was <7%. Conclusions: It is possible to create a homogeneous cylindrical dose distribution, similar to {sup 192}Ir HDR afterloading, through the superimposition of multiple spherical dose distributions by stepping a kilovolt point source.

Schneider, Frank [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg (Germany)], E-mail:; Fuchs, Holger [Carl Zeiss Surgical GmbH, Oberkochen (Germany); Lorenz, Friedlieb; Steil, Volker [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg (Germany); Ziglio, Francesco [Ospedale S. Chiara, Trento, Fisica Sanitaria, Trento (Italy); Kraus-Tiefenbacher, Uta; Lohr, Frank; Wenz, Frederik [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg (Germany)



Mini-Open Rotator Cuff Repair  

Microsoft Academic Search

\\u000a Rotator cuff tears have long been recognized as a disabling problem of the upper extremity. Codman reportedly performed the\\u000a first open rotator cuff repair in 1911.1 However, it was not until 1972 when Neer reported the results of anterior acromioplasty in combination with cuff mobilization\\u000a and repair that results substantially improved.2 The surgical fundamentals detailed by Neer significantly improved the

Jason A. Schneider; Frances Cuomo


Mini-open Rotator Cuff Repair  

Microsoft Academic Search

\\u000a Rotator cuff pathology is a common cause of shoulder pain and disability, and becomes more common with advancing patient age.\\u000a Most symptomatic rotator cuff disease is seen in patients in their fifth and sixth decades. Tears of the rotator cuff are\\u000a associated with pain and weakness and can result in significant disability.1 However, it is also known that asymptomatic rotator

W. Anthony Frisella; Frances Cuomo


Vaginal mechanical contraceptive devices.  

PubMed Central

The alleged adverse effects of oral contraceptives and intrauterine devices have led to increased consumer and physician demand for vaginal contraceptive devices. The efficacy and the advantages and disadvantages of vaginal sponges, cervical caps and diaphragms are discussed and compared in this article.

Smith, M.; Barwin, B. N.



Vaginal evisceration 3 years after abdominal hysterectomy and bilateral salpingo-oophorectomy.  


Vaginal evisceration after a pelvic operation is a rare gynecological emergency. When intercourse is the cause, most cases occur within 1 year of surgery. A 53-year-old woman presented to the emergency room for vaginal evisceration half a day after the first postoperative occurrence of intercourse 3 years after an abdominal hysterectomy and bilateral salpingo-oophorectomy. In an emergency laparotomy, the protruding small bowel was replaced within the abdominal cavity. The avulsed vaginal cuff, which measured 6 cm in length and had atrophic but non-necrotic margins, was sutured. Women who go for long periods without intercourse after a hysterectomy, especially post-menopausal women, should be made aware of unrecognized vaginal atrophy that could, in some cases, lead to rupture and evisceration during the next occurrence of intercourse. PMID:22612271

Orito, Seiya; Masuya, Norio; Sakurabashi, Ayako; Minoura, Shigeki



[Endobronchic palliative brachytherapy].  


Brachytherapy, the placement of an encapsuled radioactive source (Iridium) in or near a tumor, is a palliative therapeutic modality available for patients suffering of a bronchogenic cancer, especially if they present invalidating symptoms such an incoercible cough, haemoptysis, dyspnea. The treatment modality is indicated if chemotherapy or external irradiation are not possible. It is typically a team work. PMID:21595307

Frey, Jean-Georges; Bieri, Sabine



Arthroscopically assisted mini-openrotator cuff repair  

Microsoft Academic Search

Although open anterior acromioplasty and rotator cuff repair has reliably provided satisfactory results for several decades, efforts are continually being made to improve on these results. Arthroscopically assisted mini-open rotator cuff repair provides the advantages of arthroscopic glenohumeral inspection and identification and treatment of any concomitant lesions, deltoid origin preservation (with the arthroscopic subacromial decompression), decreased surgical morbidity, and improved

Patrick M. Connor



Arthroscopic Rotator Cuff Repairs Using Suture Anchors  

Microsoft Academic Search

Arthroscopic rotator cuff repairs using titanium-alloy suture anchors are a new treatment option for active patients with shoulder injuries. Shoulder arthroscopy and arthroscopic repair procedures are alternative treatments to traditional open surgical procedures for Bankart lesions and rotator cuff tears. Distinct advantages of arthroscopic repair techniques include decreased patient tissue trauma and morbidity rates and shortened recovery and rehabilitation periods.

Lee Anna Farrall



Anatomy and dimensions of rotator cuff insertions  

Microsoft Academic Search

The purpose of this study was to devise and implement an accurate and reproducible method of measuring the area and dimensions of the rotator cuff tendon insertions and their distance from the articular surface. Twenty fresh-frozen cadaveric upper-extremity specimens were divided into 2 groups of 10. In group 1 the specimens were dissected, leaving only the most distal rotator cuff

Jeffrey R Dugas; Deirdre A Campbell; Russell F Warren; Bruce H Robie; Peter J Millett



Rotator cuff injury: still a clinical controversy?  

Microsoft Academic Search

The rotator cuff mechanism is the primary stabiliser of the gleno-humeral joint and is vulnerable to considerable morbidity because of its anatomy and function. Both intrinsic and extrinsic factors are responsible for rotator cuff pathology, which is a disease spectrum ranging from inflammation to full thickness tears. The most notable extrinsic factors are impingement and demographic variables, whereas age-related degeneration

P. Hardy; S. Sanghavi



Polyimide cuff electrodes for peripheral nerve stimulation  

Microsoft Academic Search

This paper describes a new tripolar spiral cuff electrode, composed of a thin (10 ?m) and flexible polyimide insulating carrier and three circumneural platinum electrodes, suitable for stimulation of peripheral nerves. The cuffs were implanted around the sciatic nerve of two groups of ten rats each, one in which the polyimide ribbon was attached to a plastic connector to characterize

Francisco J. Rodri´guez; Dolores Ceballos; Antoni Valero; Elena Valderrama; Thomas Stieglitz; Xavier Navarro



[Vaginitis and vaginosis].  


Recently, within the wide subject on vaginal phlogosis a new pathology has been included. Owing to its peculiar characteristics, as it is not to be regarded as a vaginitis in the strict sense of the word, it has been identified as anaerobic bacterial vaginosis. The latter proves to be different from most common vaginitis related pathologies as a result of a series of microbiological and clinical patterns that are widely dealt with in this research. Moreover, the author place special emphasis on the diagnostic and therapeutic aspects of vaginosis. PMID:2284037

Cerza, S; Cerza, G; Custo, G M



Rotator cuff repair in spinal cord injury patients  

Microsoft Academic Search

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on nonsurgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord–injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging underwent rotator cuff repair. Two of eight shoulders

Richard L Popowitz; John E Zvijac; John W Uribe; Keith S Hechtman; Matthias R Schürhoff; Jeremy B Green



Rotator cuff repair in spinal cord injury patients  

Microsoft Academic Search

Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on non- surgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord-injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imag- ing underwent rotator cuff repair. Two of

Richard L. Popowitz; John E. Zvijac; John W. Uribe; Keith S. Hechtman


Laboratory Evaluation of 4 Brands of Endotracheal Tube Cuff Inflator  

Microsoft Academic Search

INTRODUCTION: Routine measurement of endotracheal tube (ETT) cuff pressure is a standard in respiratory care, and several devices are available for measuring ETT cuff pressure. Yet an informed choice in the buying process is hindered by the present paucity of unbiased, comparative data. METHODS: Four brands of cuff inflator were tested: Posey Cufflator, DHD Cuff-Mate 2, Rusch Endotest, and SIMS-Portex

Paul B Blanch


Determinants of the cuff-leak test: a physiological study  

Microsoft Academic Search

INTRODUCTION: The cuff-leak test has been proposed as a simple method to predict the occurrence of post-extubation stridor. The test is performed by cuff deflation and measuring the expired tidal volume a few breaths later (VT). The leak is calculated as the difference between VT with and without a deflated cuff. However, because the cuff remains deflated throughout the respiratory

George Prinianakis; Christina Alexopoulou; Eutichis Mamidakis; Eumorfia Kondili; Dimitris Georgopoulos



Review of Vaginitis  

PubMed Central

Adisruption of the dynamic equilibrium of the healthy vagina may have significant sequelae, leading to chronic or serious conditions. Therefore, all cases of vaginitis should be accurately diagnosed and appropriately treated.



Yeast Infection (Vaginal)  


... may be reprinted for personal, noncommercial use only. Yeast infection (vaginal) By Mayo Clinic staff Original Article: Definition Symptoms Causes Risk factors Preparing ...


Vaginitis - self-care  


... of all ages. It can be caused by: Yeast, bacteria, viruses, and parasites Bubble baths, soaps, vaginal ... Creams or suppositories are used to treat yeast infections in the ... some grocery stores, and other stores. Treating yourself ...


Comparative Assessment of Pelvic Floor Function Using Vaginal Cones, Vaginal Digital Palpation and Vaginal Pressure Measurements  

Microsoft Academic Search

A group-comparative study to assess pelvic floor muscle function using vaginal cones, vaginal digital palpation, and vaginal pressure measurements in 30 women suffering from genuine stress urinary incontinence and in an age-matched group of continent women was undertaken. Vaginal digital palpation score and vaginal pressure during active contraction were greater (p < 0.001) in continent women (1.9 ± 0.1 and

Inger Hahn; Ian Milsom; Bo L. Ohlssor; Peter Ekelund; Christer Uhlemann; Magnus Fall



Prospective multi-center trial utilizing electronic brachytherapy for the treatment of endometrial cancer  

PubMed Central

Background A modified form of high dose rate (HDR) brachytherapy has been developed called Axxent Electronic Brachytherapy (EBT). EBT uses a kilovolt X-ray source and does not require treatment in a shielded vault or a HDR afterloader unit. A multi-center clinical study was carried out to evaluate the success of treatment delivery, safety and toxicity of EBT in patients with endometrial cancer. Methods A total of 15 patients with stage I or II endometrial cancer were enrolled at 5 sites. Patients were treated with vaginal EBT alone or in combination with external beam radiation. Results The prescribed doses of EBT were successfully delivered in all 15 patients. From the first fraction through 3 months follow-up, there were 4 CTC Grade 1 adverse events and 2 CTC Grade II adverse events reported that were EBT related. The mild events reported were dysuria, vaginal dryness, mucosal atrophy, and rectal bleeding. The moderate treatment related adverse events included dysuria, and vaginal pain. No Grade III or IV adverse events were reported. The EBT system performed well and was associated with limited acute toxicities. Conclusions EBT shows acute results similar to HDR brachytherapy. Additional research is needed to further assess the clinical efficacy and safety of EBT in the treatment of endometrial cancer.



Current biomechanical concepts for rotator cuff repair.  


For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

Lee, Thay Q



Brachytherapy of Liver Metastases  

Microsoft Academic Search

Brachytherapy for the treatment of liver metastases is a novel approach. In this procedure, techniques of locally ablative\\u000a treatment in interventional radiology and radiation therapy are combined. After computed tomography (CT)-guided percutaneous\\u000a implantation of catheters into the hepatic tumor, the irradiation is performed in an afterloading technique. This minimally\\u000a invasive procedure offers circumscriptive high-dose rate irradiation of the lesion to

Timm Denecke; Enrique Lopez Hänninen


Localized prostate cancer: brachytherapy  

Microsoft Academic Search

Opinion statement  Brachytherapy is a treatment for localized prostate cancer that has become popular with physicians and patients. The use and\\u000a convenience of transrectal ultrasound and transperineal placement of the sources make contemporary forms of this procedure\\u000a more accurate and more patient-friendly than their predecessors. In addition, the early detection of cancer by the use of\\u000a prostate-specific antigen (PSA) makes contemporary

Anthony L. Zietman



Biologically enhanced healing of the rotator cuff.  


Failure of rotator cuff repair is a well-documented problem. Successful repair is impeded by muscle atrophy, fat infiltration, devascularization, and scar tissue formation throughout the fibrocartilagenous transition zone. This case study exemplifies a technique to biologically augment rotator cuff healing. Clinically, pain and function improved. Postoperative magnetic resonance imaging evaluation confirmed construct integrity. Biological enhancement of the healing process and physiologically based alterations in rehabilitation protocols can successfully treat complicated rotator cuff tears. Prospective studies with larger sample sizes and continued follow-up are necessary to assess the definitive efficacy of this treatment modality. PMID:22691639

Gordon, Nicole M; Maxson, Scott; Hoffman, James K



Conservative management of rotator cuff tear.  


Ranking among the most prevalent of shoulder disorders, lesions involving shoulder rotator cuff strike million of patients in the United States at different points in their lives. Despite the fact that rotator cuff disease is a very common cause of pain and disability of the upper arm, a high proportion of patients is asymptomatic and unaware of performing daily living activities despite of a shoulder lesion. Given these drawbacks, surgeons are trying exploring whether conservative treatment is a viable option for the management of these injuries. This study presents a rationale to consider nonoperative treatment an effective option when dealing with patients with rotator cuff tears. PMID:22089284

Pegreffi, Francesco; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe



The dose distribution of low dose rate Cs137 in intracavitary brachytherapy: comparison of Monte Carlo simulation, treatment planning calculation and polymer gel measurement  

Microsoft Academic Search

In this study, the dose distribution delivered by low dose rate Cs-137 brachytherapy sources was investigated using Monte Carlo (MC) techniques and polymer gel dosimetry. The results obtained were compared with a commercial treatment planning system (TPS). The 20 mm and the 30 mm diameter Selectron vaginal applicator set (Nucletron) were used for this study. A homogeneous and a heterogeneous---with

M. Fragoso; P. A. Love; F. Verhaegen; C. Nalder; A. M. Bidmead; M. Leach; S. Webb



Value of vaginal culture in management of acute vaginitis  

Microsoft Academic Search

Objective: To evaluate the relative contribution of clinical assessment and vaginal discharge cultures in the treatment of acute vaginitis.\\u000a Methods: A prospective observational study of 75 consecutive sexually active women with acute vaginal symptoms was undertaken. Each\\u000a patient underwent an evaluation that included a standardized history, interview a thorough pelvic examination and vaginal\\u000a culture. The treatment was administered based upon

S. Lurie; I. Woliovitch; S. Rotmensch; O. Sadan; M. Glezerman



Optimizing the management of rotator cuff problems.  


Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal anti-inflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery. PMID:21628648

Pedowitz, Robert A; Yamaguchi, Ken; Ahmad, Christopher S; Burks, Robert T; Flatow, Evan L; Green, Andrew; Iannotti, Joseph P; Miller, Bruce S; Tashjian, Robert Z; Watters, William C; Weber, Kristy; Turkelson, Charles M; Wies, Janet L; Anderson, Sara; St Andre, Justin; Boyer, Kevin; Raymond, Laura; Sluka, Patrick; McGowan, Richard



Rotator cuff tear measurement by arthropneumotomography  

SciTech Connect

Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size of the tear and the quality of the remaining cuff than did plain arthrograms.

Kilcoyne, R.F.; Matsen, F.A. III



Endotracheal Tube Cuff Pressure Following Intubation.  

National Technical Information Service (NTIS)

An endotracheal tube (ETT) is frequently necessary for airway management. Proper inflation of the ETT cuff is critical for patient safety. Pressure must be high enough to seal the trachea to prevent aspiration of regurgitated stomach contents and avoid ai...

M. A. Powell D. Y. Duncan D. A. Pojman R. E. Wyatt B. A. Schoneboom



Rotator cuff repair. Long-term results  

Microsoft Academic Search

Objectives. – To evaluate the results of rotator cuff repair and to look for preoperative and\\/or intraoperative predictors of long-term outcomes.Patients and methods. – All patients who underwent open rotator cuff repair surgery for a full-thickness tear between 1990 and 1996 and who were subsequently followed-up for at least 4 years were contacted. The surgical technique and postoperative rehabilitation program

Daniel Van Linthoudt; Jacques Deforge; Laurent Malterre; Harry Huber



Cup arthroplasty for rotator cuff tear arthropathy.  


Cup arthroplasty is a conservative bone-sparing option for resurfacing of the humeral head. Earlier reports have shown its effectiveness in appropriately selected patients with osteoarthritis, osteonecrosis, and severe rheumatoid arthritis. Patients with cuff tear arthropathy may also benefit from a modified cup arthroplasty technique. The purpose of this article is to describe the surgical technique involved in humeral cup arthroplasty in cuff tear arthropathy patients. We will review the indications, contraindications, complications, and postoperative rehabilitation. PMID:21358516

Mariscalco, Michael W; Patterson, Ryan W; Seitz, William H



Arthroscopic Transosseous-Equivalent Rotator Cuff Repair  

PubMed Central

Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseous-equivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseous-equivalent rotator cuff repair technique with a focus on technical pearls.

Lavery, Kyle P.; Rasmussen, Jeffrey F.; Dhawan, Aman



Management of vaginal agenesis.  


Rokitansky syndrome and complete androgen insensitivity syndrome are the most common causes of vaginal agenesis. Treatment should be deferred until adolescence to allow informed consent and compliance. The best treatment for vaginal agenesis remains controversial although vaginal dilation therapy is still widely considered the first line treatment because success rates are high and associated risks are low. A variety of surgical options are also available, each with enthusiastic proponents. Long-term outcome studies on most surgical techniques, however, are still lacking and until recently most studies have reported on success rate in terms of anatomical success only, without including sexual function. Moreover, the medical literature lacks prospective comparative outcome studies, meaning that current choice of surgical procedure relies greatly on the surgeon's preference and experience. PMID:21872517

Nakhal, Rola S; Creighton, Sarah M



Clinical examination of the rotator cuff.  


Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability and account for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing by using a goniometer, strength testing by using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can typically be completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time efficient for a busy clinical practice. It is useful in the diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology. PMID:23332909

Jain, Nitin B; Wilcox, Reg B; Katz, Jeffrey N; Higgins, Laurence D



Rotator cuff tears: pathology and repair.  


By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others). In an era of emerging biologic interventions, our interventions are increasingly being modulated by our understanding of these core processes, many of which remain uncertain today. When we do intervene surgically, the techniques we employ are particularly challenging in the context of the tremendous pace of advancement. Several recent studies have shown that arthroscopic repair gives similar functional results to that of mini-open and open procedures, with all the benefits of minimally invasive surgery. However, the 'best' repair construct remains unknown, with wide variations in surgeon preference. Here we present a literature review encompassing recent developments in our understanding of basic science in rotator cuff disease as well as an up-to-date evidence-based comparison of different techniques available to the surgeon for cuff repair. PMID:19104772

Yadav, Hemang; Nho, Shane; Romeo, Anthony; MacGillivray, John D



Vaginal polyp in a newborn.  


Vaginal fibroepithelial polyp is a rare lesion, and although benign, it can be confused with malignant connective tissue lesions. Treatment is simple excision, and recurrence is extremely uncommon. We report a case of a newborn with vaginal fibroepithelial polyp. The authors suggest that vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls. PMID:17619202

Jallouli, Mohamed; Trigui, Lilia; Gargouri, Abdellatif; Mhiri, Riadh



Occult interpositional rotator cuff - an extremely rare case of traumatic rotator cuff tear.  


Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed. PMID:22247643

Lin, Cheng-Li; Su, Wei-Ren; Jou, I-Ming; Chih, Wei-Hsing



Biologics in Rotator Cuff Surgery: Management of Rotator Cuff Tears With an Extracellular Matrix Patch  

Microsoft Academic Search

Summary: Chronic large and massive rotator cuff tears remain a treatment challenge for the orthopaedic surgeon. The use of an extracellular matrix (ECM) biologic patch is an emerging field and offers potential for the treatment of patients with failed rotator cuff repairs or those with tears that are chronic and large in nature. There are several commercially available grafts that

Matthew T. Provencher; Augustus Mazzocca; Anthony A. Romeo



Medial Rotator Cuff Failure After Arthroscopic Double-Row Rotator Cuff Repair  

Microsoft Academic Search

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness.

John N. Trantalis; Richard S. Boorman; Kristie Pletsch; Ian K. Y. Lo



Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear  

PubMed Central

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Lin, Cheng-Li; Su, Wei-Ren; Jou, I-Ming



Medial rotator cuff failure after arthroscopic double-row rotator cuff repair.  


Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients. PMID:18514118

Trantalis, John N; Boorman, Richard S; Pletsch, Kristie; Lo, Ian K Y



Advances in Brachytherapy  

PubMed Central

During the past 15 years, permanent seed brachytherapy for prostate cancer has advanced significantly in all areas, including patient selection, treatment planning, technique, and technology (eg, seeds stranded in Vicryl suture). These improvements have made transperineal seed implantation an accurate and practical treatment option for men with low-, intermediate-, and high-risk disease. Because of the evidence that the various treatment options for prostate cancer are likely to be equally successful in terms of long-term cancer control, continuing efforts focus on enhancing the quality of life of implant patients.

Grimm, Peter; Sylvester, John



Adjuvant and definitive radiation therapy for primary carcinoma of the vagina using brachytherapy and external beam radiation therapy  

PubMed Central

Purpose To report the outcomes of patients receiving vaginal brachytherapy and/or external beam radiation therapy (EBRT) for primary vaginal cancer. Material and methods Between 1983 and 2009, 63 patients received brachytherapy and/or EBRT for primary tumors of the vagina at a single tertiary center. Patient data was collected via chart review. The Kaplan-Meier method was used to calculate actuarial pelvic local control (LC), disease-free survival (DFS), overall survival (OS), and severe late toxicity rates. Acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events version 3 (CTCAE v3.0). Results Median follow up was 44.2 months. Patients with early stage disease (stages I and II) had significantly improved 5-year OS when compared to patients with locally advanced disease (stages III and IVA) (73.3 vs. 34.4%, p = 0.032). Patients with greater than 1/3 vaginal involvement had significantly worse prognosis than patients with tumors involving 1/3 or less of the vagina, with the later having superior DFS (84.0 vs. 52.4%, p = 0.007) and LC (86.9 vs. 60.4%, p = 0.018) at 5-years. Age, histology, and brachytherapy technique did not impact treatment outcomes. The 5-year actuarial grade 3 or higher toxicity rate was 23.1% (95% CI: 10.6-35.6%). Concurrent chemotherapy had no impact on outcomes or toxicity in this analysis. Conclusions Success of treatment for vaginal cancer depends primarily on disease stage, but other contributing factors such as extent of vaginal involvement and tumor location significantly impact outcomes. Treatment of vaginal cancer with primary radiotherapy yields acceptable results with reasonable toxicity rates. Management of this rare malignancy requires a multidisciplinary approach to appropriately optimize therapy.

Anderson, Bethany; Geye, Heather; Das, Rupak; Straub, Margaret; Bradley, Kristin



Vulvar and vaginal HPV disease.  


Human papilloma virus is associated with a multitude of lower genital tract diseases in women in addition to cervical cancer, including genital warts, vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia, and some vulvar, vaginal, and anal cancers that are associated with oncogenic subtypes. The degree to which HPV manifests pathology depends on viral type, host immune response, and local environmental factors. This article reviews the evaluation and management of the following vulvar and vaginal human papilloma virus diseases: condyloma, vulvar intraepithelial neoplasia, and vaginal intraepithelial neoplasia. Included is a brief discussion of the association with vulvar and vaginal cancer. PMID:23732036

Nelson, Erin L; Stockdale, Colleen K



Failed Operative Vaginal Delivery  

PubMed Central

Objective To compare maternal and neonatal outcomes in women undergoing a second stage cesarean after a trial of operative vaginal delivery with women undergoing a second stage cesarean without such an attempt. Methods This study is a secondary analysis of the women who underwent second stage cesarean. .The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Infant outcomes examined included umbilical artery pH < 7.0, Apgar of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy (HIE), stillbirth, skull fracture, and neonatal death. Results Of 3189 women who underwent second stage cesarean, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups with the exception of the admission to delivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a non-reassuring fetal heart rate tracing (18.0% vs 13.9%, p=.01), have a wound complication (2.7% vs 1.0%; OR 2.65 95% CI 1.43–4.91), and require general anesthesia (8.0% vs 4.1%, OR 2.05 95% CI 1.44–2.91). Neonatal outcomes including umbilical artery pH less than 7.0, Apgar at or below 3 at 5 minutes, and hypoxic ischemic encephalopathy were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a non-reassuring fetal heart rate tracing were removed. Conclusion Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a non-reassuring fetal heart rate tracing.

Alexander, James M.; Leveno, Kenneth J.; Hauth, John C.; Landon, Mark B.; Gilbert, Sharon; Spong, Catherine Y.; Varner, Michael W.; Caritis, Steve N.; Meis, Paul; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Gabbe, Steven G.



Brachytherapy and pancreatic cancer.  


Advances in diagnostic and therapeutic technology have not appreciably changed the outlook of patients with pancreatic cancer. While those patients presenting with localized resectable disease have the best prognosis, local control and intra-abdominal metastases remain significant obstacles to survival. Localized chemoradiation has modestly improved median survival in localized and locally advanced disease. Patients presenting with locally advanced disease at diagnosis benefit from surgical palliation which includes biliary and gastric bypass. Intraoperative interstitial brachytherapy has been effective when utilized at laparotomy to improve local control in locally advanced disease. Advances in laparoscopic techniques have provided the ability to more accurately stage patients prior to laparotomy and perform palliative procedures without the need for laparotomy. The utilization of high-dose-rate brachytherapy has proven effective in palliating obstructive symptoms with minimal morbidity on an outpatient basis. Recent efforts have focused on preoperative chemoradiation to improve resectability in selected patients and prophylactic hepatic irradiation to reduce metastases for patients with locally advanced disease. PMID:9143059

Bodner, W R; Hilaris, B S


A Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation  

Microsoft Academic Search

A new type of newe cuff electrode consisting of conduc- tive segments embedded within a self-curling sheath of biocompatihle insulation has been developed. This spiral nerve cuff is biased to self- wrap around peripheral nerves and possesses a \\




Rotator Cuff Injuries - Multiple Languages: MedlinePlus  


... sharing features on this page, please enable JavaScript. Rotator Cuff Injuries - Multiple Languages Somali (af Soomaali) Spanish (español) Somali (af Soomaali) Rotator Cuff Exercises Jimicsiyada Muruqyada Wareegga ama Gulubida - af Soomaali ( ...


Adaptable Blood Pressure Cuff for Humans and Animals.  

National Technical Information Service (NTIS)

This invention relates to blood pressure measuring cuffs for humans and animals, and more particularly to a cuff wherein the pressure-transmitting parts are composed of strong, very thin, readily flexible sheet material made of polyurethane or material of...

E. C. Walker J. E. Pierce



[High dose rate prostate brachytherapy].  


This article aims at presenting the interest of high dose rate brachytherapy in the radiation treatment of prostatic adenocarcinoma. We will discuss successively the biological and dosimetric specificity of brachytherapy for this particular cancer. Afterwards, we will review the main phase II and III studies, the therapeutic indications in the daily practice from the evidence based medicine as well as the techniques of external beam radiation therapy for the same indications. Finally, the principal avenues of development will be discussed. PMID:23578898

Nickers, P; Blanchard, P; Hannoun-Lévi, J-M; Bossi, A; Chapet, O; Guérif, S



Fatty infiltration and rotator cuff atrophy.  


Moderate to severe fatty infiltration and rotator cuff atrophy are commonly associated with poor clinical outcomes and failed rotator cuff repair. Numerous animal and human studies have attempted to elucidate the etiology of fatty infiltration and rotator cuff atrophy. Mechanical detachment of the tendon in rotator cuff tears is primarily responsible. Suprascapular nerve injury may also play a role. CT, MRI, and ultrasonography are used to evaluate severity. The Goutallier staging system is most commonly used to evaluate fatty infiltration, and rotator cuff atrophy is measured using multiple techniques. The presence and severity of fatty infiltration have been associated with increasing age, tear size, degree of tendon retraction, number of tendons involved (ie, massive tears), suprascapular neuropathy, and traumatic tears. Fatty infiltration is irreversible and progressive if left untreated. Slight reversal of muscle atrophy has been noted after repair in some studies. Novel therapies are currently being evaluated that may eventually allow clinicians to alter the natural history and improve patient outcomes. PMID:24084435

Kuzel, Bradley R; Grindel, Steven; Papandrea, Rick; Ziegler, Dean



Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear  

Microsoft Academic Search

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior

Naoki Suenaga; Akio Minami; Kiyoshi Kaneda



Treatment Options for Rotator Cuff Tears: A Guide for Adults  


... and how long treatment may take. Treating your rotator cuff tear without surgery Rotator cuff tears are treated without surgery in ... when you should start feeling better. Repairing your rotator cuff tear with surgery How long do I wait before choosing surgery? ...


Synchronized intermittent mandatory insufflation of the endotracheal tube cuff  

Microsoft Academic Search

Continuous inflation of endotracheal tube cuffs causes tracheal injury in up to 11% of intubated patients. To avoid this complication and its consequences of tracheal and laryngeal stenosis and tracheosophageal fistula, we designed a simple device which enables intermittent inflation of the cuff during inspiratory periods of mechanical ventilation. This was achieved by connecting the inlet of the cuff of

A. Lev; E. Barzilay



An artificial nerve fiber for evaluation of nerve cuff electrodes  

Microsoft Academic Search

The different applications of natural sensors for feedback in rehabilitation systems using functional electrical stimulation (FES) require specialised and optimised designs of nerve cuff electrodes for recording of the sensory information. This paper describes a simple artificial nerve fiber for evaluation of nerve cuff electrode designs, cuff recording configurations and noise reduction methods in a controlled environment. The idea is

Lotte N. S. Andreasen; Johannes J. Struijk; Morten Haugland



A flexible method for fabrication of nerve cuff electrodes  

Microsoft Academic Search

A method for construction of cuff electrodes is presented. The method is based on using platinum foil electrodes fixed by rubber bands on a Teflon coated mandrel, that is then dip-coated with silicone. The method allows for design of cuff electrodes of practically any size, shape and electrode configuration, and simple cuffs can be built in less than one hour

M. Haugland



Whole sensory nerve recordings with spiral nerve cuff electrode  

Microsoft Academic Search

We have used a self-curling nerve cuff electrode to record sensory information from a cutaneous nerve. This type of cuffs has previously been used only for stimulation, but its mechanical properties could make it very suitable for recording also, since it can be fitted closer to the nerve than traditional cuffs without compromising the nerve. In this study we show

T. Sinjar; B. Hinge; A. Jorgensen; M. L. Jensen; M. Haugland



Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.  


Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour. PMID:23223657

Dane, Cem; Rustemoglu, Yaprak; Kiray, Murat; Ozkuvanci, Unsal; Tatar, Zeynep; Dane, Banu



Tendon transfers for irreparable rotator cuff tears.  


Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears. Although surgical indications are not clearly defined, the traditional thought is that the ideal candidate is young and lacks significant glenohumeral arthritis. The proposed benefits of tendon transfers are pain relief and potential increase in strength. The biomechanical rationale for the procedure is to restore the glenohumeral joint force couple and possibly to restore normal shoulder kinematics. The selection of donor tendon depends on the location of the rotator cuff deficiency. Transfers of latissimus dorsi and pectoralis major tendons have been shown to consistently improve pain; however, functional benefits are unpredictable. Trapezius tendon transfer may be an alternative in patients with massive posterosuperior rotator cuff tears, although longer-term follow-up is required. PMID:23908255

Omid, Reza; Lee, Brian



Role of metalloproteinases in rotator cuff tear.  


The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPS) in the pathophysiology of rotator cuff tears has not been established yet. Recent advances empathize about the role of MMPs and TIMPS in extracellular matrix (ECM) remodeling and degradation in rotator cuff tears pathogenesis and healing after surgical repair. An increase in MMPs synthesis and the resulting MMPs mediated alterations in the ECM of tendons have been implicated in the etiopathogenesis of tendinopathy, and there is an increase in the expression of MMPs and a decrease in TIMP messenger ribonucleic acid expression in tenocytes from degenerative or ruptured tendons. Importantly, MMPs are amenable to inhibition by cheap, safe, and widely available drugs such as the tetracycline antibiotics and bisphosphonates. A better understanding of relationship and activity of these molecules could provide better strategies to optimize outcomes of rotator cuff therapy. PMID:21822103

Garofalo, Raffaele; Cesari, Eugenio; Vinci, Enzo; Castagna, Alessandro



[Arthroscopic reconstruction of the rotor cuff].  


Over the last years treatment of rotator cuff tears is evolving gradually from open to complete arthroscopic repair. There had been fast developments in arthroscopic techniques and instruments and there is a better understanding of biomechanical backgrounds. For a good clinical outcome it is not necessary to obtain a watertight closure in all cases but to balance the force couples in the coronal and transverse plane. There is recent discussion regarding the optimum techniques and stitches for cuff reconstruction and resulting developments in this field. To determine the individual reconstruction technique it is crucial to recognize the different tear categories. Based on these findings we are now able to treat nearly every cuff tear arthroscopically, even a retracted massive lesion. PMID:16897022

Bauer, G J; Kniesel, B



Abnormal vaginal bleeding in the nonpregnant patient  

Microsoft Academic Search

Abnormal vaginal bleeding is a common presenting complaint to most emergency departments. This article focuses on vaginal bleeding in the nonpregnant patient; pregnancy-related vaginal bleeding is reviewed elsewhere in this issue. Vaginal bleeding can be the cause of significant morbidity and mortality in nonpregnant patients. Vaginal bleeding can also herald serious underlying problems related to malignancy, chronic illness, and sexual

Richard V. Daniels; Charles McCuskey


Clinical and biological aspects of rotator cuff tears.  


Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success. PMID:23888289

Via, Alessio Giai; De Cupis, Mauro; Spoliti, Marco; Oliva, Francesco



Arthroscopic Rotator Cuff Repair with Interval Release for Contracted Rotator Cuff Tears  

Microsoft Academic Search

As experience has been gained in the arthroscopic repair of small and moderate rotator cuff tears, there has been a natural\\u000a progression toward the repair of larger tears.1–3 There is now considerable experience in the arthroscopic repair of these larger tears. The most significant advantage of\\u000a an all-arthroscopic approach in the repair of large and massive rotator cuff tears is

Joseph C. Tauro


Optimization of brachytherapy dose distributions by simulated annealing.  


An algorithm based on the method of simulated annealing is presented for optimizing brachy-therapy dose distributions. The algorithm accommodates either static configurations of multiple sources or single stepping sources, hence in principle can be used to optimize both low- and high-dose rate treatments delivered with remote afterloading equipment. Required inputs include the specification of target dose rates and dose rate limits, expressed in absolute or relative terms, at operator selected points near the treatment site. The influence of the dose rate limits can be adjusted continuously through the use of one or more penalty factors. The algorithm generates a set of integer weights, one for each available source position, which are interpreted in terms of configuration occupancy numbers for static source arrangements and relative dwell times for stepping sources. Application is made to several variations of a hypothetical low-dose rate vaginal vault planning problem involving one rectal and six applicator calculation points. The algorithm's performance for different source strengths, annealing schedules, target dose rates, dose rate limits, and values of a single penalty factor lambda was examined. With a simple annealing schedule and value of lambda = 25, the algorithm found solutions of high quality for all problem variants. The CPU time required for optimization on a Vax 11/750 computer ranged from 2 min for a single configuration to 25 min for a solution consisting of four configurations. These results support the use of simulated annealing for clinical planning of low dose rate vaginal treatments, and encourage investigation of other applications in brachytherapy. PMID:1518484

Sloboda, R S


Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound  

SciTech Connect

Purpose: To determine if transabdominal ultrasound (US) can be used for conformal brachytherapy in cervical cancer patients. Materials and Methods: Seventy-one patients with locoregionally advanced cervix cancer treated with chemoradiation and brachytherapy were included in this study. The protocol consisted of US-assisted tandem insertion and conformal US-based planning. Orthogonal films for applicator reconstruction were also taken. A standard plan was modified to suit the US-based volume and treatment was delivered. The patient then underwent a magnetic resonance imaging (MRI) scan with the applicators in situ. Retrospectively, individual standard (STD), US, and MRI plans were extrapolated for five fractions and superimposed onto the two-dimensional sagittal MRI images for comparison. Doses to Point A, target volume, International Commission on Radiation Units and Measurements (ICRU) 38 bladder and rectal points, and individualized bowel points were calculated on original implant geometry on Plato for each planning method. Results: STD (high-dose-rate) plans reported higher doses to Point A, target volume, ICRU 38 bladder and rectal points, and individualized bowel point compared with US and MRI plans. There was a statistically significant difference between standard plans and image-based plans-STD vs. US, STD vs. MRI, and STD vs. Final-having consistent (p {<=} 0.001) respectively for target volume, Point A, ICRU 38 bladder, and bowel point. US plan assessed on two-dimensional MRI image was comparable for target volume (p = 0.11), rectal point (p = 0.8), and vaginal mucosa (p = 0.19). Local control was 90%. Late bowel morbidity (G3, G4) was <2%. Conclusions: Transabdominal ultrasound offers an accurate, quick, accessible, and cost-effective method of conformal brachytherapy planning.

Van Dyk, Sylvia [Radiation Therapy Services, Peter MacCallum Cancer Center, East Melbourne (Australia)], E-mail:; Narayan, Kailash [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne (Australia); Fisher, Richard [Center for Biostatistics and Clinical Trials, Peter MacCallum Cancer Center, East Melbourne (Australia); Bernshaw, David [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne (Australia)



[Diagnosis and treatment of rotator cuff tears].  


A rotator cuff tear is a highly prevalent disorder, occurring in 25% of people over 60 years of age. In two thirds of patients the tear is small and asymptomatic. Acute, symptomatic cuff tears may occur in active sportsmen and women aged 30-50. There is often a considerable delay in diagnosis in this group, due to a lack of recognition by either the patient or the doctor. Recently identified risk factors for the development of cuff tear are nicotine abuse, hypercholesterolaemia, contralateral cuff tear and genetic predisposition. Conservative treatment can be very successful and consists of physical therapy and effective analgesics. Repeated steroid injections are harmful to the tendinous tissue and should be avoided. The aim of surgery is anatomical reinsertion of the ruptured tendon using an open or arthroscopic procedure. The arthroscopic procedure enables the surgeon to perform a more extensive evaluation and treatment of the joint. The arthroscopic procedure is technically more demanding than the open procedure, but seems to have a shorter rehabilitation period. PMID:21871139

van der Zwaal, Peer; Pekelharing, Janneke F; Thomassen, Bregje J W; Swen, Jan-Willem A; van Arkel, Ewoud R A



[Symptomatic rotator cuff tear of the shoulder].  


Rotator cuff tears of the shoulder are common in the middle age and elderly population and can cause chronic pain. The prevalence of rotator cuff tears in people in their 50s, 60s, 70s, and 80s is 12.8%, 25.6%, 45.8% and 50% respectively. Etiological theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tear. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. The symptoms are of gradual increase in shoulder pain and weakness, however, it can happen acutely due to an injury. Difficulties in overhead activities and night pain are common. Evaluation of shoulder muscle strength can imply on cuff tear. Shoulder radiograph is essential specifically to rule out other diagnosis. Imaging such as ultrasound and magnetic resonance can further define the tear, however they should be used only if they will affect the management of the condition. Common indications for surgical repair are acute tear in a relatively young and active patient or when the treatment of symptomatic patient with chronic tear had failed. Most repairs are currently performed in an all arthroscopic technique which is minimally invasive with easier rehabilitation and less pain. PMID:22741212

Haviv, Barak; Bronak, Shlomo; Thein, Rafael



Biological strategies to enhance rotator cuff healing.  


Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair. Growth factors are delivered to the repair site using tissue-engineered scaffolding, coated sutures, or dissolved in a fibrin sealant. Platelet-rich plasma is an autologous concentration of platelets and contains an high density of growth factors. There is some evidence that platelet-rich plasma may improve pain and recovery of function in a short time period, but it does not improve healing rates in rotator cuff. Thus the routine use of platelet-rich plasma in rotator cuff repair is not recommended. The addition of mesenchymal stem cells to scaffolds can lead to the production of a better quality healing tissue. Gene therapy is a gene transfer from a cell into another, in order to over-express the gene required. In this way, cultures of stem cells can over-express growth factors. Better understanding of the mechanisms of physiological tendon healing can promote the correct use of these new biological therapies for a better healing tissue. PMID:24059330

Longo, Umile Giuseppe; Rizzello, Giacomo; Berton, Alessandra; Maltese, Ludovica; Fumo, Caterina; Khan, Wasim S; Denaro, Vincenzo



Partial-Thickness Rotator Cuff Tears  

PubMed Central

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.



Physical Therapist's Guide to Rotator Cuff Tear  


... bring with you to your health care provider. Longo UG, Franceschi F, Berton A, et al. Conservative treatment and rotator cuff tear progression. Med Sport Sci . 2012;57:90–99. Article Summary on PubMed . Düzgün I, Baltac? G, Atay OA. Comparison of slow and accelerated rehabilitation ...


Shoulder Impingement/Rotator Cuff Tendinitis  


... x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special x-ray view, called an "outlet view," sometimes will show a small bone spur on the front edge of the acromion. (Left) Normal outlet view x-ray. (Right) Abnormal outlet view showing a large bone spur ...


Tripolar nerve cuff recording: stimulus artifact, EMG and the recorded nerve signal  

Microsoft Academic Search

Properties of nerve cuff recording electrodes were analyzed. Tripolar cuff electrodes have to be described essentially different for (propagating) nerve signals inside the cuff, and electrical muscle activity and stimulus artifacts arising from sources outside the cuff. It was experimentally shown that the signals originating outside the cuff are differently and much stronger influenced by the addition of a balancing

Johanna Jan Struijk; Morten Thomsen



The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears  

Microsoft Academic Search

We measured the incidence of cuff retear and injury to the suprascapular nerve after mobilization and repair of a massive rotator cuff tear. Of one hundred four rotator cuff repairs performed over a 5-year period, 10 patients (7 men and 3 women, age range 22 to 68 years) had primary repairs of massive rotator cuff tears requiring cuff mobilization and

Robert M. Zanotti; James E. Carpenter; Ralph B. Blasier; Mary Lou V. H. Greenfield; Ronald S. Adler; Mark B. Bromberg



Prostate cancer brachytherapy: guidelines overview  

PubMed Central

Prostate cancer, due to wide availability of PSA tests, is very often diagnosed in early stage, nowadays. This makes management of this disease even harder in every day oncology care. There is a wide range of treatment options including surgery, radiotherapy and active surveillance, but essential question is which treatment patient and oncologist should decide for. Due to recent publication of Prostate Cancer Results Study Group, in which brachytherapy is one of supreme curative options for prostate cancer, we decided to overview most present european and north american recommendations. National Comprehensive Cancer Network, American Society for Radiation Oncology, American Brachytherapy Society, European Association of Urology and Groupe Européen de Curiethérapie of European Society for Therapeutic Radiation Oncology guidelines are overviewed, particularly focusing on HDR and LDR brachytherapy.

Bialas, Brygida



Vaginal Mucormycosis: A Case Report  

PubMed Central

Although Zygomycetes cause life-threatening, opportunistic infections in immunocompromised hosts, the first case of vaginitis caused by Mucor species in a healthy woman is reported. Mucor vaginitis, which caused mild symptoms only, was refractory to conventional azole therapy and resistant to flucytosine. Cure was achieved with topical amphotericin B.



10 CFR 35.432 - Calibration measurements of brachytherapy sources.  

Code of Federal Regulations, 2013 CFR

...2013-01-01 2013-01-01 false Calibration measurements of brachytherapy sources... Manual Brachytherapy § 35.432 Calibration measurements of brachytherapy sources...provided by the source manufacturer or by a calibration laboratory accredited by the...



Heterogeneity of Vaginal Microbial Communities within Individuals? #  

PubMed Central

Recent culture-independent studies have revealed that a healthy vaginal ecosystem harbors a surprisingly complex assemblage of microorganisms. However, the spatial distribution and composition of vaginal microbial populations have not been investigated using molecular methods. Here, we evaluated site-specific microbial composition within the vaginal ecosystem and examined the influence of sampling technique in detection of the vaginal microbiota. 16S rRNA gene clone libraries were prepared from samples obtained from different locations (cervix, fornix, outer vaginal canal) and by different methods (swabbing, scraping, lavaging) from the vaginal tracts of eight clinically healthy, asymptomatic women. The data reveal that the vaginal microbiota is not homogenous throughout the vaginal tract but differs significantly within an individual with regard to anatomical site and sampling method used. Thus, this study illuminates the complex structure of the vaginal ecosystem and calls for the consideration of microenvironments when sampling vaginal microbiota as a clinical predictor of vaginal health.

Kim, Tae Kyung; Thomas, Susan M.; Ho, Mengfei; Sharma, Shobha; Reich, Claudia I.; Frank, Jeremy A.; Yeater, Kathleen M.; Biggs, Diana R.; Nakamura, Noriko; Stumpf, Rebecca; Leigh, Steven R.; Tapping, Richard I.; Blanke, Steven R.; Slauch, James M.; Gaskins, H. Rex; Weisbaum, Jon S.; Olsen, Gary J.; Hoyer, Lois L.; Wilson, Brenda A.



Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: Magnetic resonance imaging findings and clinical significance  

Microsoft Academic Search

Cystic lesions that arise adjacent to the shoulder have been reported in association with labral tears or as an unusual manifestation of massive rotator cuff tears. The purpose of this study was to define the relationship between intramuscular cysts of the rotator cuff and tears of the rotator cuff. Thirteen cases of intramuscular cysts of the rotator cuff were identified

Timothy G. Sanders; Phillip F. J. Tirman; John F. Feller; Harry K. Genant



The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix  

Microsoft Academic Search

Purpose: This report presents guidelines for using high-dose-rate (HDR) brachytherapy in the management of patients with cervical cancer, taking into consideration the current availability of resources in most institutions.Methods: Members of the American Brachytherapy Society (ABS) with expertise in HDR brachytherapy for cervical cancer performed a literature review, supplemented their clinical experience to formulate guidelines for HDR brachytherapy of cervical

Subir Nag; Beth Erickson; Bruce Thomadsen; Colin Orton; Jeffrey D Demanes; Daniel Petereit



The modified massive cuff stitch: functional and structural outcome in massive cuff tears  

PubMed Central

Background The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture. Methods We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification. Results The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296). Conclusions The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.



Multicatheter Device for Brachytherapy Treatment  

NASA Astrophysics Data System (ADS)

Low dose rate brachytherapy treatment for prostate cancer encompasses the delivery of capsules containing radioactive material into the prostate's cancerous tissue via injection through needles. High dose rate brachytherapy treatment for prostate cancer follows the same concept with the difference that the radioactive source has a higher activity and it is placed temporarily into the patient. For this reason, the source is driven by an afterloading device that moves the source into the catheters and back into a shielded container. From both HDR and LDR brachytherapy, two issues remain unaddressed: homogeneity and localization. Sources not being homogeneous result in a delivered dose that does not correspond to the treatment plan. In the case of HDR, the afterloader not always places the source where it should within the catheter. This results in undertreatment of the cancerous tissue as well as damage to healthy tissue. To address both issues we have placed scintillating fiber into brachytherapy needles. If placed geometrically around the radioactive seeds we are able to check for homogeneity in the sources. At the same time, by analyzing the detected signals we are trying to determine the exact physical position of the seeds within the catheter. Using a radioactive source, we have taken measurements to calibrate the device and measurements under water to simulate living tissue environment. Results are discussed.

Velasco, Carlos; Gueye, Paul; Keppel, Cynthia



Prostate brachytherapy under local anesthesia  

Microsoft Academic Search

Purpose: Local anesthesia for prostate brachytherapy was instituted at the Puget Sound Veterans Hospital in 1999, peforming the procedure in our own department without anesthesia personnel in attendance. Materials and Methods: The patient is brought into the simulator suite in the radiation oncology department, an i.v. line is started, a cardiac monitor attached, and a urinary catheter is inserted. He

Kent Wallner



Differential Suture Loading in an Experimental Rotator Cuff Repair  

Microsoft Academic Search

Background: Repairs of large rotator cuff tears often fail to heal. A possible factor in these failures is excessive tension in the repair sutures, causing them to pull through the tendon.Hypothesis: Arm positions encountered during early rehabilitation after cuff repair can dramatically increase the relative tension in the different sutures of the cuff repair.Study Design: Controlled laboratory study.Methods: In a

Christopher Howe; Philippe Huber; Fredric M. Wolf; Frederick Matsen



LactoSorb plates for rotator cuff repair  

Microsoft Academic Search

Purpose: We present our preliminary studies using LactoSorb plates (Lorenz\\/Biomet, Warsaw, IN) for rotator cuff repair in humans. The use and application of this plate are described as an adjunct to prevent hole migration in trough-tunnel repairs of rotator cuff tears. Methods: Fifty patients with rotator cuff tears documented by magnetic resonance imaging underwent arthroscopic subacromial decompression followed by a

Kevin J. Kessler; Amy E. Bullens-Borrow; Jesse Zisholtz



Indications for repair of full-thickness rotator cuff tears.  


Rotator cuff repair surgery for full-thickness tears is common and accepted in orthopaedics today. Given that a significant number of people have asymptomatic rotator cuff tears, the indications for surgery are, however, somewhat unclear. Multiple factors such as duration of symptoms, acuity and size of the tear, patient age, and others require consideration and can influence the decision to perform surgery. This article reviews these variables and the indications for surgery to repair full-thickness rotator cuff tears. PMID:17337723

Wolf, Brian R; Dunn, Warren R; Wright, Rick W



The american brachytherapy society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis  

Microsoft Academic Search

Purpose: The purpose of this report is to establish guidelines for postimplant dosimetric analysis of permanent prostate brachytherapy.Methods: Members of the American Brachytherapy Society (ABS) with expertise in prostate dosimetry evaluation performed a literature review and supplemented with their clinical experience formulated guidelines for performing and analyzing postimplant dosimetry of permanent prostate brachytherapy.Results: The ABS recommends that postimplant dosimetry should

Subir Nag; William Bice; Keith DeWyngaert; Bradley Prestidge; Richard Stock; Yan Yu



Vaginal oxytetracycline concentrations.  


Although tetracycline preparations are widely used in departments of genitourinary medicine, or sexually transmitted diseases clinics, little is known of the concentrations of these preparations in genital secretions. For this reason a microbiological method was used for estimating oxytetracycline concentrations in vaginal secretions. These concentrations varied from 0.6 to 6.5 microgram/ml in 19 women who had had sexual contact with a man with non-specific urethritis and who were taking oxytetracycline dihydrate 250 mg four times daily. They were well in excess of the minimum inhibitory concentration of oxytetracycline (0.2 microgram/ml) for the strains of Chlamydia trachomatis isolated from the patients with positive culture results. Thus, oxytetracycline 250 mg four times daily appears to be a satisfactory regimen for the treatment of chlamydial genital infection in women. PMID:509190

Thin, R N; Al Rawi, Z H; Simmons, P D; Treharne, J; Tabaqchali, S




PubMed Central

Injuries of the musculotendinous cuff are frequent and often cause long periods of disability. The cuff is subject to progressive degenerative changes which are visible microscopically in most persons past 30 years of age, and visible grossly in those past 40. The cuff ruptures through areas of degeneration. A great majority of patients recover good shoulder function under conservative treatment. Operation is not urgent. Accurate diagnosis of a complete tear of the cuff cannot be made until the acute phase of injury has passed, and delay in operating does not decrease chances of good results. ImagesFigure 1.Figure 2.

Blanche, Donald W.



Role of biomechanics in rotator cuff pathology: North American perspective.  


The biomechanical properties of, and mechanical environment surrounding, the rotator cuff continue to be a research area of great interest as injury and failure of these tendons are among the most common of shoulder pathologies, with incidence increasing in older populations. Recent literature has refined our knowledge of the anatomy, the role of the various tendons in movement and shoulder stability, and structural and material properties of the human rotator cuff. Furthermore, animal models have characterized the effects of mechanical loading on rotator cuff properties, the biomechanical interactions among cuff tendons in uninjured and deficient rotator cuffs have been described, and more recent imaging studies have provided novel insights into the function of the rotator cuff in vivo. Research to advance our understanding of the biomechanical factors contributing to rotator cuff disease is needed, as the etiology, prognostic indicators, and reasons for treatment failure are poorly understood. We summarize published biomechanical literature on the rotator cuff to provide a current perspective on potential mechanisms involved in cuff pathology. PMID:21986042

Karas, Vasili; Cole, Brian J; Wang, Vincent M



Biological Augmentation of Rotator Cuff Tendon Repair  

Microsoft Academic Search

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due\\u000a to abnormal or insufficient gene expression and\\/or cell differentiation at the repair site. Techniques to manipulate the biologic\\u000a events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive\\u000a growth factors and BMP-12 on

David Kovacevic; Scott A. Rodeo



Coracoacromial arch decompression in rotator cuff surgery  

Microsoft Academic Search

In rotator cuff surgery it is important to obtain adequate decompression of the coracoacromial arch. However, it is difficult\\u000a to localize the impingement site preoperatively. Based on histological and morphological studies and the clinical findings\\u000a in 45 patients and 15 cadavers, we have tried to determine the impingement site. In addition, as a part of these investigations,\\u000a we assessed the

N. Suenaga; A. Minami; N. Iwasaki; K. Kaneda



Conservative treatment and rotator cuff tear progression.  


There is no definite consensus on the best management for patients with rotator cuff tears. No randomized controlled studies have compared the outcome of surgical versus conservative treatment. The described successful rate of conservative treatment varies widely, from 33 to 92%. Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment of rotator cuff tears, non-operative management is often recommended in such patients. Prognostic factors seem to be clinical presentation, duration of symptoms and tear size. The best programme for conservative treatment is not defined. Physical therapy consists of stretching and strengthening exercises. The characteristics of exercise programmes are not standardized. In clinical practice, intra-articular injections are commonly used for treatment of shoulder pain. Systemic pharmacotherapy for patients with shoulder pain consists of non-steroidal anti-inflammatory drugs. Recently, cyclo-oxygenase-2-selective inhibitors have been introduced for management of shoulder pain. To date, few randomized controlled trials are available on conservative management of rotator cuff tears, and therefore further studies are required to clarify its role in such patients. PMID:21986048

Longo, Umile Giuseppe; Franceschi, Francesco; Berton, Alessandar; Maffulli, Nicola; Droena, Vincenzo



Biological Augmentation of Rotator Cuff Tendon Repair  

PubMed Central

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.

Kovacevic, David



Brachytherapy for advanced prostate cancer bleeding.  


Advanced prostate cancer patients frequently deal with intractable prostatic bleeding which is a difficult problem to manage. Intraurethral high-dose rate (HDR) brachytherapy may palliate this condition. Advanced prostate cancer patients with intractable prostatic bleeding were offered brachytherapy with Iridium-192 using a Micro-selectron HDR machine. During a 5-year period, analysis was performed in 23 patients with a median age and Gleason score of 78 years and 9, respectively. Following brachytherapy, haematuria resolved in 19 of the 23 patients and was recurrence free at 6 months. Intraurethral HDR brachytherapy is a potentially effective modality for treating haematuria in patients with advanced prostate cancer. PMID:18391938

Thurairaja, R; Pocock, R; Crundwell, M; Stott, M; Rowlands, C; Srinivasan, R; Sheehan, D



Vaginal Yeast Infections (For Parents)  


... infection is simple and painless. What Is a Yeast Infection? A yeast infection, also known as candidiasis ( ... you can be treated appropriately. Do Guys Get Yeast Infections? Guys don't get vaginal yeast infections, ...


Desquamative inflammatory vaginitis. A review.  

PubMed Central

Desquamative inflammatory vaginitis is an uncommon cause of an intractable vaginitis often accompanied by serious dyspareunia, which can occur at any stage of reproductive life and after the menopause. The cytological changes are identical with those seen in atrophic vaginitis yet the disorder often occurs in the presence of apparently normal ovarian function. Vaginal synechiae and stenosis develop in an appreciable number of patients. Treatment is unsatisfactory though there is some response to either local or systemic steroid therapy. The literature is reviewed and the association of some cases with lichen planus of the mouth and genitals discussed. Its causation and natural history remain largely unknown and there is as yet, insufficient evidence to regard it as a single entity. It is likely that the incidence of the disorder is underestimated.

Oates, J K; Rowen, D




Microsoft Academic Search

Increasing interest in shoulder pathology during the last decades has considerably diversified the possible treatment options of full thickness rotator cuff tears. This review of the recent literature combined with information gathered during recent European shoul- der meetings attempts to summarize present trends. Every full thickness cuff tear, except for the acute traumatic tear in younger patients, should always benefit




Arthroscopic repair of anterosuperior (supraspinatus\\/subscapularis) rotator cuff tears  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate the outcome of patients who underwent arthroscopic repair of anterosuperior rotator cuff tears. The null hypothesis, that there was no difference between preoperative scores and postoperative scores, was tested statistically. Type of Study: A cohort study. Methods: The preoperative and postoperative status of patients with anterosuperior rotator cuff tears was analyzed

William F. Bennett



Arthroscopic Rotator Cuff Repair: 4- to 10Year Results  

Microsoft Academic Search

Purpose: The purpose of this article is to report the 4- to 10-year results of arthroscopic repair of full- thickness rotator cuff tears. Type of Study: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. Methods: Retrospective chart reviews and telephone interviews were performed to

Eugene M. Wolf; William T. Pennington; Vivek Agrawal



Endotracheal tube cuff pressures in patients intubated before transport  

Microsoft Academic Search

IntroductionProlonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H2O cause complications ranging from sore throat to rare cases of tracheoesophageal fistula. In a series of patients, we sought to determine the proportion of patients with overinflated cuffs and to determine whether overinflation was associated with demographics, diagnostic category, or intubator credentials.

Jacob Chapman; Daniel Pallin; Larisa Ferrara; Sarah Mortell; John Pliakas; Melissa Shear; Stephen Thomas



Improved nerve cuff electrode recordings with subthreshold anodic currents  

Microsoft Academic Search

A method has been developed for improving the signal amplitudes of the recordings obtained with nerve cuff electrodes. The amplitude of the electroneurogram (ENG) has been shown to increase with increasing distance between the contacts when cuff electrodes are used to record peripheral nerve activity. The effect is directly related to the propagation speed of the action potentials. Computer simulations

Mesut Sahin; Dominique M. Durand



Quantification of recruitment properties of multiple contact cuff electrodes  

Microsoft Academic Search

Nerve-based stimulating electrodes provide the technology for advancing the function of motor system neural prostheses. The goal of this work was to measure and quantify the recruitment properties of a 12 contact spiral nerve cuff electrode. The cuff was implanted on the cat sciatic nerve trunk, which consists of at least four distinct motor fascicles, and the torque generated at

Warren M. Grill Jr; J. Thomas Mortimer



Selective recording with a multi-contact nerve cuff electrode  

Microsoft Academic Search

A multi-contact cylindrical nerve cuff electrode was evaluated for its ability to record neural signals selectively in an in vitro preparation, Three branches of a Beagle hypoglossal nerve are stimulated sequentially while compound action potentials (CAP) are recorded from its trunk with the multi-contact cuff electrode. A selectivity index (SI) is defined and applied to the CAP recorded from the

Mesut Sahin; Dominique M. Durand



Rotator Cuff Damage: Reexamining the Causes and Treatments.  

ERIC Educational Resources Information Center

|Sports medicine specialists are beginning to reexamine the causes and treatments of rotator cuff problems, questioning the role of primary impingement in a deficient or torn cuff and trying new surgical procedures as alternatives to the traditional open acromioplasty. (Author/CB)|

Nash, Heyward L.



Management of Rotator Cuff and Impingement Injuries in the Athlete  

Microsoft Academic Search

Objective: To review current concepts of the pathophysiol- ogy, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regard- ing rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the

Gerald R. Williams; Martin Kelley



Calcifying tendinitis of the rotator cuff with cortical bone erosion  

Microsoft Academic Search

Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and

Roxanne Chan; David H. Kim; Peter J. Millett; Barbara N. Weissman



Arthroscopic repair techniques for massive rotator cuff tears.  


Patients with massive rotator cuff tears present with pain, weakness, and loss of function. Candidates for arthroscopic repair include symptomatic, young, active patients; those with an acute tear or tears with early changes of atrophy; and patients willing to comply with recovery and rehabilitation processes after surgery. As massive rotator cuff tears extend, the glenohumeral articulation is destabilized, allowing superior migration. Repair of the force couples and reinforcement of the anterosuperior rotator cuff cable can restore functional elevation via the deltoid. Muscle changes, including rotator cuff atrophy and fatty infiltration, will affect shoulder strength and function. As chronic changes become more extensive (such as the absence of the acromiohumeral interval and degenerative joint changes), other repair options may be more durable. Other arthroscopic options, including partial rotator cuff closure, graft to augment the repair, and use of the long head of the biceps tendon, have been helpful in pain relief and functional gains. PMID:22301227

Abrams, Jeffrey S; Song, Frederick S



When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears  

Microsoft Academic Search

Background: Despite advances in arthroscopic repair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to

Bruce S. Miller; Brian K. Downie; Robert B. Kohen; Theresa Kijek; Bryson Lesniak; Jon A. Jacobson; Richard E. Hughes; James E. Carpenter



Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure  

Microsoft Academic Search

BACKGROUND: Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. METHODS: With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to

Papiya Sengupta; Daniel I Sessler; Paul Maglinger; Spencer Wells; Alicia Vogt; Jaleel Durrani; Anupama Wadhwa



Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears  

Microsoft Academic Search

Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires

Shane J. Nho; Demetris Delos; Hemang Yadav; Michael Pensak; Anthony A. Romeo; Russell F. Warren; John D. MacGillivray



Mode of failure for rotator cuff repair with suture anchors identified at revision surgery  

Microsoft Academic Search

Rotator cuff tears are a common cause of shoulder pain and dysfunction. After surgical repair, there is a significant re-tear rate (25%-90%). The aim of this study was to determine the primary mode of mechanical failure for rotator cuffs repaired with suture anchors at the time of revision rotator cuff repair. We prospectively followed 342 consecutive torn rotator cuffs, repaired

Craig A. Cummins; George A. C. Murrell



Intramuscular Rotator Cuff Cysts: Association with Tendon Tears on MRI and Arthroscopy  

Microsoft Academic Search

OBJECTIVE. This study was designed to explore the relationship between intramuscular cysts and rotator cuff tendon tears. CONCLUSION. Intramuscular cysts are strongly associated with rotator cuff tendon tears. Identification of such a cyst should prompt a search for a rotator cuff tear. Findings on MR arthrography and surgery suggest that a delaminating component of the rotator cuff tear may lead

Ara Kassarjian; Martin Torriani; Hugue Ouellette; William E. Palmer


Velocity-Selective Recording from Frog Nerve Using a MultiContact Cuff Electrode  

Microsoft Academic Search

Obtaining neural information from nerve cuff recordings for use as feedback signals for neural prostheses is slowly becoming state-of-the-art. Traditional tripolar cuff recordings cannot provide information on the fiber type contributing to the compound electro neurogram. In order to get this data we employed a novel nerve cuff carrying eleven electrode contacts equally distributed along its axis. Connecting this cuff

Martin Schuettler; Vipin Seetohul; John Taylor; Nick Donaldson



Impact of vaginal ascorbic acid on abnormal vaginal microflora.  


PURPOSE: To evaluate the impact of vaginal ascorbic acid (vitamin C) as a treatment/maintenance regimen on increased vaginal pH and abnormal microflora on wet mounts in premenopausal women. METHODS: A randomized study of 140 asymptomatic, low-risk pregnant and non-pregnant premenopausal women with vaginal pH ? 4.5 and a variety of partly/completely disrupted Lactobacillus microflora patterns on wet mounts in five outpatient clinics was carried out. Participants were randomized to the intervention group [250 mg vitamin C tablets vaginally at bedtime once a day for 6 days (treatment phase), followed by a one tablet per week, for 12 weeks (maintenance phase)] or the control group (no treatment). Outcomes were evaluated 4 months after randomizing, i.e., 2-3 weeks after the last vitamin C tablet insertion. RESULTS: Normalization to normal flora was observed in 51.4 % of all ascorbic acid and in 24.3 % of control group patients (difference 27.1 %, 95 % CI 11.7-42.6, p < 0.05, ITT population). In the per protocol population, normalization was confirmed in 53.5 % of the intervention and 22.4 % of the control group (difference 31 %, 95 % CI 14.3-47.8, p < 0.05). Results of pregnant subgroup analysis showed better outcomes for the subgroup: difference of normalization rate between ascorbic acid and control group was 41.2 % (95 % CI 21.8-60.1, p < 0.05). Itching occurred in 19 %; 23 % of women reported irritation and 10 % stopped the treatment because of side effects. CONCLUSIONS: Vaginal ascorbic acid improves abnormal vaginal pH and microflora, especially in pregnant women, but is not well tolerated by all women. PMID:23677418

Zodzika, Jana; Rezeberga, Dace; Donders, Gilbert; Vedmedovska, Natalija; Vasina, Olga; Pundure, Inara; Bite, Ruta; Silberga, Ingrida; Socenova, Julija; Melngaile, Olita



[Multipurpose treatment of vaginal infections].  


Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone. PMID:23234030

Nikolov, A; Masseva, A; Shopova, E; Georgiev, S



21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2010 CFR

...3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina by stretching, or to support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class II...



21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2013 CFR

...AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the...



Do We Know What Causes Vaginal Cancer?  


... section " What are the risk factors for vaginal cancer? " Research is now being done to learn more about ... Your Doctor After Treatment What`s New in Vaginal Cancer Research? Other Resources and References Cancer Information Cancer Basics ...


Outcomes after arthroscopic rotator cuff repairs.  


Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic. PMID:17011216

Lee, Edward; Bishop, Julie Y; Braman, Jonathan P; Langford, Joshua; Gelber, Jonathan; Flatow, Evan L



Management of Rotator Cuff and Impingement Injuries in the Athlete  

PubMed Central

Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.

Williams, Gerald R.; Kelley, Martin



Evaluation and management of vaginitis  

Microsoft Academic Search

OBJECTIVE: To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections,\\u000a and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting.\\u000a \\u000a \\u000a DATA SOURCES: Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997\\u000a were reviewed.\\u000a \\u000a \\u000a \\u000a \\u000a DATA

Phyllis L. Carr; Donna Felsenstein; Robert H. Friedman



Xoft Axxent electronic brachytherapy: a new device for delivering brachytherapy to the breast.  


Balloon-based brachytherapy was developed to simplify the brachytherapy technique and make accelerated partial breast irradiation more accessible to patients with breast cancer who are suitable candidates for this technique. Xoft Axxent (Xoft, Inc., Sunnyvale, CA) electronic brachytherapy is a novel method of accelerated partial breast irradiation that uses an electronic source to produce X-rays. Xoft Axxent treatment does not require a high-dose-rate afterloader unit or a shielded vault, unlike other brachytherapy techniques that use iridium-192, such as MammoSite brachytherapy. Xoft Axxent is associated with the delivery of less radiation to normal tissues, and increased high radiation dose regions or 'hot spots' to the target volume compared with treatment with the MammoSite device. Further research will be needed to determine subgroups of patients who might benefit from treatment with Xoft Axxent electronic brachytherapy. PMID:19174776

Dickler, Adam



Use of electronic brachytherapy to deliver postsurgical adjuvant radiation therapy for endometrial cancer: a retrospective multicenter study  

PubMed Central

Background: This retrospective, multicenter study evaluated the feasibility and safety of high-dose rate electronic brachytherapy (EBT) as a postsurgical adjuvant radiation therapy for endometrial cancer. Methods: Medical records were reviewed from 41 patients (age 40–89 years) with endometrial cancer (Federation of International Gynecology and Obstetrics stages IA–IIIC) treated at nine centers between April 2008 and October 2009. Treatment included intracavitary vaginal EBT alone (n = l6) at doses of 18.0–24.0 Gy in 3–4 fractions and EBT in combination with external beam radiation therapy (EBRT, n = 25) at a total radiation dose range of 40.0–80.4 Gy. Doses were prescribed to a depth of 5 mm from the applicator surface and to the upper third (n = 15) and the upper half (n = 26) of the vagina. Results: Median follow-up was 3.8 (range 0.5–12.0) months. All 41 patients received the intended dose of radiation as prescribed. Adverse events occurred in 13 of 41 patients and were mild to moderate (Grade 1–2), consisting primarily of vaginal mucositis, rectal mucosal irritation and discomfort, and temporary dysuria and diarrhea. There were no Grade 3 adverse events in the EBT-only treatment group. One patient, who was being treated with the combination of EBT and EBRT for recurrent endometrial cancer, had a Grade 3 adverse event. No recurrences have been reported to date. Conclusion: Electronic brachytherapy provides a feasible treatment option for postoperative adjuvant vaginal brachytherapy as sole radiation therapy and in combination with EBRT for primary endometrial cancer. Early and late toxicities were mild to moderate.

Dooley, William C; Thropay, John P; Schreiber, Gary J; Puthawala, Mohamed Y; Lane, Steven C; Wurzer, James C; Stewart, Charles E; Grado, Gordon L; Ahuja, Harish G; Proulx, Gary M



21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...



Vaginal douching practices and beliefs in Turkey  

Microsoft Academic Search

The aim of this study was to identify women's motivations for vaginal douching, vaginal douching practices, and women's reactions to situations that discourage vaginal douching. Research took place in the outskirts of Antalya, a city located on the Mediterranean coast of Turkey. A total of 776 women participated in the study. Age, religious affiliation, place of residence, and poverty were

Kamile Kukulu



American brachytherapy society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer  

Microsoft Academic Search

Purpose\\/Objective: To develop and disseminate the American Brachytherapy Society (ABS) recommendations for the clinical quality assurance and guidelines of permanent transperineal prostate brachytherapy with 125I or 103Pd.Methods and Materials: The ABS formed a committee of experts in prostate brachytherapy to develop consensus guidelines through a critical analysis of published data supplemented by their clinical experience. The recommendations of the panels

Subir Nag; David Beyer; Jay Friedland; Peter Grimm; Ravinder Nath



Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease  

Microsoft Academic Search

Background  Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat\\u000a a variety of problems. Although its use has expanded substantially since the FDA’s approval in 2004, the appropriateness in\\u000a patients with rotator cuff disease is unclear.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We review the use of RTSA in patients with rotator cuff disease to (1) describe

Gregory N. Drake; Daniel P. O’Connor; T. Bradley Edwards



Current Concepts of Treating Vaginitis  

PubMed Central

Vaginitis can be a frustrating entity to treat, since the incidence of recurrence is high. This paper examines evidence from the literature concerning diagnosis and treatment of Candida albicans, Trichomonas vaginalis, Corynebacterium vaginale, herpes simplex type 2 and gonorrhea. A protocol based on these readings is outlined.

Robinson, Theresa



Operative vaginal delivery - Year 2000  

Microsoft Academic Search

Literature review was performed to analyze and define the current state of operative vaginal delivery. On the basis of published data, it is concluded that outlet and low forceps deliveries with ?45 degrees of rotation are effective and safe for both mother and baby. The greatest risk to mother or fetus occurs with operations performed at the 0 or +1

Gary D. V. Hankins; Thomas F. Rowe



Vaginal birth after cesarean section  

Microsoft Academic Search

Vaginal birth after cesarean section (VBAC) is safe, cost effective, and the preferred obstetrical option for most parturients in health care settings which are equipped to manage intrapartum emergencies. Since 1981, cesarean sections have been the most frequently performed major surgical procedure in the United States. Approximately 1,000,000 cesarean deliveries are performed in the United States per year. The rate

Jordan Pritzker



Evaluation of cartilage degeneration in a rat model of rotator cuff tear arthropathy.  


BACKGROUND AND HYPOTHESIS: Rotator cuff tears are the most common injury seen by shoulder surgeons. Glenohumeral osteoarthritis develops in many late-stage rotator cuff tear patients as a result of torn cuff tendons, termed "cuff tear arthropathy." However, the mechanisms of cuff tear arthropathy have not been fully established. It has been hypothesized that a combination of synovial and mechanical factors contribute equally to the development of cuff tear arthropathy. The goal of this study was to assess the utility of this model in investigating cuff tear arthropathy. MATERIALS AND METHODS: We used a rat model that accurately reflects rotator cuff muscle degradation after massive rotator cuff tears through either infraspinatus and supraspinatus tenotomy or suprascapular nerve transection. Using a modified Mankin scoring system, we found significant glenohumeral cartilage damage after both rotator cuff tenotomy and suprascapular nerve transection after only 12 weeks. RESULTS: Cartilage degeneration was similar between groups and was present on both the humeral head and the glenoid. Denervation of the supraspinatus and infraspinatus muscles without opening the joint capsule caused cartilage degeneration similar to that found in the tendon transection group. CONCLUSIONS: Our results suggest that altered mechanical loading after rotator cuff tears is the primary factor in cartilage degeneration after rotator cuff tears. Clinically, understanding the process of cartilage degeneration after rotator cuff injury will help guide treatment decisions in the setting of rotator cuff tears. PMID:23664745

Kramer, Erik J; Bodendorfer, Blake M; Laron, Dominique; Wong, Jason; Kim, Hubert T; Liu, Xuhui; Feeley, Brian T



Massive Rotator Cuff Tear in an Adolescent Athlete  

PubMed Central

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia (“stinger” or “burner”). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.

Turman, Kimberly A.; Anderson, Mark W.; Miller, Mark D.



The role of the endotracheal tube cuff in microaspiration.  


The cuff of the endotracheal tube (ETT) is designed to provide a seal within the airway, allowing airflow through the ETT but preventing passage of air or fluids around the ETT. Deliberate or inadvertent movement of the ETT may affect cuff pressure or shift folds in the cuff, mobilizing pooled secretions. When this seal is compromised, microaspirations contaminated with gastric contents or bacterially colonized oral secretions can occur that leave the patient susceptible to a host of problems, such as hypoxia, pneumonitis, and respiratory infections. These complications are costly in terms of morbidity and mortality, as well as hospital expense. We will discuss the role of the ETT cuff in microaspiration and identify potential directions for future research to improve outcomes in mechanically ventilated patients. PMID:22209048

Hamilton, V Anne; Grap, Mary Jo



Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

Microsoft Academic Search

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup.\\u000a We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three\\u000a cohorts of patients had repair of a symptomatic

Neal L. Millar; Xiao Wu; Robyn Tantau; Elizabeth Silverstone; George A. C. Murrell



Compliance in Anastomoses With and Without Vein Cuff Interposition  

Microsoft Academic Search

Objective to compare anastomotic compliance in end-to-side anastomoses with and without vein cuff interposition. Materials polytetrafluoroethylene graft to bovine carotid artery without (standard) and with vein interposition (Linton-patch and Miller-cuff). Methods zonewise compliance measurement of end-to-side anastomoses in anin-vitro circulation system. The zone most distal to the suture-line served as reference compliance. Resultsdirectly distal to the suture-line the compliance of

D. Piorko; P. Knez; K. Nelson; T. Schmitz-Rixen



Patterns of Vascular and Anatomical Response After Rotator Cuff Repair  

Microsoft Academic Search

Background: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion.Purpose: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded

Stephen Fealy; Ronald S. Adler; Mark C. Drakos; Anne M. Kelly; Answorth A. Allen; Frank A. Cordasco; Russell F. Warren; Stephen J. OBrien



Endotracheal Tube Cuff Pressure Is Unpredictable in Children  

Microsoft Academic Search

The use of cuffed tracheal tubes in children younger than 8 yr of age has recently increased, although cuff hyperinflation may cause tracheal mucosal damage. In this study, we sought to measure the cuff pressure (Pcuff) after initial free air inflation (iPcuff) and to follow its evolution throughout the duration of 50% nitrous oxide (N2O) anesthesia. One-hundred-seventy-four children, aged 0

Marie-Louise Felten; Emmanuelle Schmautz; Sonia Delaporte-Cerceau; Gilles A. Orliaguet; Pierre A. Carli



Endotracheal tube cuff pressure monitoring: a review of the evidence.  


Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13-20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively. PMID:22165491

Sultan, Pervez; Carvalho, Brendan; Rose, Bernd Oliver; Cregg, Roman



Endotracheal tube cuff leak with mysterious laryngotracheal pathology.  


A 63 year-old obese man with gastroesophageal reflux disease, hiatal hernia, and no known history of airway pathology was to undergo a total knee arthroplasty. After intubation, however, repeated cuff leaks, decreasing tidal volumes, and desaturations prompted five additional endotracheal tube placements. Findings on radiography, computed tomography, and fiberoptic laryngoscopy and tracheoscopy were equivocal. Factors contributing to this challenge of persistent and repeated cuff leaks in the absence of known airway pathology could include various laryngotracheal abnormalities. PMID:23634577

Lafleur, J Lance; Boddu, Krishna; Baluch, Amir R; Kaye, Alan D



Lidocaine in the endotracheal tube cuff reduces postoperative sore throat  

Microsoft Academic Search

Study Objectives: To test the hypothesis that continuous application of local anesthesia at the contact area between the endotracheal tube cuff and trachea would reduce both the incidence and severity of postoperative sore throat by blocking the tracheal pain receptors with local anesthetic delivered via endotracheal tube (ETT) cuff.Design: Double-blind randomized study.Setting: University affiliate hospital.Patients: 106 ASA physical status I

Rosa M. Navarro; Verna L. Baughman



Whole nerve recordings with the spiral nerve cuff electrode  

Microsoft Academic Search

The feasibility of whole nerve recordings from the hypoglossal (HG) nerve is demonstrated in acute cats using the spiral nerve cuff electrode. A good contact between the nerve and the electrodes, provided by the spiral nerve cuff due to its self-coiling property, should improve the signal-to-noise ratio. An instrumentation amplifier with very low input noise characteristics is also utilized. The

Mesut Sahin; Dominique M. Durand; Musa A. Haxhiu



Chronic cuff electrode recordings from walking Göttingen mini-pigs.  


We present data from cuff electrode recordings from a mixed sensory-/motor nerve as expressed during walking in chronically implanted Göttingen mini-pigs. Our results show that it is possible to filter out residual electromyographic interference and that the energy content of the resulting electroneurographic (ENG) signals modulate clearly with gait. The approach may be used to detect heel strike from cuff electrode measurements to control the timing of stimulation in implantable foot drop correction systems. PMID:22254796

Andersen, Mads P; Munch, Majken; Jensen, Winnie; Sørensen, Preben; Eder, Clemens F



Measurement of the performance of nerve cuff electrodes for recording  

Microsoft Academic Search

New designs of cuff electrodes for the recording of signals from peripheral nerves are typically tested in acute animal experiments\\u000a before long-term evaluation takes place. A reproducible, cost-effective and fast method is presented for evaluating cuff electrodes\\u000a with respect to signal amplitude, noise rejection, and, in some cases, selectivity, as an alternative to acute in vivo experiments.\\u000a Comparisons with a

L. N. S. Andreasen; J. J. Struijk; S. Lawrence



The cuff-leak test: what are we measuring?  

Microsoft Academic Search

Stridor is one of the most frequent causes of early extubation failure. The cuff-leak test may help to identify patients at risk to develop post-extubation laryngeal edema. However the discrimination power of the cuff-leak test is highly variable and can be use, at best, to detect patients at risk to develop edema but should not be used to postpone extubation

Daniel De Backer



Mechanics of the occlusive arm cuff and its application as a volume sensor.  


Although a common medical instrument, the mechanical function of an occlusive arm cuff has not been fully described in an engineering sense. The occlusive arm cuff is examined here using a mathematical mechanics model and experimental measurements. Cuff stretch was modeled by a nonlinear pressure-volume function. Air compression was represented by Boyle's law. An apparatus was developed to measure pressure due to the air volume pumped into the cuff for fixed arm volume. Data were obtained for two different cuff designs, and reveal a nonlinear cuff pressure-volume relationship that could be represented accurately by the mathematical model. Calibration constants are provided for the two types of occlusive cuff. Thus, the cuff pressure was found to consist of a balance between that produced by stretch of the elastic cuff bladder and that of the compression of the air contained within the bladder. The use of the gas law alone was found to be inadequate to represent the cuff mechanics. When applying the cuff to measure change in arm volume, such as during plethysmography or oscillometry, it cannot be assumed that the cuff sensitivity is constant. More precisely, it was found that the occlusive cuff is a transducer with a volume sensitivity that increases with cuff pressure and volume until it becomes nearly constant at high levels of cuff pressure (150 mmHg). A hypothetical case of a linear elastic artery with constant pulse pressure was used as input to the cuff model to illustrate the change in cuff pressure oscillations that occurs while cuff pressure is released.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8244431

Drzewiecki, G; Bansal, V; Karam, E; Hood, R; Apple, H



Suprascapular Nerve: Is It Important in Cuff Pathology?  

PubMed Central

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

Shi, Lewis L.; Freehill, Michael T.; Yannopoulos, Paul; Warner, Jon J. P.



Suprascapular nerve: is it important in cuff pathology?  


Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting. PMID:23193484

Shi, Lewis L; Freehill, Michael T; Yannopoulos, Paul; Warner, Jon J P



Primary Vaginal Cancer Treated With Concurrent Chemoradiation Using Cis-Platinum  

SciTech Connect

Purpose: To evaluate the feasibility of concurrent weekly Cis-platinum chemoradiation (CRT) in the curative treatment of primary vaginal cancer. Methods: A retrospective review was performed of all primary vaginal cancer patients treated with curative intent at the Ottawa Hospital Regional Cancer Centre between 1999 and 2004 using concurrent Cis-platinum CRT. Results: Twelve patients were treated with concurrent weekly CRT. The median age at diagnosis was 56 years (range, 34-69 years), and the median follow-up was 50 months (range, 11-75 months). Ten patients (83%) were diagnosed with squamous cell carcinoma and 2 patients (17%) with adenocarcinoma. The distribution according to stage was as follows: 6 (50%) Stage II, 4 (33%) Stage III, and 2 (17%) Stage IVA. All patients received pelvic external beam radiotherapy (EBRT) concurrently with weekly intravenous Cis-platinum chemotherapy (40 mg/m{sup 2}) followed by brachytherapy (BT). The median dose of EBRT was 4500 cGy given in 25 fractions over 5 weeks. Ten patients received interstitial BT, and 2 patients received intracavitary BT, with the median dose being 3000 cGy. The 5-year overall survival, progression-free survival, and locoregional progression-free survival rates were 66%, 75%, and 92%, respectively. Late toxicity requiring surgery occurred in 2 patients (17%). Conclusions: For the treatment of primary vaginal cancer, it is feasible to deliver concurrent weekly Cis-platinum chemotherapy with high-dose radiation, leading to excellent local control and an acceptable toxicity profile.

Samant, Rajiv [Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, ON (Canada); Faculty of Medicine, University of Ottawa Hospital, Ottawa, ON (Canada)], E-mail:; Lau, Bedy [Department of Otolaryngology, University of British Columbia, Vancouver, BC (Canada); E, Choan [Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, ON (Canada); Faculty of Medicine, University of Ottawa Hospital, Ottawa, ON (Canada); Le, Tien [Faculty of Medicine, University of Ottawa Hospital, Ottawa, ON (Canada); Department of Gynecologic Oncology, Ottawa Hospital, Ottawa, ON (Canada); Tam, Tiffany [Department of Radiation Oncology, McMaster University, Hamilton, ON (Canada)



Lung brachytherapy. An overview and current indications.  


Although lung cancer remains a difficult and fatal illness for most patients, recent developments provide hope that control and cure are realistic goals. Conventional brachytherapy judiciously used in selected patients may improve local control or relieve severe symptoms. Systemic brachytherapy with radiolabeled antibodies also may prove to be a potentially useful approach. Combined modality therapy will be the most important area of investigation during the next several years. PMID:8055283

Hilaris, B S



Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy  

Microsoft Academic Search

Purpose: To characterize the severity and time course of rectal toxicity following transperineal prostate brachytherapy using prospectively recorded data, and to determine factors associated with toxicity.Methods and Materials: One hundred thirty-four patients with prostate cancer treated with transperineal brachytherapy from 1997 to 1999 had rectal toxicity data available for analysis. Patients with Gleason score (GS) > 6, prostate-specific antigen (PSA)

Song K Kang; Rachel H Chou; Richard K Dodge; Robert W Clough; Hi-Sung L Kang; Carol A Hahn; Arthur W Whitehurst; Niall J Buckley; Jay H Kim; Raymond E Joyner; Gustavo S Montana; Sally S Ingram; Mitchell S Anscher



[Development and perspectives of brachytherapy in France].  


During the last decade, the organization of brachytherapy in France moved to 62 units in 173 radiotherapy centres in 2009. More than 7500 patients were treated in 2009, quite exclusively with curative intent, for 80% in public or associated hospitals. The techniques improved to high tech 3D dosimetry and optimization of the dose distribution. Brachytherapy, despite representing only 5% of the treatments by irradiation, is a reference treatment for several tumors. PMID:23583231

Peiffert, D; Hannoun-Lévi, J-M



Vaginal Redox Potential in Bacterial Vaginosis (Nonspecific Vaginitis)  

Microsoft Academic Search

To explore of the association of bacterial vaginosis with anaerobic bacterial growth in the vagina, we measured the redox potential ($E_{h}$) at the vaginal epithelial surface of women with this syndrome. Among normal women, the value for $E_{h}$ in the vagina ranged from +322 mV to +137 mV (mean, +170 mV); whereas among women with bacterial vaginosis, the $E_{h}$ ranged

King K. Holmes; Kirk C. S. Chen; Carolyn M. Lipinski; David A. Eschenbach



Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study  

PubMed Central

Objective: To compare the three common methods of endotracheal tube cuff inflation (sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications. Methods: Seventy-five adult patients scheduled for N2 O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group (n=25), the cuff was inflated to a pressure of 25 cm H2O; sealing group (n=25), the cuff was inflated to prevent air leaks at airway pressure of 20 cm H2O and finger group (n=25), the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested. Results: Although cuff pressure was significantly low in the sealing group compared to the control group (P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group (P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff.. Conclusions: In N2O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat.

Al-metwalli, Roshdi R.; Al-Ghamdi, Abdulmohsen A.; Mowafi, Hany A.; Sadek, Sayed; Abdulshafi, Mohammed; Mousa, Wesam F.



10 CFR 35.2406 - Records of brachytherapy source accountability.  

Code of Federal Regulations, 2013 CFR

10 Energy 1 2013-01-01 2013-01-01...false Records of brachytherapy source accountability. 35.2406 Section 35.2406 Energy NUCLEAR REGULATORY COMMISSION...2406 Records of brachytherapy source accountability. (a)...



Antigonococcal effects of vaginal tampons.  

PubMed Central

Different brands of vaginal tampons varied significantly (p less than 0.0001) in their anti-bacterial effects when tested with 46 strains of Neisseria gonorrhoeae. Gonococcal strains recovered from patients with disseminated infections were substantially more sensitive to the anti-bacterial effects of tampons than were strains from patients with uncomplicated genital infections. Strains from patients with pelvic inflammatory disease were moderately sensitive. Tampons showing strong in-vitro antigonococcal effects were also generally effective in vivo in eliminating gonococcal infections from subcutaneous chambers in mice. Extracts of the Rely tampon showed no in-vitro antigonococcal effect, however, but did induce antibacterial activity when injected into subcutaneous chambers in mice. These results emphasise the importance of both in-vitro as well as in-vivo testing of tampon materials to elucidate more fully the nature of their antibacterial effects and their potential for affecting vaginal pathogens and disease processes.

Arko, R J; Wong, K H; Smith, S J; Finley-Price, K G



Vacuum-Assisted Vaginal Delivery  

PubMed Central

Approximately 5% (1 in 20) of all deliveries in the United States are operative vaginal deliveries. The past 20 years have seen a progressive shift away from the use of forceps in favor of the vacuum extractor as the instrument of choice. This article reviews in detail the indications, contraindications, patient selection criteria, choice of instrument, and technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at the time of cesarean delivery will also be discussed. With vacuum extraction becoming increasingly popular, it is important that obstetric care providers are aware of the maternal and neonatal risks associated with such deliveries and of the options available to effect a safe and expedient delivery.

Ali, Unzila A; Norwitz, Errol R



Uterine and Vaginal Vault Prolapse  

Microsoft Academic Search

The surgical management of pelvic organ prolapse is more challenging than that for stressurinary incontinence, and detection\\u000a and correction of apical repairs can be the most difficult of all pelvic floor defects. One-third of procedures performed\\u000a for pelvic organ prolapse are secondary procedures (1). The number of procedures performed in the United States to treat posthysterectomy vaginal vault prolapse increased

Peggy A. Norton


A simple method of partial inflation of the LMA cuff before insertion in children to allow cuff pressure without adjustment after insertion  

PubMed Central

Background The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion. Methods One hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer. Results The mean intra-cuff pressure was 50 ± 12.9 cmH2O; intra-cuff pressures were 39.1 ± 9.3, 51.6 ± 11.2, and 64.6 ± 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure. Conclusions The cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion.

Moon, Bo-Eun; Kim, Min-Soo



Dosimetric Characteristics for Brachytherapy Sources  

NASA Astrophysics Data System (ADS)

Brachytherapy sources are characterized by the dosimetric parameters in a protocol such as the American Association of Physicists in Medicine Task Group 43. The air-kerma strength is measured and traceable to a primary standard. Then the parameters such as dose-rate constant, radial dose function, and anisotropy function are measured and related back to the primary standard. This is normally accomplished with thermoluminescent dosimeters (TLDs). Since radial dose function and anisotropy function are relative parameters, some of the dosimetric corrections are negligible. For the dose-rate constant, parameters such as the energy dependence compared with a calibration beam such as 60Co need to be accounted for. A description of the primary standard measurements and TLD measurements will be discussed.

Dewerd, Larry A.; Davis, Stephen D.



Dosimetric Characteristics for Brachytherapy Sources  

SciTech Connect

Brachytherapy sources are characterized by the dosimetric parameters in a protocol such as the American Association of Physicists in Medicine Task Group 43. The air-kerma strength is measured and traceable to a primary standard. Then the parameters such as dose-rate constant, radial dose function, and anisotropy function are measured and related back to the primary standard. This is normally accomplished with thermoluminescent dosimeters (TLDs). Since radial dose function and anisotropy function are relative parameters, some of the dosimetric corrections are negligible. For the dose-rate constant, parameters such as the energy dependence compared with a calibration beam such as {sup 60}Co need to be accounted for. A description of the primary standard measurements and TLD measurements will be discussed.

DeWerd, Larry A.; Davis, Stephen D. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin (United States)



The vaginal microbiome: rethinking health and diseases  

PubMed Central

Vaginal microbiota form a mutually beneficial relationship with their host and have major impact on health and disease. In recent years our understanding of vaginal bacterial community composition and structure has significantly broadened as a result of investigators using cultivation-independent methods based on the analysis of 16S ribosomal RNA (rRNA) gene sequences. In asymptomatic, otherwise healthy women, several kinds of vaginal microbiota exist, the majority often dominated by species of Lactobacillus, while others comprise a diverse array of anaerobic microorganisms. Bacterial vaginosis is the most common vaginal conditions and is vaguely characterized as the disruption of the equilibrium of the ‘normal’ vaginal microbiots. A better understanding of ‘normal’ and ‘healthy’ vaginal ecosystems that is based on its ‘true’ function and not simply on its composition would help better define health and further improve disease diagnostics as well as the development of more personalized regimens to promote health and treat diseases.

Ma, Bing; Forney, Larry J.; Ravel, Jacques



The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma  

Microsoft Academic Search

Purpose: To develop recommendations for use of high-dose-rate (HDR) brachytherapy in patients with head-and-neck cancer.Methods: A panel consisting of members of the American Brachytherapy Society (ABS) performed a literature review, added information based upon their clinical experience, and formulated recommendations for head-and-neck HDR brachytherapy.Results: The ABS recommends the use of brachytherapy as a component of the treatment of head-and-neck tumors.

Subir Nag; Elmer R Cano; D. Jeffrey Demanes; Ajmel A Puthawala; Bhadrasain Vikram



Reverse total shoulder arthroplasty for irreparable rotator cuff tears and cuff tear arthropathy.  


Based on the available literature, we believe that reverse shoulder arthroplasty is a reasonable treatment modality in patients with CTA and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. There are still a high number of complications related to this procedure; however, with stringent patient selection criteria and meticulous technique, high patient satisfaction scores are typically achieved in these patients, at least in the short term. Further studies are required to evaluate the efficacy these devices in the long term. PMID:23040557

Ramirez, Miguel A; Ramirez, Jose; Murthi, Anand M



{sup 106}Ruthenium Brachytherapy for Retinoblastoma  

SciTech Connect

Purpose: To evaluate the efficacy of {sup 106}Ru plaque brachytherapy for the treatment of retinoblastoma. Methods and Materials: We reviewed a retrospective, noncomparative case series of 39 children with retinoblastoma treated with {sup 106}Ru plaques at the Jules-Gonin Eye Hospital between October 1992 and July 2006, with 12 months of follow-up. Results: A total of 63 tumors were treated with {sup 106}Ru brachytherapy in 41 eyes. The median patient age was 27 months. {sup 106}Ru brachytherapy was the first-line treatment for 3 tumors (4.8%), second-line treatment for 13 (20.6%), and salvage treatment for 47 tumors (74.6%) resistant to other treatment modalities. Overall tumor control was achieved in 73% at 1 year. Tumor recurrence at 12 months was observed in 2 (12.5%) of 16 tumors for which {sup 106}Ru brachytherapy was used as the first- or second-line treatment and in 15 (31.9%) of 47 tumors for which {sup 106}Ru brachytherapy was used as salvage treatment. Eye retention was achieved in 76% of cases (31 of 41 eyes). Univariate and multivariate analyses revealed no statistically significant risk factors for tumor recurrence. Radiation complications included retinal detachment in 7 (17.1%), proliferative retinopathy in 1 (2.4%), and subcapsular cataract in 4 (9.7%) of 41 eyes. Conclusion: {sup 106}Ru brachytherapy is an effective treatment for retinoblastoma, with few secondary complications. Local vitreous seeding can be successfully treated with {sup 106}Ru brachytherapy.

Abouzeid, Hana [Jules-Gonin Eye Hospital, University of Lausanne, Vaud (Switzerland); Moeckli, Raphael [University Institute for Radiation Physics, CHUV, University of Lausanne, Vaud (Switzerland); Gaillard, Marie-Claire [Jules-Gonin Eye Hospital, University of Lausanne, Vaud (Switzerland); Beck-Popovic, Maja [Unit of Paediatric Oncology, CHUV, University of Lausanne, Vaud (Switzerland); Pica, Alessia [Department of Radiation Oncology, CHUV, University of Lausanne, Vaud (Switzerland); Zografos, Leonidas; Balmer, Aubin [Jules-Gonin Eye Hospital, University of Lausanne, Vaud (Switzerland); Pampallona, Sandro [forMed, Statistics for Medicine, Evolene, Valais (Switzerland); Munier, Francis L. [Jules-Gonin Eye Hospital, University of Lausanne, Vaud (Switzerland)], E-mail:



Metronidazole in the treatment of cervical cancer using Cf-252 neutron brachytherapy  

SciTech Connect

Metronidazole was tested for its possible use in the Cf-252 brachytherapy of cervical cancer as a radiosensitizer and to deal with anaerobic pelvic infection. 15 patients were treated by only 14 were evaluable. All stages from stage IB-IVB were treated and complete local tumor regression was noted in all cases although it could take place very slowly. 5/14 (36%) are 1.5-3 year survivors but only among the patients with stage I-II disease. No unusual radio-enhancing action was observed but metronidazole appeared to be useful to treat the vaginal, cervix and uterine infections often associated with high stage disease and bulky, ulcerative or necrotic tumors.

Maruyama, Y.



Experimental study on rotator cuff repair.  


It was the purpose of the experimental study to use laboratory experience to verify the effectiveness of different methods used to repair the rotator cuff. The sheep was used as an animal model because its infraspinous tendon is the most similar to that in the human. Three static trials were conducted using Instron machines, comparing the repair systems used most by the same authors in their clinical work, the hold of the suturing wires with two different threading procedures in the bone tunnels and two types of knotting, and the breakage loading of the suturing wires in the two different miniplate systems. The authors conclude that tendinous anchoring must be entrusted to reinforced suturing systems (modified SCOI and Mason Allen), the threading of wires in pairs in a single bone tunnel makes surgery easier and shortens the amount of time required, with threading of wires similar to or better than threading with a single wire. There are no differences in breakage loading of the wire at the level of the holes in the two miniplates considered in this study. PMID:12056246

Rotini, R; Giardino, R; Veronesi, C A; Baleani, M; Shrader, S


What's New in Vaginal Cancer Research and Treatment?  


... resources for vaginal cancer What`s new in vaginal cancer research and treatment? Research is under way to find ... Your Doctor After Treatment What`s New in Vaginal Cancer Research? Other Resources and References Cancer Information Cancer Basics ...


Subdeltoid lipoma arborescens combined with rotator cuff tears.  


Lipoma arborescens, a rare benign intra-articular lesion, is characterized by lipomatous proliferation of the synovium in which the subsynovial tissue is replaced by mature adipocytes. Subdeltoid bursa is a rare location for lipoma arborescens, and only a few cases have been reported in the literature. This article reports 2 cases of subdeltoid lipoma arborescens combined with rotator cuff tears, and the possible relationships between subdeltoid lipoma arborescens and rotator cuff tears are discussed. The intra-articular villous proliferations on fat-suppressed T2-weighted magnetic resonance imaging appeared as yellowish-white lipomatous villous proliferations on arthroscopy, and finger-like lipomatous proliferation of the synovium, where the subsynovial connective tissue is replaced by mature adipocytes, on histology. Although further evidence would be necessary, the bony proliferations, in addition to bone-to-bone abrasion and inflammatory processes, may contribute to the relationship between subdeltoid lipoma arborescens and rotator cuff tears. Because this is a rare disease in a rare location, no established treatment guidelines are available for lipoma arborescens in subdeltoid bursa. For the current patients, arthroscopic excision of the lipoma arborescens and concomitant rotator cuff repair were prescribed after more than 6 months of conservative management. All patients had symptom relief and were satisfied with their results. Paying special attention to the radiologic and arthroscopic characteristics of the lipoma arborescens will help physicians and surgeons to achieve a more accurate diagnosis and effective treatment strategy, especially in patients with concomitant rotator cuff tears. PMID:23937762

Kim, Min-Hyung; Chung, Seok Won; Yoon, Jong Pil; Kim, Sae Hoon; Oh, Joo Han



Degenerative rotator cuff tear in an elderly athlete: a case report  

Microsoft Academic Search

The incidence of rotator cuff tear increases with age. Degenerative rotator cuff tears are commonly seen in athletes above 40 years. These athletes are commonly involved in overhead activities. Repetitive microtrauma is a more important factor in rotator cuff degeneration than acute trauma. Conservative treatment is the mainstay treatment for these injuries. A case report of an elderly athlete who

Mohsen Kazemi



Operative repair of anterior instability and rotator cuff tears in athletes  

Microsoft Academic Search

Rotator cuff tears in individuals under age 40 are uncommon; especially rare is the younger patient with acombination of full thickness rotator cuff tear and a Bankart lesion. Operative management of this challenging patient must provide for a “stable” repair of both lesions to allow for optimal rehabilitation. Our surgical preference includes arthroscopic subacromial decompression, rotator cuff repair, and a

Kenneth Brislin; David Rubenstein; Merrick Wetzler; Christian Subbio



The relative importance of acromial morphology and age with respect to rotator cuff pathology 1  

Microsoft Academic Search

The purpose of this study was to examine the relationship between patient age, acromial morphology, and rotator cuff pathology. Data on 523 patients who had arthroscopic and\\/or open shoulder surgery were reviewed. Acromial morphology was classified by the system of Bigliani. All patients were categorized by postoperative diagnosis as having tendinitis of the rotator cuff, partial rotator cuff tear, complete

Thomas J Gill; Elizabeth McIrvin; Mininder S Kocher; Karen Homa; Scott D Mair; Richard J Hawkins



Endotracheal tube cuff--small important part of a big issue.  


Many of the complications related to prolonged ventilation are related to inappropriate handling of endotracheal tube (ETT) cuff. This article reviews the possible complications associated with the ETT cuff, and the landmark development made in that field. The article challenges the present paradigm of cuff use and reviews the current clinical practice in that area. PMID:22212414

Efrati, Shai; Deutsch, Israel; Gurman, Gabriel M



Utility of portable chest radiographs as a predictor of endotracheal tube cuff pressure  

Microsoft Academic Search

Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure




A miniaturized cuff electrode for electrical stimulation of peripheral nerves in the freely moving rat  

Microsoft Academic Search

A bipolar cuff electrode for electrical stimulation of small diameter peripheral nerves is described. The cuff is made of a highly flexible rubber-impression material, and the electrode assembly is suited for chronic implantation. Its manual construction is easy and reliable, utilizing only simple tools. The cuff completely envelopes nerves of varying diameter and requires a minimal amount of manipulations of

T. Jellema; J. L. J. M. TEEPENI



Minimally invasive transrotator cuff approach for arthroscopic stabilization of the posterosuperior glenoid labrum  

Microsoft Academic Search

We describe a novel technique for repair of the superior glenoid labrum posterior to the biceps anchor. This approach optimizes access for fixation of the superior and posterosuperior labrum, but involves significantly less trauma to the rotator cuff and subacromial space compared with previously described transrotator cuff methods. We suspect that the relative lack of trauma to the rotator cuff

Heber C Crockett; John M Wright; Daniel P Slawski; Bruce Kohtz; Dwain Rosse; Sandra Rosse



A Biomechanical Analysis of Rotator Cuff Deficiency in a Cadaveric Model  

Microsoft Academic Search

We conducted this cadaveric study to define a biome chanical rationale for rotator cuff function in several deficiency states. A dynamic shoulder testing appara tus was used to examine change in middle deltoid muscle force and humeral translation associated with simulated rotator cuff tendon paralyses and various sizes of rotator cuff tears. Supraspinatus paralysis re sulted in a significant increase

William O. Thompson; Richard E. Debski; N. Douglas Boardman; Emin Taskiran; Jon J. P. Warner; Freddie H. Fu; Savio L.-Y. Woo



Comparison between monopolar and tripolar configurations in chronically implanted nerve cuff electrodes  

Microsoft Academic Search

Nerve cuff electrodes have been shown to be safe and able to activate selectively specific fascicles in a nerve trunk. Selectivity has been shown using a cuff with four radially placed tripoles thus requiring twelve contacts and twelve lead wires. This study evaluates a simplified cuff electrode, consisting of four radially placed monopole electrodes, requiring only four lead wires, and

H. Tarler; W. M. Grill; J. T. Mortimer



Brachytherapy for Prostate Cancer: A Systematic Review  

PubMed Central

Low-dose rate brachytherapy has become a mainstream treatment option for men diagnosed with prostate cancer because of excellent long-term treatment outcomes in low-, intermediate-, and high-risk patients. To a great extend due to patient lead advocacy for minimally invasive treatment options, high-quality prostate implants have become widely available in the US, Europe, and Japan. High-dose-rate (HDR) afterloading brachytherapy in the management of localised prostate cancer has practical, physical, and biological advantages over low-dose-rate seed brachytherapy. There are no free live sources used, no risk of source loss, and since the implant is a temporary procedure following discharge no issues with regard to radioprotection use of existing facilities exist. Patients with localized prostate cancer may benefit from high-dose-rate brachytherapy, which may be used alone in certain circumstances or in combination with external-beam radiotherapy in other settings. The purpose of this paper is to present the essentials of brachytherapies techniques along with the most important studies that support their effectiveness in the treatment of prostate cancer.

Koukourakis, Georgios; Kelekis, Nikolaos; Armonis, Vassilios; Kouloulias, Vassilios



Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis.  

PubMed Central

OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons (supraspinatus and subscapularis tendons, n = 53) were obtained during open shoulder surgery to repair shoulder lesions (age range 38-80 years). Glycosaminoglycans were extracted by papain digestion and analysed by cellulose acetate electrophoresis, the carbazole assay for uronic acid and the dimethylmethylene blue dye-binding assay for sulphated glycosaminoglycans. Some digests were analysed for keratan sulphate by 5D4 monoclonal antibody ELISA. Soluble proteoglycans were extracted in 4M guanidine hydrochloride and analysed by 4-15% SDS PAGE. RESULTS--The mean (SD) sulphated glycosaminoglycan (GAG) content of the normal cadaver supraspinatus tendon was 12.3 (4.3) micrograms/mg dry weight, between three and ten times greater than in the common biceps tendon [1.2 (0.6) micrograms/mg dry weight]. The major GAG was chondroitin sulphate [6.9 (2.6) micrograms/mg dry weight], with a smaller proportion of dermatan sulphate [2.5 (1.2) micrograms/mg dry weight]. In contrast, the common biceps tendon contained predominantly dermatan sulphate [0.8 (0.2) microgram/mg dry weight] with less chondroitin sulphate [0.2 (0.2) microgram/mg dry weight]. There was no difference in the concentration of hyaluronan in these tendons [9.3 (2.8) micrograms/mg dry weight and 10.8 (4.3) micrograms/mg dry weight respectively] and there was no significant change of hyaluronan with age. Keratan sulphate was a small but significant component of the supraspinatus tendon [0.43 (0.33) microgram/mg dry weight, n = 25], whereas there was little or none in the common biceps tendon [0.04 (0.05) microgram/mg dry weight, n = 8] and there was no significant change across the age range. In the supraspinatus tendon, there was a significant decrease in total glycosaminoglycan, chondroitin sulphate and dermatan sulphate with age (p < 0.001), whether expressed relative to the tendon dry weight or total collagen content, and no change in the relative proportion of the different GAG types. There was, however, a large degree of variation within the samples. Supraspinatus tendons from patients with chronic tendinitis had a significantly increased concentration of hyaluronan [30.4 (10.1) micrograms/mg dry weight, p < 0.001], chondroitin sulphate [8.4 (1.8) micrograms/mg dry weight, p < 0.05] and dermatan sulphate [3.8 (1.1) micrograms/mg dry weight, p < 0.001] compared with normal cadaver supraspinatus tendons, although the keratan sulphate content was not significantly different [0.18 (0.05) microgram/mg dry weight]. CONCLUSIONS--The normal supraspinatus tendon has the proteoglycan/glycosaminoglycan of tendon fibrocartilage, which it is suggested is an adaptation to mechanical forces (tension, compression and shear) which act on the rotator cuff tendons in the shoulder, although other factors such as reduced vascularity, low oxygen tension and the influence of local growth factors may also be important. This functional adaptation may have important consequences for the structural strength of the supraspinatus tendon and to influence the ability of the tendon to repair after injury. The glycosaminoglycan composition of tendon specimens from patients with chronic tendinitis is consistent with acute inflammation and new matrix proteoglycan synthesis, even in relatively old tendon specimens and after at least one injection of corticosteroid. Images

Riley, G P; Harrall, R L; Constant, C R; Chard, M D; Cawston, T E; Hazleman, B L



Outcomes of term vaginal breech delivery.  


In December 2001, the American College of Obstetricians and Gynecologists revised their recommendations for breech delivery. These recommendations acknowledge that although a planned vaginal delivery may no longer be appropriate, there are instances in which vaginal breech delivery is inevitable. Moreover, there continues to be patients who for any number of reasons will choose vaginal over cesarean delivery when faced with a fetus in the breech presentation. We sought to review maternal and fetal outcomes in such circumstances when vaginal breech delivery occurs, and compare these outcomes to elective cesarean deliveries for breech presentation. We performed a retrospective review of all singleton breech deliveries at our county hospital from January 2002 through June 2003. We reviewed maternal age, ethnicity, gestational age, gravity, parity, birthweight, mode of delivery, Apgar scores, umbilical arterial blood gases, and maternal and infant complications of both cesarean deliveries and vaginal breech deliveries. Univariate and logistic regression statistical analyses were performed with NCSS software. We had a total of 150 term breech deliveries with gestational ages between 37 and 42 weeks. Of these, 41 were vaginal breech and 109 were cesarean deliveries. Greater than 95% of patients are of Hispanic origin. There were no statistically significant differences in maternal age, ethnicity, gravity, or gestational age. Mean birthweight was significantly lower and parity was significantly higher in the vaginal delivery group. There was also a higher proportion of patients who underwent labor induction/augmentation in the vaginal group. We found no differences in the outcomes of 5-minute Apgar scores, umbilical arterial blood gas values, neonatal intensive care unit admissions, deaths or maternal/fetal complications reported between the two groups. Mean umbilical arterial blood gas values were greater than 7.18 in both groups. Vaginal breech delivery cannot always be avoided. Moreover, at our county hospital several patients continue to choose vaginal breech delivery. Our data would suggest that vaginal breech delivery remains a viable option in selected patients. PMID:16118722

Doyle, Nora M; Riggs, John W; Ramin, Susan M; Sosa, Manuel A; Gilstrap, Larry C



Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa  

Microsoft Academic Search

BACKGROUND: Bacterial vaginosis (BV) – a syndrome characterised by a shift in vaginal flora – appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge

Edward Demba; Linda Morison; Maarten Schim van der Loeff; Akum A Awasana; Euphemia Gooding; Robin Bailey; Philippe Mayaud; Beryl West



Development of Fatty Atrophy After Neurologic and Rotator Cuff Injuries in an Animal Model of Rotator Cuff Pathology  

PubMed Central

Background: Detachment of a tendon from its osseous insertion, as can be the case with severe rotator cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a rotator cuff injury model in the rabbit and to test the hypothesis that tenotomy of a rotator cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle. Methods: New Zealand white rabbits were divided into three groups: (1) partial rotator cuff tear without retraction of the muscle, (2) complete rotator cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury. Results: At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury. Conclusions: This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with rotator cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic rotator cuff tears may induce a neurologic injury. Clinical Relevance: Chronic rotator cuff injuries are associated with neuronal injury of the affected muscle. As such, neuronal injury may explain the histopathologic changes that have been observed following chronic rotator cuff tears.

Rowshan, Kasra; Hadley, Scott; Pham, Khoa; Caiozzo, Vince; Lee, Thay Q.; Gupta, Ranjan



Vaginitis: Its Diagnosis and Treatment  

PubMed Central

Ninety-nine patients with a variety of specific and non-specific vaginitis were treated initially with a broad spectrum anti-microbial agent (AVC cream) in an effort to alleviate the acute symptoms of these problems even before specific organisms could be isolated. Diagnostic methods are discussed for Candida albicans and trichomonas vaginalis which could be employed in routine office practice. This agents advantage in being effective against almost all known pathogens, is offset by its some-what limited effectiveness against trichomoniasis. It has been shown in this study to be well tolerated, and it offers an overall cure rate of 66 percent against the more common pathogens.

O'Brien, John R.; Hayden, Peter D.



Normal isometric strength of rotator cuff muscles in adults  

PubMed Central

Objectives The most prevalent disorders of the shoulder are related to the muscles of rotator cuff. In order to develop a mechanical method for the evaluation of the rotator cuff muscles, we created a database of isometric force generation by the rotator cuff muscles in normal adult population. We hypothesised the existence of variations according to age, gender and dominancy of limb. Methods A total of 400 healthy adult volunteers were tested, classified into groups of 50 men and women for each decade of life. Maximal isometric force was measured at standardised positions for supraspinatus, infraspinatus and subscapularis muscles in both shoulders in every person. Torque of the force was calculated and normalised to lean body mass. The profiles of mean torque-time curves for each age and gender group were compared. Results Our data showed that men gradually gained maximal strength in the fifth decade, and showed decreased strength in the sixth. In women the maximal strength was gained in the fourth decade with gradual decline to the sixth decade of life. The dominant arm was stronger in most of the tested groups. The torque profiles of the rotator cuff muscles in men at all ages were significantly higher than that in women. Conclusions We found previously unrecognised variations of rotator cuff muscles’ isometric strength according to age, gender and dominancy in a normal population. The presented data may serve as a basis for the future studies for identification of the abnormal patterns of muscle isometric strength in patients with pathology of the rotator cuff muscles. Cite this article: Bone Joint Res 2013;2:214–19.

Chezar, A.; Berkovitch, Y.; Haddad, M.; Keren, Y.; Soudry, M.; Rosenberg, N.



Rotator Cuff Tear Pain and Tear Size and Scapulohumeral Rhythm  

PubMed Central

Context: The body of knowledge concerning shoulder kinematics in patients with rotator cuff tears is increasing. However, the level of understanding regarding how pain and tear size affect these kinematic patterns is minimal. Objective: To identify relationships between pain associated with a full-thickness rotator cuff tear, tear size, and scapulohumeral rhythm (SHR) and to determine whether pain and tear size serve as predictors of SHR. Design: A test-retest design was used to quantify pain and SHR before and after a subacromial lidocaine injection. Correlation and multivariate analyses were used to identify relationships among pain, tear size, and SHR. Setting: Orthopaedic biomechanics research laboratory. Patients or Other Participants: Fifteen patients (age range, 40–75 years) with diagnosed full-thickness rotator cuff tears participated. They were experiencing pain at the time of testing. Intervention(s): Shoulder kinematic data were collected with an electromagnetic tracking system before and after the patient received a lidocaine injection. Main Outcome Measure(s): Pain was rated using a visual analog scale. Three-dimensional scapular kinematics and glenohumeral elevation were assessed. Scapular kinematics included anterior-posterior tilt, medial-lateral tilt, and upward-downward rotation. A regression model was used to calculate SHR (scapular kinematics to glenohumeral elevation) for phases of humeral elevation and lowering. Results: Linear relationships were identified between initial pain scores and SHR and between tear size and SHR, representing an increased reliance on scapular motion with increasing pain and tear size. Pain was identified as an independent predictor of SHR, whereas significant findings for the effect of tear size on SHR and the interaction between pain and tear size were limited. Conclusions: We noted an increased reliance on scapular contributions to overall humeral elevation with increasing levels of pain and rotator cuff tear size. Pain associated with a rotator cuff tear serves as a primary contributor to the kinematic patterns exhibited in patients with rotator cuff tears.

Scibek, Jason S; Carpenter, James E; Hughes, Richard E



Perivascular fluid cuffs decrease lung compliance by increasing tissue resistance  

PubMed Central

Objective Lung inflammation causes perivascular fluid cuffs to form around extra-alveolar blood vessels; however, the physiologic consequences of such cuffs remain poorly understood. Herein, we tested the hypothesis that perivascular fluid cuffs, without concomitant alveolar edema, are sufficient to decrease lung compliance. Design Prospective, randomized, controlled study. Setting Research laboratory. Subjects One hundred twenty male CD40 rats. Interventions To test this hypothesis, the plant alkaloid thapsigargin was used to activate store-operated calcium entry and increase cytosolic calcium in endothelium. Thapsigargin was infused into a central venous catheter of intact, sedated, and mechanically ventilated rats. Measurements Static and dynamic lung mechanics and hemodynamics were measured continuously. Main Results Thapsigargin produced perivascular fluid cuffs along extra-alveolar vessels but did not cause alveolar flooding or blood gas abnormalities. Lung compliance dose-dependently decreased after thapsigargin infusion, attributable to an increase in tissue resistance that was attributed to increased tissue damping and tissue elastance. Airway resistance was not changed. Neither central venous pressure nor left ventricular end diastolic pressure was altered by thapsigargin. Heart rate did not change, although thapsigargin decreased pressure over time sufficient to reduce cardiac output by 50%. Infusion of the type 4 phosphodiesterase inhibitor, rolipram, prevented thapsigargin from inducing perivascular cuffs and decreasing lung compliance. Rolipram also normalized pressure over time and corrected the deficit in cardiac output. Conclusions Our findings resolve for the first time that perivascular cuff formation negatively impacts mechanical coupling between the bronchovascular bundle and the lung parenchyma, decreasing lung compliance without impacting central venous pressure.

Lowe, Kevin; Alvarez, Diego F.; King, Judy A.; Stevens, Troy



External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma-A Prospective Randomized Study  

SciTech Connect

Purpose: To evaluate the value of adjuvant external beam pelvic radiotherapy as adjunct to vaginal brachytherapy (VBT) in medium-risk endometrial carcinoma, with regard to locoregional tumor control, recurrences, survival, and toxicity. Methods and Materials: Consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study endpoints were locoregional recurrences and overall survival. Secondary endpoints were recurrence-free survival, recurrence-free interval, cancer-specific survival, and toxicity. Results: Five-year locoregional relapse rates were 1.5% after external beam radiotherapy (EBRT) plus VBT and 5% after vaginal irradiation alone (p = 0.013), and 5-year overall survival rates were 89% and 90%, respectively (p = 0.548). Endometrial cancer-related death rates were 3.8% after EBRT plus VBT and 6.8% after VBT (p = 0.118). Pelvic recurrences (exclusively vaginal recurrence) were reduced by 93% by the addition of EBRT to VBT. Deep myometrial infiltration was a significant prognostic factor in this medium-risk group of endometrioid carcinomas but not International Federation of Gynecology and Obstetrics grade or DNA ploidy. Combined radiotherapy was well tolerated, with serious (Grade 3) late side effects of less than 2%. However, there was a significant difference in favor of VBT alone. Conclusions: Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded, but increased late toxicity was noted in the intestine, bladder, and vagina. Combined RT should probably be reserved for high-risk cases with two or more high-risk factors. VBT alone should be the adjuvant treatment option for purely medium-risk cases.

Sorbe, Bengt, E-mail: [Department of Gynecological Oncology, Oerebro University Hospital, Oerebro (Sweden); Horvath, Gyoergy; Andersson, Hakan [Department of Gynecological Oncology, Sahlgrenska University Hospital, Gothenburg (Sweden); Boman, Karin [Department of Gynecological Oncology, Umea University Hospital, Umea (Sweden); Lundgren, Caroline [Department of Gynecological Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden); Pettersson, Birgitta [Medical Products Agency, Uppsala (Sweden)



Cuff of wrist-mount blood pressure monitor  

US Patent & Trademark Office Database

A cuff of a wrist-mount blood pressure monitor capable of oppressing an artery of the wrist securely without having effects of muscle, tendon or bone existing in the wrist area is presented. This cuff 10 of a wrist-mount blood pressure monitor comprises a first air bag 14A as a first inflatable portion, and a second air bag 16A as a second inflatable region disposed between the first inflatable portion 14A and the wrist, being made of a material of a higher stretchability than the material for the first air bag 14A.

Yamakoshi; Ken-ichi (Kanazawa, JP); Oku; Shojiro (Kyoto, JP); Tanaka; Takahide (Kyoto, JP); Sano; Yoshihiko (Kyoto, JP); Kato; Hiroyuki (Kyoto, JP)



Variables affecting leakage past endotracheal tube cuffs: a bench study  

Microsoft Academic Search

Purpose  Leakage of oral secretions past endotracheal tubes (ETT) has been implicated in ventilator associated pneumonia. The aim of\\u000a this bench study was to compare the ability of current generation ETT cuffs to prevent fluid leakage and to determine the\\u000a specific mechanical ventilator settings that affect movement of fluid across an inflated ETT cuff.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Using a 2.3-cm internal diameter (ID) tracheal

Renée Pitts; Daniel Fisher; Demet Sulemanji; Joseph Kratohvil; Yandong Jiang; Robert Kacmarek



Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review  

Microsoft Academic Search

Background  Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator\\u000a cuffs may show improved healing when biologic factors are added during surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed\\u000a in tendon augmentation? (3) What approaches are being developed with the addition

Emilie V. Cheung; Luz Silverio; John W. Sperling



A low-noise preamplifier for nerve cuff electrodes.  


A single-stage, low-noise preamplifier is designed using the concept of noise matching for recordings of neural signal with cuff electrodes. The signal-to-noise ratio is approximately 1.6 times higher than that of a low-noise integrated amplifier (AMP-01) for a cuff impedance of 1.5 komega. The bandwidth is 230 Hz-8.25 kHz (Rs=2 komega), and the common-mode-rejection-ratio is 91.2 dB at 1 kHz. PMID:16425839

Sahin, Mesut



A low-noise preamplifier for nerve cuff electrodes  

Microsoft Academic Search

A single-stage, low-noise preamplifier is designed using the concept of noise matching for recordings of neural signal with cuff electrodes. The signal-to-noise ratio is approximately 1.6 times higher than that of a low-noise integrated amplifier (AMP-01) for a cuff impedance of 1.5 k?. The bandwidth is 230 Hz-8.25 kHz (Rs=2 k?), and the common-mode-rejection-ratio is 91.2 dB at 1 kHz.

Mesut Sahin



A double-layer tracheal tube cuff designed to prevent leakage: a bench-top study  

Microsoft Academic Search

Objective  We designed a new endotracheal tube (ETT) cuff that does not form the folds that cause leakage of colonized subglottic secretions\\u000a upon inflation within the trachea: a standard high-volume low-pressure cuff was draped with a second, highly elastic cuff\\u000a made of a low-protein guayule natural latex rubber with 0.5?ml gel between the cuffs. We compared this prototype ETT cuff\\u000a with four commercially available ETTs

Alberto Zanella; Massimo Cressoni; Myra Epp; Mario Stylianou; Theodor Kolobow



Impact of point A asymmetry on local control and survival for low dose-rate (LDR) brachytherapy in cervical cancer  

PubMed Central

Purpose To evaluate whether Point A asymmetry in low dose-rate (LDR) brachytherapy is associated with local control (LC), disease-free survival (DFS) and/or overall survival (OS). Material and methods A retrospective analysis of disease control and survival outcomes was conducted for patients who underwent LDR brachytherapy for advanced cervical cancer. Institutional protocol entailed concurrent chemotherapy and whole pelvis radiotherapy (WPRT) over 5 weeks, followed by placement of Fletcher-Suit tandem and colpostat applicators at weeks 6 and 8. Objective Point A doses, 80-85 Gy, were accomplished by placement of Cesium-137 (Cs-137) sources. Cox proportional hazards regression models were used to assess associations between disease control and survival endpoints with variables of interest. Results The records of 50 patients with FIGO stage IB1-IVA cervical cancer undergoing LDR brachytherapy at our institution were identified. Thirty of these patients had asymmetry > 2.5%, and 11 patients had asymmetry > 5%. At a median survivor follow-up of 20.25 months, 15 patients had experienced disease failure (including 5 cervical/vaginal apex only failures and 2 failures encompassing the local site). Right/left dose asymmetry at Point A was associated with statistically significantly inferior LC (p = 0.035) and inferior DFS (p = 0.011) for patients with mean Point A dose of > 80 Gy. Insufficient evidence existed to conclude an association with OS. Conclusions LDR brachytherapy may be associated with clinically significant dose asymmetry. The present study demonstrates that patients with Point A asymmetry have a higher risk of failure for DFS and LC.

Wahlquist, Amy; Watkins, John; Kohler, Matthew; Jenrette, Joseph



10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.  

Code of Federal Regulations, 2013 CFR

... 2013-01-01 false Records of calibration measurements of brachytherapy sources... Records § 35.2432 Records of calibration measurements of brachytherapy sources...licensee shall maintain a record of the calibrations of brachytherapy sources required...



Metal markers for radiographic visualization of rotator cuff margins: A new technique for radiographic assessment of cuff repair integrity  

PubMed Central

Surgically repaired rotator cuff repairs may re-tear in the post-operative follow-up phase, and periodic imaging is useful for early detection. The authors describe a simple surgical technique that provides a visible clue to the tendon edge on an anteroposterior radiograph of the shoulder. The technique involves arthroscopic or mini-open radio-opaque tagging of the tendon edge using a metal marker, and followed by a double-row rotator cuff repair using suture anchors. Serial post-operative radiographs may then be used to monitor the position of the marker. Progressive or marked displacement of the marker suggests a failure of cuff repair integrity and should be evaluated further.

Bhatia, Deepak N.; De Beer, Joe F.





... Date: 04/03/2013 Related A-Z Topics Bacterial Vaginosis Contraception and Birth Control Sexually Transmitted Diseases (STDs) All related topics NICHD News and Spotlights Division of Epidemiology, Statistics, and Prevention Research 2012 Annual Report Harnessing Research ...


Validation of the western ontario rotator cuff index in patients with arthroscopic rotator cuff repair: A study protocol  

Microsoft Academic Search

Background  Arthroscopic rotator cuff repair is described as being a successful procedure. These results are often derived from clinical\\u000a general shoulder examinations, which are then classified as 'excellent', 'good', 'fair' or 'poor'. However, the cut-off points\\u000a for these classifications vary and sometimes modified scores are used.\\u000a \\u000a \\u000a Arthroscopic rotator cuff repair is performed to improve quality of life. Therefore, disease specific health-related

Ronald N Wessel; Tjoan E Lim; Henk van Mameren; Rob A de Bie



Protection against rat vaginal candidiasis by adoptive transfer of vaginal B lymphocytes.  


Vulvovaginal candidiasis is a mucosal infection affecting many women, but the immune mechanisms operating against Candida albicans at the mucosal level remain unknown. A rat model was employed to further characterize the contribution of B and T cells to anti-Candida vaginal protection. Particularly, the protective role of vaginal B cells was studied by means of adoptive transfer of vaginal CD3(-) CD5(+) IgM(+) cells from Candida-immunized rats to naïve animals. This passive transfer of B cells resulted into a number of vaginal C. albicans CFU approximately 50% lower than their controls. Sorted CD3(-) CD5(+) IgM(+) vaginal B lymphocytes from Candida-infected rats proliferated in response to stimulation with an immunodominant mannoprotein (MP) antigen of the fungus. Importantly, anti-MP antibodies and antibody-secreting B cells were detected in the supernatant and cell cultures, respectively, of vaginal B lymphocytes from infected rats incubated in vitro with vaginal T cells and stimulated with MP. No such specific antibodies were found when using vaginal B cells from uninfected rats. Furthermore, inflammatory and anti-inflammatory cytokines, such as interleukin-2 (IL-2), IL-6 and IL-10, were found in the supernatant of vaginal B cells from infected rats. These data are evidence of a partial anti-Candida protective role of CD3(-) CD5(+) IgM(+) vaginal B lymphocytes in our experimental model. PMID:20402794

De Bernardis, Flavia; Santoni, Giorgio; Boccanera, Maria; Lucciarini, Roberta; Arancia, Silvia; Sandini, Silvia; Amantini, Consuelo; Cassone, Antonio



Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.  


Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital. PMID:23252881

Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara



Arthroscopic repair of full-thicknessrotator cuff tears: Operative technique  

Microsoft Academic Search

Arthroscopic repair of full-thickness rotator cuff tears is currently performed by a number of surgeons. The goals, indications, and postoperative rehabilitation are identical to traditional open repair. The principles of the operative technique are also identical to open repair, with the differences occurring in the manner in which the tendon is repaired to bone. This article describes in detail the

Gary M. Gartsman; Steven M. Hammerman



Open techniques for repair of largeand massive rotator cuff tears  

Microsoft Academic Search

Rotator cuff tears can be a significant source of shoulder pain and weakness. Repair of full-thickness tears canimprove patient satisfaction and functional outcome. Several repair techniques have been described in the literature; these include arthroscopic and open approaches. Although arthroscopic repair has been popularized in the recent literature, it may not be optimal for some cases of large or massive

Bernard C. Ong; Jon K. Sekiya; Mark W. Rodosky



Captured shoulder: A complication of rotator cuff surgery  

Microsoft Academic Search

Thirteen patients who developed restrictive subdeltoid adhesions after rotator cuff repair were identified. These patients underwent second-look arthroscopy and takedown of adhesions at an average of 37 weeks after their index surgery. Clinical findings include pain and restricted motion that does not yield to manipulation under anesthesia. Arthroscopic findings are subdeltoid adhesions and a chondral lesion (companion lesion) of the

Matthew A. Mormino; R. Michael Gross; Jack A. McCarthy



The influence of acromioclavicular joint morphology on rotator cuff tears  

Microsoft Academic Search

A detailed anatomic study of 123 shoulders was performed to define the location of the acromioclavicular (AC) joint within the supraspinatus outlet and to determine the correlation of AC joint morphologic characteristics with the presence of full-thickness rotator cuff tears (RCTs). The presence, location, and extent of RCTs were first documented for each shoulder, and 2 anatomic landmarks consisting of

Frances Cuomo; Frederick J. Kummer; Joseph D. Zuckerman; Thomas Lyon; Benjamin Blair; Todd Olsen



Properties of orderly recruited motor units with tripolar cuff electrode  

Microsoft Academic Search

Summary form only given, as follows. Motor units of the soleus and m. gastrocnemius muscles were recruited in order according to size with stimuli delivered by a tripolar nerve cuff electrode. One stimulus controlled the firing rate, while the second recruited the motor units, with the electrode's center pole serving both stimuli. A series of test procedures verified that motor

R. Barratta; M. Ichie; M. Solomonow



Measurement of external pressures generated by nerve cuff electrodes  

Microsoft Academic Search

When external pressures are applied to a peripheral nerve, tissue damage can occur via compression and blood flow occlusion, resulting in degeneration and demyelination of axons. Although many types of nerve electrodes have been designed to avoid or minimize this pressure during stimulation of the nerve or recording of its activity, the measurement of the pressure exerted by these cuffs

Frank A. Cuoco; Dominique M. Durand



Multichannel neural cuff electrodes with integrated multiplexer circuit  

Microsoft Academic Search

In order to restore hand function in spinal cord injured people by functional electrical stimulation of arm nerves, the authors developed an 18polar neural cuff type electrode with integrated multiplexer circuit. This circuit reduces the number of necessary interconnection leads to a stimulator from twelve to four. Cable reduction was intended to reduce the risk of cable breakage which is

Martin Schuettler; Klaus Peter Koch; Thomas Stieglitz; Oliver Scholz; Werner Haberer; Ralf Keller; Joerg-Uwe Meyer



Fascicle selective recording with a nerve cuff electrode  

Microsoft Academic Search

A multipolar split cuff electrode is used for fascicle selective recording of the electroneurogram (ENG) of the sciatic nerve of the rabbit. Several electrode configurations were evaluated with regarding to selectivity: the peroneal and tibial nerves were stimulated alternately and the ENG was recorded at different sides of the sciatic nerve. The results for two electrode configurations are presented

Johannes J. Struijk; Morten K. Haugland; Morten Thomsen



Intraoperative Testing of Selectivity of Spiral Nerve Cuff Electrodes  

Microsoft Academic Search

Nerve cuff electrodes were used intraoperatively to stimulate peripheral nerves to examine electrode selectivity in the human upper extremity. Subjects were recruited from patients undergoing upper extremity nerve repair procedures. The nerves were stimulated through four individual contacts located radially around the nerve with varying parameters. Data was recorded to estimate stimulation threshold and determine selectivity. Thresholds appeared to be

Polasek KH; Hoyen HA; Keith MW; Kirsch RF; Tyler DJ


18polar Hybrid Cuff Electrodes for Stimulation of Peripheral Nerves  

Microsoft Academic Search

For restoration of neuro-muscular functions in disabled people, cuff type electrodes have been used for several 10 years. A lot of experiences were collected using 12polar electrodes, which consisted of silicone tubes, carrying 4 stimulation tripoles, each tripole orientated longitudinally to the nerve. The tripoles were at 0°, 90°, 180°, and 270° position around the nerve. It is obvious that

Martin Schuettler; Thomas Stieglitz


An interface for nerve recording and stimulation with cuff electrodes  

Microsoft Academic Search

A nerve cuff electrode interface capable of both stimulating and recording from a nerve is described. The interface also rejects the EMG contamination in the recordings using reactive components without adding noise to the ENG signal. A transformer is added to the design for noise matching and the signal-to-noise ratio improvement is evaluated for a specific amplifier (AMP-O1)

Mesut Sahin; Dominique M. Durand



Temporal stability of nerve cuff electrode recruitment properties  

Microsoft Academic Search

The recruitment properties of multiple contact nerve cuff electrodes chronically implanted on the cat sciatic nerve were measured, and the week to week variability was documented. The variability in recruitment properties was greatest between 1 week and 8 weeks post-implant. After 8 weeks the session to session changes were significantly smaller than in the early post-implant period. No trends were

Warren M. Grill; J. Thomas Mortimer



21 CFR 868.5800 - Tracheostomy tube and tube cuff.  

Code of Federal Regulations, 2013 CFR

...tracheostomy tube. The cuff is used to prevent the patient's aspiration of substances, such as blood or vomit, or to provide a means for positive-pressure ventilation of the patient. This device is made of either stainless steel or plastic....



The American Brachytherapy Society Treatment Recommendations for Locally Advanced Carcinoma of the Cervix Part II: High Dose-Rate Brachytherapy  

PubMed Central

Purpose This report presents the 2011 update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) brachytherapy guidelines for locally advanced cervical cancer. Methods Members of the American Brachytherapy Society (ABS) with expertise in cervical cancer brachytherapy formulated updated guidelines for HDR brachytherapy using tandem and ring, ovoids, cylinder or interstitial applicators for locally advanced cervical cancer were revised based on medical evidence in the literature and input of clinical experts in gynecologic brachytherapy. Results The Cervical Cancer Committee for Guideline Development affirms the essential curative role of tandem-based brachytherapy in the management of locally advanced cervical cancer. Proper applicator selection, insertion, and imaging are fundamental aspects of the procedure. Three-dimensional imaging with magnetic resonance or computed tomography or radiographic imaging may be used for treatment planning. Dosimetry must be performed after each insertion prior to treatment delivery. Applicator placement, dose specification and dose fractionation must be documented, quality assurance measures must be performed, and follow-up information must be obtained. A variety of dose/fractionation schedules and methods for integrating brachytherapy with external-beam radiation exist. The recommended tumor dose in 2 Gray (Gy) per fraction radiobiologic equivalence (EQD2) is 80–90 Gy, depending on tumor size at the time of brachytherapy. Dose limits for normal tissues are discussed. Conclusion These guidelines update those of 2000 and provide a comprehensive description of HDR cervical cancer brachytherapy in 2011.

Viswanathan, Akila N.; Beriwal, Sushil; De Los Santos, Jennifer; Demanes, D. Jeffrey; Gaffney, David; Hansen, Jorgen; Jones, Ellen; Kirisits, Christian; Thomadsen, Bruce; Erickson, Beth



Intracerebral neutron brachytherapy for hemispheric glioblastoma multiforme  

Microsoft Academic Search

The University of Kentucky Brain Tumor Study and Research Group has developed a new treatment protocol of interstitial brain brachytherapy using Californium-252 neutron source implantation in 1980. Only patients with malignant gliomas were eligible for this pilot study. Nine patients entered the Phase I trial of the protocol study between November 1980 and October 1981. According to the design of

Hong W Chin; Yosh Maruyama; Byron Young; William Markesbery; Steven Goldstein; Phillip Tibbs; Larry Beach



Mullerian agenesis with vaginal vault prolapse following mechanically created neovagina.  


A 21-year-old with mullerian agenesis, presented with vaginal mass. Previously, she developed a neovagina by the use of vaginal dilators. Examination revealed vaginal vault prolapse. She was surgically treated with vaginal vault suspension using a mesh. PMID:22578488

Burns, Eve; Naim, Masood; Badawy, Shawky Z A



High-Dose Rate Brachytherapy Using Inverse Planning Simulated Annealing for Locoregionally Advanced Cervical Cancer: A Clinical Report With 2-Year Follow-Up  

SciTech Connect

Purpose: We present clinical outcomes of image-guided brachytherapy using inverse planning simulated annealing (IPSA) planned high-dose rate (HDR) brachytherapy boost for locoregionally advanced cervical cancer. Methods and Materials: From February 2004 through December 2006, 51 patients were treated at the University of California, San Francisco with HDR brachytherapy boost as part of definitive radiation for International Federation of Gynecology and Obstetrics Stage IB1 to Stage IVA cervical cancer. Of the patients, 46 received concurrent chemotherapy, 43 with cisplatin alone and 3 with cisplatin/5-fluorouracil. All patients had IPSA-planned HDR brachytherapy boost after whole-pelvis external radiation to a total tumor dose of 85 Gy or greater (for alpha/beta = 10). Toxicities are reported according to National Cancer Institute CTCAE v3.0 (Common Terminology Criteria for Adverse Events version 3.0) guidelines. Results: At a median follow-up of 24.3 months, there were no toxicities of Grade 4 or greater and the frequencies of Grade 3 acute and late toxicities were 4% and 2%, respectively. The proportion of patients having Grade 1 or 2 gastrointestinal and genitourinary acute toxicities was 48% and 52%, respectively. Low-grade late toxicities included Grade 1 or 2 vaginal, gastrointestinal, and hormonal toxicities in 31%, 18%, and 4% of patients, respectively. During the follow-up period, local recurrence developed in 2 patients, regional recurrence developed in 2, and new distant metastases developed in 15. The rates of locoregional control of disease and overall survival at 24 months were 91% and 86%, respectively. Conclusions: Definitive radiation by use of inverse planned HDR brachytherapy boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease.

Kim, Daniel H.; Wang-Chesebro, Alice [Department of Radiation Oncology, University of California, San Francisco, CA (United States); Weinberg, Vivian [Comprehensive Cancer Center Biostatistics Core, University of California San Francisco, CA (United States); Pouliot, Jean [Department of Radiation Oncology, University of California, San Francisco, CA (United States); Chen, Lee-May [Division of Gynecologic Oncology, University of California, San Francisco, CA (United States); Speight, Joycelyn [Department of Radiation Oncology, University of California, San Francisco, CA (United States); Littell, Ramey [Permanente Medical Group, San Francisco, CA (United States); Hsu, I.-Chow, E-mail: ihsu@radonc.ucsf.ed [Department of Radiation Oncology, University of California, San Francisco, CA (United States)



Vaginal rings for delivery of HIV microbicides  

PubMed Central

Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing.

Malcolm, R Karl; Fetherston, Susan M; McCoy, Clare F; Boyd, Peter; Major, Ian



[Local combined therapy of vaginal infections by nifuratel-nistatin].  


A test included 40 women in the reproductive age with clinical symptoms of vaginitis and microbiological examination. They were treated by combined therapy of vaginal tablets of nifuratel, 500 mg and nistatin 200 000 i. u. during six days, after which they underwent gynaecological reexamination and repeated microbiological examination of vaginal and cervical smears. An analiysis of vaginal secretion found bacterial flora in 34 smears (65%), fungus (Candida albicans) in 15 (24%) and Trichomonas vaginalis in 7 (11%). Local vaginal therapy in vaginitis caused by Trichomonas vaginalis was successfull in all 7 patients, vaginitis caused by Candida albicans was successly treated in 14 (93%) patients. Bacterial vaginitis was cured in 29 (71%) patients during this tharapy. Local vaginal combined therapy of nifuratel and nistatin is eficient in patients with vaginitis caused by fungi and Trichomonas vaginalis too. PMID:20387731

Jahi?, Mahira; Bali?, Adem; Nurki?, Mahmud; Dragovi?, Jasmina; Adzajli?, Amela; Habibovi?, Amra; Mesali?, Lejla; Zigi?, Aza



Automated intraoperative calibration for prostate cancer brachytherapy  

SciTech Connect

Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 {+-} 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 {+-} 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 {+-} 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 {+-} 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor [Queen's University, Kingston, Ontario K7L 3N6 (Canada); University of British Columbia, Vancouver, British Columbia V6T 1Z4 (Canada); Acoustic MedSystems, Inc., Champaign, Illinois 61820-3979 (United States); Queen's University, Kingston, Ontario K7L 3N6 (Canada) and Johns Hopkins University, Baltimore, Maryland 21218-2682 (United States)



Efficacy and safety of Vitamin C vaginal tablets in the treatment of non-specific vaginitis  

Microsoft Academic Search

Methods: This was a randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of Vitamin C vaginal tablets (250mg) given once a day in patients suffering from non-specific vaginitis. The total length of the study was 20 days, including a treatment phase of 6 days. The primary end-point was the presence in the two groups of non-specific vaginitis 1

E. Eiko Petersen; Paola Magnani



Nursing considerations in patients with vaginitis.  


Vaginitis is defined as an inflammation of the vagina. It can result in symptoms of any or all of the following: discharge, itching and pain, and often irritation or infection of the vulva. There is no specific cause for vaginitis, and many other conditions can cause the symptoms. Vaginitis is a distressing condition that affects many women of reproductive age and beyond, and encompasses candidiasis (also known as thrush), bacterial vaginosis, and trichomoniasis. It can occur in a single episode, or recur throughout a woman's lifetime. Some women will seek medical help, but many more self-treat with over-the-counter medications, suspecting the recurrence of Candida in particular. This article aims to explore the causes, signs and symptoms, and treatments of vaginitis to provide nurses with the necessary background information to feel more confident in dealing with women's health issues. PMID:20852467

Holloway, Debra


Vaginal Discharge: What's Normal, What's Not  


... period Vaginal infections, such as bacterial vaginosis, candidiasis (yeast infection), and trichomoniasis are common causes of abnormal ... having sex, such as bacterial vaginosis or a yeast infection. If you notice any changes in your ...


Rulemaking History for OTC Vaginal Drug Products  

Center for Drug Evaluation (CDER)

... Correction [PDF], 3/21/1994, 59FR13284. Notice: Guidance on vaginal yeast infection topical drug product labeling [PDF], 7/16/1998, 63FR38412. ... More results from


Vaginitis: Questions to Discuss with Your Doctor  


? Harvard Health Publications ? Order the Book ? Contact Us Sign up for our free e-mail newsletter, HEALTHbeat . ... the vaginal discharge ©2000–2006 President & Fellows of Harvard College Sign Up Now For HEALTH beat Our ...


Vaginal childbirth and pelvic floor disorders.  


Childbirth is an important event in a woman's life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study. PMID:23638782

Memon, Hafsa U; Handa, Victoria L



Fatty Infiltration and Atrophy of the Rotator Cuff Do Not Improve After Rotator Cuff Repair and Correlate With Poor Functional Outcome  

Microsoft Academic Search

Background: The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood. In addition, the reversibility of these changes with repair of the tendons is questionable.Hypothesis: Poorer preoperative muscle quality negatively affects outcome, and a successful outcome (in terms of a

James N. Gladstone; Julie Y. Bishop; Ian K. Y. Lo; Evan L. Flatow



Emerging therapies for postmenopausal vaginal atrophy.  


Symptoms related to vaginal atrophy are a significant problem for postmenopausal women and estrogen has been the gold standard for its treatment. A number of recent reviews of vaginal estrogen products are available. This review will, therefore, focus on other products and potential products for this indication, including the tissue selective estrogen complex and selective estrogen receptor modulators. Additionally, lesser-studied approaches will be discussed. PMID:23434231

Pickar, James H



Vaginal cysts causing tenesmus in a bitch.  


An eight-year-old female border collie was referred with a two-month history of faecal tenesmus. Ultrasonography and radiology identified fluid-filled masses in the cranial vagina. The fluid was drained from the vaginal cysts via an episiotomy and the clinical signs resolved. Histological examination confirmed that the cysts were of urogenital origin. This is believed to be the first report of vaginal cysts causing faecal tenesmus in the dog. PMID:7474963

Cauvin, A; Sullivan, M; Harvey, M J; Thompson, H



Effects of miphil, a new polycarbophil vaginal gel, in suspected bacterial vaginosis: a randomized study versus vaginal douche  

Microsoft Academic Search

Background: Vaginal pH is an important factor in maintaining a normal vaginal flora. Miphil (Mi) (Mipharm, Italy) is a new polycarbophil-based vaginal gel with high bioadhesivity and a long-lasting (>72 h) pH-lowering effect.Objective: To evaluate the effects on vaginal pH and odor of Mi in comparison with a vaginal douche (Lactacid) (L) in suspected bacterial vaginosis.Patients and methods: Thirty women

Massimo Milani; Bruno Molteni



Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.  


Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes. PMID:23945890

Mahmoodpoor, Ata; Peyrovi-Far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad Eslam Jamal



Desflurane analgesia for vaginal delivery.  


The use of subanaesthetic concentration of inhalational anaesthetic for vaginal delivery offers many advantages to the mother and newborn. Desflurane, with the characteristics of rapid onset and minimal metabolism, may provide better analgesia and safety for labour pain control. Eighty healthy parturients were randomly assigned to receive either desflurane 1.0-4.5% and oxygen (n = 40) or nitrous oxide 30-60% in oxygen (n = 40). Analgesia was assessed using a score from 0 (no relief) to 4+ (excellent analgesia), amnesia for the delivery, blood loss were recorded. Neonates were evaluated by Apgar scores and neurologic and adaptive capacity scores (NACS). Data were analyzed for statistical significance using Student's t-test or Chi-square when appropriate. Analgesia scores were similar for both groups with more amnesia in desflurane group (23% vs 0% P < 0.05). Blood loss did not differ significantly, 364 ml for the desflurane group and 335 ml for the nitrous oxide group. There were no significant differences for neonatal Apgar score at 1 min or at 5 min or the NACS at 2 hr or 24 hr between the two groups. We conclude that desflurane in subanaesthetic doses is safe and effective inhalation agent for normal delivery but might be associated with amnesia. PMID:7793195

Abboud, T K; Swart, F; Zhu, J; Donovan, M M; Peres Da Silva, E; Yakal, K



The derotation sign for perioperative diagnosis of significant partial-thickness rotator cuff tears  

Microsoft Academic Search

Purpose: To describe and evaluate a simple perioperative test (the derotation sign) that differentiates significant (grade 3) partial-thickness and small full-thickness rotator cuff tears from insignificant (grades 1 and 2) partial-thickness rotator cuff tears and intact rotator cuffs. Type of Study: Sensitivity and specificity study. Methods: A study was conducted of 123 patients who underwent shoulder arthroscopy for chronic symptomatic

David E. Attarian



Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?  

Microsoft Academic Search

Background  One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm\\u000a in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical\\u000a examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion.

Xiaofeng Jia; Jong Hun Ji; Vinodhkumar Pannirselvam; Steve A. Petersen; Edward G. McFarland



Cuff electrodes for long-term recording of natural sensory information  

Microsoft Academic Search

Cuff electrodes for recording of the electro-neurogram from peripheral nerves were introduced by Hoffer [1974] and Stein, et al. [1975]. The cuffs were used to obtain higher signal amplitudes than previously possible, at least in chronic recordings, and to decrease the pick-up of noise, especially from muscles. Cuff electrodes are relatively stable in long-term recordings, but the stability has never

J. J. Struijk; M. Thomsen; J. O. Larsen; T. Sinkjaer



Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia  

Microsoft Academic Search

The aim of this study was to evaluate the use of computerized cuff pressure algometry (CPA) in fibromyalgia (FM) and to correlate deep-tissue sensitivity assessed by CPA with other disease markers of FM. Forty-eight women with FM and 16 healthy age-matched women were included. A computer-controlled, pneumatic tourniquet cuff was placed over the gastrocnemius muscle. The cuff was inflated, and

Anders Jespersen; Lene Dreyer; Sally Kendall; Thomas Graven-Nielsen; Lars Arendt-Nielsen; Henning Bliddal; Bente Danneskiold-Samsoe



Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation  

Microsoft Academic Search

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness\\u000a and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including\\u000a a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically\\u000a intact rotator cuff tendons were

S. Waldt; M. Bruegel; D. Mueller; K. Holzapfel; A. B. Imhoff; E. J. Rummeny; K. Woertler



Repair of Full-Thickness Rotator Cuff Tears in Professional Baseball Players  

Microsoft Academic Search

Background: Despite the relative frequency of partial-thickness rotator cuff tears seen in baseball players, full-thickness rotator cuff tears in baseball players are uncommon.Hypothesis: Return to competitive baseball is difficult after surgical treatment of a full-thickness rotator cuff tear.Study Design: Case series; Level of evidence, 4.Methods: We evaluated the results of 16 professional baseball players after a mini-open repair of a

Christopher G. Mazoué; James R. Andrews



Arthroscopic Versus Mini-open Rotator Cuff RepairA Comprehensive Review and Meta-analysis  

Microsoft Academic Search

Background: Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs.Hypothesis: There is no difference between the clinical results obtained from all arthroscopic rotator

Kenneth Morse; A. David Davis; Robert Afra; Elizabeth Krall Kaye; Anthony Schepsis; Ilya Voloshin



Arthroscopic Single-Row Versus Double-Row Suture Anchor Rotator Cuff Repair  

Microsoft Academic Search

Background: Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair.Purpose: To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques.Hypothesis: Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to

Augustus D. Mazzocca; Peter J. Millett; Carlos A. Guanche; Stephen A. Santangelo; Robert A. Arciero



Protection of macaques from vaginal SHIV challenge by vaginally delivered inhibitors of virus-cell fusion  

Microsoft Academic Search

Human immunodeficiency virus type 1 (HIV-1) continues to spread, principally by heterosexual sex, but no vaccine is available. Hence, alternative prevention methods are needed to supplement educational and behavioural-modification programmes. One such approach is a vaginal microbicide: the application of inhibitory compounds before intercourse. Here, we have evaluated the microbicide concept using the rhesus macaque `high dose' vaginal transmission model

Ronald S. Veazey; Per Johan Klasse; Susan M. Schader; Qinxue Hu; Thomas J. Ketas; Min Lu; Preston A. Marx; Jason Dufour; Richard J. Colonno; Robin J. Shattock; Martin S. Springer; John P. Moore



The evolution of brachytherapy treatment planning  

SciTech Connect

Brachytherapy is a mature treatment modality that has benefited from technological advances. Treatment planning has advanced from simple lookup tables to complex, computer-based dose-calculation algorithms. The current approach is based on the AAPM TG-43 formalism with recent advances in acquiring single-source dose distributions. However, this formalism has clinically relevant limitations for calculating patient dose. Dose-calculation algorithms are being developed based on Monte Carlo methods, collapsed cone, and solving the linear Boltzmann transport equation. In addition to improved dose-calculation tools, planning systems and brachytherapy treatment planning will account for material heterogeneities, scatter conditions, radiobiology, and image guidance. The AAPM, ESTRO, and other professional societies are working to coordinate clinical integration of these advancements. This Vision 20/20 article provides insight into these endeavors.

Rivard, Mark J.; Venselaar, Jack L. M.; Beaulieu, Luc [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States); Department of Medical Physics, Instituut Verbeeten, P.O. Box 90120, 5000 LA Tilburg (Netherlands); Departement de Radio-Oncologie et Centre de Recherche en Cancerologie de l'Universite Laval, Centre Hospitalier Universitaire de Quebec, 11 Cote du Palais, Quebec, Quebec G1R 2J6 (Canada) and Departement de Physique, de Genie Physique et d'Optique, Universite Laval, Quebec, Quebec G1K 7P4 (Canada)



The evolution of brachytherapy treatment planning.  


Brachytherapy is a mature treatment modality that has benefited from technological advances. Treatment planning has advanced from simple lookup tables to complex, computer-based dose-calculation algorithms. The current approach is based on the AAPM TG-43 formalism with recent advances in acquiring single-source dose distributions. However, this formalism has clinically relevant limitations for calculating patient dose. Dose-calculation algorithms are being developed based on Monte Carlo methods, collapsed cone, and solving the linear Boltzmann transport equation. In addition to improved dose-calculation tools, planning systems and brachytherapy treatment planning will account for material heterogeneities, scatter conditions, radiobiology, and image guidance. The AAPM, ESTRO, and other professional societies are working to coordinate clinical integration of these advancements. This Vision 20/20 article provides insight into these endeavors. PMID:19610303

Rivard, Mark J; Venselaar, Jack L M; Beaulieu, Luc



Latissimus dorsi transfer for treatment of irreparable rotator cuff tears.  


Massive rotator cuff tendon ruptures are not uncommon in older patients. We propose the transfer of the latissimus dorsi muscle for treatment of irreparable ruptures associated with functional impairment and chronic pain. Five women and 11 men were so treated and reviewed with an average follow-up of 26 months. The mean age was 60 years. Four patients also had subscapularis deficiency. Results were assessed with the Constant score and the Oxford shoulder score. Humeral head position was analysed. Statistical analysis was performed by the Wilcoxon non-parametrical test. The Constant score increased by 24.2% (p?=?0.001) with all parameters showing improvement. Nine patients showed improved humeral head positioning in internal rotation. Three of four patients with a deficient subscapularis had unfavourable results. Latissimus dorsi transfer for the treatment of irreparable massive rotator cuff tears leads to a substantial clinical improvement. An intact subscapularis tendon is mandatory. PMID:20155494

Weening, Alexander A; Willems, W Jaap



Anterior superior instability with rotator cuff tearing: SLAC lesion.  


Anterosuperior instability of the shoulder may occur from a variety of pathologic lesions. We describe a specific entity, the SLAC (superior labrum, anterior cuff) lesion that involves an association of anterior-superior labral tear with a partial supraspinatus tear. We retrospectively isolated a group of 40 patients with this lesion. The presenting complaints, physical examination findings, surgical findings, and results were isolated. Overhead activities were the most common etiology; load and shift instability testing and whipple rotator cuff testing were the most common physical examination findings. Surgical repair was successful in 37 of the 40 patients. The SLAC lesion is a definable clinical entity with predictable history, examination, surgical pathology, and satisfactory results from surgery. PMID:11888140

Savoie, F H; Field, L D; Atchinson, S



Biologically based strategies to augment rotator cuff tears  

PubMed Central

Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

Schaer, M.; Schober, M.; Berger, S.; Boileau, P.; Zumstein, M. A.



Wearable PWV technologies to measure Blood Pressure: eliminating brachial cuffs.  


The clinical demand for technologies to monitor Blood Pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is strong: new generation of BP monitors are expected to be not only accurate, but also non-occlusive. In this paper we review recent advances on the use of the so-called Pulse Wave Velocity (PWV) technologies to estimate BP in a beat-by-beat basis. After introducing the working principle and underlying methodological limitations, two implementation examples are provided. Pilot studies have demonstrated that novel PWV-based BP monitors depict accuracy scores falling within the limits of the British Hypertensive Society (BHS) Grade A standard. The reported techniques pave the way towards ambulatory-compliant, continuous and non-occlusive BP monitoring devices, where the use of inflation cuffs is drastically reduced. PMID:24110633

Sola, J; Proenca, M; Chetelat, O



Nonarthroplasty options for the management of massive and irreparable rotator cuff tears.  


Massive, irreparable rotator cuff tears remain a clinical challenge. In low-demand patients, debridement of the tear may relieve pain. Partial repair using the technique of margin convergence decreases the size of the tear gap and reduces strain. Biceps tenotomy or tenodesis has a role in providing pain relief in massive rotator cuff tears. Tendon transfers offer good results in patients with massive, irreparable rotator cuff tears. The treatment modality specifically chosen for the massive, irreparable rotator cuff tear must be tailored to the individual patient, their needs and expectations, and their ability to comply with intensive rehabilitation. PMID:23040556

Delaney, Ruth A; Lin, Albert; Warner, Jon J P



Erectile Function Durability Following Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate long-term changes in erectile function following prostate brachytherapy. Methods and Materials: This study included 226 patients with prostate cancer and preimplant erectile function assessed by the International Index of Erectile Function-6 (IIEF-6) who underwent brachytherapy in two prospective randomized trials between February 2001 and January 2003. Median follow-up was 6.4 years. Pre- and postbrachytherapy potency was defined as IIEF-6 >= 13 without pharmacologic or mechanical support. The relationship among clinical, treatment, and dosimetric parameters and erectile function was examined. Results: The 7-year actuarial rate of potency preservation was 55.6% with median postimplant IIEF of 22 in potent patients. Potent patients were statistically younger (p = 0.014), had a higher preimplant IIEF (p < 0.001), were less likely to be diabetic (p = 0.002), and were more likely to report nocturnal erections (p = 0.008). Potency preservation in men with baseline IIEF scores of 29-30, 24-28, 18-23, and 13-17 were 75.5% vs. 73.6%, 51.7% vs. 44.8%, 48.0% vs. 40.0%, and 23.5% vs. 23.5% in 2004 vs. 2008. In multivariate Cox regression analysis, preimplant IIEF, hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly predicted for potency preservation. Impact of proximal penile dose was most pronounced for men with IIEF of 18-23 and aged 60-69. A significant minority of men who developed postimplant impotence ultimately regained erectile function. Conclusion: Potency preservation and median IIEF scores following brachytherapy are durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.

Taira, Al V. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.or [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Galbreath, Robert W.; Butler, Wayne M. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Kurko, Brian S.; Anderson, Richard; Lief, Jonathan H. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States)



Isotope selection for patients undergoing prostate brachytherapy  

Microsoft Academic Search

Purpose: Ultrasound-guided transperineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103Pd or 125I. The use of 125I for low Gleason score tumors and 103Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected

Christine M Cha; Louis Potters; Richard Ashley; Katherine Freeman; Xiao-Hong Wang; Robert Waldbaum; Steven Leibel



Design and optimization of a brachytherapy robot  

NASA Astrophysics Data System (ADS)

Trans-rectal ultrasound guided (TRUS) low dose rate (LDR) interstitial brachytherapy has become a popular procedure for the treatment of prostate cancer, the most common type of non-skin cancer among men. The current TRUS technique of LDR implantation may result in less than ideal coverage of the tumor with increased risk of negative response such as rectal toxicity and urinary retention. This technique is limited by the skill of the physician performing the implant, the accuracy of needle localization, and the inherent weaknesses of the procedure itself. The treatment may require 100 or more sources and 25 needles, compounding the inaccuracy of the needle localization procedure. A robot designed for prostate brachytherapy may increase the accuracy of needle placement while minimizing the effect of physician technique in the TRUS procedure. Furthermore, a robot may improve associated toxicities by utilizing angled insertions and freeing implantations from constraints applied by the 0.5 cm-spaced template used in the TRUS method. Within our group, Lin et al. have designed a new type of LDR source. The "directional" source is a seed designed to be partially shielded. Thus, a directional, or anisotropic, source does not emit radiation in all directions. The source can be oriented to irradiate cancerous tissues while sparing normal ones. This type of source necessitates a new, highly accurate method for localization in 6 degrees of freedom. A robot is the best way to accomplish this task accurately. The following presentation of work describes the invention and optimization of a new prostate brachytherapy robot that fulfills these goals. Furthermore, some research has been dedicated to the use of the robot to perform needle insertion tasks (brachytherapy, biopsy, RF ablation, etc.) in nearly any other soft tissue in the body. This can be accomplished with the robot combined with automatic, magnetic tracking.

Meltsner, Michael A.


Brachytherapy needle deflection evaluation and correction  

SciTech Connect

In prostate brachytherapy, an 18-gauge needle is used to implant radioactive seeds. This thin needle can be deflected from the preplanned trajectory in the prostate, potentially resulting in a suboptimum dose pattern and at times requiring repeated needle insertion to achieve optimal dosimetry. In this paper, we report on the evaluation of brachytherapy needle deflection and bending in test phantoms and two approaches to overcome the problem. First we tested the relationship between needle deflection and insertion depth as well as whether needle bending occurred. Targeting accuracy was tested by inserting a brachytherapy needle to target 16 points in chicken tissue phantoms. By implanting dummy seeds into chicken tissue phantoms under 3D ultrasound guidance, the overall accuracy of seed implantation was determined. We evaluated methods to overcome brachytherapy needle deflection with three different insertion methods: constant orientation, constant rotation, and orientation reversal at half of the insertion depth. Our results showed that needle deflection is linear with needle insertion depth, and that no noticeable bending occurs with needle insertion into the tissue and agar phantoms. A 3D principal component analysis was performed to obtain the population distribution of needle tip and seed position relative to the target positions. Our results showed that with the constant orientation insertion method, the mean needle targeting error was 2.8 mm and the mean seed implantation error was 2.9 mm. Using the constant rotation and orientation reversal at half insertion depth methods, the deflection error was reduced. The mean needle targeting errors were 0.8 and 1.2 mm for the constant rotation and orientation reversal methods, respectively, and the seed implantation errors were 0.9 and 1.5 mm for constant rotation insertion and orientation reversal methods, respectively.

Wan Gang; Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron [Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Program, University of Western Ontario, London, Ontario N6A 5B9 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Program, University of Western Ontario, London, Ontario N6A 5B9 (Canada); Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London, Ontario N6A 5A5 (Canada)



Natural Extracellular Matrix Grafts for Rotator Cuff Repair  

Microsoft Academic Search

The results of open or arthroscopic repair of the rotator cuff vary widely in the literature.1–15 The factors that have been shown to affect outcome relate to the technique of surgery,3,9,16–18 the size of the tear,9–11 the quality of the tissue and age of the patient,10,11,15 the chronicity of the tear,9–11,19,20 the degree of muscle atrophy, and the degree of

Joseph P. Iannotti; Michael J. DeFranco; Michael J. Codsi; Steven D. Maschke; Kathleen A. Derwin


Chronic rotator cuff impingement in the throwing athlete.  


Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability. PMID:64122

Jackson, D W


Management of the throwing shoulder: cuff, labrum and internal impingement.  


Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology. Nonoperative treatment is directed at restoring strength, flexibility, and neuromuscular control to the entire kinetic chain. Surgery is indicated when nonoperative treatment fails, and is directed at correcting labral, capsular, and rotator cuff pathology. PMID:20497808

Greiwe, R Michael; Ahmad, Christopher S



[Conservative therapy and rehabilitation following surgery of the rotator cuff].  


To achieve the best results after shoulder surgery, an optimal rehabilitation program is absolutely necessary. The physiotherapist must pay attention to some basic features such as biomechanics, functional anatomy and the current findings. The schedule of rehabilitation depends on the operative technique, the possibility of reconstruction of the rotator cuff and on the load capacity of the soft tissue. The goal of shoulder rehabilitation is the recovery of painless and normal shoulder function. PMID:8532340

Jessner-Kaplans, M; Jessner, A



In vitro diffusion of lidocaine across endotracheal tube cuffs  

Microsoft Academic Search

Purpose  Lidocaine diffuses across endotracheal tube cuffs, which may serve as a reservoir for local anesthetic to assist in the prevention\\u000a of ETT-induced cough while emerging from general anesthesia. However, the rate of diffusion is slow. Two techniques, alkalization\\u000a and warming, may increase the proportion of uncharged drug available for diffusion. The purpose of this study is to determine\\u000a the effectiveness

Chun-Jen Huang; Ming-Chuan Tsai; Chien-Tsu Chen; Ching-Rong Cheng; Kuo-Hwa Wu; Tze-Taur Wei



Paraspinal tumors: Techniques and results of brachytherapy  

SciTech Connect

Because of their proximity to nerve roots and the spinal cord, it is frequently difficult to achieve complete resection of paraspinal tumors. We have used brachytherapy in an attempt to prevent local recurrence and its associated neurological sequelae. This report analyzes our experience with 35 patients to determine the feasibility, optimal techniques, and efficacy of this approach. The tumor types were non small-cell lung cancer (18), sarcomas (9), and other tumor types (8). Temporary, single plane implants using Ir-192 (median minimum peripheral dose 3000 cGy) were used in 21 patients, and permanent I-125 implants were used in 14 cases (median matched peripheral dose 12,500 cGy). Local control was achieved in 51% (18/35). However, local control was poor when lung cancers were implanted and in cases where the dura was exposed. Radiation myelitis did not occur despite the combined effects of previous external beam radiotherapy (N = 21) and brachytherapy. Our experience demonstrates that combined surgery and paraspinal brachytherapy can be performed with acceptable toxicity and is reasonably effective in preventing local relapse and its neurologic sequelae, particularly for tumors other than lung cancers.

Armstrong, J.G.; Fass, D.E.; Bains, M.; Mychalczak, B.; Nori, D.; Arbit, E.; Martini, N.; Harrison, L.B. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))



Primary standards and dosimetry protocols for brachytherapy sources  

NASA Astrophysics Data System (ADS)

Current primary standards for the calibration of both photon and beta particle emitting brachytherapy sources are reviewed. Methods for quality control being used as well as methods of transferring these standards to secondary laboratories and users are also discussed. Finally, dosimetry protocols for brachytherapy sources are described.

Soares, C. G.; Douysset, G.; Mitch, M. G.



High dose rate brachytherapy for superficial cancer of the esophagus  

Microsoft Academic Search

Purpose: We analyzed our experience with external radiotherapy, combined modality treatment, or HDR brachytherapy alone to limited esophageal cancers.Methods and Materials: From 1991 to 1996, 25 patients with limited superficial esophagus carcinomas were treated by high dose rate brachytherapy. The mean age was 63 years (43–86 years). Five patients showed superficial local recurrence after external radiotherapy. Eleven patients without invasion

Philippe Maingon; Anne d’Hombres; Gilles Truc; Isabelle Barillot; Christophe Michiels; Laurent Bedenne; Jean Claude Horiot



Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?  


The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values. PMID:21641528

Watson, Sheri; Aguas, Marita; Bienapfl, Tracy; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Yosses, Mary Beth; Yu, Larissa; Anastas, Zoe



[How to prepare the brachytherapy of the future].  


For more than a century, brachytherapy has been a treatment of choice for delivering a high dose in a small volume. However, over the past 15 years, this irradiation technique has stalled. Even so, brachytherapy allows the delivery of the right dose at the right place by dispensing with target volume motion and repositioning. The evolution of brachytherapy can be based on a road-map including at least the following three points: the acquisition of clinical evidence, teaching and valuation of the procedures. The evolution of brachytherapy will be also impacted by technological considerations (end of the production of low dose rate 192 iridium wires). Regarding the evolution toward a personalized treatment, brachytherapy of the future should take its place as a partner of other modern external beam radiation techniques, be performed by experimented actors (physicians, physicists, technicians, etc.) who received adequate training, and be valued in proportion to the delivered medical service. PMID:23993062

Hannoun-Lévi, J-M; Peiffert, D



[Vulvo-vaginitis in pediatric age].  


In pediatric gynecology, inflammatory vulvo-vaginitis are very common. Their diagnosis cannot be based either on the symptoms (itching or pain) or on the signs (leucoxanthorrhea) for these classifications are "non-specific". At the Consulting Room of pediatric gynecology of the Vittore Buzzi Hospital, 215 "non-specific" vulvo-vaginitis cases have been analyzed through bacteriological and microscopical examinations of vaginal secretions. The vaginal tampon resulted negative in 53% of the cases and positive in the remaining 47%. Comparing these results with microscopical examinations we obtain: 81.8% of sensibility, 77.4% of specificity, 87.8% of negative predictive value and 62.2% of positive predictive value. In particular, this last figure is influenced by the high number of false positives of the vaginal tampons, due to the growth "in vitro" of opportunist germs momentarily quiescent "in vivo". Thus it is useful to associated the microscopical examination (that will indicate all the cases in need of treatment) and the bacteriological examination (that will indicate the right cure). PMID:8133837

Beolchi, S; Brambilla, C; Roberti, P; Fadin, M; Facchini, M; Pansini, L; Maestri, L; Morandi, C



Breech vaginal delivery at or near term.  


Three percent to 4% of term fetuses will be breech at delivery. Evidence from randomized controlled trials has found a policy of planned cesarean section to be significantly better for the singleton fetus in breech presentation at term compared to a policy of planned vaginal birth. However, some women may wish to avoid cesarean section and for others, cesarean section may not be possible. We undertook this review to identify factors associated with higher and lower risk of adverse fetal or neonatal outcome at term during vaginal breech delivery. We searched MEDLINE from 1966 to 2002 using the search terms vaginal breech delivery and breech presentation and retrieved all relevant articles. We also reviewed personal references and reference lists of articles retrieved. Women who are older or who have a fetus that is either in footling presentation, has a hyperextended head or is estimated to weigh <2500 g or >4000 g may be at higher risk of adverse fetal outcome. Prolonged labor or not having an experienced clinician at vaginal breech birth may also increase the risk. Women with a fetus in breech presentation at term should be offered the option of delivery by planned cesarean section and should be informed that this will reduce their risk of adverse fetal or neonatal outcome. Practitioners should develop and maintain skills at vaginal breech delivery for those women not wishing or not able to be delivered by cesarean section. PMID:12641301

Tunde-Byass, Modupe O; Hannah, Mary E



Effect of Vaginal Lubricants on Natural Fertility  

PubMed Central

Objective Over-the-counter vaginal lubricants have been shown to negatively affect in vitro sperm motility. The objective of this study was to estimate the effect of vaginal lubricant use during procreative intercourse on natural fertility. Methods Women aged 30–44 years with no history of infertility who had been trying to conceive for less than 3 months completed a baseline questionnaire on vaginal lubricant use. Subsequently, women kept a diary to record menstrual bleeding, intercourse, and vaginal lubricant use and conducted standardized pregnancy testing for up to 6 months. Diary data were used to determine the fertile window and delineate lubricant use during the fertile window. A proportional hazards model was used to estimate fecundability ratios with any lubricant use in the fertile window considered as a time-varying exposure. Results Of the 296 participants, 75 (25%) stated in their baseline questionnaire that they use vaginal lubricants while attempting to conceive. Based on daily diary data, 57% of women never used a lubricant, 29% occasionally used a lubricant, and 14% used a lubricant frequently. Women who used lubricants during the fertile window had similar fecundability to those women who did not use lubricants (fecundability ratio 1.05, 95% CI: 0.59, 1.85) after adjusting for age, partner race, and intercourse frequency in the fertile window. Conclusion Lubricants are commonly used by couples during procreative intercourse. Lubricant use during procreative intercourse does not appear to reduce the probability of conceiving.

Steiner, Anne Z.; Long, D. Leann; Tanner, Catherine; Herring, Amy H.



[Clinical characteristics of aerobic vaginitis and its mixed infections.  


OBJECTIVE: To investigate clinical characteristics of aerobic vaginitis (AV) and its mixed infections for diagnosis efficiently. METHODS: From April 2008 to December 2008, 516 patients with vaginitis treated in Tianjin Medical University General Hospital were enrolled in this study. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV), and cytolytic vaginosis (CV) were diagnosed based on symptoms, sign and vaginal discharge examination. RESULTS: Among 516 cases, AV cases were found in 14.7% (76/516), and AV was common vaginal infection. AV mixed infections was diagnosed in 58% (44/76), including mixed with BV (45%, 20/44), mixed with VVC (30%, 13/44), and mixed with TV (25%, 11/44). Those common symptom of AV were yellow vaginal discharge (63%, 20/32), more vaginal discharge (44%, 14/32). Vaginal pH value was usually more than 4.5 (84%, 27/32). Vaginal cleanliness mainly was grade III - IV (88%, 28/32). Six cases with enterococcus faecium and 4 cases with streptococci were frequently isolated. The symptom and sign of mixed AV infection was atypical. CONCLUSIONS: Aerobic vaginitis is a common lower vaginal infection and easily mixed with other pathogens, especially with BV, VVC or TV. When patients were diagnosed with AV or other vaginal infection, it should be mentioned whether those patients have mixed vaginal infection or AV. PMID:21211421

Fan, Ai-Ping; Xue, Feng-Xia



Penile brachytherapy: Results for 49 patients  

SciTech Connect

Purpose: To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. Methods and Materials: From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx. Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had either Iridium wire (n 22) or seeds (n = 4). Four patients had a single plane implant with a plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h, with no correction in total dose, which was 60 Gy in all cases. Results: Median follow-up was 33.4 months (range, 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90.0%. Four men died of penile cancer, and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact and tumor-free penis at last follow-up or death. The actuarial penile preservation rate at 5 years was 86.5%. Conclusions: Brachytherapy is an effective treatment for T1, T2, and selected T3 SCC of the penis. Close follow-up is mandatory because local failures and many regional failures can be salvaged by surgery.

Crook, Juanita M. [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Princess Margaret Hospital, Toronto, Ontario (Canada)]. E-mail:; Jezioranski, John [Department of Radiation Physics, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Grimard, Laval [Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario (Canada); Esche, Bernd [Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario (Canada); Pond, G. [Department of Biostatistics, University Health Network, Toronto, Ontario (Canada)



Vaginal T lymphocyte population kinetics during experimental vaginal candidosis: evidence for a possible role of CD8+ T cells in protection against vaginal candidosis  

PubMed Central

Vaginal candidosis represents a significant health problem to women of childbearing age worldwide. It has been postulated that localized T cells play a role in protection against vaginal candidosis. In an attempt to evaluate the role of vaginal T cells in protection against vaginal candidosis, T cell population kinetics was evaluated using an oestrogen-dependent vaginal candidosis murine model. Vaginal T lymphocytes were isolated at different time points post C. albicans inoculation, viable cells were enumerated, phenotypically analysed for the expression of CD3, CD4 and CD8 T cell markers and absolute numbers of T cell subsets were calculated. Oestrogen-induced persistence of vaginal candidosis resulted in a significant increase in the total number of vaginal lymphocytes within 24–48 h post infection; increased vaginal lymphocyte numbers persisted throughout the infection period. The number of CD3+ T cells dramatically increased following C. albicans administration and was maintained at high levels throughout the infection period. The majority of CD3+ T cells were of the CD8+ type; however, considerable numbers of both CD4+ T cells and CD4+CD8+ T cells were also observed throughout the infection period. The considerable and persistent increase in vaginal T cell numbers in general and that of CD8+ T cells in particular are evidence of the possible role played by localized T cells in protection against vaginal candidosis.




Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?  

Microsoft Academic Search

Study objectivesTo study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints.

José Reinaldo Cerqueira Braz; Alexandre Volney; Laís Helena Camacho Navarro; Leandro Gobbo Braz; Giane Nakamura



SU-GG-T-49: Real Time Dose Verification for Novel Shielded Balloon Brachytherapy  

SciTech Connect

Purpose: The validation of a novel approach for reducing skindoses to an acceptable level during Accelerated Partial Breast Irradiation (APBI) when the balloon-to-skin distance is inadequate (less than 7 mm) is reported. The study uses a real time dose verification method for a metallic shielded balloon applicator using scintillation fiber technology. Method and Materials: Partial shielding of the radiationdose to the skin using iron or other ferrous powder could enable the extension of APBI to some patients. With small external and pre-determined magnetic fields (Brachytherapy treatments with relatively weak magnetic fields. Additional measurements provided negligible corrections (< few %) on the saline water density from the suspended ironpowder.Conclusion: This project opens the possibility to increasing the survival expectancy and minimizing negative side effects during brachytherapy treatments, as well as improving cosmetic outcome for all APBI patients. The proposed method may also be used in other procedures for brain, heart, rectal, or vaginal cancers.

Govindarajan, Nandakarthik; Nazaryan, Vahagn; Gueye, Paul; Keppel, Cynthia



A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn  

PubMed Central

Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD), which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1?cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP) was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST), Pelvic Organ Prolapse Quantification (POP-Q) evaluation, Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

Kose, Osman; Saglam, Hasan S.; Kumsar, Sukru; Budak, Salih; Adsan, Oztug



Vaginal delivery through annular placenta -- case report.  


Annular placenta is an extremely rare morphological type of human placenta. It is commonly related to placental vessel abnormalities frequently causing antenatal and postnatal hemorrhage and operative delivery. Gravida 4 para 1 had an uneventful course of pregnancy and normal vaginal delivery followed by moderate postpartum hemorrhage. Hemorrhage was found to be local in origin but the placenta was annular in shape and the newborn was delivered through one of the openings. Annular placenta was not recognized before delivery. Its implantation site was in the lower uterine segment but high enough to allow the passage of the fetus through its annular defect and vaginal birth. To our knowledge, this is a first report of annular placenta ending in normal vaginal delivery. PMID:23630149

Živkovi?, Nikica; Krezo, Stipe; Matijevi?, Ratko; Živkovi?, Kresimir



Vaginal delivery through annular placenta - case report  

PubMed Central

Annular placenta is an extremely rare morphological type of human placenta. It is commonly related to placental vessel abnormalities frequently causing antenatal and postnatal hemorrhage and operative delivery. Gravida 4 para 1 had an uneventful course of pregnancy and normal vaginal delivery followed by moderate postpartum hemorrhage. Hemorrhage was found to be local in origin but the placenta was annular in shape and the newborn was delivered through one of the openings. Annular placenta was not recognized before delivery. Its implantation site was in the lower uterine segment but high enough to allow the passage of the fetus through its annular defect and vaginal birth. To our knowledge, this is a first report of annular placenta ending in normal vaginal delivery.

Zivkovic, Nikica; Krezo, Stipe; Matijevic, Ratko; Zivkovic, Kresimir



Operative vaginal delivery: current trends in obstetrics.  


After centuries of use in obstetrics, have forceps and vacuum deliveries become a dying art? Contemporary trends in operative vaginal delivery show increasing numbers of vacuum deliveries and decreasing numbers of forceps deliveries worldwide. Primary drivers of such trends include concerns over neonatal and maternal safety as well as fewer clinicians skilled in forcep use. Current literature reports a comparable efficacy rate for the two instruments, as well as a decrease in maternal morbidity compared with cesarean section. It has also been suggested that the neonatal morbidity once associated with operative vaginal delivery may actually be a function of an abnormal labor process itself, rather than a consequence of an operative vaginal intervention. Both the American College and the Royal College of Obstetricians and Gynecologists continue to support the use of both vacuum and forceps and strongly encourage residency programs to incorporate the teaching of these skills into their curricula. PMID:19072477

Goetzinger, Katherine R; Macones, George A



Neural morphological effects of long-term implantation of the self-sizing spiral cuff nerve electrode  

Microsoft Academic Search

The paper reports on the histological effects of chronic implantation of self-sizing spiral cuff nerve electrodes on the cat\\u000a sciatic nerve. The implantation period is about 4.4 months. Four different experimental conditions are evaluated: control,\\u000a sham, bare cuff (cuffs without contacts and leads) and full cuff. The total number of axons in the nerves of the control group\\u000a is compared

E. Romero; J. Delbeke; A. Robert; C. Veraart



Hormone Replacement Therapy: Can It Cause Vaginal Bleeding?  


... may be reprinted for personal, noncommercial use only. Hormone replacement therapy: Cause of vaginal bleeding? By Mayo Clinic staff ... share your e-mail address Sign up Question Hormone replacement therapy: Cause of vaginal bleeding? I'm taking hormone ...


Efficacy and Tolerability of Fitostimoline (Vaginal Cream, Ovules, and Vaginal Washing) and of Benzydamine Hydrochloride (Tantum Rosa Vaginal Cream and Vaginal Washing) in the Topical Treatment of Symptoms of Bacterial Vaginosis  

PubMed Central

Two hundred and 91 patients showing signs and symptoms of bacterial vaginosis (BV) were randomized to receive topical treatment with Fitostimoline (vaginal cream and vaginal ovules + vaginal washing) or benzydamine hydrochloride (vaginal cream + vaginal washing) for 7 days. Signs (leucorrhoea, erythema, oedema, and erosion) and symptoms (burning, pain, itching, vaginal dryness, dyspareunia, and dysuria) (scored 0–3) were evaluated at baseline and at the end of treatment; the total symptoms score (TSS) was also calculated. In 125 patients, a bacterial vaginosis was confirmed by vaginal swab test. The primary efficacy variable analysis, that is, the percentage of patients with therapeutic success (almost complete disappearance of signs and symptoms), demonstrated that Fitostimoline ovules and vaginal cream were therapeutically equivalent and that pooled Fitostimoline treatment was not inferior to benzydamine hydrochloride. All the treatments were well tolerated, with only minor local adverse events infrequently reported. The results of this study confirmed that gynaecological Fitostimoline is a safe and effective topical treatment for BV.

Boselli, F.; Petrella, E.; Campedelli, A.; Muzi, M.; Rullo, V.; Ascione, L.; Papa, R.; Saponati, G.



A dosimetric comparison of Xoft Axxent Electronic Brachytherapy and iridium-192 high-dose-rate brachytherapy in the treatment of endometrial cancer  

Microsoft Academic Search

PurposeThis analysis was undertaken to dosimetrically compare iridium-192 high-dose-rate brachytherapy (IB) and Xoft Axxent Electronic Brachytherapy (XB; Xoft Inc., Sunnyvale, CA) in the treatment of endometrial cancer.

Adam Dickler; Michael C. Kirk; Alan Coon; Damian Bernard; Tom Zusag; Jacob Rotmensch; David E. Wazer



Cardiac and vascular adaptation to 0g with and without thigh cuffs (Antares 14 and Altair 21 day Mir spaceflights)  

Microsoft Academic Search

Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output,

Ph. Arbeille; G. Fomina; F. Achaibou; J. Pottier; A. Kotovskaya



Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare!  

Microsoft Academic Search

An avulsion fracture of the greater tuberosity of the humerus with associated rotator cuff tear is rare. The authors describe the unusual case of a shoulder injury with an isolated, displaced greater tuberosity fracture associated with a massive rotator cuff tear. Due to the rotator cuff dysfunction, this patient presented with significant functional loss.

Amr Fahmy; Nick Antonakopoulos; Amer Khan



The role of the biceps tendon in massive rotator cuff tears.  


Tendinopathy of the long head of the biceps (LHB) tendon commonly occurs in patients with rotator cuff tears, and the inflammation of one head tends to lead to inflammation of the other. Many theories have been proposed regarding the function of the LHB tendon; however, its exact purpose is poorly understood. It has been described as an important stabilizer of the glenohumeral joint, a depressor of the humeral head, and as a vestigial structure. The LHB tendon can be a significant source of pain in patients with rotator cuff tears. The appropriate treatment depends on the patient's age, comorbidities, activity level, extent of disability, the presence of rotator cuff arthropathy, and the quality of the rotator cuff tissue. Conservative treatment is usually attempted first, with modalities such as nonsteroidal anti-inflammatory drugs, corticosteroid injections, physical therapy, and activity modification. If symptoms persist, biceps tenotomy or tenodesis may be combined with rotator cuff repair, depending on the quality of the rotator cuff tissue, the severity of rotator cuff arthropathy, and the willingness of the patient to comply with postoperative immobilization and rehabilitation. Even when rotator cuff repair is not possible, isolated tenotomy or tenodesis of the LHB tendon can provide substantial pain relief. PMID:22301226

Pill, Stephan G; Walch, Gilles; Hawkins, Richard J; Kissenberth, Michael J



Simultaneous rupture of bilateral quadriceps tendon and rotator cuff tear: a case report.  


This is a case report of a patient who sustained both a bilateral quadriceps tendon rupture and a complete rotator cuff tear. Overuse is a known risk factor for rotator cuff tears, but this case suggests that it can also be a risk factor for quadriceps tendon rupture. PMID:23155972

Chen, H T



Dermal Tissue Allograft for the Repair of Massive Irreparable Rotator Cuff Tears  

Microsoft Academic Search

Background: Massive irreparable rotator cuff tears in patients without advanced glenohumeral arthritis can pose a challenge to surgeons. Numerous management strategies have been utilized, and studies have shown varied results with regard to shoulder pain, range of motion, strength, and overall function.Hypothesis: Patients undergoing repair of massive irreparable rotator cuff tears through a mini-open approach with the use of human

Anil K. Gupta; Kevin Hug; David J. Berkoff; Blake R. Boggess; Molly Gavigan; Paul C. Malley; Alison P. Toth



Rotator cuff tendinopathy: a model for the continuum of pathology and related management  

Microsoft Academic Search

BackgroundPathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are extremely common and are a principal cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the

Jeremy S Lewis



Rotator cuff repair with bioabsorbable screws: An in vivo and ex vivo investigation  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate in vivo the clinical outcomes of rotator cuff repairs with bioabsorbable screws compared with metal suture anchors, and to compare the ex vivo initial load to failure of rotator cuff repairs using 3 different bioabsorbable screws, suture anchors, and transosseous sutures. Type of Study: In vivo clinical outcomes investigation, and ex

Craig A. Cummins; Sabrina Strickland; Richard C. Appleyard; Zoltan L. Szomor; Jeanette Marshall; George A. C. Murrell



Cyclic loading of transosseous rotator cuff repairs: Tension overload as a possible cause of failure  

Microsoft Academic Search

Previous experimental studies of failure of rotator cuff repair have involved a single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 cm × 2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with transosseous simple sutures, and cyclically loaded the repairs by a servohydraulic

Stephen S. Burkhart; Todd C. Johnson; Michael A. Wirth; Kyriacos A. Athanasiou



Association of Sonographically Detected Subacromial\\/Subdeltoid Bursal Effusion and Intraarticular Fluid with Rotator Cuff Tear  

Microsoft Academic Search

OBJECTIVE. Although an association between sonographically detected joint fluid and rotator cuff disease has been reported, the significance of sonographically detected subacromial\\/subdeitold bursal effusion has not been studied. We examined a group of patients who had shoulder sonography and surgery to determine the associa- tion between bursal and joint effusion and surgically proved tears of the rotator cuff. MATERIALS AND

Mary S. Hollister; Laurence A. Mack; Randall M. Patten; Thomas C. Winter; Fredrick A. Matsen; Ryan A. Veith


The Outcome and Repair Integrity of Completely Arthroscopically Repaired Large and Massive Rotator Cuff Tears  

Microsoft Academic Search

Background: The impact of a recurrent defect on the outcome after rotator cuff repair has been controversial. The purpose of this study was to evaluate the functional and anatomic results after arthroscopic repair of large and mas- sive rotator cuff tears with use of ultrasound as an imaging modality to determine the postoperative integrity of the repair. Methods: Eighteen patients



The coracoacromial ligament: anatomical and biomechanical properties with respect to age and rotator cuff disease  

Microsoft Academic Search

The coracoacromial ligament (CAL) plays an important role in the pathoetiology of the subacromial impingement syndrome especially in those patients who do not have bony abnormalities. A total of 40 shoulders were dissected to determine the anatomical and biomechanical properties of the CAL in shoulders with either intact rotator cuffs or rotator cuff disease, taken from cadavers of persons who

R. Fremerey; L. Bastian; W. E. Siebert



Age-related prevalence of rotator cuff tears in asymptomatic shoulders  

Microsoft Academic Search

To determine the prevalence of rotator cuff tears in asymptomatic shoulders we conducted a prospective clinical and ultrasonographic study of 411 volunteers. We anticipated an age-dependent outcome and divided the patients into 4 age-groups. Overall, we found evidence of a rotator cuff tear in 23% of the patients. In group 1 (aged 50 to 59 years), 13% (22 of 167)

Siegbert Tempelhof; Stefan Rupp; Romain Seil



Design of an Adaptive Interference Reduction System for Nerve-Cuff Electrode Recording  

Microsoft Academic Search

This paper describes the design of an adaptive control system for recording neural signals from tripolar cuff electrodes. The control system is based on an adaptive version of the true-tripole amplifier configuration and was developed to compensate for possible errors in the cuff electrode balance by continuously adjusting the gains of the two differential amplifiers. Thus, in the presence of

Andreas Demosthenous; I. f. Triantis; R. Rieger; N. Donaldson



Selective control of muscle activation with a multipolar nerve cuff electrode  

Microsoft Academic Search

Acute experiments were performed on adult cats to study selective activation of medial gastrocnemius, soleus, tibialis anterior, and extensor digitorium longus with a cuff electrode. A spiral nerve cuff containing twelve dot electrodes was implanted around the sciatic nerve, and evoked muscle twitch forces were recorded in six experiments. Spatially isolated dot electrodes in four geometries (monopolar, longitudinal tripolar, tripolar

C. Veraart; W. M. Grill; J. T. Mortimer



Fascicular Selectivity in Transverse Stimulation with a Nerve Cuff Electrode: A Theoretical Approach  

Microsoft Academic Search

The performance of cathode-anode configurations in a cuff electrode to stimulate a single fascicle in a nerve trunk has been investigated theoretically. A three-dimensional volume conductor model of a nerve trunk with four fascicles in a cuff electrode and a model of myelinated nerve fiber stimulation were used to calculate the recruitment of 15 m fibers in each fascicle. The

Kirsten E. I. Deurloo; Jan Holsheimer; Piet Bergveld



Stability of the input-output properties of chronically implanted multiple contact nerve cuff stimulating electrodes  

Microsoft Academic Search

The objective of this investigation was to measure the input-output (EO) properties of chronically implanted nerve cuff electrodes. Silicone rubber spiral nerve cuff electrodes, containing 12 individual platinum electrode contacts, were implanted on the sciatic nerve of 7 adult cats for 28-34 weeks. Measurements of the torque generated at the ankle joint by electrical stimulation of the sciatic nerve were

Warren M. Grill; J. Thomas Mortimer



A simple cuff electrode for nerve recording and stimulation in acute experiments on small animals  

Microsoft Academic Search

We describe a cuff-type electrode specifically designed for recording from, and electrical stimulation of, cut nerves in acute experiments on small animals. Unlike existing designs of cuff electrodes, it is simple to manufacture, inexpensive and takes little time to implant. The electrode was tested on the hypoglossal, phrenic, recurrent laryngeal, and superior laryngeal nerves in anesthetized rats. It provides satisfactory

Victor Fenik; Polina Fenik; Leszek Kubin



Reducing stiffness and electrical losses of high channel hybrid nerve cuff electrodes  

Microsoft Academic Search

For restoration of grasp in disabled people by means of functional electrical stimulation of peripheral nerves, 18 polar Hybrid Cuff Electrodes were developed. These electrodes consisted of a micromachined polyimide-based thin-film structure with integrated electrode contacts and interconnection lines which was glued to a silicone cuff. Interconnection lines were made of only 300 nm of sputtered gold, which led to

M. Schuettler; T. Stieglitz; M. Gross; D. Altpeter; A. Staiger; T. Doerge; F. Katzenberg



MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture  

Microsoft Academic Search

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of

J. M. Mellado; J. Calmet; M. Olona; J. Ballabriga; A. Camins; L. Pérez del Palomar; J. Giné



From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts  

Microsoft Academic Search

High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of

M. J. C. M. Rutten; G. J. Jager; J. G. Blickman



Stimulation Stability and Selectivity of Chronically Implanted Multicontact Nerve Cuff Electrodes in the Human Upper Extremity  

Microsoft Academic Search

Nine spiral nerve cuff electrodes were implanted in two human subjects for up to three years with no adverse functional effects. The objective of this study was to look at the long term nerve and muscle response to stimulation through nerve cuff electrodes. The nerve conduction velocity remained within the clinically accepted range for the entire testing period. The stimulation

Katharine H. Polasek; Harry A. Hoyen; Michael W. Keith; Robert F. Kirsch; Dustin J. Tyler



Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair  

PubMed Central

Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate interpretation of the results. However, we hypothesized the indications for surgery are poorly described in outcome studies of rotator cuff surgery. We undertook a detailed literature review over 11 years of six major orthopaedic journals to assess whether the indications for surgery were described adequately in studies of rotator cuff repair. Eighty-six papers fit the criteria for the study and were reviewed. Limitations of activities of daily living (31%), failure of nonoperative treatment (52%), duration of nonoperative treatment (26%), and history of nocturnal pain (16%) were reported in a minority of papers overall. The patients’ characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Koulouvaris, Panagiotis; Chu, Samuel K.; Levy, Bruce A.



Preterm Singleton Breech in North Jordan: Vaginal versus Abdominal Delivery  

Microsoft Academic Search

The safety of vaginal birth for singleton preterm breech has not often been addressed before. We retrospectively compared the perinatal outcome of two groups of preterm breech delivery. Sixty-six patients delivered vaginally and 32 delivered abdominally between 26 and 36 completed weeks. Vaginal delivery was allowed under the same protocol for singleton breech delivery at term. Both groups had similar

Saeed Ziadeh; Adel T. Abu-Heija; Ellias El-Sunna; Mohammad F. El-Jallad; Ahmad Shatnawi; A. Obeidat



Bacterial vaginosis and vaginal fluid defensins during pregnancy  

Microsoft Academic Search

Objective: The purpose of this study was to examine the association between Gram stain findings of vaginal fluid and the concentration of vaginal fluid neutrophil defensins. Study Design: Vaginal fluid specimens obtained from 749 women at 24 to 29 weeks of gestation were tested for bacterial vaginosis and assayed for neutrophil defensins. Bacterial vaginosis was studied as a categoric variable

Rukmini B. Balu; David A. Savitz; Cande V. Ananth; Katherine E. Hartmann; William C. Miller; John M. Thorp; R. Phillips Heine



The current state of intraoperative interstitial brachytherapy in lung cancer.  


Low dose-rate intraoperative brachytherapy allows for a more precise tumor localization of the delivered radiation and its easier adaptation to the tumor shape than it is possible with external radiation. As a result a higher dose is usually delivered to the tumor volume and the damage to the normal lung is less. In an attempt to determine the value of lung brachytherapy we provide in this article a complete review of the evolution of brachytherapy in lung cancer at Memorial Sloan-Kettering Cancer Center, an experience which exceeds 1,000 patients. The use of encapsulated sources of I-125, greatly reduced radiation outside the treatment volume and simplified medical and nursing staff radiation protection. Lung brachytherapy in combination with surgery and postoperative external radiation, improved local tumor control in advanced tumors (from 63% to 76%) with no increase in late pulmonary morbidity, but only a modest survival advantage. The results of brachytherapy in patients with early lung cancer who had limited pulmonary reserve, suggest that intraoperative brachytherapy is an effective alternative treatment option. The limited experience with interstitial brachytherapy under fluoroscopic and CT guidance is encouraging, but needs more investigation. PMID:2848787

Hilaris, B S; Martini, N



The role of platelet-rich plasma in rotator cuff repair.  


The shoulder is a common source of disability resulting from traumatic and degenerate tears of the rotator cuff, subacromial impingement, and osteoarthritis. Nonoperative management has focused on treatment of the predisposing factors, the use of analgesics and anti-inflammatory medication usually in association with local anesthetic and steroid injections. Surgical intervention allows debridement of the degenerate cuff and partial thickness cuff tears, subacromial bursitis, impinging bone spurs and osteophytes together with rotator cuff repairs. Repairs of degenerate and torn tissue are often prone to failure due to many intrinsic and extrinsic factors. It is assumed that some biological therapies might improve clinical, mechanical, and histologic outcomes. Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears. PMID:21822108

Mei-Dan, Omer; Carmont, Michael R



[Contribution of MRI to the preoperative evaluation of rotator cuff tears].  


The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was completed with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning. PMID:1812516

Gagey, N; Desmoineaux, P; Gagey, O; Idy-Peretti, I; Mazas, F



[MRI in the pre-operative evaluation of lesions of the rotator cuff].  


The authors report a series of 38 patients who had been examined by MRI and then operated for a rotator cuff syndrome. The correlation between the description of the cuff lesions after MRI and the surgical observations were excellent for 37 patients. In one case MRI showed a false image of tear of the supra spinatus m. on its anterior edge. This was due to a bad knowledge of the anatomy of the muscle and tendon and to a poor orientation of the frontal cut plane. This study was complete with MRI and anatomic study of 12 non embalmed cadaveric shoulders. The results showed that MRI was very sensitive (0.93) and specific (0.94) for the diagnosis of rotator cuff tears. MRI allowed also to show partial tears of the tendons of the rotator cuff. The authors propose a MRI classification of cuff lesions which permits to establish a good surgical planning. PMID:8483150

Gagey, N; Desmoineaux, P; Gagey, O; Idy-Peretti, I; Mazas, F



A Novel MRI Marker for Prostate Brachytherapy  

SciTech Connect

Purpose: Magnetic resonance imaging (MRI) is the optimal imaging modality for the prostate and surrounding critical organ structures. However, on MRI, the titanium radioactive seeds used for brachytherapy appear as black holes (negative contrast) and cannot be accurately localized. We sought to develop an encapsulated contrast agent marker (ECAM) with high-signal intensity on MRI to permit accurate localization of radioactive seeds with MRI during and after prostate brachytherapy. Methods and Materials: We investigated several agents with paramagnetic and superparamagnetic properties. The agents were injected into titanium, acrylic, and glass seeds, which were linked together in various combinations and imaged with MRI. The agent with the greatest T1-weighted signal was tested further in a canine prostate and agarose phantom. Studies were performed on a 1.5-T clinical MRI scanner. Results: The cobalt-chloride complex contrast (C4) agent with stoichiometry (CoCl{sub 2}){sub 0.8}(C{sub 2}H{sub 5}NO{sub 2}){sub 0.2} had the greatest T1-weighted signal (positive contrast) with a relaxivity ratio >1 (r{sub 2}/r{sub 1} = 1.21 {+-} 0.29). Acrylic-titanium and glass-titanium seed strands were clearly visualized with the encapsulated contrast agent marker. Conclusion: We have developed a novel ECAM that permits positive identification of the radioactive seeds used for prostate brachytherapy on MRI. Preclinical in vitro phantom studies and in vivo canine studies are needed to further optimize MRI sequencing techniques to facilitate MRI-based dosimetry.

Frank, Steven J. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)], E-mail:; Stafford, R. Jason; Bankson, James A. [Department of Imaging Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Li Chun [Department of Experimental Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Swanson, David A. [Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Kudchadker, Rajat J. [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Martirosyan, Karen S. [Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX (United States)



Neovascularization Prevalence in the Supraspinatus of Patients With Rotator Cuff Tendinopathy.  


OBJECTIVE:: A high prevalence of neovascularity in lower extremity tendinopathies has been reported. Neovascularity in those with rotator cuff tendinopathy exclusively has not been examined. The objective was to determine the prevalence of neovascularization in patients with rotator cuff tendinopathy compared with asymptomatic controls. DESIGN:: Single-blind cross-sectional study. SETTING:: Research laboratory. PARTICIPANTS:: Participants (n = 40; age = 44.9 years, 23-62 years; 20 females) with rotator cuff tendinopathy (n = 20) but without full-thickness rotator cuff tears, and asymptomatic controls that were age, gender, and hand dominance matched (n = 20) to the patients. INTERVENTIONS:: The participants laying in supine had their shoulder positioned in internal rotation and extension. Ultrasound images were collected of the supraspinatus tendon and subacromial bursae in the transverse and longitudinal planes using a linear transducer in color Doppler mode. MAIN OUTCOME MEASURES:: Images were assessed for neovascularization by 2 trained raters who were blinded to group (rotator cuff tendinopathy or asymptomatic group). RESULTS:: No statistically significant difference in neovascularization was identified between participants with and without rotator cuff tendinopathy (? = 0.13, df = 1, P = 0.72). Neovascularization was identified in 6 of 20 patients with rotator cuff tendinopathy (30%) and 5 of 20 asymptomatic control participants (25%). CONCLUSIONS:: The authors found no differences in neovascularization rate in patients with rotator cuff tendinopathy (30%) and asymptomatic controls (25%). The study indicates that neovascularization is not related to presence of symptomatic tendinopathy in those with rotator cuff tendinopathy. Neovascularization may not be a relevant sonographic finding to aid the clinical assessment of those with rotator cuff tendinopathy. PMID:23732364

Kardouni, Joseph R; Seitz, Amee L; Walsworth, Matthew K; Michener, Lori A



Interstitial brachytherapy using virtual planning and Doppler transrectal ultrasonography guidance for internal iliac lymph node metastasis.  


To expand the indications for high-dose-rate interstitial brachytherapy (HDR-ISBT) for deep-seated pelvic tumors, we investigated the usefulness of Doppler transrectal ultrasonography (TRUS) guidance and virtual planning. The patient was a 36-year-old female. She had right internal iliac lymph node oligometastasis of vaginal cancer 12 months after radical radiotherapy. The tumor could not be found by gray-scale TRUS and physical examination. Virtual planning was performed using computed tomography with template and vaginal cylinder insertion. We uploaded the images to our treatment planning software and reconstructed the contours of the clinical target volume (CTV) and right internal iliac vessel. Virtual needle applicators were plotted using the template holes for virtual planning. At the time of implantation, Doppler TRUS was used to prevent vessel injury by needle applicators. Applicators were implanted in accordance with virtual planning and Doppler TRUS could detect the right iliac vessel. The percentage of CTV covered by the prescribed dose was 99.8%. The minimum dose received by the maximally irradiated 0.1-cc volume for the right internal iliac vessel was 95% prescribed dose. Complete response was achieved, however, radiological findings showed marginal recurrence at 15 months after HDR-ISBT. Post-radiation neuropathy occurred as a late complication four months after treatment; however, the pain was well controlled by medication. We consider that virtual planning and Doppler TRUS are effective methods in cases where it is difficult to detect the tumor by physical examination and gray-scale TRUS, thereby expanding the indications for ISBT. PMID:22240939

Yoshida, Ken; Ueda, Mari; Yamazaki, Hideya; Takenaka, Tadashi; Yoshida, Mineo; Miyake, Shunsuke; Yoshida, Susumu; Koizumi, Masahiko; Ban, Chiaki; Tanaka, Eiichi



Protocols for vaginal inoculation and sample collection in the experimental mouse model of Candida vaginitis.  


Vulvovaginal candidiasis (VVC), caused by Candida species, is a fungal infection of the lower female genital tract that affects approximately 75% of otherwise healthy women during their reproductive years. Predisposing factors include antibiotic usage, uncontrolled diabetes and disturbance in reproductive hormone levels due to pregnancy, oral contraceptives or hormone replacement therapies. Recurrent VVC (RVVC), defined as three or more episodes per year, affects a separate 5 to 8% of women with no predisposing factors. An experimental mouse model of VVC has been established and used to study the pathogenesis and mucosal host response to Candida. This model has also been employed to test potential antifungal therapies in vivo. The model requires that the animals be maintained in a state of pseudoestrus for optimal Candida colonization/infection. Under such conditions, inoculated animals will have detectable vaginal fungal burden for weeks to months. Past studies show an extremely high parallel between the animal model and human infection relative to immunological and physiological properties. Differences, however, include a lack of Candida as normal vaginal flora and a neutral vaginal pH in the mice. Here, we demonstrate a series of key methods in the mouse vaginitis model that include vaginal inoculation, rapid collection of vaginal specimens, assessment of vaginal fungal burden, and tissue preparations for cellular extraction/isolation. This is followed by representative results for constituents of vaginal lavage fluid, fungal burden, and draining lymph node leukocyte yields. With the use of anesthetics, lavage samples can be collected at multiple time points on the same mice for longitudinal evaluation of infection/colonization. Furthermore, this model requires no immunosuppressive agents to initiate infection, allowing immunological studies under defined host conditions. Finally, the model and each technique introduced here could potentially give rise to use of the methodologies to examine other infectious diseases of the lower female genital tract (bacterial, parasitic, viral) and respective local or systemic host defenses. PMID:22215135

Yano, Junko; Fidel, Paul L



Vaginal epithelial surface appearances in women using vaginal rings for contraception  

Microsoft Academic Search

Vaginal inspections using colposcopy before insertion of contraceptive vaginal rings and at 2-month intervals during ring use were conducted on 169 users of four different formulations. The rings studied released Nestorone® alone (50, 75, 100 ?g daily over 6 months); ethinyl estradiol: Nestorone (30:100 and 15:150 ?g daily over 6 months); ethinylestradiol:norethindrone acetate (20:1000 and 15:1000 ?g daily over 4

Ian S Fraser; Maria Lacarra; Daniel R Mishell Jr; Francisco Alvarez; Vivian Brache; Pekka Lähteenmäki; Kaisa Elomaa; Edith Weisberg; Harold A Nash



Liposomal gels for vaginal drug delivery.  


The aim of our study was to develop a liposomal drug carrier system, able to provide sustained and controlled release of appropriate drug for local vaginal therapy. To optimise the preparation of liposomes with regards to size and entrapment efficiency, liposomes containing calcein were prepared by five different methods. Two optimal liposomal preparations (proliposomes and polyol dilution liposomes) were tested for their in vitro stability in media that simulate human vaginal conditions (buffer, pH 4.5). To be closer to in vivo application of liposomes and to achieve further improvement of their stability, liposomes were incorporated in vehicles suitable for vaginal self-administration. Gels of polyacrylate were chosen as vehicles for liposomal preparations. Due to their hydrophilic nature and bioadhesive properties, it was possible to achieve an adequate pH value corresponding to physiological conditions as well as desirable viscosity. In vitro release studies of liposomes incorporated in these gels (Carbopol 974P NF or Carbopol 980 NF) confirmed their applicability as a novel drug carrier system in vaginal delivery. Regardless of the gel used, even 24 h after the incubation of liposomal gel in the buffer pH 4.5 more than 80% of the originally entrapped substance was still retained. PMID:11337174

Paveli?, Z; Skalko-Basnet, N; Schubert, R



Adhesion of Tritrichomonas foetus to Bovine Vaginal  

Microsoft Academic Search

An in vitro culture system of bovine vaginal epithelial cells (BVECs) was developed to study the cytopatho- genic effects of Tritrichomonas foetus and the role of lipophosphoglycan (LPG)-like cell surface glycoconjugates in adhesion of parasites to host cells. Exposure of BVEC monolayers to T. foetus resulted in extensive damage of monolayers. Host cell disruption was measured quantitatively by a trypan

Epithelial Cells; B. N. SINGH; J. J. LUCAS; D. H. BEACH; S. T. SHIN; R. O. GILBERT



Anterior vaginal wall repair using local anaesthesia  

Microsoft Academic Search

Background: The purpose of the present study was to describe the possibility of surgical repair of anterior vaginal prolapse including amputation of the cervix using local anaesthesia. The description was made according to postoperative complication, recurrence rate, influence on urinary incontinence, and satisfaction of the patient. Material and methods: Eighty-three women were consecutively operated in the anterior wall of the

Susanne Maigaard Axelsen; Karl Møller Bek



[Vaginal polyp in an infant girl].  


A case of vaginal polyp in an infant girl was presented. The tumor was polypoid shape and yellow so that it resembled sarcoma botryoides. Histopathological findings showed hamartomatous appearance with hemangiomatous portions in the stroma. For 5 years after simple resection, she has been well without recurrence. PMID:3425530

Takahashi, G



Vaginal Lacerations from Consensual Intercourse in Adolescents  

ERIC Educational Resources Information Center

|Objective: (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.…

Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W.



Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?  

PubMed Central

Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

Yamaguchi, Hiroshi; Suenaga, Naoki; Oizumi, Naomi; Hosokawa, Yoshihiro; Kanaya, Fuminori



Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview  

PubMed Central

It is now over a decade since the features defining a contractile dysfunction of the shoulder were first reported. Since this time, some progress has been made to better understand this mechanical syndrome. In response to these developments, this narrative review will explore current understanding in relation to pathology, diagnosis, treatment, and prognosis of this syndrome with reference to literature specifically relating to contractile dysfunction but also literature relating to rotator cuff tendinopathy where necessary. The review not only identifies the strengths of the mechanical diagnosis and therapy approach with reference to a contractile dysfunction of the shoulder but also identifies where further progress needs to be made.

Littlewood, Chris



Tracheal ulcers due to endotracheal tube cuff pressure.  


Tracheal injury is a well-known complication of endotracheal intubation. We present a case of a 73-year-old man who underwent craniotomy because of parenchymal hemorrhage involving the left hemisphere. After the surgical procedure, he was admitted to the intensive care unit. Bronchoscopy-guided percutaneous dilational tracheostomy was performed on day 8 of mechanical ventilation. During the procedure, tracheal ulcers were found affecting the anterior tracheal wall. The site of the lesions corresponded to the site where the endotracheal tube cuff was placed previously. PMID:23208578

Alvarez-Maldonado, Pablo; Vidal, Erick; Cerón-Díaz, Ulises



Pulmonary Embolism after Arthroscopic Rotator Cuff Repair: A Case Report  

PubMed Central

Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively.

Yamamoto, Tadashi; Tamai, Kazuya; Akutsu, Miwa; Tomizawa, Kazuo; Sukegawa, Takuya; Nohara, Yutaka



Epidemiology, natural history, and indications for treatment of rotator cuff tears.  


The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma and macrotrauma. The incidence of rotator cuff tears increases with aging with more than half of individuals in their 80s having a rotator cuff tear. Smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing. Substantial full-thickness rotator cuff tears, in general, progress and enlarge with time. Pain, or worsening pain, usually signals tear progression in both asymptomatic and symptomatic tears and should warrant further investigation if the tear is treated conservatively. Larger (>1-1.5 cm) symptomatic full-thickness cuff tears have a high rate of tear progression and, therefore, should be considered for earlier surgical repair in younger patients if the tear is reparable and there is limited muscle degeneration to avoid irreversible changes to the cuff, including tear enlargement and degenerative muscle changes. Smaller symptomatic full-thickness tears have been shown to have a slower rate of progression, similar to partial-thickness tears, and can be considered for initial nonoperative treatment due to the limited risk for rapid tear progression. In both small full-thickness tears and partial-thickness tears, increasing pain should alert physicians to obtain further imaging as it can signal tear progression. Natural history data, along with information on factors affecting healing after rotator cuff repair, can help guide surgeons in making appropriate decisions regarding the treatment of rotator cuff tears. The management of rotator cuff tears should be considered in the context of the risks and benefits of operative versus nonoperative treatment. Tear size and acuity, the presence of irreparable changes to the rotator cuff or glenohumeral joint, and patient age should all be considered in making this decision. Initial nonoperative care can be safely undertaken in older patients (>70 years old) with chronic tears; in patients with irreparable rotator cuff tears with irreversible changes, including significant atrophy and fatty infiltration, humeral head migration, and arthritis; in patients of any age with small (<1 cm) full-thickness tears; or in patients without a full-thickness tear. Early surgical treatment can be considered in significant (>1 cm-1.5 cm) acute tears or young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes. PMID:23040548

Tashjian, Robert Z



`Normal' vaginal microbiology of women of childbearing age in relation to the use of oral contraceptives and vaginal tampons  

PubMed Central

The vaginal microbiology of women attending a family planning clinic was found to be unrelated to the use of oral contraceptives and vaginal tampons. Beta haemolytic streptococci isolated from this `normal' population were compared with those from 1,104 women attending general practitioners complaining of vaginal discharge. There is a caution regarding the indications for antibiotic therapy. Observations were made on the effects of contamination of vaginal swabs with yeasts and ?-haemolytic streptococci from the vulva. The persistent character of the vaginal flora over a six-month period is described.

Morris, C. A.; Morris, Delia F.



Benign vaginal polyp: a histological, histochemical and immunohistochemical study of 20 polyps with comparison to normal vaginal subepithelial layer.  


Twenty benign vaginal polyps from 18 patients, together with sections from normal vaginal epithelium, were studied histologically, histochemically using elastic van Gieson stain and immunohistochemically using monoclonal antibodies against vimentin, desmin and actin. The striking finding was the similarity, both histologically and immunohistochemically, of the stroma of vaginal polyps to that of the loose subepithelial layer found in normal vagina. The important difference was the marked degeneration of the elastic tissue, increased number of stellate and giant fibroblasts and subepithelial condensation of fibroblasts in the polyps. These findings support the hypothesis that vaginal polyps may represent a reactive hyperplasia of the loose subepithelial zone of the vaginal wall. PMID:1302457

al-Nafussi, A I; Rebello, G; Hughes, D; Blessing, K



Improving photoacoustic imaging contrast of brachytherapy seeds  

NASA Astrophysics Data System (ADS)

Prostate brachytherapy is a form of radiotherapy for treating prostate cancer where the radiation sources are seeds inserted into the prostate. Accurate localization of seeds during prostate brachytherapy is essential to the success of intraoperative treatment planning. The current standard modality used in intraoperative seeds localization is transrectal ultrasound. Transrectal ultrasound, however, suffers in image quality due to several factors such speckle, shadowing, and off-axis seed orientation. Photoacoustic imaging, based on the photoacoustic phenomenon, is an emerging imaging modality. The contrast generating mechanism in photoacoustic imaging is optical absorption that is fundamentally different from conventional B-mode ultrasound which depicts changes in acoustic impedance. A photoacoustic imaging system is developed using a commercial ultrasound system. To improve imaging contrast and depth penetration, absorption enhancing coating is applied to the seeds. In comparison to bare seeds, approximately 18.5 dB increase in signal-to-noise ratio as well as a doubling of imaging depth are achieved. Our results demonstrate that the coating of the seeds can further improve the discernibility of the seeds.

Pan, Leo; Baghani, Ali; Rohling, Robert; Abolmaesumi, Purang; Salcudean, Septimiu; Tang, Shuo



Effect on vaginal pH of a polycarbophil vaginal gel compared with an acidic douche in women with suspected bacterial vaginosis: a randomized, controlled study  

Microsoft Academic Search

Background: Vaginal pH is a key factor in maintaining a healthy vaginal ecosystem. An increase in vaginal pH is commonly observed during bacterial vaginosis.Objective: This study was undertaken to compare the effects of polycarbophil, a new bioadhesive polymer in gel form, with those of an acidic vaginal douche on restoration of physiologic vaginal pH in women with a vaginal pH

Massimo Milani; Bruno Molteni; Ilaria Silvani



Contemporary brachytherapy approaches in non-small-cell lung cancer.  


Brachytherapy has the ability to deliver a higher tumor dose compared to external beam irradiation, while sparing normal tissue outside the tumor; it is the most effective means of delivering conformal radiation and can be tailored to clinical circumstances, either at open surgery or in an ambulatory setting, which is currently the preferred method. Intraoperative lung and/or endobronchial brachytherapy in the management of non-small-cell lung cancer offers a good curative potential in patients with accessible localized tumors, well defined and small to moderate in size, that have not metastasized to the lymph nodes and are technically or medically inoperable. Effective palliation can be frequently obtained by endobronchial brachytherapy on an outpatient procedure basis. Brachytherapy administered simultaneously with chemotherapy is better tolerated than a course of external beam irradiation and chemotherapy. PMID:9881944

Hilaris, B S; Mastoras, D A



Dose Determination in Breast Tumor in Brachytherapy Using Iridium-192.  

National Technical Information Service (NTIS)

Thermoluminescent dosimetry studies in vivo and in vitro aiming to determing radiation dose in the breast tumor, in brachytherapy using Iridium-192 was done. The correlation between radiation doses in tumor and external surface of the breast was investiga...

S. F. Okuno



21 CFR 892.5730 - Radionuclide brachytherapy source.  

Code of Federal Regulations, 2013 CFR

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5730 Radionuclide brachytherapy source. (a) Identification. A...



Coregistered photoacoustic-ultrasound imaging applied to brachytherapy  

NASA Astrophysics Data System (ADS)

Brachytherapy is a form of radiation therapy commonly used in the treatment of prostate cancer wherein sustained radiation doses can be precisely targeted to the tumor area by the implantation of small radioactive seeds around the treatment area. Ultrasound is a popular imaging mode for seed implantation, but the seeds are difficult to distinguish from the tissue structure. In this work, we demonstrate the feasibility of photoacoustic imaging for identifying brachytherapy seeds in a tissue phantom, comparing the received intensity to endogenous contrast. We have found that photoacoustic imaging at 1064 nm can identify brachytherapy seeds uniquely at laser penetration depths of 5 cm in biological tissue at the ANSI limit for human exposure with a contrast-to-noise ratio of 26.5 dB. Our realtime combined photoacoustic-ultrasound imaging approach may be suitable for brachytherapy seed placement and post-placement verification, potentially allowing for realtime dosimetry assessment during implantation.

Harrison, Tyler; Zemp, Roger J.



Interrater reproducibility of clinical tests for rotator cuff lesions  

PubMed Central

Background: Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use. Objective: To study interrater reproducibility of standard tests for shoulder evaluation among a rheumatology specialist, rheumatology trainee, and research nurse. Methods: 136 patients were reviewed over 12 months at a major teaching hospital. The three assessors examined each patient in random order and were unaware of each other's evaluation. Each shoulder was examined in a standard manner by recognised tests for specific lesions and a diagnostic algorithm was used. Between-observer agreement was determined by calculating Cohen's ? coefficients (measuring agreement beyond that expected by chance). Results: Fair to substantial agreement was obtained for the observations of tenderness, painful arc, and external rotation. Tests for supraspinatus and subscapularis also showed at least fair agreement between observers. 40/55 (73%) ? coefficient assessments were rated at >0.2, indicating at least fair concordance between observers; 21/55 (38%) were rated at >0.4, indicating at least moderate concordance between observers. Conclusion: The reproducibility of certain tests, employed by observers of varying experience, in the assessment of the rotator cuff and general shoulder disease was determined. This has implications for delegation of shoulder assessment to nurse specialists, the development of a simplified evaluation schedule for general practitioners, and uniformity in epidemiological research studies.

Ostor, A; Richards, C; Prevost, A; Hazleman, B; Speed, C



Surgical treatment of tears of the rotator cuff in athletes.  


Forty-five athletes with either a partial or a complete tear of the rotator cuff were treated with anterior acromioplasty and repair of the tear. The minimum duration of follow-up was twenty-four months (average, forty-two months). Thirty patients had an incomplete tear and fifteen had a complete tear. Postoperatively, thirty-nine (87 per cent) of the patients stated that they were improved compared with their preoperative status, although only thirty-four patients (76 per cent) felt that they had a significant reduction of pain postoperatively. Objectively, twenty-five (56 per cent) of the patients were rated as having a good result, which allowed them to return to their former competitive level without significant pain. Twelve (41 per cent) of the twenty-nine athletes who had been involved in pitching and throwing returned to their former competitive status. Seven (32 per cent) of the twenty-two pitchers and throwers who had been active at a professional or collegiate level returned to the same competitive level. In our experience, a repair of the rotator cuff combined with an acromioplasty in a young athletic population provides satisfactory relief of pain but does not guarantee that the patient will be able to return to his or her former competitive status in all sports. PMID:3733777

Tibone, J E; Elrod, B; Jobe, F W; Kerlan, R K; Carter, V S; Shields, C L; Lombardo, S J; Yocum, L



Rotator cuff injuries in baseball. Prevention and rehabilitation.  


Rotator cuff and ligamentous capsule injuries are common in the young baseball player. In order to understand these injuries, it is important to first appreciate the delicate balance between shoulder mobility and stability as well as the biomechanics of throwing. This background information makes it easy to see how shoulder injuries are really part of a progressive continuum beginning with instability leading to subluxation, and later impingement which can result in a rotator cuff tear. A detailed and precise history and physical is crucial in determining where a patient might be on the continuum. An accurate evaluation will also help appropriately place a patient in one of the following 4 groups: pure impingement, anterior instability due to trauma with secondary impingement, anterior stability due to a hyperelasticity with secondary impingement, and pure anterior instability. A kinesiological repair is the initial treatment of choice. It is the best preventative or early treatment available, and consists of a specific strengthening programme. If this fails (as in only 5 to 10% of the cases), an anatomical repair is instituted. There are 4 basic guidelines when doing this surgery: (a) maintain muscle attachments and proprioceptive fibres; (b) do not shorten the capsule significantly; (c) build up the anterior labrum; and (d) regain full range of motion quickly through abduction splinting and rehabilitation. A postoperative rehabilitation programme is then diligently adhered to, as it is at least as important as the surgery itself. PMID:3231953

Jobe, F W; Bradley, J P



Calcific Tendinitis of the Rotator Cuff: A Review  

PubMed Central

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences.

Kachewar, Sushil G; Kulkarni, Devidas S



Effect of rotator cuff pathology on shoulder rhythm.  


The purpose of this study was to test the hypothesis that shoulder rhythm is affected by rotator cuff pathology during arm elevation. We divided 42 subjects into 3 groups: those with full-thickness rotator cuff tears (RCTs) (n = 14), those with tendinopathy (n = 13), and control subjects (n = 15). Shoulder kinematics was recorded while subjects performed elevation in the sagittal and scapular planes. Euler angles were computed for scapular and humeral elevation. Data were divided into 3 equal phases. Lines were fit and the slope determined for each phase. Significant differences in slopes ( P < .05) were found between experimental groups for both motions. The RCT group had higher slopes in the initial and middle phases for sagittal elevation and in the middle phase for scapular abduction. The scapula was elevated more in the RCT group in the initial two thirds of movement. This motion may change the length of remaining muscles so that they operate on a more effective part of their length-tension curve. PMID:15726088

Mell, Amy G; LaScalza, Suzanne; Guffey, Patrick; Ray, Jennifer; Maciejewski, Mike; Carpenter, James E; Hughes, Richard E


Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy.  


Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24-48 months), and the average age was 71 years (range, 57-84 years). Of these 14 patients, 9 were men and 5 women. None of these patients had undergone previous shoulder surgery, and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Preoperatively, the average active forward flexion was 30 degrees, active external rotation was 10 degrees, and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperatively, the average active forward flexion improved to 88 degrees, active external rotation increased to 37 degrees, and the ASES score improved to 80 points. Of the 14 patients, 12 stated that they had no pain with activities of daily living. Two patients continued to have moderate pain in everyday activity. PMID:12629606

Sarris, Ioannis K; Papadimitriou, Nicholas G; Sotereanos, Dean G



Calcific tendinitis of the rotator cuff: a review.  


Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non - operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non - steroidal anti - inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non - operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short - wave, and radiation therapy. Rest, immobilization with a sling, and oral non - steroidal and steroid anti - inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102

Kachewar, Sushil G; Kulkarni, Devidas S



Robotic-Assisted Laparoscopic Nephroureterectomy and Bladder Cuff Excision  

PubMed Central

Background and Objectives: Our aim was to show that bladder cuff excision and distal ureterectomy can be safely performed by using the LigaSure device during robotic-assisted laparoscopic nephroureterectomy. Methods: A 60-year-old man presented with gross hematuria. He was diagnosed with upper urinary tract transitional cell carcinoma (TCC) on the left side and was scheduled for robot-assisted laparoscopic surgery. Without changing the patient's position, sealing with the LigaSure atlas for bladder cuff excision and distal ureterectomy was performed. Results: The operating time was 140 minutes from the initial incision to skin closure of all incisions. The estimated blood loss during the surgery was 120mL. There were no intraoperative or postoperative complications. The Foley drain was removed on day 3 after normal cystographic findings, and the patient was discharged from the hospital on the fourth postoperative day. Conclusion: Robot-assisted nephroureterectomy with distal ureterectomy in the same position using a LigaSure device is a safe alternative for upper tract transitional cell carcinoma.

Ozdemir, A. T.; Asil, E.; Balbay, M. D.



Arthroscopic technique for patch augmentation of rotator cuff repairs.  


The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears. PMID:17027416

Labbé, Marc R



HDR intraluminal brachytherapy in the treatment of malignant bronchial obstructions.  


Symptomatology of malignant intrabronchial obstructions has a serious negative effect on the quality of patients' life. Intrabronchial brachytherapy can play an important role in the palliation of these symptoms. Between December 1996 and September 1998 48 patients suffering from malignant intrabronchial obstructions were treated with intraluminal brachytherapy in the Dept. of Radiation Oncology at the University Maternity Hospital in Brno. Gammamed HDR automatical afterloading equipment was used to treat all patients. The first group (23 patients) was treated with a combination of intraluminal brachytherapy and external radiotherapy. The second group (18 patients who had relapsed after previous external radiotherapy) was given intraluminal radiotherapy only. A third group (7 patients) underwent intraluminal brachytherapy only. In the first group 17 patients (77%) showed symptomatic relief with tumor regression on X-ray in 16 patients and with bronchoscopic regression in 19 patients. Seven patients died before October 1998 having survived 1-6 months after the first brachytherapy application. Sixteen patients are still alive (1-14 months). In the second group, 10 patients (56%) reported significant improvement of symptoms, with endoscopic regression in 12 patients. Twelve patients died before October 1998 surviving 1-6 months after the first brachytherapy session, 6 patients are still alive 1-5 months after the first brachytherapy fraction. In the third group, bronchoscopy confirmed a complete disappearance of intrabronchial lesion in two cases with early intrabronchial tumor. Five patients reported symptomatic improvement with endoscopic regression of the tumor. There was only one complication recorded: bronchospasm in one patient. The short follow up and limited number of patients does not allow comment on the late effects and survival, yet. In conclusion, intraluminal brachytherapy is an effective and safe approach for palliation of malignant bronchial obstructions. PMID:10870688

Petera, J; Neumanová, R; Vrba, M; Coupek, P; Salajka, F; Hrazdírová, A; Kucera, M; Snízek, T; Kolman, P; Hanák, V



Blood pressure measurement in freely moving rats by the tail cuff method.  


Inconsistency in consecutive blood pressure values is one of the most frequently observed problems in tail cuff method. The aim of this study was to measure blood pressure using the tail cuff method in rats without heating, anesthesia, and movement restriction. In this study, it has been shown that blood pressure measurement could be obtained without problem using the tail cuff method in freely moving rats in their cage environment. Also, the reliability of consecutive blood pressure values obtained from freely moving rats was higher than ether anesthesia and restricted groups. PMID:22571543

Erken, Haydar Ali; Erken, Gülten; Genç, Osman



Enhanced Ultrasound Visualization of Brachytherapy Seeds by a Novel Magnetically Induced Motion Imaging Method.  

National Technical Information Service (NTIS)

We have devised a method called Magnetically Induced Motion Imaging (MIMI) for identifying brachytherapy seeds in ultrasound images. Ultrasound guided brachytherapy is a common treatment for prostate cancer. The overall goal of this project is the unambig...

S. McAleavey



[Radiotherapy of primary vaginal carcinoma and effects of histological and clinical factors on the prognosis].  


434 cases of primary vaginal carcinoma were treated from 1950 to 1984 at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna. The five-year survival rate for various clinical stages is as follows: Stage I 76.7%, stage II 44.5%, stage III 31%, stage IV 18.2%. In this retrospective study 110 patients seen from 1975 to 1984 were reviewed in detail and evaluated with a view toward their clinical and morphological aspects and survival rates. Patients up to the age of 60 have a five-year survival rate of 50%, those over 75 years of age reach only 34.3%. If the carcinoma was discovered in a routine check up the survival rate is 61.1%, whereas in cases with symptoms the rate decreases to 36.9%. Survival differences were also observed for patients with a carcinoma in the upper third of the vagina (61.1%) versus patients with a carcinoma in the lower third (33.3%); for patients with well-differentiated tumours (62.5%) versus patients with grades II and III (41.5% and 34.9%). It can be seen, that with brachytherapy local control of the carcinoma can be achieved with excellent results in early stages. Treatment of patients with more advanced carcinomas should include external beam therapy. The importance of gynecological screening especially for older women is emphasized. PMID:1992537

Vavra, N; Seifert, M; Kucera, H; Weghaupt, K



Calculated and measured brachytherapy dosimetry parameters in water for the Xoft Axxent X-Ray Source: An electronic brachytherapy source  

Microsoft Academic Search

A new x-ray source, the model S700 Axxent trade mark sign X-Ray Source (Source), has been developed by Xoft Inc. for electronic brachytherapy. Unlike brachytherapy sources containing radionuclides, this Source may be turned on and off at will and may be operated at variable currents and voltages to change the dose rate and penetration properties. The in-water dosimetry parameters for

Mark J. Rivard; Stephen D. Davis; Larry A. DeWerd; Thomas W. Rusch; Steve Axelrod



Association between atopy and recurrent vaginal candidiasis  

PubMed Central

To determine whether there is an association between atopy and recurrent vaginal candidiasis (RVC) and to evaluate the type-2 immune response in patients with RVC. Evaluation of immediate hypersensitivity skin tests to aeroallergens, measurement of total IgE and Candida albicans specific IgE and levels of IL-5 in 44 women with RVC and 26 with sporadic vaginal candidiasis (SVC). Statistical analyses were performed by Mann–Whitney test and ?2 test with Yates correction. History of atopy (68%) and positive skin test (42%) were higher (P < 0·05) in RVC than in patients with SVC. No significant difference was found in total IgE, C. albicans specific IgE and IL-5 levels. There was a strong association between atopy and RVC, but type-2 immune response to C. albicans antigen was absent or similar in the two groups of patients.

Neves, NA; Carvalho, LP; De Oliveira, MAM; Giraldo, PC; Bacellar, O; Cruz, AA; Carvalho, EM



Cytolytic vaginosis: misdiagnosed as candidal vaginitis.  

PubMed Central

OBJECTIVES: In this study, 210 women with vaginal discharge and other symptoms/signs of genital pathology suggestive of vulvovaginal candidiasis (VVC) were involved in order to distinguish true WC and cytolytic vaginosis (CV) cases. METHODS: Fungal cultures, 10% potassium hydroxide (KOH) and Gram stained preparations and pH measurements were performed on the vaginal discharge material of each patient. RESULTS: Fifteen patients (7.1%) were diagnosed with cytolytic vaginosis according to their clinical and microbiological findings, including abundant lactobacilli, fragmented epithelial cells and/or free nuclei due to cytolysis, seen in their discharge materials on microscopic examination, but no fungal growth. CONCLUSIONS: The results of this study may contribute to the reports in the literature indicating the importance of such disorders, which are generally misdiagnosed as candidiasis.

Cerikcioglu, Nilgun; Beksac, M Sinan



Murine Models of Vaginal Trichomonad Infections  

PubMed Central

Trichomonas vaginalis and Tritrichomonas foetus cause common sexually transmitted infections in humans and cattle, respectively. Mouse models of trichomoniasis are important for pathogenic and therapeutic studies. Here, we compared murine genital infections with T. vaginalis and T. foetus. Persistent vaginal infection with T. foetus was established with 100 parasites but T. vaginalis infection required doses of 106, perhaps because of greater susceptibility to killing by mouse vaginal polymorphonuclear leukocytes. Infection with T. vaginalis persisted longest after combined treatment of mice with estrogen and dexamethasone, whereas infection was only short-lived when mice were given estrogen or dexamethasone alone, co-infected with Lactobacillus acidophilus, and/or pretreated with antibiotics. Infection rates were similar with metronidazole-resistant (MR) and metronidazole-sensitive (MS) T. vaginalis. High dose but not low dose metronidazole treatment controlled infection with MS better than MR T. vaginalis. These murine models will be valuable for investigating the pathogenesis and treatment of trichomoniasis.

Cobo, Eduardo R.; Eckmann, Lars; Corbeil, Lynette B.



Probiotic and prebiotic applications for vaginal health.  


Infections of the urogenital tract in women are extremely common, and there is no evidence of a reduction in incidence. Treatment and preventive strategies have been relatively unchanged for 50 years. The concept of using probiotic lactobacilli or prebiotics that stimulate the growth of protective organisms emerged in the mid-1980s and has led to several strains being tested successfully in women. With the advent of genomic profiling of the healthy vaginal microbiota, an improved understanding of metabolic systems within lactobacilli, and the ability to deliver products in food and supplement forms, the future should see new ways for women to restore and maintain their vaginal health, without the side effects of pharmaceutical agents. Indeed, studies indicate that probiotics can be taken in conjunction with the antibiotics and antifungal agents used to eradicate infections. In the future, probiotics and prebiotics will represent an important adjunct to pharmaceutical and other approaches used to care for feminine health. PMID:22468339

Reid, Gregor


Trial of vaginal breech delivery: current role.  


Breech presentation occurs at term in approximately 3% to 4% of singleton gestations. This presentation is associated with a variety of maternal and fetal conditions including preterm labor, abnormal amniotic fluid volume, hydrocephaly, anencephaly, mullerian anomalies, abnormal placentation, and multifetal gestation. Cesarean delivery has been associated with increased risk of subsequent accreta, placenta previa, hemorrhage, and hysterectomy. The Term Breech Trial initially suggested that planned vaginal breech delivery is associated with increased neonatal morbidity and mortality compared with planned cesarean delivery. Long-term follow-up of these vaginally delivered infants contradict the initial findings. Current debate surrounds the dilemma of whether the untoward complications of cesarean delivery are warranted given uncertain minimal increases in neonatal survival and improvement in neurologic outcome with planned cesarean. PMID:17513938

Yamamura, Yasuko; Ramin, Kirk D; Ramin, Susan M



[Vaginal metastasis of renal carcinoma (author's transl)].  


Four cases of vaginal metastases of renal carcinoma are reported. This is an incidence of 1.3% in 313 operated patients (from 1/1/70 to 12/31/76). A surgical treatment of primary renal carcinoma and vaginal metastasis seems to be reasonable in there cases. Since in accordance with the literature metastatic involvement of vagina and vulva seems not to be a very rare finding, the diagnostic in renal carcinoma should imply a gynecologic examination. Although in carcinoma of the left kidney metastatic spreading into the external female genitalia most probably occurs by a retrograde venous pathway (left ovarian vein), the way of dissemination in carcinoma of the right side is unclear. PMID:924104

Carl, P; Marx, F J



Can group B streptococci cause symptomatic vaginitis?  

PubMed Central

BACKGROUND: Maternal cervicovaginal colonization with Lancefield group B streptococci (GBS) is an important risk factor for neonatal morbidity and mortality. About 15% of women are carriers of GBS. Usually, they are asymptomatic. CASES: We describe two patients with symptomatic vaginitis for which no apparent cause was found. Both patients were heavily colonized with GBS. After antibiotic treatment, both became asymptomatic and culture negative, but after recolonization with GBS, symptoms resumed. This phenomenon was repeatedly observed. After emergence of resistance to antibiotics, local application of chlorhexidine appeared to be the only useful treatment. CONCLUSION: We hypothesize that GBS-vaginitis may be a possible disease entity. Although at present it is not clear why some patients become symptomatic, we speculate that the immunologic response is somehow selectively hampered in such patients.

Honig, E; Mouton, J W; van der Meijden, W I



Adolescent Experiences with the Vaginal Ring  

PubMed Central

Purpose To understand racial/ethnic minority adolescent females’ experiences with the vaginal ring. Methods We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15–24 years who had used the vaginal ring. Results Qualitative analysis using grounded theory revealed that adolescents undergo a multi-stage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. Conclusions The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered.

Epstein, Laura B.; Sokal-Gutierrez, Karen; Ivey, Susan L.; Raine, Tina; Auerswald, Colette



Development and evaluation of acid-buffering bioadhesive vaginal tablet for mixed vaginal infections.  


An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4), which is an attribute of a healthy vagina. The effervescent mixture (citric acid and sodium bicarbonate) along with a superdisintegrant (Ac-Di-sol) was used to enhance the swellability of the bioadhesive tablet. The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as an antibacterial) were used in the formulation along with Lactobacillus acidophilus spores to treat mixed vaginal infections. From the ex vivo retention study it was found that the bioadhesive polymers hold the tablet for more than 24 hours inside the vaginal tube. The hardness of the acid-buffering bioadhesive vaginal tablet was optimized, at 4 to 5 kg hardness the swelling was found to be good and the cumulative release profile of the developed tablet was matched with a marketed conventional tablet (Infa-V). The in vitro spreadability of the swelled tablet was comparable to the marketed gel. In the in vitro antimicrobial study it was found that the acid-buffering bioadhesive tablet produces better antimicrobial action than marketed intravaginal drug delivery systems (Infa-V, Candid-V and Canesten 1). PMID:18181530

Alam, Mohd Aftab; Ahmad, Farhan Jalees; Khan, Zeenat Iqbal; Khar, Roop Krishen; Ali, Mushir



Predictors of Metastatic Disease After Prostate Brachytherapy  

SciTech Connect

Purpose: To identify predictors of metastatic disease after brachytherapy treatment for prostate cancer. Methods and Materials: All patients who received either brachytherapy alone (implant) or brachytherapy in combination with external beam radiation therapy for treatment of localized prostate cancer at The Mount Sinai Hospital between June 1990 and March 2007 with a minimum follow-up of 2 years were included. Univariate and multivariable analyses were performed on the following variables: risk group, Gleason score (GS), clinical T stage, pretreatment prostate-specific antigen level, post-treatment prostate-specific antigen doubling time (PSA-DT), treatment type (implant vs. implant plus external beam radiation therapy), treatment era, total biological effective dose, use of androgen deprivation therapy, age at diagnosis, and race. PSA-DT was analyzed in the following ordinate groups: 0 to 90 days, 91 to 180 days, 180 to 360 days, and greater than 360 days. Results: We included 1,887 patients in this study. Metastases developed in 47 of these patients. The 10-year freedom from distant metastasis (FFDM) rate for the entire population was 95.1%. Median follow-up was 6 years (range, 2-15 years). The only two significant predictors of metastatic disease by multivariable analyses were GS and PSA-DT (p < 0.001 for both variables). Estimated 10-year FFDM rates for GS of 6 or less, GS of 7, and GS of 8 or greater were 97.9%, 94.3%, and 76.1%, respectively (p < 0.001). Estimated FFDM rates for PSA-DT of 0 to 90 days, 91 to 180 days, 181 to 360 days, and greater than 360 days were 17.5%, 67.9%, 74%, and 94.8%, respectively (p < 0.001). Estimated 10-year FFDM rates for the low-, intermediate-, and high-risk groups were 98.6%, 96.2%, and 86.7%, respectively. A demographic shift to patients presenting with higher-grade disease in more recent years was observed. Conclusions: GS and post-treatment PSA-DT are both statistically significant independent predictors of metastatic disease. Patients with a high GS and/or short PSA-DT have a higher likelihood of developing metastatic disease and should be considered for systemic therapy.

Forsythe, Kevin [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan [Department of Radiation Oncology, New York-Presbyterian Hospital, New York, NY (United States); Stone, Nelson [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G., E-mail: [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)



Vaginal Intercourse Frequency and Heart Rate Variability  

Microsoft Academic Search

We examined the relationship between recalled and diary recorded frequency of penile-vaginal intercourse (FSI) and both resting heart rate variability (HRV; an index of cardiac autonomic control and parasympathetic tone associated with cardiovascular health outcomes) and resting diastolic blood pressure (DBP) in 120 healthy adults aged 19-38 (subjects scoring above the 87th percentile on the Lie scale of the Eysenck




Posterior vaginal prolapse and bowel function  

Microsoft Academic Search

Objective: This study’s objectives were to describe symptoms related to bowel dysfunction in women with uterovaginal prolapse and to compare these symptoms according to extent of posterior vaginal prolapse. Study Design: One hundred forty-three women completed a questionnaire assessment of bowel function and underwent standardized physical examination according to the International Continence Society’s system for grading uterovaginal prolapse. Results: The

Anne M. Weber; Mark D. Walters; Lester A. Ballard; Delbert L. Booher; Marion R. Piedmonte




PubMed Central

Introduction Vaginal douching is a widespread practice among American women. Little research has been done examining variation in the practice or identifying risk factors. Methods We collected data on douching, as well as hypothesized predictors of vaginal douching, as part of a cohort study on preterm birth. African-American women residing in Baltimore City, Maryland, were enrolled if they received prenatal care or delivered at The Johns Hopkins Medical Institution. Interview data were collected on 872 women between March 2001 and July 2004, with a response rate of 68%. Logistic regression analysis was selected to identify factors associated with douching in the 6 months prior to pregnancy. Results Almost two thirds of women reported ever douching and more than two thirds of those women reported douching in the 6 months prior to pregnancy. Variation was seen in the practice of douching with regard to frequency as well as technique. After adjusting for several confounders, prenatal enrollment (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.29, 2.53), more unmet needs for time for “nonessentials” (OR, 1.83; 95% CI, 1.27, 2.63), smoking in the year prior to the birth (OR, 1.78; 95% CI, 1.22, 2.60), and age > 19 years (OR, 2.60; 95% CI, 1.36, 4.97) were significant predictors of douching in the 6 months prior to pregnancy. Discussion We identified considerable heterogeneity in the practice of vaginal douching in a cohort of low income African-American women. Conclusions Future studies should incorporate measures of the predictors of douching and detailed exposure information to determine the independent contribution of vaginal douching to health outcomes.

Misra, Dawn P.; Trabert, Britton; Atherly-Trim, Shelly



Vernix Caseosa Peritonitis After Vaginal Delivery  

PubMed Central

Introduction Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section. Case presentation We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Conclusion Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

Sadath, Shameema A.; Abo Diba, Fathiya I.; Nayak, Surendra; Shamali, Iman Al; Diejomaoh, Michael F.



Strength after surgical repair of the rotator cuff.  


Forty-two consecutive patients (20 men and 22 women, age range 39 to 78 years) with full-thickness rotator cuff tears underwent a comprehensive isokinetic strength assessment before and at 3-month intervals for 1 year after surgery. All patients underwent acromioplasty and rotator cuff repair and were treated with a standardized postoperative rehabilitation program. Isokinetic strength testing was performed in flexion/extension, abduction/adduction, and external/internal rotation at 60 degrees/sec. The unaffected contralateral shoulder was tested for comparison. Clinical outcomes were assessed with the University of California Los Angeles Shoulder Rating Scale (maximum = 35 points). The average University of California Los Angeles score was 31.2 by 1 year after operation. Patients with small and medium tears had an average rating of 33.5, whereas those with large and massive tears had an average score of 28.3. Strength increased gradually during the first postoperative year. The preoperative mean peak torque was 54%, 45%, and 64% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively; after operation it increased to 78%, 80%, and 79% by 6 months and 84%, 90%, and 91% by 12 months. The greatest improvement in strength consistently occurred during the first 6 months after surgery. Patients also showed marked increases in both work and power. By 12 months after operation mean work had increased to 70% in flexion and abduction and 90% in external rotation of the uninvolved shoulder. Similarly, mean power had increased to 68%, 79%, and 90% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively, by 12 months after operation. Recovery of strength correlated primarily with the size of the tear: for small and medium tears recovery of strength was almost complete during the first year, and for large and massive tears it was much slower and less consistent. By using isokinetic strength evaluation we found that recovery of strength after rotator cuff repair requires at least 1 year of rehabilitation. PMID:8919437

Rokito, A S; Zuckerman, J D; Gallagher, M A; Cuomo, F


Vaginal route: a gynaecological route for much more than hysterectomy.  


Vaginal hysterectomy is the method of choice for gynaecologists who carry out hysterectomies. Undertaking this procedure regularly will enhance the gynaecologist's level of skill and enable conditions such as ovarian cysts, broad ligament fibroids and other adnexal pathology to be dealt with vaginally during hysterectomy surgery without abdominal invasion. It is also important as the vaginal route allows access to the posterior cul-de-sac, which can facilitate surgery or offer an alternative route to achieving the desired outcome. In this chapter, we look at the main indications for vaginal surgery, and also at other conditions in which vaginal surgery may be suitable (e.g. benign and malignant conditions). We believe that gynaecologists who include vaginal surgery in their armamentarium are better equipped to serve their patients. PMID:21349773

Sheth, Shirish S; Paghdiwalla, Kurush P; Hajari, Anju R



Harmony search optimization for HDR prostate brachytherapy  

NASA Astrophysics Data System (ADS)

In high dose-rate (HDR) prostate brachytherapy, multiple catheters are inserted interstitially into the target volume. The process of treating the prostate involves calculating and determining the best dose distribution to the target and organs-at-risk by means of optimizing the time that the radioactive source dwells at specified positions within the catheters. It is the goal of this work to investigate the use of a new optimization algorithm, known as Harmony Search, in order to optimize dwell times for HDR prostate brachytherapy. The new algorithm was tested on 9 different patients and also compared with the genetic algorithm. Simulations were performed to determine the optimal value of the Harmony Search parameters. Finally, multithreading of the simulation was examined to determine potential benefits. First, a simulation environment was created using the Python programming language and the wxPython graphical interface toolkit, which was necessary to run repeated optimizations. DICOM RT data from Varian BrachyVision was parsed and used to obtain patient anatomy and HDR catheter information. Once the structures were indexed, the volume of each structure was determined and compared to the original volume calculated in BrachyVision for validation. Dose was calculated using the AAPM TG-43 point source model of the GammaMed 192Ir HDR source and was validated against Varian BrachyVision. A DVH-based objective function was created and used for the optimization simulation. Harmony Search and the genetic algorithm were implemented as optimization algorithms for the simulation and were compared against each other. The optimal values for Harmony Search parameters (Harmony Memory Size [HMS], Harmony Memory Considering Rate [HMCR], and Pitch Adjusting Rate [PAR]) were also determined. Lastly, the simulation was modified to use multiple threads of execution in order to achieve faster computational times. Experimental results show that the volume calculation that was implemented in this thesis was within 2% of the values computed by Varian BrachyVision for the prostate, within 3% for the rectum and bladder and 6% for the urethra. The calculation of dose compared to BrachyVision was determined to be different by only 0.38%. Isodose curves were also generated and were found to be similar to BrachyVision. The comparison between Harmony Search and genetic algorithm showed that Harmony Search was over 4 times faster when compared over multiple data sets. The optimal Harmony Memory Size was found to be 5 or lower; the Harmony Memory Considering Rate was determined to be 0.95, and the Pitch Adjusting Rate was found to be 0.9. Ultimately, the effect of multithreading showed that as intensive computations such as optimization and dose calculation are involved, the threads of execution scale with the number of processors, achieving a speed increase proportional to the number of processor cores. In conclusion, this work showed that Harmony Search is a viable alternative to existing algorithms for use in HDR prostate brachytherapy optimization. Coupled with the optimal parameters for the algorithm and a multithreaded simulation, this combination has the capability to significantly decrease the time spent on minimizing optimization problems in the clinic that are time intensive, such as brachytherapy, IMRT and beam angle optimization.

Panchal, Aditya


A dynamic dosimetry system for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

The lack of dynamic dosimetry tools for permanent prostate brachytherapy causes otherwise avoidable problems in prostate cancer patient care. The goal of this work is to satisfy this need in a readily adoptable manner. Using the ubiquitous ultrasound scanner and mobile non-isocentric C-arm, we show that dynamic dosimetry is now possible with only the addition of an arbitrarily configured marker-based fiducial. Not only is the system easily configured from accessible hardware, but it is also simple and convenient, requiring little training from technicians. Furthermore, the proposed system is built upon robust algorithms of seed segmentation, fiducial detection, seed reconstruction, and image registration. All individual steps of the pipeline have been thoroughly tested, and the system as a whole has been validated on a study of 25 patients. The system has shown excellent results of accurately computing dose, and does so with minimal manual intervention, therefore showing promise for widespread adoption of dynamic dosimetry.

Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Song, Danny Y.; Prince, Jerry L.; Lee, Junghoon



Automatic Brachytherapy Seed Placement Under MRI Guidance  

PubMed Central

The paper presents a robotic method of performing low dose rate prostate brachytherapy under magnetic resonance imaging (MRI) guidance. The design and operation of a fully automated MR compatible seed injector is presented. This is used with the MrBot robot for transperineal percutaneous prostate access. A new image-registration marker and algorithms are also presented. The system is integrated and tested with a 3T MRI scanner. Tests compare three different registration methods, assess the precision of performing automated seed deployment, and use the seeds to assess the accuracy of needle targeting under image guidance. Under the ideal conditions of the in vitro experiments, results show outstanding image-guided needle and seed placement accuracy.

Patriciu, Alexandru; Petrisor, Doru; Muntener, Michael; Mazilu, Dumitru; Schar, Michael; Stoianovici, Dan



Photoacoustic imaging of prostate brachytherapy seeds  

PubMed Central

Brachytherapy seed therapy is an increasingly common way to treat prostate cancer through localized radiation. The current standard of care relies on transrectal ultrasound (TRUS) for imaging guidance during the seed placement procedure. As visualization of individual metallic seeds tends to be difficult or inaccurate under TRUS guidance, guide needles are generally tracked to infer seed placement. In an effort to improve seed visualization and placement accuracy, the use of photoacoustic (PA) imaging, which is highly sensitive to metallic objects in soft tissue, was investigated for this clinical application. The PA imaging properties of bare (i.e., embedded in pure gelatin) and tissue-embedded (at depths of up to 13 mm) seeds were investigated with a multi-wavelength (750 to 1090 nm) PA imaging technique. Results indicate that, much like ultrasonic (US) imaging, an angular dependence (i.e., seed orientation relative to imaging transducer) of the PA signal exists. Despite this shortcoming, however, PA imaging offers improved contrast, over US imaging, of a seed in prostate tissue if sufficient local fluence is achieved. Additionally, although the PA signal of a bare seed is greatest for lower laser wavelengths (e.g., 750 nm), the scattering that results from tissue tends to favor the use of higher wavelengths (e.g., 1064 nm, which is the primary wavelength of Nd:YAG lasers) when the seed is located in tissue. A combined PA and US imaging approach (i.e., PAUS imaging) shows strong potential to visualize both the seed and the surrounding anatomical environment of the prostate during brachytherapy seed placement procedures.

Su, Jimmy L.; Bouchard, Richard R.; Karpiouk, Andrei B.; Hazle, John D.; Emelianov, Stanislav Y.



Calibration of Photon Sources for Brachytherapy  

NASA Astrophysics Data System (ADS)

Source calibration has to be considered an essential part of the quality assurance program in a brachytherapy department. Not only it will ensure that the source strength value used for dose calculation agrees within some predetermined limits to the value stated on the source certificate, but also it will ensure traceability to international standards. At present calibration is most often still given in terms of reference air kerma rate, although calibration in terms of absorbed dose to water would be closer to the users interest. It can be expected that in a near future several standard laboratories will be able to offer this latter service, and dosimetry protocols will have to be adapted in this way. In-air measurement using ionization chambers (e.g. a Baldwin—Farmer ionization chamber for 192Ir high dose rate HDR or pulsed dose rate PDR sources) is still considered the method of choice for high energy source calibration, but because of their ease of use and reliability well type chambers are becoming more popular and are nowadays often recommended as the standard equipment. For low energy sources well type chambers are in practice the only equipment available for calibration. Care should be taken that the chamber is calibrated at the standard laboratory for the same source type and model as used in the clinic, and using the same measurement conditions and setup. Several standard laboratories have difficulties to provide these calibration facilities, especially for the low energy seed sources (125I and 103Pd). Should a user not be able to obtain properly calibrated equipment to verify the brachytherapy sources used in his department, then at least for sources that are replaced on a regular basis, a consistency check program should be set up to ensure a minimal level of quality control before these sources are used for patient treatment.

Rijnders, Alex


Wavelet Packet Analysis for Angular Data Extraction from Muscle Afferent Cuff Electrode Signals.  

National Technical Information Service (NTIS)

Rehabilitation devices can greatly benefit from the use of natural sensors. Thus, we have extended on our efforts to extract angular information from muscle afferent nerves by means of cuff electrodes. Is this study we applied wavelet analysis to electron...

F. Sepulveda A. Buskgaard M. V. Fjorback J. B. Huber K. Jensen



Reducing Stiffness and Electrical Losses of High Channel Hybrid Nerve Cuff Electrodes.  

National Technical Information Service (NTIS)

For restoration of grasp in disabled people by means of functional electrical stimulation of peripheral nerves, 18 polar Hybrid Cuff Electrodes were developed. These electrodes consisted of a micromachined polyimide-based thin-film structure with integrat...

M. Schuettler T. Stieglitz M. Gross D. Altpeter A. Staiger



Management of degenerative rotator cuff tears: a review and treatment strategy  

PubMed Central

The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence. Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction. The management of these tears is controversial, as to whether they should be managed non-operatively or operatively. In addition when operative intervention is undertaken, there is question as to what technique of repair should be used. This review describes the epidemiology and natural history of degenerative rotator cuff tears. The management options, and the evidence to support these, are reviewed. We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.



Relationship between lactobacilli and opportunistic bacterial pathogens associated with vaginitis  

PubMed Central

Background: Vaginitis, is an infectious inflammation of the vaginal mucosa, which sometimes involves the vulva. The balance of the vaginal flora is maintained by the Lactobacilli and its protective and probiotic role in treating and preventing vaginal infection by producing antagonizing compounds which are regarded as safe for humans. Aim: The aim of this study was to evaluate the protective role of Lactobacilli against common bacterial opportunistic pathogens in vaginitis and study the effects of some antibiotics on Lactobacilli isolates. Materials and Methods: In this study (110) vaginal swabs were obtained from women suffering from vaginitis who admitted to Babylon Hospital of Maternity and Paediatrics in Babylon province, Iraq. The study involved the role of intrauterine device among married women with vaginitis and also involved isolation of opportunistic bacterial isolates among pregnant and non pregnant women. This study also involved studying probiotic role of Lactobacilli by production of some defense factors like hydrogen peroxide, bacteriocin, and lactic acid. Results: Results revealed that a total of 130 bacterial isolates were obtained. Intrauterine device was a predisposing factor for vaginitis. The most common opportunistic bacterial isolates were Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumoniae. All Lactobacilli were hydrogen peroxide producers while some isolates were bacteriocin producers that inhibited some of opportunistic pathogens (S. aureus, E. coli). Lactobacilli were sensitive to erythromycin while 93.3% of them were resistant to ciprofloxacin and (40%, 53.3%) of them were resistant to amoxicillin and gentamycin respectively. Results revealed that there was an inverse relationship between Lactobacilli presence and organisms causing vaginitis. This may be attributed to the production of defense factors by Lactobacilli. Conclusion: The types of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria (Lactobacilli) that help in preservation of vaginal health and ecosystem as being one of the probiotic bacteria.

Razzak, Mohammad Sabri A.; Al-Charrakh, Alaa H.; AL-Greitty, Bara Hamid



Recovery of neural activity from nerve cuff electrodes.  


The ability to recover signals from the peripheral nerves would provide natural and physiological signals for controlling artificial limbs and neural prosthetic devices. Current cuff electrode systems can provide multiple channels but the signals have low signal to noise ratio and are difficult to recover. Previous work has shown that beamforming algorithms provide a method to extract such signals from peripheral nerve activiy [1]. This paper describes in-silico and in vivo experiments done to validate that method in a more realistic case. A modified beam forming algorithm capable of significantly decrease cross talk between channels is described and the results of the a 16-channel Flat Interface Nerve Electrode used to recover signals from the sciatic nerve in rabbit while the distal tibial and peroneal branches were stimulated The beamforming spatial filters were able to distinguish which branch was being stimulated, and in many cases how strongly, over a large range of stimulation intensities. PMID:22255375

Wodlinger, B; Durand, D M



Factors that impact rehabilitation strategies after rotator cuff repair.  


Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes. PMID:23306420

Mulligan, Edward P; Devanna, Raymond R; Huang, Mu; Middleton, Emily F; Khazzam, Michael



Vaginal Foreign Bodies and Child Sexual Abuse: An Important Consideration  

PubMed Central

Vaginal foreign bodies are a complaint occasionally encountered in pediatric clinics and emergency departments, and when pediatric patients present with a vaginal foreign body sexual abuse may not be considered. We describe two children with vaginal foreign bodies who were found to have been sexually abused. Each child had a discharge positive for a sexually transmitted infection despite no disclosure or allegation of abuse. We recommend that all pre-pubertal girls who present with a vaginal foreign body should be considered as possible victims of sexual abuse and should receive a sexual abuse history and testing for sexually transmitted infections.

Closson, Forrest T.; Lichenstein, Richard



[Vaginal disbacteriosis--social and sexual risk factors].  


The vaginal microbe equilibrium could be impaired by different agents. Many of the risk factors can change the preventive mechanisms of the vagina and can lead to inflammation and disease. We even do not suppose about the role of most of them in impairing of vaginal microbe equilibrium. The exact understanding of those risk factors and mechanisms by which they disturb the vaginal microbe balance could reduce female morbidity of vaginal disbacteriosis and vaginal inflammations. The aim of this literature synopsis is to review some of the most frequent risk factors for vaginal disbacteriosis and about how they change vaginal micro-flora with dominant lactobacillus within it. The most informative and detailed articles on the theme which were found in the resent literature as well as in Medline for the period between 1990 and 2012 were selected. The risk agents for vaginal disbacteriosis are: endogenetic, social, sexual, infectious and iatrogenic. The social and sexual factors are the most frequent in our daily round. The intensity and the kind of sexual life, smoking, homosexual connections, vaginal douching and contraception method