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1

Prospective Clinical Trial of Bladder Filling and Three-Dimensional Dosimetry in High-Dose-Rate Vaginal Cuff Brachytherapy  

SciTech Connect

Purpose: To investigate the effect of bladder filling on dosimetry and to determine the best bladder dosimetric parameter for vaginal cuff brachytherapy. Methods and Materials: In this prospective clinical trial, a total of 20 women underwent vaginal cylinder high-dose-rate brachytherapy. The bladder was full for Fraction 2 and empty for Fraction 3. Dose-volume histogram and dose-surface histogram values were generated for the bladder, rectum, and urethra. The midline maximal bladder point (MBP) and the midline maximal rectal point were recorded. Paired t tests, Pearson correlations, and regression analyses were performed. Results: The volume and surface area of the irradiated bladder were significantly smaller when the bladder was empty than when full. Of the several dose-volume histogram and dose-surface histogram parameters evaluated, the bladder maximal dose received by 2 cm{sup 3} of tissue, volume of bladder receiving {>=}50% of the dose, volume of bladder receiving {>=}70% of the dose, and surface area of bladder receiving {>=}50% of the dose significantly predicted for the difference between the empty vs. full filling state. The volume of bladder receiving {>=}70% of the dose and the maximal dose received by 2 cm{sup 3} of tissue correlated significantly with the MBP. Bladder filling did not alter the volume or surface area of the rectum irradiated. However, an empty bladder did result in the nearest point of bowel being significantly closer to the vaginal cylinder than when the bladder was full. Conclusions: Patients undergoing vaginal cuff brachytherapy treated with an empty bladder have a lower bladder dose than those treated with a full bladder. The MBP correlated well with the volumetric assessments of bladder dose and provided a noninvasive method for reporting the MBP dose using three-dimensional imaging. The MBP can therefore be used as a surrogate for complex dosimetry in the clinic.

Stewart, Alexandra J.; Cormack, Robert A. [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA (United States); Lee, Hang [Department of Biostatistical Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Xiong Li; Hansen, Jorgen L.; O'Farrell, Desmond A. [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA (United States); Viswanathan, Akila N. [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA (United States)], E-mail: aviswanathan@lroc.harvard.edu

2008-11-01

2

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: pgrigsby@wustl.edu [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)

2012-03-15

3

Oxidized Regenerated Cellulose Resembling Vaginal Cuff Abscess  

PubMed Central

Introduction: Application of oxidized regenerated cellulose is commonly performed in laparoscopy to achieve hemostasis during surgery. The appearance of an abscess resembles oxidized regenerated cellulose, causing imaging studies to be difficult to interpret. Case Description: We describe the cases of 3 patients who underwent oxidized regenerated cellulose placement during laparoscopic gynecologic surgery. They subsequently presented with signs and symptoms resembling an abscess. Computed tomographic imaging can be challenging to interpret in such cases; radiologic findings can be used to differentiate between the characteristics of oxidized regenerated cellulose and those of abscess formation on the vaginal cuff. Discussion: Oxidized regenerated cellulose has an appearance that often mimics postsurgical abscess formation. There are distinct characteristics that distinguish both findings. It is essential that patients' records accurately describe the presence and location of regenerated oxidized cellulose when placed intraoperatively, and this information must be relayed to the interpreting radiologist to facilitate medical diagnosis and guide clinical management.

Harkins, Gerald; Dykes, Thomas; Gockley, Allison; Davies, Matthew

2014-01-01

4

Trends in the Utilization of Adjuvant Vaginal Cuff Brachytherapy and/or External Beam Radiation Treatment in Stage I and II Endometrial Cancer: A Surveillance, Epidemiology, and End-Results Study  

SciTech Connect

Purpose: The optimal adjuvant radiation treatment for endometrial carcinoma (EC) remains controversial. Adjuvant vaginal cuff brachytherapy (VB) has emerged as an increasingly common treatment modality. However, the time trends for using VB, external beam radiation therapy (EBRT), or combined therapy (VB+EBRT) have not been well characterized. We therefore examined the utilization trends of VB, EBRT, and VB+EBRT for adjuvant RT in International Federation of Gynecologic Oncology (FIGO) stage I and II EC over time. Methods and Materials: We evaluated treatment patterns for 48,122 patients with EC diagnosed between January 1995 and December 2005, using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) public use database. Chi-squared tests were used to assess differences by radiation type (VB, EBRT, and VB+EBRT) and various demographic and clinical variables. Results: Analyses were limited to 9,815 patients (20.4%) with EC who met the inclusion criteria. Among women who received adjuvant RT, the proportion receiving VB increased yearly (12.9% in 1995 compared to 32.8% in 2005 (p < 0.0001). The increasing use of VB was proportional to the decreasing use of EBRT (56.1% in 1995 to 45.8% in 2005; p < 0.0001) and VB+EBRT (31.0% in 1995 to 21.4% in 2005; p < 0.001). Conclusions: This population-based report demonstrates an increasing trend in the use of VB in the adjuvant setting after hysterectomy for treatment of women with FIGO stage I-II EC. VB alone appears to be replacing pelvic EBRT and VB+EBRT therapy in the management of stage I-II EC.

Patel, Mehul K. [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Cote, Michele L. [Karmanos Cancer Institute and Wayne State University, Detroit, Michigan (United States); Ali-Fehmi, Rouba [Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan (United States); Buekers, Thomas; Munkarah, Adnan R. [Department of Women's Health Services, Division of Gynecologic Oncology, Henry Ford Health System, Detroit, Michigan (United States); Elshaikh, Mohamed A., E-mail: melshai1@hfhs.org [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States)

2012-05-01

5

Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy  

PubMed Central

Background and Objectives: Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. Methods: We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Results: A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34–0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. Conclusion: In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding.

Medina, Byron Cardoso; Riano, Giovanni; Hoyos, Luis R.; Otalora, Camila

2014-01-01

6

Vaginal dose, toxicity and sexual outcomes in patients of cervical cancer undergoing image based brachytherapy.  

PubMed

Background: The aim of the study was to evaluate the vaginal dose and toxicity in patients of cervical cancer treated with image guided brachytherapy at our institute. Materials and Methods: Thirty-five patients treated with image based brachytherapy for cervical cancer were included. Vaginal contouring was done on MRI at brachytherapy and with CT scans of subsequent brachytherapy fractions. Dose volume parameters (DVH) were reported in accordance with the GEC-ESTRO guidelines. These were correlated with vaginal toxicity (assessed by CTCAE version 3) and quality of sexual life assessed at one year of completion of treatment. Results: Vaginal shortness was observed in 22 out of 30 (62.8%) patients, Nine (25.7%) had vaginal dryness and in 10 (28.5%) patients, there was contact bleeding. No association could be demonstrated between the dose volume parameters and vaginal toxicity in the present study. Conclusions: The lack of association between dose volume parameters of vagina with vaginal morbidity may be due to uncertainties involved in the delineation of vaginal wall and dosimetry. Future research is required to accurately define vaginal dose distribution to study its correlation with vaginal morbidity. Vaginal morbidity needs to be documented in order to improve the sexual outcome in these patients. PMID:24870767

Rai, Bhavana; Dhanireddy, Bhaswanth; Patel, Firuza Darius; Kumari, Reena; Oinam, Arun Singh; Simha, Vijai; Sharma, Suresh

2014-01-01

7

Outcome after salvage radiotherapy (brachytherapy +\\/? external) in patients with a vaginal recurrence from endometrial carcinomas  

Microsoft Academic Search

Background and purpose: The vagina is the site most commonly affected by loco-regional failure in endometrial carcinoma (EC). The aim of this study was to evaluate the efficacy of vaginal brachytherapy (BT) combined or not with whole pelvic external radiotherapy (RT) for the treatment of patients with vaginal recurrences from endometrial cancer.Patients and methods: Between 1986 and 1999 25 women

Ali Hasbini; Christine Haie-Meder; Philippe Morice; Eric Chirat; Pierre Duvillard; Catherine Lhommé; Monique Delapierre; Alain Gerbaulet

2002-01-01

8

Adherence to Vaginal Dilation Following High Dose Rate Brachytherapy for Endometrial Cancer  

SciTech Connect

Purpose: We report demographic, clinical, and psychosocial factors associated with adherence to vaginal dilation and describe the sexual and marital or nonmarital dyadic functioning of women following high dose rate (HDR) brachytherapy for endometrial cancer. Methods and Materials: We retrospectively evaluated women aged 18 years or older in whom early-stage endometrial (IAgr3-IIB) cancers were treated by HDR intravaginal brachytherapy within the past 3.5 years. Women with or without a sexual partner were eligible. Patients completed questionnaires by mail or by telephone assessing demographic and clinical variables, adherence to vaginal dilation, dyadic satisfaction, sexual functioning, and health beliefs. Results: Seventy-eight of 89 (88%) eligible women with early-stage endometrial cancer treated with HDR brachytherapy completed questionnaires. Only 33% of patients were adherers, based on reporting having used a dilator more than two times per week in the first month following radiation. Nonadherers who reported a perceived change in vaginal dimension following radiation reported that their vaginas were subjectively smaller after brachytherapy (p = 0.013). Adherers reported more worry about their sex lives or lack thereof than nonadherers (p = 0.047). Patients reported considerable sexual dysfunction following completion of HDR brachytherapy. Conclusions: Adherence to recommendations for vaginal dilator use following HDR brachytherapy for endometrial cancer is poor. Interventions designed to educate women about dilator use benefit may increase adherence. Although sexual functioning was compromised, it is likely that this existed before having cancer for many women in our study.

Friedman, Lois C., E-mail: Lois.Friedman@UHhospitals.org [Department of Psychiatry, CASE Comprehensive Cancer Center and University Hospitals of Cleveland, Cleveland, OH (United States); Abdallah, Rita [Ireland Cancer Center, CASE Comprehensive Cancer Center and University Hospitals of Cleveland, Cleveland, OH (Ireland); Schluchter, Mark; Panneerselvam, Ashok [Department of Epidemiology and Biostatistics, CASE Comprehensive Cancer Center and University Hospitals of Cleveland, Cleveland, OH (United States); Kunos, Charles A. [Department of Radiation Oncology, CASE Comprehensive Cancer Center and University Hospitals of Cleveland, Cleveland, OH (United States)

2011-07-01

9

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: rkim@uabmc.edu [Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, AL (United States)

2012-07-01

10

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

Microsoft Academic Search

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

Nicolas Magné; Odile Oberlin; Hélène Martelli; Alain Gerbaulet; Daniel Chassagne; Christine Haie-Meder

2008-01-01

11

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: christine.haie@igr.fr

2008-11-01

12

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: tomokaz31@cancer-c.pref.saitama.jp; 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)

2007-11-15

13

Eradicative brachytherapy with hyaluronate gel injection into pararectal space in treatment of bulky vaginal stump recurrence of uterine cancer  

PubMed Central

The purpose of this study is to develop a procedure for eradicative brachytherapy that can deliver a curative boost dose to bulky (>4 cm) vaginal stump recurrence of uterine cancer without risk of damaging surrounding organs. We separated risk organs (the rectum and sigmoid) from the target during brachytherapy, with a hyaluronate gel injection into the pararectal space via the percutaneous paraperineal approach under local anesthesia. The rectum anchored to the sacrum by native ligament was expected to shift posteriorly. We encountered a patient with bulky stump recurrence of uterine cancer, approximately 8 cm in maximum diameter. She was complaining of abdominal pain and constipation due to bowel encasement. Following 50 Gy of external beam radiotherapy, we applied a single fraction of brachytherapy under gel separation and delivered 14.5 Gy (50.8 GyE: equivalent dose in 2-Gy fraction calculated with linear quadratic model at ?/? = 3) to the target. The gel injection procedure was completed in 30 min without complications. A total irradiation dose of 100.8 GyE was delivered to the target and the cumulative minimum dose to the most irradiated rectosigmoidal volume of 2 cc (cumulative D2cc) was calculated as 58.5 GyE with gel injection, and was estimated to be 96 GyE without. Over three years, the local stump tumor has completely disappeared, with no complications. Brachytherapy with a pararectal gel injection can be a safe and effective eradicative option for bulky vaginal stump recurrence.

Kishi, Kazushi; Mabuchi, Yasushi; Sonomura, Tetsuo; Shirai, Shintaro; Noda, Yasutaka; Sato, Morio; Ino, Kazuhiko

2012-01-01

14

Technical aspects and perspectives of the vaginal mold applicator for brachytherapy of gynecologic malignancies  

Microsoft Academic Search

PurposeThe importance of the quality of cervical cancer brachytherapy applicators has been reported, suggesting a direct influence of competent technical implant performance on outcome. In our institute, an original brachytherapy technique based on the use of a molded applicator for genital tract brachytherapy has been applied routinely in clinical practice. Here, we report the technical aspects of this customized applicator

Nicolas Magné; Cyrus Chargari; Nicholas SanFilippo; Taha Messai; Alain Gerbaulet; Christine Haie-Meder

2010-01-01

15

Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies  

PubMed Central

Background Purpose of this study was to identify predictors of vaginal ulcer after CT based three-dimensional image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for gynecologic malignancies. Methods Records were reviewed for 44 female (14 with primary disease and 30 with recurrence) with gynecological malignancies treated with HDR-ISBT with or without external beam radiation therapy. The HDR-ISBT applicator insertion was performed with image guidance by trans-rectal ultrasound and CT. Results The median clinical target volume was 35.5 ml (2.4-142.1 ml) and the median delivered dose in equivalent dose in 2 Gy fractions (EQD2) for target volume D90 was 67.7 Gy (48.8-94.2 Gy, doses of external-beam radiation therapy and brachytherapy were combined). For re-irradiation patients, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 91.1 Gy, 100.9 Gy, 260.3 Gy, 212.3 Gy, 170.1 Gy, 117.1 Gy, 105.2 Gy, and 94.7 Gy, respectively. For those without prior radiation therapy, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 56.3 Gy, 54.3 Gy, 147.4 Gy, 126.2 Gy, 108.0 Gy, 103.5 Gy, 94.7 Gy, and 80.7 Gy, respectively. Among five patients with vaginal ulcer, three had prior pelvic radiation therapy in their initial treatment and three consequently suffered from fistula formation. On univariate analysis, re-irradiation and vaginal wall D2cc in EQD2 was the clinical predictors of vaginal ulcer (p?=?0.035 and p?=?0.025, respectively). The ROC analysis revealed that vaginal wall D2cc is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D2cc in EQD2 equal to or less than 145 Gy and over 145 Gy were 3.7% and 23.5%, respectively, with a statistically significant difference (p?=?0.026). Conclusions Re-irradiation and vaginal D2cc is a significant predictor of vaginal ulcer after HDR-ISBT for gynecologic malignancies. Three-dimensional image-guided treatment planning should be performed to ensure adequate target coverage while minimizing vaginal D2cc in order to avoid vagina ulcer.

2014-01-01

16

Endometrial adenocarcinoma in one horn of a didelphic uterus with vaginal duplication.  

PubMed

A 59-year-old female patient presented with vaginal bleeding. A didelphic uterus with vaginal duplication was diagnosed on the basis of physical examination and radiology tests. Biopsy revealed an endometrial cancer in the left horn, while the right was atrophic. Laparoscopic hysterectomy, bilateral salphingo-oophorectomy, pelvic and para-aortic lymphadenectomy were performed. According to Federation International of Gynecology and Obstetrics (FIGO) staging the tumour was classified Ib. The adjuvant therapy was vaginal cuff brachytherapy. After 6?months, she has no evidence of the disease. PMID:24842355

Vázquez Vicente, Daniel; Di Fiore, Hugo Ariel; Garcia-Foncillas, Jesús; Plaza Arranz, Javier

2014-01-01

17

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: geoffrey.zhang@moffitt.org [Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States); Finkelstein, Steven E.; Biagioli, Matthew C. [Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States)

2011-07-15

18

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.

2013-01-01

19

Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer  

SciTech Connect

Purpose: The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use. Methods and Materials: We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at the Hospital of University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02. Results: The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively. Conclusion: Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.

Bahng, Agnes Y.; Dagan, Avner [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Bruner, Deborah W. [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Lin, Lilie L., E-mail: lin@xrt.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

2012-02-01

20

Vaginal repair of vaginal vault dehiscence after postpartum hysterectomy.  

PubMed

Vaginal vault dehiscence (VVD) may occur rarely after hysterectomy. Although mostly, a vaginal cuff dehiscence is seen after robotic or laparoscopic hysterectomy, it may also be observed as a complication of abdominal or vaginal hysterectomy. Vaginal repair is one of the techniques used for VVD. Here, we will describe a case of vaginally repaired VVD, associated with intra-abdominal hematoma after postpartum hysterectomy. PMID:24876366

Avc?o?lu, Sümeyra Nergiz; Alt?nkaya, Sündüz Özlem; Küçük, Mert; Yüksel, Hasan; Demircan-Sezer, Selda

2014-01-01

21

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)

2004-11-01

22

Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy  

SciTech Connect

Purpose: To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). Methods and Materials: All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Results: Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. Conclusions: The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

Diavolitsis, V. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)] [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Rademaker, A. [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)] [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Lurain, J.; Hoekstra, A. [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)] [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Strauss, J. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)] [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Small, W., E-mail: wsmall@nmff.org [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)

2012-10-01

23

Treatment of Locally Advanced Vaginal Cancer With Radiochemotherapy and Magnetic Resonance Image-Guided Adaptive Brachytherapy: Dose-Volume Parameters and First Clinical Results  

SciTech Connect

Purpose: To investigate the clinical feasibility of magnetic resonance image-guided adaptive brachytherapy (IGABT) for patients with locally advanced vaginal cancer and to report treatment outcomes. Methods and Materials: Thirteen patients with vaginal cancer were treated with external beam radiotherapy (45-50.4 Gy) plus IGABT with or without chemotherapy. Distribution of International Federation of Gynecology and Obstetrics stages among patients were as follows: 4 patients had Stage II cancer, 5 patients had Stage III cancer, and 4 patients had Stage IV cancer. The concept of IGABT as developed for cervix cancer was transferred and adapted for vaginal cancer, with corresponding treatment planning and reporting. Doses were converted to the equivalent dose in 2 Gy, applying the linear quadratic model ({alpha}/{beta} = 10 Gy for tumor; {alpha}/{beta} = 3 for organs at risk). Endpoints studied were gross tumor volume (GTV), dose-volume parameters for high-risk clinical target volume (HRCTV), and organs at risk, local control (LC), adverse side effects, and survival. Results: The mean GTV ({+-} 1 standard deviation) at diagnosis was 45.3 ({+-}30) cm{sup 3}, and the mean GTV at brachytherapy was 10 ({+-}14) cm{sup 3}. The mean D90 for the HRCTV was 86 ({+-}13) Gy. The mean D2cc for bladder, urethra, rectum, and sigmoid colon were 80 ({+-}20) Gy, 76 ({+-}16) Gy, 70 ({+-}9) Gy, and 60 ({+-}9) Gy, respectively. After a median follow-up of 43 months (range, 19-87 months), one local recurrence and two distant metastases cases were observed. Actuarial LC and overall survival rates at 3 years were 92% and 85%. One patient with Stage IVA and 1 patient with Stage III disease experienced fistulas (one vesicovaginal, one rectovaginal), and 1 patient developed periurethral necrosis. Conclusions: The concept of IGABT, originally developed for treating cervix cancer, appears to be applicable to vaginal cancer treatment with only minor adaptations. Dose-volume parameters for HRCTV and organs at risk are in a comparable range. First clinical results indicate excellent LC. Further prospective multicenter studies are needed to establish this method and to confirm these results.

Dimopoulos, Johannes C.A. [Department of Radiation Oncology, Metropolitan Hospital, Athens (Greece); Schmid, Maximilian P., E-mail: maximilian.schmid@akhwien.at [Department of Radiotherapy, Medical University of Vienna, Vienna (Austria); Fidarova, Elena; Berger, Daniel; Kirisits, Christian; Poetter, Richard [Department of Radiotherapy, Medical University of Vienna, Vienna (Austria)

2012-04-01

24

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: pgrigsby@wustl.edu

2007-02-01

25

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: sanjayssupe@gmail.com; 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)

2009-04-01

26

Comparison of 2D and 3D Imaging and Treatment Planning for Postoperative Vaginal Apex High-Dose Rate Brachytherapy for Endometrial Cancer  

SciTech Connect

Purpose: To evaluate bladder and rectal doses using two-dimensional (2D) and 3D treatment planning for vaginal cuff high-dose rate (HDR) in endometrial cancer. Methods and Materials: Ninety-one consecutive patients treated between 2000 and 2007 were evaluated. Seventy-one and 20 patients underwent 2D and 3D planning, respectively. Each patient received six fractions prescribed at 0.5 cm to the superior 3 cm of the vagina. International Commission on Radiation Units and Measurements (ICRU) doses were calculated for 2D patients. Maximum and 2-cc doses were calculated for 3D patients. Organ doses were normalized to prescription dose. Results: Bladder maximum doses were 178% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were no different than ICRU doses (p = 0.22). Two-cubic centimeter doses were 59% of maximum doses (p < 0.0001). Rectal maximum doses were 137% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were 87% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were 64% of maximum doses (p < 0.0001). Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final bladder dose to within 10% for 44%, 59%, 83%, 82%, and 89% of patients by using the ICRU dose, and for 45%, 55%, 80%, 85%, and 85% of patients by using the maximum dose, and for 37%, 68%, 79%, 79%, and 84% of patients by using the 2-cc dose. Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final rectal dose to within 10% for 100%, 100%, 100%, 100%, and 100% of patients by using the ICRU dose, and for 60%, 65%, 70%, 75%, and 75% of patients by using the maximum dose, and for 68%, 95%, 84%, 84%, and 84% of patients by using the 2-cc dose. Conclusions: Doses to organs at risk vary depending on the calculation method. In some cases, final dose accuracy appears to plateau after the third fraction, indicating that simulation and planning may not be necessary in all fractions. A clinically relevant level of accuracy should be determined and further research conducted to address this issue.

Russo, James K. [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Armeson, Kent E. [Division of Biostatistics and Epidemiology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Richardson, Susan, E-mail: srichardson@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri (United States)

2012-05-01

27

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: ppiern@libero.it [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)

2012-01-01

28

Combined experimental and Monte Carlo verification of brachytherapy plans for vaginal applicators  

NASA Astrophysics Data System (ADS)

Dose rates in a phantom around a shielded and an unshielded vaginal applicator containing Selectron low-dose-rate sources were determined by experiment and Monte Carlo simulation. Measurements were performed with thermoluminescent dosimeters in a white polystyrene phantom using an experimental protocol geared for precision. Calculations for the same set-up were done using a version of the EGS4 Monte Carlo code system modified for brachytherapy applications into which a new combinatorial geometry package developed by Bielajew was recently incorporated. Measured dose rates agree with Monte Carlo estimates to within 5% (1 SD) for the unshielded applicator, while highlighting some experimental uncertainties for the shielded applicator. Monte Carlo calculations were also done to determine a value for the effective transmission of the shield required for clinical treatment planning, and to estimate the dose rate in water at points in axial and sagittal planes transecting the shielded applicator. Comparison with dose rates generated by the planning system indicates that agreement is better than 5% (1 SD) at most positions. The precision thermoluminescent dosimetry protocol and modified Monte Carlo code are effective complementary tools for brachytherapy applicator dosimetry.

Sloboda, Ron S.; Wang, Ruqing

1998-12-01

29

Rotator cuff exercises  

MedlinePLUS

... to these tendons may result in: Rotator cuff tendinitis, which is irritation and swelling of these tendons ... Brien MJ, Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, ...

30

Rotator Cuff Pathology  

MedlinePLUS

... Hand Anatomy Find a Hand Surgeon Rotator Cuff Pathology Email to a friend * required fields From * To * ... locking and a feeling of instability. Rotator cuff pathology ranges from a normal, asymptomatic aging process to ...

31

Vaginal dryness  

MedlinePLUS

Vaginal dryness is present when the tissues of the vagina are no longer well-lubricated and healthy. When ... sexual intercourse more comfortable. It also helps decrease vaginal dryness. If estrogen levels drop off, the vaginal tissue ...

32

Vaginal Diseases  

MedlinePLUS

... symptoms. Common causes are bacterial infections, trichomoniasis, and yeast infections. Some other causes of vaginal symptoms include sexually transmitted diseases, vaginal cancer, and vulvar cancer. Treatment of vaginal problems depends ...

33

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

2006-01-01

34

Rotator Cuff Repair  

MedlinePLUS Videos and Cool Tools

... CUFF REPAIR DOCTORS HOSPITAL CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE CORAL GABLES, FLORIDA June 18, 2008 00:00: ... Coral Gables, Florida. I'm Dr. John Zvijac, sports medicine and shoulder surgeon here at Doctors Hospital, and ...

35

Rotator cuff injuries.  

PubMed

Different types of rotator cuff injuries frequently present to Accident and Emergency departments and minor injury units but can be difficult to differentiate clinically. This brief case study describes the examination and diagnosis of related shoulder injuries, specifically rotator cuff tears/disruption and calcifying supraspinatus tendinitis. The relevant anatomy and current therapies for these injuries is also discussed to enable the emergency nurse practitioner to have a greater understanding of the theory surrounding their diagnosis and treatments. PMID:10893553

Crusher, R H

2000-07-01

36

Vaginal Atrophy  

MedlinePLUS

... no symptoms at all. Or you may have Vaginal dryness Burning feelings in your vagina Discomfort or pain ... uptodate.com/patients/index.html and search for vaginal dryness About Us Contact Us Donate Connect: © 2014 Copyright ...

37

Rotator cuff - self-care  

MedlinePLUS

... and remain stable. Common rotator cuff problems include: Tendinitis , which is irritation of the tendons and inflammation ... Brien MJ, Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, ...

38

Vaginal leiomyoma  

PubMed Central

Leiomyomas are common benign tumors in the uterus. However, vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. Here, we report a case of a 38-year-old multigravida who presented with lower abdominal pain and vaginal bleeding. A physical examination and ultrasonography were performed, and a diagnosis of cervical fibroid was made. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Although a rare tumor, vaginal leiomyomas may present with a variety of clinical features and may be mistaken preoperatively for cervical fibroid. Removal of tumor by vaginal route, wherever possible, with subsequent histopathological examination appears to be the optimum management plan.

Chakrabarti, Indranil; De, Anuradha; Pati, Shyamapada

2011-01-01

39

Rotator cuff problems  

MedlinePLUS

... often show a tear in the rotator cuff. MRI of the shoulder may show swelling or a tear in the ... Your doctor will inject contrast material into your shoulder joint. Then an x-ray, CT scan, or MRI scan are used to take a picture of ...

40

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

41

[Brachytherapy training].  

PubMed

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

2013-04-01

42

21 CFR 868.5760 - Cuff spreader.  

Code of Federal Regulations, 2013 CFR

...Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class I (general controls). The device is exempt from the premarket...

2013-04-01

43

[Vaginal leiomyoma].  

PubMed

Vaginal leiomyomas are rare benign tumors. This is a case report with menstrual and urinary difficulties and vaginal mass with inner urethral meatus and hymen displacement. Miccional cystourethrography showed a posterior displaced, comprised and elongated urethra. Excretory urography and pelvic sonogram were normal. Preurethral enucleation extirpation with no complications was practiced. Current literature is reviewed. PMID:16972526

Briceño Pérez, Carlos; Briceño Sanabria, Liliana; Briceño Sanabria, Juan; Briceño Sanabria, Carlos

2006-05-01

44

Vaginal leiomyoma.  

PubMed

Leiomyomas are common benign tumors in the uterus. However, vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. Here, we report a case of a 38-year-old multigravida who presented with lower abdominal pain and vaginal bleeding. A physical examination and ultrasonography were performed, and a diagnosis of cervical fibroid was made. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Although a rare tumor, vaginal leiomyomas may present with a variety of clinical features and may be mistaken preoperatively for cervical fibroid. Removal of tumor by vaginal route, wherever possible, with subsequent histopathological examination appears to be the optimum management plan. PMID:21897740

Chakrabarti, Indranil; De, Anuradha; Pati, Shyamapada

2011-01-01

45

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

46

Vaginal Discharge  

MedlinePLUS

... who is infected. What about other infections? Two sexually transmitted infections, chlamydia and gonorrhea, can also cause vaginal discharge. ... I need any tests, such as tests for sexually transmitted infections? What do my test results mean? Based on ...

47

Vaginal Pessary  

MedlinePLUS

... your vagina). A pessary can also help many women who have stress urinary incontinence (the leaking of urine when you cough, strain or exercise). Pregnant women who have incontinence can also use a vaginal ...

48

Estrogen Vaginal  

MedlinePLUS

... 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 ...

49

Factors affecting rotator cuff healing.  

PubMed

? Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients.? Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing.? Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP.? There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair. PMID:24806015

Mall, Nathan A; Tanaka, Miho J; Choi, Luke S; Paletta, George A

2014-05-01

50

Special report: Occlusive cuff controller  

NASA Technical Reports Server (NTRS)

A mechanical occlusive cuff controller suitable for blood flow experiments in space shuttle flights is described. The device requires 115 volt ac power and a pressurized gas source. Two occluding cuff pressures (30 and 50 mmHg) are selectable by a switch on the front panel. A screw driver adjustment allows accurate cuff pressurization levels for under or oversized limbs. Two pressurization cycles (20 second and 2 minutes) can be selected by a front panel switch. Adjustment of the timing cycles is also available through the front panel. A pushbutton hand switch allows remote start of the cuff inflation cycle. A stop/reset switch permits early termination of the cycle and disabling of the controller to prevent inadvertent reactivation. Pressure in the cuff is monitored by a differential aneroid barometer. In addition, an electrocardiogram trigger circuit permits the initiation of the pressurization cycle by an externally supplied ECG cycle.

Baker, J. T.

1975-01-01

51

Rolling cuff flexible bellows  

DOEpatents

A flexible connector apparatus used to join two stiff non-deformable members, such as piping. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

Lambert, Donald R. (Livermore, CA)

1985-01-01

52

Vaginal Anomalies: Congenital Vaginal Obstruction  

MedlinePLUS

... Female infants are normally born with a thin membrane ( hymen ) that surrounds the vaginal opening. In rare ... specific physiological purpose. high transverse septum: A thin membrane up high in an organism that lies crosswise. ...

53

[Humeral head fracture and cuff].  

PubMed

During the past decade the evaluation of the rotator cuff in the management of proximal humeral fractures has received increasing attention. Different studies have investigated the pathomorphology, prevalence and impact of rotator cuff lesions on the outcome of non-operative or surgical treatment of proximal humeral fractures. Tendon defects, either chronic or trauma related, are observed mainly in the anterosuperior or posterosuperior aspect of the rotator cuff and present as partial- or full-thickness tears. Structural changes of the rotator cuff muscles including atrophy and fatty infiltration in the context of proximal humeral fractures have been inadequately investigated. The prevalence of coexisting rotator cuff pathology varies between 5 and greater than 50% depending on the method of evaluation, the fracture morphology and the age of the patient. The influence of a concomitant rotator cuff tear on the clinical outcome has not been conclusively investigated. However, different studies indicate that some lesions can be a source of persistent pain and functional deficit after conservative or surgical management of proximal humeral fractures. Therefore, a simultaneous repair of the rotator cuff defect during surgical reconstruction of the proximal humerus is indicated. PMID:22108771

Scheibel, M

2011-12-01

54

Treatment of vaginal intraepithelial neoplasia with laser ablation and upper vaginectomy.  

PubMed

To assess the effectiveness of laser ablation and upper vaginectomy in the treatment of vaginal intraepithelial neoplasia (VAIN), we have reviewed the charts of 52 patients managed with laser ablation (28 patients) and upper colpectomy (24 patients). On the basis of our results, patient selection and operator skill have a significant influence on the outcome. In posthysterectomy patients with VAIN(3) at the vaginal apex, in the region of vaginal cuff scar, upper vaginectomy is the treatment of choice, while multifocal VAIN(2-3) or colposcopically well defined lesions, involving large areas of vaginal mucosa, could be successfully managed by CO(2) laser ablation. PMID:12297712

Diakomanolis, Emmanuel; Rodolakis, Alexadros; Boulgaris, Zanis; Blachos, Georgios; Michalas, Stylianos

2002-01-01

55

[Vaginal leiomyoma].  

PubMed

Vaginal leiomyoma is a very rare condition. The earliest reference made to such a tumor is attributed to Denys De Leyden in 1773, and the first review of the literature concerning such tumors was published in 1882. It is estimated approximately 300 leiomyomas of the vagina have been reported in the world literature. The case of a 39-year-old female with large vaginal leiomyoma illustrates the diagnostic difficulties in such cases. In leiomyoma of the vagina surgical treatment is recommended. PMID:12916261

Gottwald, Leszek; Welfel, Jakub; Akoel, Kindah Mo; Lech, Waldemar; Suzin, Jacek; Bie?kiewicz, Andrzej

2003-03-01

56

Biomechanics of the rotator cuff: European perspective.  

PubMed

The rotator cuff has an important role in the stability and function of the glenohumeral joint. To understand the biomechanical proprieties of the rotator cuff, it is essential to understand the pathogenesis and effects of rotator cuff tears. The rotator cuff provides a stabilizing effect to the shoulder, because of compression of the humeral head against the glenoid cavity. The wide range of motion of the shoulder is allowed by the variety of rotational moments of the cuff muscles. Rotator cuff muscles action must be precisely coordinated to obtain the desired movement. Rotator cuff tendons are subjected to complex tension loads. The rotator cuff is also subjected to compressive loads. Upwardly directed humeral load squeezes the cuff between the humeral head and the coracoacromial arch. Extrinsic factors have always been considered among causes of cuff tears. However, evidence shows that acromial impingement is not the primary cause of rotator cuff tears. Tears of the rotator cuff change load distribution and determine a pattern that induces tear progression and extension. Progressive tears of the rotator cuff compromise glenohumeral stability and determine superior translation of the humeral head. PMID:21986041

Longo, Umile Giuseppe; Berton, Alessandra; Papapietro, Nicola; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

57

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

1973-01-01

58

Rotator cuff tears: pathology and repair  

Microsoft Academic Search

By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical\\u000a intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably\\u000a impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others).\\u000a In an era of emerging biologic interventions, our interventions

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

2009-01-01

59

Arthroscopic transosseous rotator cuff repair.  

PubMed

The arthroscopic approach for rotator cuff repair is extensively used worldwide. Different repairing procedures have evolved with the aim of restoring anatomy and function of rotator cuff tendon. Several studies have analyzed biomechanical factors to understand their influence on tendon to bone healing and improve repair configurations. From a biomechanical point of view, single-row anchor techniques are not able to restore all of the original footprint of the rotator cuff, and result in circumferential tension around the tendon. Transosseus simple suture repairs may have greater potential for healing at the tendon-bone interface, because they allow a larger insertion site area and better pressure characteristics. Biomechanically, double-row suture anchor repair increases the area of contact and the initial fixation strength, decreases the load for each suture loop, knot and anchor, and decreases the stress at each suture-cuff contact point. To optimize healing, transosseous-equivalent techniques have been developed. The oblique suture bridges allow greater pressurized contact, low profile, and interconnection between fixation points that permits to shear load. Clinical studies showed equivalent clinical results of single- and double-row suture anchor repair. However, to date, there are no randomized controlled trials on transosseous or transosseous-equivalent techniques for rotator cuff repair. Clearly, studies of higher levels of evidence, including large randomized trials, should be conducted. Future trials should use validated functional and clinical outcomes, adequate methodology, and be sufficiently powered. PMID:21986052

Longo, Umile Giuseppe; Franceschi, Francesco; Berton, Alessandra; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

60

21 CFR 882.5275 - Nerve cuff.  

Code of Federal Regulations, 2010 CFR

...8 2010-04-01 2010-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath...

2010-04-01

61

21 CFR 882.5275 - Nerve cuff.  

Code of Federal Regulations, 2010 CFR

...8 2009-04-01 2009-04-01 false Nerve cuff. 882.5275 Section 882.5275 Food...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath...

2009-04-01

62

MRI of vaginal conditions.  

PubMed

Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies. PMID:16038691

López, C; Balogun, M; Ganesan, R; Olliff, J F

2005-06-01

63

Vaginal Birth  

NSDL National Science Digital Library

This patient education program reviews female reproductive anatomy and explains vaginal birth. It also discusses the stages of labor and delivery, as well as potential risks and complications. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

Institute, Patient E.

2008-11-28

64

[Brachytherapy for penile carcinoma].  

PubMed

Malignant tumours of the penis are a rare entity. They are mostly squamous cell carcinomas and arise from the glands or the coronal sulcus. Glans brachytherapy has been developed to avoid mutilating surgery and allow organ preservation. Indications of brachytherapy are tumours less than 4 cm with no invasion of the uretra or corpora cavernosa. Local control is equivalent after brachytherapy and surgery. This article describes the indications, the technique, outcome and toxicity of penile brachytherapy. PMID:23490170

Blanchard, P; Delannes, M; Haie-Meder, C

2013-04-01

65

Retrohymenal vaginal atresia with perforate transverse vaginal septum.  

PubMed

A transverse vaginal septum is the most common congenital anomaly of the vagina. Vaginal atresia is seen less frequently. There have been some variations in cases of transverse vaginal septum and vaginal atresia. This is the first report of a patient with retrohymenal vaginal atresia and perforate transverse vaginal septum. PMID:1427424

Oga, M; Anai, T; Yoshimatsu, J; Kawano, Y; Hayata, T; Miyakawa, I

1992-01-01

66

Retrohymenal Vaginal Atresia with Perforate Transverse Vaginal Septum  

Microsoft Academic Search

A transverse vaginal septum is the most common congenital anomaly of the vagina. Vaginal atresia is seen less frequently. There have been some variations in cases of transverse vaginal septum and vaginal atresia. This is the first report of a patient with retrohymenal vaginal atresia and perforate transverse vaginal septum.Copyright © 1992 S. Karger AG, Basel

Masayuki Oga; Takanobu Anai; Jun Yoshimatsu; Yasushi Kawano; Takashi Hayata; Isao Miyakawa

1992-01-01

67

Prostate brachytherapy - discharge  

MedlinePLUS

Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge ... You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, ...

68

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

2009-01-01

69

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

2002-01-01

70

National Trends in Rotator Cuff Repair  

PubMed Central

Background: Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair. Methods: The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities. Results: The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001). Conclusions: The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.

Colvin, Alexis Chiang; Egorova, Natalia; Harrison, Alicia K.; Moskowitz, Alan; Flatow, Evan L.

2012-01-01

71

Biomechanical evaluation of rotator cuff fixation methods  

Microsoft Academic Search

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (su praspinatus tendon) was also determined. The different rotator

E. Paul France; Lonnie E. Paulos; Chris D. Harner; Chris B. Straight

1989-01-01

72

Vaginal wall fibroid.  

PubMed

Localization of leiomyomas in the vaginal wall is very rare. We report about a case of a vaginal leiomyoma in the anterior vaginal wall, preoperatively identified with sonography and CT. Surgical enucleation was performed. Surgical removal in these cases is safe and usually with minimal bleeding. PMID:18317784

Theodoridis, T D; Zepiridis, L; Chatzigeorgiou, K N; Papanicolaou, A; Bontis, J N

2008-09-01

73

[Ultrasound assessment of reconstructed rotator cuffs].  

PubMed

The evaluation of recurrent shoulder symptoms in patients who have had rotator cuff repair is a diagnostic challenge. Pain and limitation of motion may be caused by a recurrence of the rotator cuff tear. Arthrography is not considered to be helpful in postoperative cases, since it is false-positive in most of them. Pre-operative ultrasonography of the shoulder is regarded as a highly accurate diagnostic tool for rotator cuff tears. The diagnostic criteria used are: the continuity of the rotator cuff, its contour, its thickness and its echogenicity. Our study was aimed at determining which ultrasonographic criteria were significant for a retear. In addition, the "normal" postoperative sonographic appearance of the rotator cuff was established. Of 133 patients with a full thickness rotator cuff tear, 110 were evaluated 4-48 months (mean in 21 months) after surgery. A total of 85 cuffs were reconstructed, in 46 cases by direct suture, in 33 cases by suture to the major tubercle and in 6 cases by tendon transfer (Cofield technique). In 25 cases cuffs the could not be reconstructed. Subacromial decompression was performed routinely. The patients were evaluated clinically by range of movement, force and isometric and impingement tests. The subjective outcome was assessed by the algo-functional index of Patte. Ultrasonography was performed using a 7.5-MHz linear scanner. Each sonographic criterion was referred to the clinical and subjective findings. Ultrasonographic evaluation of the rotator cuffs that could not be reconstructed revealed non-visualization of the tendons. In 13 of the 85 patients in whom reconstruction of the cuff was possible a normal sonographic pattern was seen.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1287844

Cammerer, U; Habermeyer, P; Plenk, A; Huber, R

1992-12-01

74

Rolling-cuff flexible bellows  

DOEpatents

A flexible connector apparatus used to join two stiff non-deformable members, such as piping, is described. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

Lambert, D.R.

1982-09-27

75

Rotator cuff tears in the throwing athlete.  

PubMed

Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time. PMID:24787724

Shaffer, Benjamin; Huttman, Daniel

2014-06-01

76

Current Biomechanical Concepts for Rotator Cuff Repair  

PubMed Central

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.

2013-01-01

77

Biologically enhanced healing of the rotator cuff.  

PubMed

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

2012-06-01

78

Reconstruction of vaginal agenesis.  

PubMed

Vaginal ageneses are by no means rare anomalies. Complete Mullerian agenesis is the most common reason for vaginal agenesis requiring reconstruction. Patients usually present with pain, hematocolpos, or hematometra in puberty, and later with amenorrhea and dyspareunia. Detailed information is given here regarding etiologies, timing of surgery, and current treatment options for vaginal agenesis. Outcomes and short- and long-term complications of recent treatment options are also discussed. PMID:21372677

Ozkan, Ozlenen; Erman Akar, Münire; Ozkan, Omer; Do?an, N Utku

2011-06-01

79

Physical Therapist's Guide to Rotator Cuff Tear  

MedlinePLUS

... first sign of symptoms. Back to Top Real Life Experiences Over the past 3 weeks, Jonathan has ... Baltac? G, Atay OA. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain ...

80

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

2013-01-01

81

Degenerative change and rotator cuff tears  

Microsoft Academic Search

In order to determine the effects of friction and rubbing in the development of rotator cuff tear, we studied 160 shoulders of 80 cadavers (age at death 43–93 years, mean 69.3 years). Seventy-two cadavers were fixed with formalin and eight were fresh cadavers. The surface of the cuff and the undersurface of the acromion were observed macroscopically. Eight shoulders of

A. Hijioka; K. Suzuki; T. Nakamura; T. Hojo

1993-01-01

82

Rotator cuff injuries in adolescent athletes.  

PubMed

The cause of rotator cuff injuries in the young athlete has been described as an overuse injury related to internal impingement. Abduction coupled with external rotation is believed to impinge on the rotator cuff, specifically the supraspinatus, and lead to undersurface tears that can progress to full-thickness tears. This impingement is believed to be worsened with increased range of motion and instability in overhead athletes. A retrospective review of seven patients diagnosed with rotator cuff injuries was performed to better understand this shoulder injury pattern. The type of sport played, a history of trauma, diagnosis, treatment method, and outcome were noted. Six patients were male and one was a female. Baseball was the primary sport for four patients, basketball for one, gymnastics for one, and wrestling for one. The following injury patterns were observed: two patients tore their subscapularis tendon, two sustained avulsion fractures of their lesser tuberosity, one tore his rotator interval, one tore his supraspinatus, and one avulsed his greater tuberosity. Only four patients recalled a specific traumatic event. Three patients were treated with arthroscopic rotator cuff repair, three with miniopen repair, and one was treated with rehabilitation. Six of the seven patients returned to their preinjury level of sport after treatment. Rotator cuff tears are rare in the adolescent age group. The injury patterns suggest that acute trauma likely accounts for many rotator cuff tears and their equivalents in the young patient. Adolescents with rotator cuff tears reliably return to sports after treatment. The possibility of rotator cuff tears in skeletally immature athletes should be considered. The prognosis is very good once this injury is identified and treated. PMID:22668571

Weiss, Jennifer M; Arkader, Alexandre; Wells, Lawrence M; Ganley, Theodore J

2013-03-01

83

Clinical Examination of the Rotator Cuff  

PubMed Central

Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability accounting 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 using a goniometer, strength testing 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 be typically 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 diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology.

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

2013-01-01

84

Rotator cuff tears in overhead athletes.  

PubMed

The rotator cuff is under significant stress during overhead athletics, which can predictably lead to a certain spectrum of rotator cuff injuries in this population. Although the cause is often multifactorial; tensile overload, outlet impingement, and internal impingement are common causes of cuff pathologic conditions in this group. Identification of symptomatic rotator cuff disease can be challenging in the overhead athlete because abnormalities of the rotator cuff are common in asymptomatic throwers and rotator cuff pathologic conditions often occur in conjunction with other injuries. Although nonoperative options should be exhausted, surgical treatment is typically necessary for any rotator cuff tear for which conservative treatment fails. Tear thickness has been classically used to determine the surgical approach, with tears involving less than 50% of the tendon thickness treated with debridement and more substantial tears treated with formal repair. However, some authors and some noted surgeons with experience in managing this patient population have more recently advocated a higher threshold of tendon involvement before considering formal repair. Multiple repair options have been described, but few reports have focused specifically on the outcomes of rotator cuff surgery in overhead athletes. The limited available data do lead, however, to a few reasonable conclusions. Surgical results typically correlate with tear severity. Partial-thickness tears treated with arthroscopic debridement and management of concomitant pathologic conditions seem to have fairly good outcomes in the literature, with most athletes able to return to activity at their preinjury level. Full-thickness tears, however, have fared much more poorly in the overhead athlete, with largely dismal outcomes after surgical repair. What is abundantly clear is that further refinement of surgical options is necessary to improve patient outcomes after rotator cuff repair in this particularly challenging patient population and to allow more consistent return to sports. Identification of symptomatic rotator cuff disease can be challenging in the overhead athlete because abnormalities of the rotator cuff are common in asymptomatic throwers and rotator cuff pathologic conditions often occur in conjunction with other injuries. Although nonoperative options should be exhausted, surgical treatment is typically necessary for any rotator cuff tear for which conservative treatment fails. Tear thickness has been classically used to determine the surgical approach, with tears involving less than 50% of the tendon thickness treated with debridement and more substantial tears treated with formal repair. However, some authors and some noted surgeons with experience in managing this patient population have more recently advocated a higher threshold of tendon involvement before considering formal repair. Multiple repair options have been described, but few reports have focused specifically on the outcomes of rotator cuff surgery in overhead athletes. The limited available data do lead, however, to a few reasonable conclusions. Surgical results typically correlate with tear severity. Partial-thickness tears treated with arthroscopic debridement and management of concomitant pathologic conditions seem to have fairly good outcomes in the literature, with most athletes able to return to activity at their preinjury level. Full-thickness tears, however, have fared much more poorly in the overhead athlete, with largely dismal outcomes after surgical repair. What is abundantly clear is that further refinement of surgical options is necessary to improve patient outcomes after rotator cuff repair in this particularly challenging patient population and to allow more consistent return to sports. PMID:23040553

Economopoulos, Kostas J; Brockmeier, Stephen F

2012-10-01

85

Afterloading Techniques in Brachytherapy.  

National Technical Information Service (NTIS)

The advantages of applying modern afterloading methods in brachytherapie of malignant diseases are outlined. They include, among other things, a considerable reduction in radiation exposure to staff involved. Furthermore, the radiation protection requirem...

M. Kirsch R. Orban B. Lorenz

1981-01-01

86

Vaginal erotic sensitivity  

Microsoft Academic Search

Vaginal erotic sensitivity was investigated in a group of 48 coitally experienced volunteers by means of systematic digital stimulation of both vaginal walls. It was found that 45 subjects reported erotic sensitivity located in most cases on the upper anterior wall, and of those, 30 (66. 7%) either reached orgasm or requested to stop stimulation short of orgasm. This study

Heli Alzate; Maria Ladi Londono

1984-01-01

87

Inaccuracies introduced by single width blood pressure cuffs.  

PubMed

Blood pressure cuff dimensions directly affect accuracy of blood pressure measurements. For accurate blood pressure measurements, the width of the cuff must be proportional to arm circumference. A cuff that is too narrow results in falsely high blood pressure values, and a cuff that is too wide results in falsely low values. Some blood pressure standards permit a single width cuff regardless of arm circumference. The purpose of this study was to evaluate whether 12?cm single width cuffs currently permitted by the British Hypertension Society (BHS) standard are sufficiently accurate to pass the Association for the Advancement of Medical Instrumentation (AAMI), BHS, and European Society of Hypertension (ESH) International Protocol (IP1) Working Group standards for accuracy. Each of 101 subjects was tested sequentially with both a single and a proportional width cuff in random order. Auscultatory blood pressure was determined by 2 observers using a double binaural stethoscope. Accuracy was determined by comparing the resulting differences with the AAMI, BHS, and IP1 standards for accuracy. The single width blood pressure cuff failed the AAMI accuracy standards for both systolic blood pressure on large arms and diastolic blood pressure on small and large arms, and overall. The single width cuffs, also, failed the BHS accuracy standards for diastolic BP. In conclusion, these single width cuffs could result in a significant number of people being misdiagnosed and mistreated for hypertension. Therefore, to avoid 'cuff hypertension' and 'cuff hypotension', the cuff width should be proportional to arm circumference. PMID:21048776

Andrews, Jeffrey C; Dewitt, Blake; Czerwien, Terry E; Bijelic, Miro; Latman, Neal S

2011-02-01

88

Vaginal agenesis or distal vaginal atresia associated with anorectal malformations  

Microsoft Academic Search

Background: Mayer-Rokitansky-Küster-Hauser syndrome is defined as Müllerian aplasia with vaginal agenesis and uterine remnants. It is commonly associated with renal and sometimes vertebral anomalies. MRKH syndrome or distal vaginal atresia is sometimes associated with anorectal malformations. The purpose of this study was to describe seven females with vaginal agenesis or distal vaginal atresia and an anorectal malformation and review the

Tomas Wester; Juan A. Tovar; Risto J. Rintala

89

Vaginal hysterectomy in generally considered contraindications to vaginal surgery  

Microsoft Academic Search

Objective The objective was to evaluate the feasibility and complication rate of vaginal hysterectomy with or without adnexectomy in women with enlarged uteri and\\/or other considered contraindications to the vaginal route. Study design Over a period of 2 years, a total of 204 women underwent vaginal hysterectomy for benign pathology. Normally considered contraindications to the vaginal route were: moderate to excessive

Pierluigi Paparella; Ornella Sizzi; Alfonso Rossetti; Franco De Benedittis; Raffaele Paparella

2004-01-01

90

Innovations and advances in brachytherapy.  

PubMed

The treatment of cancer with radioactive sources using topical molds and intracavitary radium showed the efficacy of brachytherapy long before external radiation therapy became common practice. Brachytherapy is progressing in several clinical directions that reflect technological innovation as well as changes in medical care which combine to provide significant advances in the practice of brachytherapy today. A major change in brachytherapy, the development of high intensity sources, promoted clinical and technologic innovations in high dose-rate brachytherapy. Pulse dose-rate brachytherapy is the use of these sources to treat a target by using pulses of radiation for several minutes each hour with the same overall time and total dose as low dose-rate treatment. Recent novel approaches of using radiotherapy for prevention of restenosis in coronary and peripheral vessels has interested laboratory and clinical researchers. Most of the work toward new source material for brachytherapy centers around intravascular applications. Technology to support brachytherapy continues to advance rapidly. The interaction between images from diverse modalities and the various phases of the treatment planning is the basis of enhanced treatment planning procedures. Optimization in brachytherapy entails calculating the source strengths or source dwell times to satisfy a set of dose criteria to achieve the best dose distribution for a brachytherapy implant. Progress in computerization and calculation modeling has promoted this technical advance. Education and training in brachytherapy indications and techniques is mandatory to maintain high standards of brachytherapy practice. PMID:9422265

Stitt, J A; Thomadsen, B R

1997-12-01

91

Prehospital endotracheal intubation; need for routine cuff pressure measurement?  

PubMed

In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulnerable group of patients. We reviewed cuff pressures after intubation by Helicopter Emergency Medical Services and paramedics noted in a dispatch database. Initial cuff pressures are almost all too high, needing adjustment to be in the safe zone. Dutch paramedics lack manometers and, therefore, only few paramedic intubations are followed by cuff pressure measurements. We recommend cuff pressure measurements after all (prehospital) intubations and, therefore, all ambulances need to be equipped with cuff manometers. PMID:23100319

Peters, Joost H; Hoogerwerf, Nico

2013-10-01

92

Single row rotator cuff repair with modified technique  

PubMed Central

Rotator cuff tear is a common medical condition. We introduce various suture methods that can be used for arthroscopic rotator cuff repair, review the single row rotator cuff repair method with modified technique, and introduce the Ulsan-University (UU) stich. We compare the UU stitch with the modified Mason-Allen (MA) suture method. The UU stitch configuration is a simple alternative to the modified MA suture configuration for rotator cuff repair.

Ko, Sang-Hun; Shin, Seung-Myeong

2012-01-01

93

Rotator cuff repair during shoulder arthroplasty in rheumatoid arthritis  

Microsoft Academic Search

A prospective study of 40 shoulder arthroplasties in patients with rheumatoid arthritis was performed to evaluate the results of rotator cuff repair at the time of arthroplasty. A large cuff tear was present in 21 shoulders, and good repair of the cuff was performed in 9. In the other shoulders the repair was considered insufficient. All patients were clinically evaluated

P. M. Rozing; R. Brand

1998-01-01

94

Sonography of the Rotator CuffAn Overview  

Microsoft Academic Search

The rotator cuff is formed by the subscapularis, supraspinatus, infraspinatus, and teres minor muscles. Together, these muscles help stabilize the glenohumeral joint by holding the head of the humerus in the glenoid cavity of the scapula. The tendinous insertions of the rotator cuff create tension within the capsule when these muscles contract, providing stability in the joint. The rotator cuff

Amanda Holling

2001-01-01

95

Diagnosis of tears in rotator-cuff-injuries  

Microsoft Academic Search

Pathology of the rotator cuff is the cause of most common problems at the shoulder joint. Acute injuries are not as frequent as chronic cuff disease, but often they aggravate inflammatory or degenerative tendon alterations, even if they are of minor severity. Traumatic rotator cuff tears predominantly affect the supraspinatus tendon or the rotator interval. The subscapularis tendon is involved

Claudius Gückel; Andreas Nidecker

1997-01-01

96

Current imaging of the rotator cuff.  

PubMed

Rotator cuff pathology is a common cause of shoulder pain, and imaging plays a major role in the management of shoulder problems. General radiography may be useful as an initial screening test particularly in trauma and arthritis. Musculoskeletal ultrasound and magnetic resonance imaging are the most suitable modalities for the investigation of the rotator cuff, having high sensitivities and specificities for full-thickness tears. Musculoskeletal ultrasound and magnetic resonance imaging are less accurate in the detection of partial-thickness tears with greater observer variability. This article reviews the normal and pathologic imaging features of the rotator cuff and highlights the potential usefulness and limitations of various imaging modalities in the assessment of the tendon and the potential impact of imaging findings on clinical patient care. PMID:21822112

Gazzola, Steve; Bleakney, Robert R

2011-09-01

97

Vaginal bleeding between periods  

MedlinePLUS

... IUD use (may cause occasional spotting) Ectopic pregnancy Miscarriage Other pregnancy complications Vaginal dryness due to lack ... information Are you pregnant? Have you had a miscarriage or abortion? Have you had a D and ...

98

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.

1993-01-01

99

MRI of vaginal leiomyomas.  

PubMed

The MR appearances of two cases of vaginal leiomyoma are described. Both patients presented with a periurethral mass; one patient presented during pregnancy. MRI allowed precise anatomic localization of the masses and confident preoperative characterization in both cases. PMID:11351183

Shadbolt, C L; Coakley, F V; Qayyum, A; Donat, S M

2001-01-01

100

Massive rotator cuff tears: arthroscopy to arthroplasty.  

PubMed

The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option. PMID:20415384

Singh, Anshu; Jawa, Andrew; Morman, Monica; Sanofsky, Benjamin; Higgins, Laurence

2010-01-01

101

Clinical and biological aspects of rotator cuff tears  

PubMed Central

Summary 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.

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

2013-01-01

102

Vaginal fibroma. Case report.  

PubMed

A case of a vaginal fibroma in a 50-year-old woman is presented. The tumor presented as a solid mass in the upper third of the anterior vaginal wall. Intravenous pyelography (IVP) and cystoscopy excluded any association of the mass with the urinary tract. Surgical excision of the tumor was easily accomplished and histopathological examination established the diagnosis of a fibroid tumor of the vagina. PMID:12556111

Daskalakis, G J; Karabinas, C D; Papantoniou, N E; Papaspyrou, I A; Antsaklis, A J; Michalas, S

2002-01-01

103

Free Biceps Tendon Autograft to Augment Arthroscopic Rotator Cuff Repair  

PubMed Central

Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while one is performing rotator cuff surgery. A subpectoral biceps tenodesis provides a source of autograft to augment rotator cuff repairs of all sizes. Two techniques are presented to augment rotator cuff repairs with a free biceps tendon autograft. This is a novel idea in an attempt to improve healing rates and long-term results of rotator cuff repairs of all sizes.

Obma, Padraic R.

2013-01-01

104

Vaginal stenosis and hydrometrocolpos: late complication of inadvertent perivaginal placement of an artificial urinary sphincter in prepubertal girls(1).  

PubMed

Urinary incontinence in pediatric and adolescent patients has been successfully managed with the artificial urinary sphincter for several decades. Placement of the sphincter can be difficult in the preadolescent girl due to poorly developed vaginal tissue that can result in difficulty establishing the surgical plane between the bladder and vagina. We report 2 patients in whom the sphincter was placed around the urethra and vagina, a complication that has been reported in only 1 patient previously. All 3 patients presented with hematometrocolpos and bloody vaginal discharge. All were successfully managed with replacement of the sphincter cuff around the urethra and delayed vaginoplasty. PMID:10754150

Cain, M P; Rink, R C

1999-11-01

105

Biological aspects of rotator cuff healing  

PubMed Central

Summary Tendon tears of the rotator cuff show a high prevalence in today’s population. Patients suffer from permanent pain and disability, and surgical reconstruction may be the only possibility for abatement. The complex process of tendon-bone healing leads to mechanically inferior scar-tissue, which often results in retears or non-healing. In the current literature, factors such as patients age, sex and fatty muscle infiltration are highly correlated to the presence of rotator cuff tears and the incidence of retears. To improve the tendon tissue quality after surgical reconstructions biologically based strategies with use of growth factors arouse more and more interest in the last years. However, to optimize the treatment of rotator cuff tears the biological background of tears and retears must be investigated in more detail. This article will elucidate different aspects that have an impact on rotator cuff healing and give a brief insight in tendon/ligament cell culture and animal studies focusing on growth factor treatments.

Wildemann, Britt; Klatte, Franka

2011-01-01

106

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.

2011-01-01

107

Cuff deflation: rehabilitation in critical care.  

PubMed

This is a case series of rehabilitation failures that resulted in severe reactive depression from patients unnecessarily bereft of verbal communication by being left to breathe or be ventilated via tracheostomy tubes, with or without inflated cuffs, for months to years. PMID:24879555

Bach, John R; Gonçalves, Miguel R; Rodriguez, Pedro Landete; Saporito, Louis; Soares, Luisa

2014-08-01

108

Vaginal bleeding in early pregnancy  

MedlinePLUS

Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen any time from conception ( ... out of every 10 pregnant women have vaginal bleeding during their first 20 weeks of pregnancy.

109

Vaginal Anomalies: Fusion and Duplication  

MedlinePLUS

... dolor sit amet, consectetur adipiscing elit. Vaginal Abnormalities: Fusion and Duplication Having two of everything may be ... if your child's doctor diagnoses an "anomaly of fusion and duplication." What causes vaginal fusion and duplication? ...

110

Spontaneous vaginal evisceration  

PubMed Central

Management of vaginal prolapse in the elderly lacks a uniform consensus and continues to remain challenging. The authors report a case of an elderly lady who presented with a spontaneous vaginal evisceration. She had a long-standing vaginal prolapse being controlled by a shelf pessary, which, in her case became displaced 2 weeks prior to admission. The patient underwent a laparotomy with an intent to replace the bowel back within the peritoneal cavity and repair the vault. During the pelvic floor repair, she sustained an inadvertent button-hole injury to the rectum, which was oversewn. She went on to develop a rectovaginal fistula requiring a de-functioning colostomy. The patient made good recovery subsequently.

I, Siddiqui; A, Samee; C, Hall; J, Cooper; F, O'Mahony

2011-01-01

111

Vaginal Tactile Imaging  

PubMed Central

Changes in the elasticity of the vaginal walls, connective support tissues, and muscles are thought to be significant factors in the development of pelvic organ prolapse, a highly prevalent condition affecting at least 50% of women in the United States during their lifetimes. It creates two predominant concerns specific to the biomechanical properties of pelvic support tissues: how does tissue elasticity affect the development of pelvic organ prolapse and how can functional elasticity be maintained through reconstructive surgery. We designed a prototype of vaginal tactile imager (VTI) for visualization and assessment of elastic properties of pelvic floor tissues. In this paper, we analyze applicability of tactile imaging for evaluation of reconstructive surgery results and characterization of normal and pelvic organ prolapse conditions. A pilot clinical study with 13 patients demonstrated that VTI allows imaging of vaginal walls with increased rigidity due to implanted mesh grafts following reconstructive pelvic surgery and VTI has the potential for prolapse characterization and detection.

van Raalte, Heather; Sarvazyan, Armen P.

2010-01-01

112

A vaginal temperature registration system  

Microsoft Academic Search

A radiotelemetric method for measurements of vaginal temperature in the home milieu is presented. Registrations from two subjects show that vaginal temperatures vary up to and about 1°C nighttime. Initially, on going to bed, vaginal temperature drops. A further distinct drop occurs with any kind of experienced sexual arousal, reaching a minimum when and if orgasm is achieved. At rest,

Axel R. Fugl-Meyer; Kerstin Sjögren; Kenneth Johansson

1984-01-01

113

Vaginal Toxic Shock Reaction Triggering Desquamative Inflammatory Vaginitis  

PubMed Central

Objective To report two cases of desquamative inflammatory vaginitis (DIV) associated with toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus strains. Materials and Methods Case report of two patients, one with an acute and one with a chronic presentation, diagnosed with DIV on the basis of clinical findings and wet mount microscopy. Pre- and posttreatment vaginal bacterial and yeast cultures were obtained. Results Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial cultures following oral antibiotic therapy were negative. Conclusions DIV may be triggered through TSST-1-mediated vaginal toxic shock reaction.

Pereira, Nigel; Edlind, Thomas D.; Schlievert, Patrick M.; Nyirjesy, Paul

2012-01-01

114

Paraurethral vaginal leiomyoma.  

PubMed

A case of paraurethral vaginal leiomyoma becoming clinically apparent in the postpartum period is presented. As is frequently the case, the diagnosis was not apparent. Urinary tract origin is commonly suspected, since the majority of these tumors occur in the midline of the anterior vaginal wall. The tumors are often asymptomatic, but can cause dysuria, urinary frequency, urinary retention, and dyspareunia. Pathologically, they are well circumscribed and have the typical microscopic features of leiomyomas found elsewhere. Simple excision is usually adequate treatment. PMID:3603914

Castle, W N; McLaughlin, W L

1987-07-01

115

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.

2013-01-01

116

Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?  

PubMed

In a multicenter, randomized, controlled, open-label, parallel- group trial hyaluronic acid vaginal gel (Hyalofemme) was compared to estriol vaginal cream (Ovestin) in women with vaginal dryness due to various causes. A total of 144 supposedly postmenopausal women below age 70 years were randomized in a 1:1 ratio to either receive hyaluronic acid vaginal gel (5 g per application) or estriol vaginal cream (0.5 g cream per application = 0.5 mg estriol) every 3 days for a total of ten applications, respectively. Exclusion criteria included vaginal infections, conventional contraindications to estrogens, use of vaginal products other than the investigational compounds, being unmarried, pregnant, or breastfeeding. The aim of the study was to test for non-inferiority of hyaluronic acid vaginal gel compared to estriol vaginal cream. The primary efficacy end point was the percentage (%) improvement in vaginal dryness, with the secondary end points being the percentage (%) improvements in vaginal itching, burning, and dyspareunia. Efficacy was assessed by using a visual analog scale (VAS) (0-10; 0 = absent, 10 = intolerable) at baseline (V0), during telephone contact after the third administration (V1), and at the final visit after the tenth administration (V2). Safety parameters included vaginal pH, endometrial thickness, and a vaginal smear for vaginal microecosystem assessment. Adverse events were recorded according to international guidelines. 133 women completed the study. At baseline, participants' characteristics did not differ significantly. Mean age was 54 years, time since menopause was 5 years on average, and cause of menopause was mostly natural. However, mean menstrual cycle days were also reported, although according to inclusion criteria only postmenopausal women were eligible for the study. At V1, an improvement in vaginal dryness was reported by about 49 % of women using hyaluronic acid vaginal gel, and by 53 % of women using estriol vaginal cream (p = 0.31). At V2, the percentage improvement rates were 84 and 89 % (p = 0.13), respectively. Improvement rates for vaginal itching, burning, and dyspareunia at V2 were about 86, 85, and 57 % for hyaluronic acid vaginal gel, and 82, 87, and 62 % for estriol vaginal cream (p[0.05), respectively. After treatment, vaginal pH was significantly lower in estriol-treated women compared to those having received hyaluronic acid. Endometrial thickness did not differ between groups. In the majority of women, the vaginal microenvironment remained unaffected by treatment. However, the proportion of women whose abnormal vaginal microecological results became normal was higher in women using estriol vaginal cream. Adverse events (suspected to be) related to the investigational compounds were minor and included vaginal infection and genital itching. The authors concluded that hyaluronic acid vaginal gel was not inferior to estriol vaginal cream in women presenting with vaginal dryness. They suggest using hyaluronic acid vaginal gel not only as an alternative treatment to vaginal estrogens, but also to consider its general use in women presenting with vaginal dryness of any cause. PMID:24178484

Stute, Petra

2013-12-01

117

Arthroscopic Fixation of Bursal-Sided Rotator Cuff Tears  

Microsoft Academic Search

Subacromial decompression and debridement of partial-thickness bursal-sided rotator cuff tears are often reported with a high rate of unsatisfactory outcomes. We describe an arthroscopic procedure to repair partial-thickness bursal-sided rotator cuff tears without converting to a full-thickness tear in patients with a normal articular-sided rotator cuff and an A0B2 or A0B3 pattern of tear (minimum thickness of 25% to 75%).

Andrew B. Wolff; David P. Magit; Seth R. Miller; Jeff Wyman; Paul M. Sethi

2006-01-01

118

Vaginitis in adolescents.  

PubMed

Vaginitis is a common complaint of adolescent females. It can cause extreme distress for some patients, especially those with recurrent symptoms. Thus, it is important to take care when evaluating these patients and to acknowledge their frustration when appropriate. A thoughtful and thorough history will determine most causes, with the most common being yeast, trichomoniasis, and BV. PMID:15449843

Syed, Tahniat S; Braverman, Paula K

2004-06-01

119

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

2008-01-01

120

Ruthenium-106 brachytherapy.  

PubMed

Brachytherapy is the most common method for treating uveal melanoma, and currently the ruthenium-106 (Ru-106) and iodine-125 (I-125) applicators are the most frequently used. Ru-106 applicators were introduced by Prof. Peter Lommatzsch in the 1960s, and since then have been used widely by many ocular oncologists, mainly in Europe. The Ru-106 isotope is a beta ray (electron) emitter, and as such it has a limited depth of penetration. This is the reason why many experts use Ru-106 applicators for tumors with a maximal thickness of up to 7.0 mm, although others use it successfully for thicker tumors. The Ru-106 applicators are manufactured commercially and have a half-life of about 1 year. Ru-106 brachytherapy for uveal melanoma provides excellent local control rates and eye preservation with a relatively low recurrence rate. The main advantage of Ru-106 over other isotopes is the better preservation of vision in the treated eye, and less damage to the healthy parts of the eye due to its limited range of radiation. This can also be achieved by positioning the Ru-106 plaque eccentrically, away from the macula and optic nerve head. Ru-106 brachytherapy can be used in combination with other methods of treatment of uveal melanoma, such as local resection or transpupillary thermotherapy, and is sporadically combined with other isotopes, such as gamma-emitting cobalt-60 and I-125. PMID:22042011

Pe'er, Jacob

2012-01-01

121

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

2008-01-01

122

Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus  

PubMed Central

Purpose To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma. Material and methods The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy. Results The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV. Conclusions Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances.

Wallace, Charlie; Gondi, Vinai; Das, Rupak; Straub, Margaret; Al-Niaimi, Ahmed; Applegate, Glenn; Bradley, Kristin A.

2014-01-01

123

Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.  

PubMed

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

2012-12-01

124

Effective treatment of vaginal atrophy with isoflavone vaginal gel.  

PubMed

OBJETIVE: To assess efficacy and tolerability of a isoflavone (Glycine max L. Merr.) vaginal gel to the treatment of vaginal atrophy in postmenopausal women. METHODS: The double-blind, randomized, placebo-controlled, clinical trial. Ninety women were treated for 12 weeks with isoflavone vaginal gel 4% (1g/day) and a placebo gel and conjugated equine estrogen cream (0.3mg/day). After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. The endometrial safety (by transvaginal ultrasonography) was evaluated through at screening and the end of the trial. RESULTS: Isoflavone vaginal gel appears to be effective for relief of vaginal dryness and dyspareunia symptons and an increase in the intermediate and superficial cells was noted. These results were similar to the effects with use of conjugated equine estrogens and superior to placebo gel. No changes in endometrial thickness, sera FSH and estradiol levels were observed at study endpoint. CONCLUSION: Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms and a significant increase in cell maturation values. Isoflavones proved good treatment options for relief of vulvovaginal symptoms especially in women who do not wish to use hormonal therapy or have contra-indications for this treatment. PMID:23312487

Lima, Sonia M Rolim Rosa; Yamada, Silvia Saito; Reis, Benedito Fabiano; Postigo, Sostenes; Galvão da Silva, Maria Antonieta L; Aoki, Tsutomu

2013-01-01

125

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.

1988-01-01

126

Repair of rotator cuff tears in tennis players  

Microsoft Academic Search

Twenty-three tennis players with a symptomatic full- thickness rotator cuff tear underwent anterior acro mioplasty and rotator cuff repair. There were 8 small tears (<1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (>5 cm). The dominant shoulder was involved in all patients and all were unable to play

Louis U. Bigiliani; Jay Kimmel; Peter D. McCann; Ira Wolfe

1992-01-01

127

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

1996-01-01

128

Vaginal Vault Prolapse  

PubMed Central

Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

Uzoma, Azubuike; Farag, K. A.

2009-01-01

129

Radiographic findings associated with symptomatic rotator cuff tears.  

PubMed

This study compared shoulder radiographs of patients with a documented rotator cuff tear with those of asymptomatic age-matched controls. Radiographs of 40 subjects with documented rotator cuff tears were evaluated along with similar films of 84 asymptomatic age-matched controls. Three radiographs were taken of each shoulder: (1) acromioclavicular joint view, (2) anterior-posterior view with 30 degrees of external rotation, and (3) supraspinatus outlet view. Two fellowship-trained radiologists interpreted 14 radiographic areas in a blinded fashion. Inspection of the greater tuberosity showed large positive abnormal ratings for sclerosis, osteophytes, subchondral cysts, and osteolysis. No association was noted between acromial morphology and rotator cuff tears. These results indicate that shoulder radiographs of subjects with a documented rotator cuff tear have greater tuberosity radiographic abnormalities that are not noted in asymptomatic subjects without a rotator cuff tear. No relationship was found between tear length and any of the degenerative conditions. PMID:12700562

Pearsall, Albert W; Bonsell, Shawn; Heitman, R J; Helms, Clyde A; Osbahr, Daryl; Speer, Kevin P

2003-01-01

130

Analysis of rotator cuff muscles in adult human cadaveric specimens.  

PubMed

Management of irreparable massive rotator cuff tears remains a challenging and controversial problem. Defining glenohumeral force relations may allow for the development of treatment strategies based on biomechanical principles. Five fresh-frozen adult human cadaveric shoulder specimens were dissected to determine fiber length, mass, and lever arm of (a) the 3 bellies of the deltoid and (b) the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis). From these data, physiologic cross-sectional areas and moment relations were calculated. These relations provide evidence for a balanced axial force couple between the anterior and posterior rotator cuff. Demonstration of an axial force couple across the glenohumeral joint may have clinical significance for treatment of irreparable massive rotator cuff tears and may explain why many patients with full-thickness rotator cuff tears can regain acceptable shoulder function. PMID:12647876

Aluisio, Frank V; Osbahr, Daryl C; Speer, Kevin P

2003-03-01

131

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

PubMed Central

Background Arthroscopic rotator cuff repair is described as being a successful procedure. These results are often derived from clinical general shoulder examinations, which are then classified as 'excellent', 'good', 'fair' or 'poor'. However, the cut-off points for these classifications vary and sometimes modified scores are used. Arthroscopic rotator cuff repair is performed to improve quality of life. Therefore, disease specific health-related quality of life patient-administered questionnaires are needed. The WORC is a quality of life questionnaire designed for patients with disorders of the rotator cuff. The score is validated for rotator cuff disease, but not for rotator cuff repair specifically. The aim of this study is to investigate reliability, validity and responsiveness of WORC in patients undergoing arthroscopic rotator cuff repair. Methods/Design An approved translation of the WORC into Dutch is used. In this prospective study three groups of patients are used: 1. Arthroscopic rotator cuff repair; 2. Disorders of the rotator cuff without rupture; 3. Shoulder instability. The WORC, SF-36 and the Constant Score are obtained twice before therapy is started to measure reliability and validity. Responsiveness is tested by obtaining the same tests after therapy.

2011-01-01

132

Venlafaxine-associated vaginal bleeding.  

PubMed

A 41-year-old amenorrheic woman started taking venlafaxine 37.5 mg/day for treatment of depression; 7 days later, she experienced vaginal bleeding, which ceased 1 day after she stopped taking the drug. On rechallenge with venlafaxine, she again experienced vaginal bleeding that resolved after discontinuation. We found no published reports describing vaginal bleeding associated with venlafaxine. However, premarketing and postmarketing data report similar adverse effects in patients taking the agent. In addition, several cases of menstrual irregularities have occurred with two other antidepressants: fluoxetine and bupropion. This case report supports previous surveillance data indicating that venlafaxine may cause vaginal bleeding. PMID:12013367

Linnebur, Sunny A; Saseen, Joseph J; Pace, Wilson D

2002-05-01

133

Vaginal contraceptives still evolving.  

PubMed

The effort to develop vaginal contraceptives began in the distant past and is still underway today. 1000 years ago, South American Indians inserted into the vagina bark strips impregnated with quinine. In medieval times women used vaginal inserts of cloth soaked in honey or vinegar. Quinine pessaries were introduced into Europe in the late 1800s, and in the early 1900s investigators began to study the effects of various chemicals on sperm motility. Following World War II, surfactant spermicides which disrupt the sperm membrane were developed and marketed. Many of these preparations contained nonoxynol-9. Currently, the D-isomer of propranolol is being examined as a spermicidal contraceptive, and several bacteriocides, e.g., benzalkonium and chlorhexidine, are being developed as spermicides which reduce the penetrability of cervical mucus. Other chemicals being investigated act by inhibiting the acrosome reaction. Advantages of vaginal contraceptives are that they are inexpensive, reversible, and relatively safe and easy to use. Generally they require no medical intervention or supervision. In addition, spermicides may kill or inhibit the growth of organisms responsible for sexually transmitted diseases. Disadvantages of spermicides are that they are generally less effective than many other methods, some interfere with sexual spontaneity, they may cause local irritations, and some women find them messy to use. Recently, concerns were expressed about the possible teratogenic effects of sperimicides. Most of these concerns proved to be unfounded. Given the many new avenues of research, the major disadvantage of sperimicides, i.e., their high failure rates, may be minimized in the near future. PMID:12340621

Pearson, R M

1986-01-01

134

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

2000-01-01

135

Vaginal eroticism: A replication study  

Microsoft Academic Search

Vaginal eroticism was investigated in a group of 27 coitally experienced volunteers by means of systematic digital stimulation of both vaginal walls. Erogenous zones were found in all subjects, mainly located on the upper anterior wall and the lower posterior one. An orgasmic response was elicited by stimulation of these zones in 89% of the subjects.

Heli Alzate

1985-01-01

136

Vaginal fistula following restorative proctocolectomy  

Microsoft Academic Search

Vaginal fistula (VF) is a devastating complication following restorative proctocolectomy. PURPOSE: This study was designed to examine the perioperative factors influencing the outcome and management of vaginal fistula. METHOD: Between October 1983 and September 1994, 526 women underwent restorative proctocolectomy. Nineteen develop VF (3.6 percent), and six were referred from other institutions with this complication. These 25 women were followed

Patrick Y. Lee; Victor W. Fazio; James M. Church; Tracy L. Hull; Kong-Weng Eu; Ian C. Lavery

1997-01-01

137

Quantitative studies of vaginal bacteria  

Microsoft Academic Search

A quantitative method of culture, based on a weighed sample and with results expressed as colony forming units (cfu)\\/g was assessed and used to investigate the vaginal flora of normal women and that of women with vaginal disease. Samples were collected by means of disposable plastic loops into modified proteose peptone water transport medium in preweighed bottles. Counts expressed as

A N Masfari; B I Duerden; G R Kinghorn

1986-01-01

138

Treatment of vaginal atrophy.  

PubMed

Vaginal or vulvovaginal atrophy is a widespread but poorly recognized condition of peri- and post-menopausal women. It causes urogenital symptoms of dryness, reduced lubrication, itching, burning, irritable bladder symptoms and painful intercourse. This impacts quality of life and sexual health, but increases with time rather than reduces, as with most other menopausal symptoms. With early identification, treatments can improve these symptoms and reverse the physical changes. However, when embedded, bladder and sexual changes have occurred and these may be more difficult to remedy. Therefore, it is important to educate both healthcare professionals and women about these symptoms and advise on the range of interventions available. PMID:24601810

Domoney, Claudine

2014-03-01

139

Red herring vaginal discharge.  

PubMed

Labial hair tourniquet syndrome is a rare condition that can be easily misdiagnosed and ultimately lead to irreversible damage. An 11-year-old premenarche girl presented with a 5-day history of pain and swelling in the labia with associated vaginal discharge. The general practitioner treated her with clotrimazole without improvement. On examination, there was an oedematous swelling of the right labia with a proximal hair tourniquet. Local anaesthetic was applied and the hair removed with forceps. There was instant relief of pain and the discharge stopped within 24 h. The patient was sent home with a course of antibiotics. PMID:24049092

Lee, Jun Hee; Pringle, Kirsty; Rajimwale, Ashok

2013-01-01

140

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.

2009-01-01

141

The role of acromioplasty for rotator cuff problems.  

PubMed

Acromioplasty is a well-described technique used throughout the wide spectrum of treatment options for shoulder impingement and rotator cuff pathology. Several randomized prospective studies have described clinical outcomes that are statistically similar when comparing patients undergoing rotator cuff repair either with or without concomitant acromioplasty. This article reviews the current evidence for use of acromioplasty in patients with subacromial impingement syndrome and during arthroscopic rotator cuff repair. Despite recently published studies, more long-term data, especially with regard to failure rates and return-to-surgery rates over time, are needed to better determine the role of acromioplasty. PMID:24684915

Frank, Jonathan M; Chahal, Jaskarndip; Frank, Rachel M; Cole, Brian J; Verma, Nikhil N; Romeo, Anthony A

2014-04-01

142

Rotator Cuff Repair Augmented With Endogenous Fibrin Clot  

PubMed Central

Despite recent technical advances, rotator cuff repair continues to have a high retear rate. Recent research focused on biologic augmentation of rotator cuff repair with platelet-rich plasma has shown mixed results, and use of an endogenous fibrin clot from either peripheral blood or bone marrow may have advantages over the use of platelet-rich plasma. This technique describes a method to make an endogenous fibrin clot and arthroscopically apply the fibrin clot to the superior surface of the rotator cuff repair site.

Proctor, Christopher S.

2012-01-01

143

Vaginoscopic resection of vaginal septum.  

PubMed

We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect. PMID:23315718

Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmad; Ghulmiyyah, Labib

2012-12-01

144

Laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor.  

PubMed

Introduction: Although cuff leak test has been proposed as a simple method of predicting the occurrence of postextubation stridor, cut-off point of cuff-leak volume substantially differs between previous studies. In addition, laryngeal ultrasonography including measurement of air column width could predict postextubation stridor. The aim of the present study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor. Methods: In a prospective study, all patients intubated for a minimum of 24 h for acute respiratory failure, airway protection and other causes were included. Patients were evaluated for postextubation stridor and need for reintubation after extubation. The cuff leak volume was defined as a difference between expiratory tidal volumes with the cuff inflated and deflated. Laryngeal air column width was defined as the width of air passed through the vocal cords as determined by laryngeal ultrasonography. The air-column width difference was the width difference between balloon-cuff inflation and deflation. Results: Forty one intubated patients with the mean age of 57.16±20.07 years were included. Postextubation stridor was observed in 4 patients (9.75%). Cuff leak test (cut off point: 249 mL) showed sensitivity and specificity of 75% and 59%, respectively. In addition, laryngeal ultrasonography (cut off point for air column width: 10.95 mm) resulted in sensitivity and specificity of 50% and 54%, respectively. Positive predictive value of both methods were <20%. Conclusion: Both cuff leak test and laryngeal ultrasonography have low positive predictive value and sensitivity in predicting postextubation stridor and should be used with caution in this regard. PMID:24753828

Mikaeili, Haleh; Yazdchi, Mohammad; Tarzamni, Mohammad Kazem; Ansarin, Khalil; Ghasemzadeh, Maryam

2014-01-01

145

Radiographic findings associated with symptomatic rotator cuff tears  

Microsoft Academic Search

This study compared shoulder radiographs of patients with a documented rotator cuff tear with those of asymptomatic age-matched controls. Radiographs of 40 subjects with documented rotator cuff tears were evaluated along with similar films of 84 asymptomatic age-matched controls. Three radiographs were taken of each shoulder: (1) acromioclavicular joint view, (2) anterior-posterior view with 30° of external rotation, and (3)

Albert W. Pearsall; Shawn Bonsell; R. J. Heitman; Clyde A. Helms; Daryl Osbahr; Kevin P. Speer

2003-01-01

146

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

2009-01-01

147

Ultrasound of the rotator cuff with MRI and anatomic correlation.  

PubMed

Magnetic resonance imaging and high-resolution ultrasound (US) are frequently used for the detection of rotator cuff tears. The diagnostic yield of US is influenced by several factors as technique, knowledge of the imaging characteristics of anatomic and pathologic findings and of pitfalls. The purpose of this article is to illustrates that the standardized high-resolution US examination of the shoulder covers the entire rotator cuff and correlates with MR imaging and anatomic sections. PMID:17196354

Rutten, Matthieu J C M; Maresch, Bas J; Jager, Gerrit J; Blickman, Johan G; van Holsbeeck, Marnix T

2007-06-01

148

Humeral head cysts: association with rotator cuff tears and age.  

PubMed

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1 % (60 patients) in the study population. Anterior GT cysts were found in 56 % of patients and were strongly associated with full-thickness (p < .001) and articular-sided partial-thickness rotator cuff tears (p = .02). Posterior GT and lesser tuberosity cysts were found in 27 and 17 % of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p = .09). A significant relation was found between patient age and the cyst size (p = .01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age. PMID:23748696

Suluova, Fatih; Kanatli, Ulunay; Ozturk, Burak Yagmur; Esen, Erdinc; Bolukbasi, Selcuk

2014-07-01

149

Vaginal leiomyoma in a dog.  

PubMed

The surgical treatment of vaginal leiomyoma in a seven year old Blue Heeler bitch is described. A smooth, 12 cm diameter submucosal, intraluminal, firm mass was found on vaginal examination. It appeared to arise from the left ventral vaginal wall, cranial to the clitoris but caudal to the cervix. There was no history of urinary problems and the dog was normal in all other aspects. The treatment was surgical excision of the mass via an episiotomy. Histological examination indicated a leiomyoma. The differential diagnoses, possible etiologies and control or prevention of the condition by ovariohysterectomy are also discussed. PMID:17422296

Kang, T B; Holmberg, D L

1983-08-01

150

Vaginal Leiomyoma in a Dog  

PubMed Central

The surgical treatment of vaginal leiomyoma in a seven year old Blue Heeler bitch is described. A smooth, 12 cm diameter submucosal, intraluminal, firm mass was found on vaginal examination. It appeared to arise from the left ventral vaginal wall, cranial to the clitoris but caudal to the cervix. There was no history of urinary problems and the dog was normal in all other aspects. The treatment was surgical excision of the mass via an episiotomy. Histological examination indicated a leiomyoma. The differential diagnoses, possible etiologies and control or prevention of the condition by ovariohysterectomy are also discussed. ImagesFigure 1.Figure 2.

Kang, T. B.; Holmberg, D. L.

1983-01-01

151

Vaginal aplasia and reconstruction.  

PubMed

Congenital vaginal agenesis, with a prevalence of 1 in 4000 females, occurs mainly as a feature of the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Management of patients with MRKH syndrome includes, along with the proper psychological support, the creation of a neovagina to give them the opportunity to have a normal sexual life. Both surgical and non-surgical techniques have been suggested during the past century, for neovagina creation. Among them, the most widespread non-surgical techniques performed are the Frank technique and its modification by Ingram, while the surgical techniques include the McIndoe operation, the Vechietti procedure and its laparoscopic modification and the Williams vaginoplasty and its Creatsas modification. The Creatsas vaginoplasty is a simple, fast and safe technique that has been performed in 178 patients in our Institution over the past 22 years and has provided excellent results in the vast majority of patients. PMID:20089458

Creatsas, G; Deligeoroglou, E

2010-04-01

152

Improved apparatus for predictive diagnosis of rotator cuff disease  

NASA Astrophysics Data System (ADS)

Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

2014-03-01

153

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.

2012-01-01

154

Epidemiology, genetics and biological factors of rotator cuff tears.  

PubMed

Rotator cuff disease is among the most common musculoskeletal disorders with high direct and indirect costs in industrialized countries. Not all rotator cuff tears are symptomatic. Genetics has recently been investigated as a factor involved in the pathogenesis of rotator cuff pathology. Genetic factors seem to be involved in symptom presentation and tear progression. As rotator cuff disease is multifactorial, no single gene is directly involved in the pathology. Phenotypic expression of genetic susceptibility manifests at the level of ultrastructure of the tendon. Predisposing genes may also operate through apoptosis and regenerative capacity. Studies on cellular and molecular biology are more numerous, but still incomplete, and recently have focussed on the role of apoptosis in tendinopathy, analyzing its key mediators and cellular changes. Oxidative stress is responsible for reduction of collagen synthesis. Biological investigations have identified recently new risk factors. Preliminary reports introduced the possible role of glucose as a risk factor for rotator cuff tear. Further studies are required to fully clarify the genetic and biological factors involved in rotator cuff tears. PMID:21986040

Longo, Umile Giuseppe; Berton, Alessandra; Papapietro, Nicola; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

155

Vaginal Misoprostol versus Vaginal Estradiol in Overcoming Unsatisfactory Colposcopy.  

PubMed

Background: Unsatisfactory colposcopy, an inability to visualize the entire transformation zone, is found in about 10-20% of the patients undergoing the procedure. These patients usually require conization for a comprehensive evaluation of the cervix. Our study aims to compare the efficacy and safety of vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy. Methods: We studied 48 women with unsatisfactory colposcopy. They were randomized into two groups: group I (n = 24) received 200 µg misoprostol vaginally and colposcopy was repeated after 6 h, while the subjects in group II (n = 24) were prescribed a 7-day course of 50 µg estradiol for vaginal insertion followed by a repeat colposcopy. The efficacy and safety of these two drugs were compared. Results: Repeat colposcopy was satisfactory in 70.8% of the women given vaginal misoprostol compared to 82.6% of the women who used vaginal estradiol. The difference was not statistically significant. The adverse effects were reported more often by the women in the misoprostol group (41.6%) as compared to those in estradiol group (13%) (p = 0.04). Conclusion: Both estradiol and misoprostol were comparable in overcoming unsatisfactory colposcopy. However, a higher incidence of adverse effects was noted with misoprostol as compared to estradiol. © 2014 S. Karger AG, Basel. PMID:24642984

Makkar, Binni; Batra, Swaraj; Gandhi, Gauri; Zutshi, Vijay; Goswami, Deepti

2014-01-01

156

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

2012-01-01

157

Transverse vaginal septum with congenital vesical-vaginal communication and cyclical hematuria.  

PubMed

Cyclical hematuria is an unusual presentation of a müllerian fusion anomaly. We report a patient with transverse vaginal septum and menstruation by way of the lower urinary tract because of a vesical-vaginal communication. A defect of vertical fusion, transverse vaginal septum results from failure of canalization of the vaginal plate. Reconstruction using a transvaginal and transabdominal approach created a direct anastomosis between the proximal vaginal segment and the distal vaginal pouch. Previously described cases are reviewed. PMID:17382175

Chin, Arnold I; Rutman, Matthew; Raz, Shlomo

2007-03-01

158

Vaginal bleeding in late pregnancy  

MedlinePLUS

One out of 10 women will have vaginal bleeding during their third trimester. At times, it may ... few months of pregnancy, you should always report bleeding to your health care provider right away. You ...

159

Humoral immunity in vaginal candidiasis.  

PubMed Central

Serum antibody titers to Candida albicans were estimated in 37 women with recurrent vaginal candidiasis and in 148 normal American and Finnish subjects, using the passive-hemagglutination technique. The antibody titers ranged from 0 to 16 in normal individuals and 4 to 256 in vaginal candidiasis patients. Antibodies to C. albicans in the sera of vaginal candidiasis patients were found to be the secretory immunoglobulin A type, as determined by gel filtration and double-diffusion tests. The results were confirmed by the indir-ct fluorescent-antibody technique. Our findings suggest that, in vaginal candidiasis, the antibody response is mainly local, consisting of secretory immunoglobulin A, some of which finds its way into systemic circulation. Images

Mathur, S; Koistinen, G V; Horger, E O; Mahvi, T A; Fudenberg, H H

1977-01-01

160

How Is Vaginal Cancer Diagnosed?  

MedlinePLUS

... tumors, it may be used to biopsy possible metastasis. Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) ... in detecting cancer that has spread to the brain or spinal cord. This rarely occurs in vaginal ...

161

Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer  

SciTech Connect

Purpose: The aim of our study was to assess prognostic factors and overall survival after salvage radiotherapy for patients who had endometrial carcinoma and who experienced an isolated vaginal recurrence. Methods and Materials: We reviewed the records of 50 patients treated at our institution between 1967 and 2003 for an isolated vaginal recurrence of endometrial carcinoma. Initial treatment for endometrial carcinoma was definitive surgery in 49 patients and definitive radiotherapy in 1 patient. The median time from initial diagnosis of endometrial carcinoma to recurrence was 25 months (range, 4-179 months). Three patients (6%) received external-beam radiotherapy alone, 8 patients (16%) received brachytherapy only, and 39 patients (78%) received combined external-beam radiation therapy and brachytherapy. Median dose of radiation to the recurrence was 60 Gy (range, 16-85 Gy). Overall survival was calculated by the Kaplan-Meier method. Endpoints were measured from the date of diagnosis of the vaginal recurrence. Median follow-up of survivors after recurrence was 53 months (range, 8-159 months). Results: The 5-year and 10-year disease-free and overall survivals were 68% and 55%, and 53% and 40%, respectively. On multivariate analysis, age (p = 0.0242), Grade 1 or 2 vs. Grade 3 tumor (p = 0.002), and size of recurrence (p < 0.001) were significant predictors of overall survival. All patients who had Grade 3 disease were dead by 3.6 years from the time of recurrence. Five patients experienced a Grade 3 or 4 complication. Conclusions: Patients treated with radiotherapy for an isolated vaginal recurrence can be cured in over 50% the cases. Radiotherapy is well tolerated, with a low risk of complications. Factors predictive of overall survival include tumor grade, patient age at recurrence, and tumor size.

Lin, Lilie L. [Department of Radiation Oncology, Washington University Medical School, St. Louis, MO (United States); Grigsby, Perry W. [Department of Radiation Oncology, Washington University Medical School, St. Louis, MO (United States) and Alvin J. Siteman Cancer Center, St. Louis, MO (United States)]. E-mail: pgrigsby@wustl.edu; Powell, Matthew A. [Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Division Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University Medical School, St. Louis, MO (United States); Mutch, David G. [Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Division Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University Medical School, St. Louis, MO (United States)

2005-10-01

162

Vaginal creation for müllerian agenesis  

Microsoft Academic Search

Objective: The purpose of this study was to determine the effectiveness of passive vaginal dilation and McIndoe vaginoplasty in the creation of a neovagina for patients with müllerian agenesis. Study Design: Fifty-one patients with Mayer-Rokitansky-Kuster-Hauser syndrome were treated for vaginal agenesis at either Johns Hopkins Hospital or Emory University. These historic prospective data were obtained by a review of medical

Carla P. Roberts; Michael J. Haber; John A. Rock

2001-01-01

163

Vaginal Bleeding and Preterm Delivery  

Microsoft Academic Search

\\u000a Vaginal bleeding during gestation is an ominous sign indicating an adverse pregnancy outcome. Bleeding can occur during all\\u000a stages of gestation. It complicates up to 20% of pregnancies during the first trimester and is regarded as a sign of threatened\\u000a abortion. During the second and third trimesters, vaginal bleeding was found to be a risk factor for adverse maternal and

Offer Erez; Idit Erez-Weiss; Ruth Beer-Weisel; Vered Kleitman-Meir; Moshe Mazor

164

Intraoperative utilization of dexamethasone/bupivacaine/gentamicin solution in laparoscopic assisted vaginal hysterectomy and pain management.  

PubMed

Adequately controlling pain is a key component of postoperative care after a hysterectomy. The purpose of this study was to evaluate the effects of two intraperitoneal (IP) administered solutions during Laparoscopic Assisted Vaginal Hysterectomy (LAVH), on the amount of postoperative self-administered morphine. In this prospective, randomized, double blinded study, twenty women undergoing LAVH randomly distributed to two treatment groups: (1) 100 ml dexamethasone/ bupivacaine/ gentamicin (DMG) solution: 60 cc injected vaginally at cuff and 40 cc placed topically via laparoscopy over intra-peritoneal postoperative surfaces (IP) and 5 ml bupivacaine or 5 ml saline injected at the laparoscopic incision sites, (2) 100 ml saline solution: 60 cc injected vaginally at cuff and 40 cc placed topically via laparoscopy over intra-peritoneal postoperative surfaces (IP) and 5 ml bupivacaine or 5 ml saline injected at the laparoscopic incision sites. The amount of morphine utilized by the patients was documented from their patient controlled anesthesia (PCA) pump. Patient parameters recorded included perceived pain score, height, weight, age, race, reason for surgery, pre-surgery medications, American Society of Anesthesiologist (ASA) classification, length of the surgery and estimated blood loss (EBL). Age, EBL, length of surgery, and ASA classification were not significantly different between the groups. The postoperative amount of morphine utilized was higher at 4 (p=.02) and 16 hours (p = .04) and tended to be higher at 8, 12 hours (p=.06), and 24 hours (p=.09) in the saline IP group. Overall the saline IP group (n=10) used (median; range) 21.5; 8-82 mg of morphine while the DMG IP group (n=10) used 10.5; 1-23 mg. No participants reported a postoperative infection. This study demonstrates that intraoperative utilization of DMG solution during LAVH enables patients clinically to have less perceived pain and subsequently tend to utilize about half the amount of morphine, helping to avoid the potential harmful side effects and adverse reactions of morphine. PMID:24640268

Fulcher, Paul H; Granese, Marsha; Chun, Yoon; Welch, Christine A; Seybold, Dara J; Randall, Gary; DePond, R Todd

2014-01-01

165

EM-Navigated Catheter Placement for Gynecologic Brachytherapy: An Accuracy Study  

PubMed Central

Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and/or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

2014-01-01

166

EM-navigated catheter placement for gynecologic brachytherapy: an accuracy study  

NASA Astrophysics Data System (ADS)

Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and /or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

2014-03-01

167

Impingement is not impingement: the case for calling it "Rotator Cuff Disease"  

PubMed Central

Summary Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than “impingement” as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease.

McFarland, Edward G.; Maffulli, Nicola; Del Buono, Angelo; Murrell, George A. C.; Garzon-Muvdi, Juan; Petersen, Steve A.

2013-01-01

168

Impingement is not impingement: the case for calling it "Rotator Cuff Disease".  

PubMed

Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease. PMID:24367779

McFarland, Edward G; Maffulli, Nicola; Del Buono, Angelo; Murrell, George A C; Garzon-Muvdi, Juan; Petersen, Steve A

2013-07-01

169

Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

PubMed Central

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. We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three cohorts of patients had repair of a symptomatic rotator cuff tear using (1) an open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, and 2 years postoperatively. Ultrasound studies were performed with a validated protocol at 6 months and 2 years postsurgery. Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better American Shoulder and Elbow Surgeons scores than the open group at 6 months and 2 years. Retear correlated with tear size and operation time and occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. An intact cuff on ultrasound corresponded to better results for supraspinatus strength, patient outcomes, and rotator cuff functional ability. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Millar, Neal L.; Wu, Xiao; Tantau, Robyn; Silverstone, Elizabeth

2009-01-01

170

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

PubMed

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

2012-02-01

171

The effect of rotator cuff tears on reaction forces at the glenohumeral joint  

Microsoft Academic Search

The rotator cuff muscles maintain glenohumeral stability by compressing the humeral head into the glenoid. Disruption of the rotator cuff compromises concavity compression and can directly affect the loads on the glenohumeral joint. The purpose of this study was to quantify the effect of rotator cuff tears on the magnitude and direction of glenohumeral joint reaction forces during active shoulder

I. M Parsons; IV; Maria Apreleva; Freddie H. Fu; Savio L.-Y. Woo

2002-01-01

172

High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse  

Microsoft Academic Search

Objective: The purpose of this study was to review retrospectively the functional and anatomic outcomes of women who underwent vaginal repair of enterocele and vault prolapse with the use of an intraperitoneal suspension of the vaginal vault to the uterosacral ligaments in conjunction with fascial reconstruction of the anterior and posterior vaginal wall. Study Design: Two hundred two women with

M. Karram; S. Goldwasser; S. Kleeman; A. Steele; B. Vassallo; P. Walsh

2001-01-01

173

Vaginitis: Questions to Discuss with Your Doctor  

MedlinePLUS

... contact us Vaginitis Questions to Discuss with Your Doctor: How long have you had this vaginal discomfort? ... abdominal pain, joint pain, or a rash? Your Doctor Might Examine the Following Body Structures or Functions: ...

174

Vaginal itching and discharge - Adult and adolescent  

MedlinePLUS

... and low estrogen levels, which may lead to vaginal dryness and other symptoms ( Atrophic vaginitis ). Forgotten tampon or foreign body, which may cause a foul odor. Chemicals found in ... irritate the vagina or the skin around the vagina Less common ...

175

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...

2010-04-01

176

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...

2009-04-01

177

Heterogeneity of Vaginal Microbial Communities within Individuals  

Microsoft Academic Search

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 micro- bial populations have not been investigated using molecular methods. Here, we evaluated site-specific micro- bial composition within the vaginal ecosystem and examined the influence of sampling technique in detection of the vaginal microbiota. 16S

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

2009-01-01

178

[Vaginal hysterectomy leniens: intrafascial technique].  

PubMed

The appearance of a new intrafascial technique for vaginal hysterectomy serves to remind us that in spite of well-standardized techniques, gynecologists perform this less often than formerly. The described technique is an intrafascial variation of the extrafascial vaginal hysterectomy beginning at the fundus uteri. We mobilize the anterior vaginal wall using Strassmann's incision. The body of the uterus should be delivered through the anterior fornix. Then follows the ligation of the broad ligaments and careful dissection of the fibroareolar space of the posterior cervical wall. The cardinal ligament requires intrafascial clamping and ligation. This technique is simple and avoids injury to the ureters. If this operation is successfully performed, postoperative pain is minimal, and hospitalization could be greatly reduced. PMID:15459520

Tapia, Jorge E

2004-10-01

179

Saline-filled cuffs help prevent laser-induced polyvinylchloride endotracheal tube fires.  

PubMed

To determine whether the filling of tracheal tube cuffs with saline would decrease their combustibility during laser surgery, 20 polyvinylchloride tracheal tubes were studied. The cuffed end of each tracheal tube was inserted into the neck of an empty flask, and the tube and flask were flushed with oxygen for 5 min before cuff inflation. Ten tracheal tubes had their cuffs inflated with air, and 10 were inflated with saline. A Lasersonics LS880 CO2 laser, set to 5 W for five of each of the two types of filled cuffs and to 40 W for the other pair of five tubes, was fired continuously at the cuffs for up to 1 min. No combustion occurred at the 5-W setting. The times to cuff perforation when the laser was set at 5 W were (mean +/- SD) 1.00 +/- 0.83 and 4.21 +/- 3.91 s for the air- and saline-filled cuffs, respectively, a difference that was not statistically significant. The time to deflation of the saline-filled cuff (104.6 +/- 67.5 s) was, however, significantly longer than that of the air-filled cuff (2.59 +/- 1.97 s). When the tracheal tube cuffs were exposed to 40-W laser radiation, the cuff and adjacent tube shaft ignited in all cases when the cuffs were inflated with air, but only in one of five cases when the cuffs were filled with saline (P less than 0.05). The filling of tracheal tube cuffs with saline provides simple, moderately effective partial protection of the cuff of endotracheal tubes during CO2 laser airway surgery. PMID:1985502

Sosis, M B; Dillon, F X

1991-02-01

180

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.

2013-01-01

181

Matrix metalloproteinase levels as a marker for rotator cuff tears.  

PubMed

Although many studies report the role of matrix metalloproteinases (MMPs) in rotator cuff tears, a paucity of data exists correlating the clinical severity of the disease with the implicated MMP levels. The purpose of this study was to investigate and compare the levels of expression of MMP-1, -3, -9 and -13 in patients with rotator cuff tears. We hypothesized that patients with clinically worse symptoms as measured by a standardized pain and function scale would have a higher expression of MMPs.Rotator cuff specimens were obtained from 16 consecutive patients undergoing rotator cuff repair. Total protein was extracted from these specimens and quantified. Equalized total protein extracts were used for performing enzyme-linked immunosorbent assay for quantitative determination of MMP-1, -3, -9 and -13. Preoperatively, the University of California, Los Angeles (UCLA) Shoulder Rating Scale was administered to each patient. Statistical comparisons were performed using analysis of variance. The expression of MMP-13 was notably increased in the rotator cuff extracts of all patients (P=.02). In addition, MMP-13 levels showed a significant proportional correlation with the patient pain score as per their UCLA ratings (r=-0.5). Although higher MMP-9 levels were assayed, this was not statistically significant. Expression of MMP-1 and-3 was insignificant.Our data suggest a critical role for MMP-13 in rotator cuff tears; elevated levels are a possible indicator for an impending tear. Further studies with increased sample size are warranted to prove the possible use of MMP-13 as therapeutic targets that may be inhibited by anti-inflammatory agents to limit disease progression. PMID:22495845

Jacob, Jinny; Eisemon, Eric; Sheibani-Rad, Shahin; Patel, Archit; Jacob, Theresa; Choueka, Jack

2012-04-01

182

What is normal vaginal flora?  

PubMed Central

OBJECTIVE: To observe the composition of the vaginal flora of healthy women over time, and in relation to hormonal changes, sexual activity, and hygiene habits. DESIGN: A longitudinal surveillance of the vaginal flora over an eight week period. SUBJECTS: 26 female health care workers in local genitourinary medicine clinics. METHODS: The participants were anonymised. They filled in diary cards daily. Blind vaginal swabs were self-taken two-seven times weekly. A smear was air-dried for later Gram staining. The swabs were also cultured for Candida spp, Gardnerella vaginalis, anaerobes, Mycoplasma hominis and Ureaplasma urealyticum. RESULTS: Of 26 subjects, only four had normal vaginal microbiology throughout. One woman, who was not sexually active, had bacterial vaginosis (BV) throughout and nine (35%) had intermittent BV. Candidiasis was found intermittently in eight women (31%), and eight had normal microscopy. U urealyticum was isolated intermittently in 40% of women with BV, 25% with candida, and 50% with normal microscopy. Many women were symptomatic, but symptoms correlated poorly with microbiological findings. All but two women were sexually active; however, more women with BV were exposed to semen. BV seemed to be related to frequent use of scented soap, and there appeared to be an additive effect of clothing and hygiene factors. CONCLUSIONS: Our study raises doubts about what should be regarded as normal vaginal flora. It calls into question the significance of finding BV or U urealyticum on a single occasion in asymptomatic women, or of finding normal flora in symptomatic women. The effect of external factors on the vaginal flora deserve further study.

Priestley, C J; Jones, B M; Dhar, J; Goodwin, L

1997-01-01

183

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

2010-01-01

184

Internal cuff reimplantation technique for aortic branch reconstruction.  

PubMed

Massive blood loss during thoracoabdominal aortic aneurysm repair may impair postoperative outcomes but can be reduced by a secure suture line. Our internal cuff reimplantation is a novel technique for the reconstruction of branch arteries with a cuff of the native aortic wall, which is anastomosed inside the prosthesis through a hole created in it. This technique can ensure hemostasis at the anastomosis by decompression of the suture line, improve patency of the reconstructed branches by leaving the diseased orifices untouched, and prevent future enlargement of the remnant native aortic wall by covering it with the prosthesis. PMID:24792286

Wakasa, Satoru; Naito, Yuji; Kubota, Suguru; Iijima, Makoto; Shingu, Yasushige; Matsui, Yoshiro

2014-05-01

185

Shoulder labral pathomechanics with rotator cuff tears.  

PubMed

Rotator cuff tears (RCTs), the most common injury of the shoulder, are often accompanied by tears in the superior glenoid labrum. We evaluated whether superior humeral head (HH) motion secondary to RCTs and loading of the long head of the biceps tendon (LHBT) are implicated in the development of this associated superior labral pathology. Additionally, we determined the efficacy of a finite element model (FEM) for predicting the mechanics of the labrum. The HH was oriented at 30° of glenohumeral abduction and neutral rotation with 50N compressive force. Loads of 0N or 22N were applied to the LHBT. The HH was translated superiorly by 5mm to simulate superior instability caused by RCTs. Superior displacement of the labrum was affected by translation of the HH (P<0.0001), position along the labrum (P<0.0001), and interaction between the location on the labrum and LHBT tension (P<0.05). The displacements predicted by the FEM were compared with mechanical tests from 6 cadaveric specimens and all were within 1 SD of the mean. A hyperelastic constitutive law for the labrum was a better predictor of labral behavior than the elastic law and insensitive to ±1 SD variations in material properties. Peak strains were observed at the glenoid-labrum interface below the LHBT attachment consistent with the common location of labral pathology. These results suggest that pathomechanics of the shoulder secondary to RCTs (e.g., superior HH translation) and LHBT loading play significant roles in the pathologic changes seen in the superior labrum. PMID:24636720

Hwang, Eunjoo; Carpenter, James E; Hughes, Richard E; Palmer, Mark L

2014-05-01

186

Clinical inquiries. Which history and physical findings are most useful in identifying rotator cuff tears?  

PubMed

It's unknown which-if any-historical factors are most useful for identifying rotator cuff tears, because no studies evaluating their accuracy with rotator cuff tears have been done. As for physical findings, no single physical examination finding is sensitive or specific enough to detect partial-thickness rotator cuff tears. The combination of the painful arc sign, drop-arm sign, and infraspinatus muscle strength test are helpful in detecting a full-thickness rotator cuff tear. A negative supraspinatus muscle strength test alone is sensitive enough to decrease the likelihood of a significant rotator cuff tear. PMID:20230738

Colsant, Brian; Sams, Richard; Paden, Shelley

2010-03-01

187

The influence of the acromial coverage index in rotator cuff tears.  

PubMed

Several intrinsic and extrinsic factors have been advocated in the pathogenesis of rotator cuff tears, but it is still unclear whether the origin of the tear is related to tendon degeneration itself or induced by several morphologic changes. The purpose of this study is to determine the relationship between the acromial coverage of the humeral head and the presence of a cuff tear. We evaluated 148 shoulders, including 45 that underwent surgical rotator cuff repair (group I), 26 with documented rotator cuff tears treated conservatively (group II), and 77 with no cuff pathology as a control group (group III). The mean acromial coverage index was 0.68 in group I, 0.72 in group II, and 0.59 in group III, giving a highly significant difference (P < .0001) between the control group and both cuff tear groups. Patients with a cuff tear have a significantly higher acromial coverage index than the control group. PMID:17113323

Torrens, Carlos; López, Joan-Miquel; Puente, Isabel; Cáceres, Enrique

2007-01-01

188

The vaginal microbiome in health and disease  

PubMed Central

Infections of the vaginal tract result from perturbations in the complex interactions between the microbiome and the host vaginal ecosystem. Recent data have linked specific vaginal microbes and urogenital infection with pre-term birth. Here we discuss how next generation sequencing-based approaches to study the vaginal microbiome will be important for defining what constitutes an imbalance of the microbiome and the associated host conditions that lead to subsequent infection and disease states. These studies will provide clinicians reliable diagnostic tools and treatments for women who are at increased risk for vaginal infections, preterm birth, HIV and other sexually acquired diseases, and will provide opportunities for intervention.

White, Bryan A.; Creedon, Douglas J.; Nelson, Karen E.; Wilson, Brenda A.

2011-01-01

189

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

1977-01-01

190

[Natural remedies for vaginal infections].  

PubMed

Vaginal infections, affecting half of all women, are more severe in women with AIDS. The infection vulva vaginitis, caused by candida, may require medical attention. The doctor performs a pelvic exam and examines vaginal fluids under a microscope. Antibiotics, diet, or a suppressed immune system can increase candida yeast presence. Sweets should be avoided, as well as foods high in leavening, such as bread, cheese, fruit, or alcoholic beverages. Vegetables, grains, rice and wheat can be added to the diet. Eating a half-cup of yogurt daily will help maintain a proper level of yeast. Acidophilus capsules can be taken two or three times daily to relieve digestive problems. Raw or cooked garlic can be used as a vaginal suppository at night. Pau D'arco, the bark of a South American tree, is also anti-yeast. Boil for ten to twenty minutes, and take a teaspoon two or three times a day. Tea, or vinegar and water, can be used as a douche. Some women get relief by adding a half-cup of white vinegar to their bath. Do not wash genitals with soap and do not use sanitary napkins or tampons. Visit a doctor if the condition persists. PMID:11362438

Genet, J

1995-01-01

191

Study of brachytherapy for intraocular tumor.  

National Technical Information Service (NTIS)

Our purpose of this study is to perform brachytherapy for intraocular tumor. The result were as followed. 1. Eye model was determined as a 25 mm diameter sphere. Ir-192 was considered the most appropriate as radioisotope for brachytherapy, because of the ...

Y. H. Ji D. H. Lee K. H. Ko T. W. Lee S. K. Lee

1994-01-01

192

Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study.  

PubMed

The purpose of the study was to compare postoperative vaginal irradiation with surgery alone in low-risk International Federation of Gynecology and Obstetrics (FIGO) stage IA-IB endometrial carcinoma. The study was a prospective, randomized trial of 645 evaluable low-risk endometrial carcinoma patients from 6 European gynecologic cancer centers. All tumors were in FIGO stage IA-IB, of endometrioid histological type, and FIGO grade 1-2. High-dose-rate afterloading equipments (iridium [Ir] 192 or cobalt [co] 60) were used at 5 centers, and low-dose-rate (LDR) afterloading equipment (cesium [Cs] 137) at 1 center. Perspex vaginal applicators or ovoids were normally used, and the dose was specified at 5 mm from the surface of the applicator. Three to 6 fractions (3.0-8.0 Gy) were given, and the overall treatment time was 4 to 15 days. A total of 319 patients were treated with surgery plus vaginal irradiation (treatment group), and 326 patients with surgery alone (control group).Twenty-six recurrences (4.0%) were recorded in the complete series. The locoregional recurrence rate was 2.6%, whereas distant metastases occurred in 1.4%. The rate of vaginal recurrences was 1.2% in the treatment group versus 3.1% in the control group. The difference was not statistically significant (P = 0.114). Side effects were few and mild (grade 1-2). Dysuria, frequency, and incontinence were slightly more common after vaginal irradiation (2.8% vs 0.6%, respectively). Late intestinal problems were few and similar in the 2 groups. The conclusions were that the impact of postoperative brachytherapy on even the locoregional recurrence rate seems to be limited in patients with low-risk endometrial carcinoma. The overall recurrence rate and survival were similar in the 2 groups. PMID:19574776

Sorbe, Bengt; Nordström, Britta; Mäenpää, Johanna; Kuhelj, Janez; Kuhelj, Dimitrij; Okkan, Sait; Delaloye, Jean-Francois; Frankendal, B

2009-07-01

193

[Therapy of degenerative and posttraumatic rotator cuff lesions].  

PubMed

The prevalence of rotator cuff lesions is age-dependent and up to 19-32?% for full-thickness ruptures and 13-32?% for partial-thickness lesions respectively. The therapy of partial-thickness ruptures should be considered in accordance with the articular, bursal or intratendinous location of the lesion. The therapy of full-thickness ruptures should be applied in accordance with topography and area of defect, retraction, atrophy and fatty infiltration. These parameters are considered to be important prognostic factors for the intraoperative repairability and the success of the surgery. Symptomatic or chronically progredient partial-thickness lesions as well as full-thickness lesions should generally be treated by means of surgical reconstruction. No current scientific consensus exists regarding improved clinical outcome data after the surgical approach in mini-open or arthroscopic technique. Both procedures should meet the requirements of the Gerber criteria for rotator cuff reconstruction: high primary stability, reduction of micro-movements, minimized approach associated morbidity and persisting stability to enable the fibroblastic tendon-to-bone healing. Current studies revealed a potential improvement of the tendon-to-bone healing by the application of several biologic augmentations. At the moment, these additive procedures can be applied in revision situations and for complex rotator cuff lesions with low tendon quality. No high-level in-vivo investigations concerning the human shoulder exist in the current literature that show evidence-based improvements by the additively applied biologic augmentations for rotator cuff repair. PMID:24578118

Stein, T; Mehling, A P; Welsch, F

2014-02-01

194

Biomechanical analysis of tendon transfers for massive rotator cuff tears  

Microsoft Academic Search

Objective. To determine why certain tendon transfers are mechanically more effective than other tendon transfers for the treatment of a massive rotator cuff tear.Design. A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper

D. J. Magermans; E. K. J. Chadwick; H. E. J. Veeger; P. M. Rozing

2004-01-01

195

Anatomical Considerations of the Suprascapular Nerve in Rotator Cuff Repairs  

PubMed Central

Introduction. When using the double interval slide technique for arthroscopic repair of chronic large or massive rotator cuff tears, the posterior interval release is directed toward the scapular spine until the fat pad that protects the suprascapular nerve is reached. Injury to the suprascapular nerve can occur due to the nerve's proximity to the operative field. This study aimed to identify safe margins for avoiding injury to the suprascapular nerve. Materials and Methods. For 20 shoulders in ten cadavers, the distance was measured from the suprascapular notch to the glenoid rim, the articular margin of the rotator cuff footprint, and the lateral border of the acromion. Results. From the suprascapular notch, the suprascapular nerve coursed an average of 3.42?cm to the glenoid rim, 5.34?cm to the articular margin of the rotator cuff footprint, and 6.09?cm to the lateral border of the acromion. Conclusions. The results of this study define a safe zone, using anatomic landmarks, to help surgeons avoid iatrogenic injury to the suprascapular nerve when employing the double interval slide technique in arthroscopic repair of the rotator cuff.

Tom, James A.; Shah, Mitesh P.; Lee, Dan J.; Cerynik, Douglas L.; Amin, Nirav H.

2014-01-01

196

Progression from calcifying tendinitis to rotator cuff tear  

Microsoft Academic Search

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon

Masafumi Gotoh; Fujio Higuchi; Ritsu Suzuki; Kensuke Yamanaka

2003-01-01

197

The effect of shoulder manipulation on rotator cuff integrity.  

PubMed

The use of shoulder manipulation in the treatment of frozen shoulder remains controversial. Humeral fractures and neurological damage are the risks associated with the procedure. A concern of causing a rotator cuff tear exists but the incidence of iatrogenic rotator cuff tears is not reported. The purpose of this study was to assess the effect of shoulder manipulation for frozen shoulder on the integrity of the rotator cuff. In a prospective study, 32 consecutive patients (33 shoulders) with the diagnosis of frozen shoulder underwent manipulation of the shoulder under anaesthesia (MUA), 18 female and 15 males with mean age at manipulation of 503 years (range: 42-63). The average duration of symptoms before treatment was 6.2 months (range: 2-18 months). The patients were examined prior to the manipulation and at follow-up for combined shoulder range of motion, external and internal rotation and strength. All patients had an ultrasound assessment of the rotator cuff before and at 3 weeks after manipulation of the shoulder. Mean time between manipulation and last follow-up was 133 weeks. None of the patients had ultrasound findings of a rotator cuff tear, prior to the manipulation. In all patients the rotator cuff remained undamaged on ultrasound examination at 3 weeks after the procedure. The mean improvement in motion was 81.2 degrees (from 933 degrees pre-op to 174.5 degrees at last follow-up) for forward flexion; 102.6 degrees (from 68.8 degrees pre-op to 171.4 degrees at last follow-up) for abduction, 49.4 degrees (from 8.8 degrees pre-op to 58.2 degrees at last follow-up) for external rotation and 3.5 levels of internal rotation (range: 2 to 5 levels). These gains in motion were all highly significant (p < 0.0001). No fractures, dislocations or nerve palsies were observed. In this study, manipulation of the shoulder has not been associated with rotator cuff tears. If done properly the procedure appeared to be safe and to result in a marked improvement of range of movement and function. PMID:23926725

Atoun, Ehud; Funk, Lennard; Copland, Stephen A; Even, Tirtza; Levy, Ofer; Rath, Ehud

2013-06-01

198

Arthroscopic rotator cuff repair in elite rugby players  

PubMed Central

Background Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. Aims We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Materials and Methods Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans. Results There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360° labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6–31 months) post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed. Conclusion We conclude that full-thickness rotator cuff tears in the contact athlete can be addressed successfully by arthroscopic repair, with a rapid return to preinjury status.

Tambe, Amol; Badge, Ravi; Funk, Lennard

2009-01-01

199

Dynamic rotating-shield brachytherapy  

SciTech Connect

Purpose: To present dynamic rotating shield brachytherapy (D-RSBT), a novel form of high-dose-rate brachytherapy (HDR-BT) with electronic brachytherapy source, where the radiation shield is capable of changing emission angles during the radiation delivery process.Methods: A D-RSBT system uses two layers of independently rotating tungsten alloy shields, each with a 180° azimuthal emission angle. The D-RSBT planning is separated into two stages: anchor plan optimization and optimal sequencing. In the anchor plan optimization, anchor plans are generated by maximizing the D{sub 90} for the high-risk clinical-tumor-volume (HR-CTV) assuming a fixed azimuthal emission angle of 11.25°. In the optimal sequencing, treatment plans that most closely approximate the anchor plans under the delivery-time constraint will be efficiently computed. Treatment plans for five cervical cancer patients were generated for D-RSBT, single-shield RSBT (S-RSBT), and {sup 192}Ir-based intracavitary brachytherapy with supplementary interstitial brachytherapy (IS + ICBT) assuming five treatment fractions. External beam radiotherapy doses of 45 Gy in 25 fractions of 1.8 Gy each were accounted for. The high-risk clinical target volume (HR-CTV) doses were escalated such that the D{sub 2cc} of the rectum, sigmoid colon, or bladder reached its tolerance equivalent dose in 2 Gy fractions (EQD2 with ?/?= 3 Gy) of 75 Gy, 75 Gy, or 90 Gy, respectively.Results: For the patients considered, IS + ICBT had an average total dwell time of 5.7 minutes/fraction (min/fx) assuming a 10 Ci{sup 192}Ir source, and the average HR-CTV D{sub 90} was 78.9 Gy. In order to match the HR-CTV D{sub 90} of IS + ICBT, D-RSBT required an average of 10.1 min/fx more delivery time, and S-RSBT required 6.7 min/fx more. If an additional 20 min/fx of delivery time is allowed beyond that of the IS + ICBT case, D-RSBT and S-RSBT increased the HR-CTV D{sub 90} above IS + ICBT by an average of 16.3 Gy and 9.1 Gy, respectively.Conclusions: For cervical cancer patients, D-RSBT can boost HR-CTV D{sub 90} over IS + ICBT and S-RSBT without violating the tolerance doses to the bladder, rectum, or sigmoid. The D{sub 90} improvements from D-RSBT depend on the patient, the delivery time budget, and the applicator structure.

Liu, Yunlong [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 (United States)] [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 (United States); Flynn, Ryan T.; Kim, Yusung [Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States)] [Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States); Yang, Wenjun [Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States)] [Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States); Wu, Xiaodong [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 and Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States)] [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 and Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States)

2013-12-15

200

Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use.  

PubMed

There are few clear guidelines on the proper use of tourniquets in pediatric surgery, in particular on how to set the tourniquet pressure, how to select the most appropriate cuff, and whether to use some type of soft padding beneath the cuff for limb protection. The authors could find only one published study specifically addressing pediatric cuff pressures, and no studies showing what types of cuff and/or padding create the smoothest skin surface under the cuff. Of 46 pediatric orthopaedic surgeons surveyed, 44 use a tourniquet 4.6 times per week on average and 2 have discontinued their use as a result of complications. To set cuff pressure, 13 of 44 use a standard value, 14 of 44 base pressure on age, extremity, and size, and 17 of 44 base cuff pressure on blood pressure. Thirty-four of 44 use skin protection under the cuff, but damage to the skin is common, accounting for 21 of the 67 reported complications. Nerve (15/67) and muscle (8/67) complications, related to both pressure and tourniquet time, were also reported. Using a molding and digital measurement technique, the authors compared the maximum wrinkle heights and the sums of all wrinkle heights in the skin surface under four different cuff/padding configurations. In a total of 44 trials on the upper arms and thighs of two healthy child volunteers, one type of pediatric cuff with a matching limb-protection sleeve designed and recommended by the manufacturer (Delfi) produced significantly fewer, less severe pinches and wrinkles in the skin surface than a second type of tourniquet cuff (Zimmer) with or without two layers of commonly available cast padding, and a third type (Kidde) with padding. With the second type of cuff, using cast padding reduced skin wrinkling compared to applying the same cuff on unprotected skin. In view of the survey, clinical literature, and results of this study, a guideline for use of pediatric tourniquets is proposed. PMID:11521040

Tredwell, S J; Wilmink, M; Inkpen, K; McEwen, J A

2001-01-01

201

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

1999-01-01

202

Round Cell Vaginal Malignant Melanoma  

PubMed Central

Malignant melanoma is predominantly a skin disease but in rare instances it may occur at other sites. A vaginal melanoma is a rare clinical entity and the round cell type is an uncommon variant. Although the present case was clinically diagnosed as a urethral caruncle, on histopathological examination and immunostaining it was diagnosed as a round cell pigmented malignant melanoma. The patient refused radical surgery and was given a full course radiotherapy treatment but died a year later. Malignant vaginal melanoma carries a very poor prognosis even when lesion is localised at the time of presentation. The five-year survival rate ranges from 10–20% with the prognosis being influenced by tumour size. A tumour size ?3cm has a poor prognosis. Age, mitotic count, stage, and location of the lesion do not influence survival rates.

Chauhan, Neena; Gaur, Dushyant S.; Pathak, Ved P.

2012-01-01

203

Evaluation and Management of Vaginitis  

PubMed Central

OBJECTIVE To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections, and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting. DATA SOURCES Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997 were reviewed. DATA SYNTHESIS Techniques that enable the identification of the various strains of candida have helped lead to a better understanding of the mechanisms of recurrent candida infection. From this information a rationale for the treatment of recurrent disease can be developed. Bacterial vaginosis has been associated with complications, including upper genital tract infection, preterm delivery, and wound infection. Women undergoing pelvic surgery, procedures in pregnancy, or pregnant women at risk of preterm delivery should be evaluated for bacterial vaginosis to decrease the rate of complications associated with this condition. New, more standardized criteria for the diagnosis of bacterial vaginosis may improve diagnostic consistency among clinicians and comparability of study results. Use of topical therapies in the treatment of bacterial vaginosis are effective and associated with fewer side effects than systemic medication. Trichomonas vaginalis, although decreasing in incidence, has been associated with upper genital tract infection. Therapy of T. vaginalis infection has been complicated by an increasing incidence of resistance to metronidazole. CONCLUSIONS Vaginitis is a common medical problem in women that is associated with significant morbidity and previously unrecognized complications. Research in recent years has improved diagnostic tools as well as treatment modalities for all forms of vaginitis.

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

1998-01-01

204

Pregnancy Interruption by Vaginal Misoprostol  

Microsoft Academic Search

A total of 132 pregnant women with average gestational age of 14.2 weeks (range 11–22 weeks) undergoing legal abortion volunteered for a trial utilizing vaginal administration of misoprostol. In 106 women a dose of 800 ?g was utilized, whilst in 26 women 1,200-1,600 ?g were given. Nonsurgical expulsion of the fetus was successful in 117 cases (88.6%). Four cases had

Antonio Bugalho; Cassimo Bique; Luisa Almeida; Staffan Bergström

1993-01-01

205

Vaginal leiomyoma--an imitator of prolapse.  

PubMed

Vaginal leiomyoma is a rare tumor with a variable clinical presentation and broad differential diagnosis that can lead to preoperative misdiagnosis. We present a case of vaginal leiomyoma with a symptom complex of prolapse, urinary urgency and urge incontinence. A 50-year-old woman presented with a 4-year history of deteriorating sensation of prolapse, significant complex urinary complaints and prolonged vaginal bleeding. Clinical examination revealed a mobile 6 x 8 cm mass arising from the anterior vaginal wall. She underwent hysteroscopy, curettage, urethrocystoscopy (normal findings) and mass enucleation through a vertical incision. Histology showed a benign leiomyoma. Ultrasonography, MRI, positive-pressure urethrography and urethrocystoscopy should be considered in the evaluation of an anterior wall vaginal mass. Surgical enucleation via a vaginal approach is the treatment of choice. If this surgical procedure results in skeletonization of the urethral and bladder support, a colporrhaphy/pubourethral ligament plication is required. PMID:11484748

Leron, E; Stanton, S L

2000-06-01

206

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

2013-01-01

207

Antifungal resistance in yeast vaginitis.  

PubMed Central

The increased number of vaginal yeast infections in the past few years has been a disturbing trend, and the scientific community has been searching for its etiology. Several theories have been put forth to explain the apparent increase. First, the recent widespread availability of low-dosage, azole-based over-the-counter antifungal medications for vaginal yeast infections encourages women to self-diagnose and treat, and women may be misdiagnosing themselves. Their vaginitis may be caused by bacteria, parasites or may be a symptom of another underlying health condition. As a result, they may be unnecessarily and chronically expose themselves to antifungal medications and encourage fungal resistance. Second, medical technology has increased the life span of seriously immune compromised individuals, yet these individuals are frequently plagued by opportunistic fungal infections. Long-term and intense azole-based antifungal treatment has been linked to an increase in resistant Candida and non-Candida species. Thus, the future of limiting antifungal resistance lies in identifying the factors promoting resistance and implementing policies to prevent it.

Dun, E.

1999-01-01

208

Vaginal Birth after Cesarean Section  

PubMed Central

Background: The rate of primary cesarean section (CS) is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. Aims: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC) in selected cases of one previous lower segment CS (LSCS). Materials and Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. Conclusion: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

Bangal, Vidyadhar B; Giri, Purushottam A; Shinde, Kunaal K; Gavhane, Satyajit P

2013-01-01

209

Refinement of McIndoe's vaginal reconstruction with ORFIT "S" vaginal stent.  

PubMed

Using McIndoe's vaginal reconstruction with the ORFIT "S" vaginal stent, we achieved good results in 5 patients with congenital vaginal absence over the past 3 years. The ORFIT "S" vaginal stent is a semirigid, porous, and inexpensive stent. The application is easy intraoperatively, and minimal daily care is required for long-term postoperative dilatation. The stent keeps the neovagina in full acceptance of the speculum after long-term follow-up. PMID:8041835

Chen, T H

1994-08-01

210

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

PubMed

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

2013-01-01

211

Assisted breech delivery with transverse vaginal septum.  

PubMed

The incidence of vaginal septum is rare. The infrequency of this anomaly makes accurate estimates of the true incidence very difficult to obtain. Diagnosis is based on careful historyand examination. This is the case of a patient who presented with transverse vaginal septum in labour and breech presentation. The septum was resected and the foetus delivered normally. Careful vaginal examination should be performed in pregnant women at term before labour to detect such manageable abnormalities. PMID:24397081

Anwar, Sadia; Moon, Tooba; Baloch, Sajjad Ahmad; Shah, Syed Humayun

2012-01-01

212

Laparoscopic uterosacral ligament uterine suspension compared with vaginal hysterectomy with vaginal vault suspension for uterovaginal prolapse  

Microsoft Academic Search

This study compares the outcomes of laparoscopic uterosacral ligament uterine suspension (LUSUS) to those of vaginal vault suspension with total vaginal hysterectomy (TVH) for the treatment of symptomatic uterovaginal prolapse. We compared the outcomes of 25 LUSUS to those of 25 TVH with vaginal vault suspension among age-matched controls. No significant complications occurred in either group. EBL and hospitalization duration

Aparna Diwan; Charles R. Rardin; William C. Strohsnitter; Alexandra Weld; Peter Rosenblatt; Neeraj Kohli

2006-01-01

213

Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy  

Microsoft Academic Search

Objectives: To determine if the efficacy of continuous low dose estradiol released from a vaginal ring is equivalent to estriol vaginal cream regarding improvement of the patient's subjective feeling of vaginal dryness and to determine if there is a preference for either of the two study treatments. Methods: Open-label randomized parallel group trial with active control with a blind evaluation

Ronald Barentsen; Peter H. M. van de Weijer; Jan H. N. Schram

1997-01-01

214

Simple vaginal mold for use in the postoperative care of patients with a transverse vaginal septum.  

PubMed

Severe vaginal stenosis is a potentially disabling complication of transverse vaginal septum resection due to the constriction of the resulting circular scar. We describe a vaginal mold that can be easily created by an occupational therapist, and used as a long-term stent of the vagina in young girls. PMID:17418828

Lacy, Judith; Correll, Gretchen R; Walmer, David K; Price, Thomas M

2007-05-01

215

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections  

PubMed Central

Objectives: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations. Methods: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit. Results: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values. Conclusions: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.

Geisler, W; Yu, S; Venglarik, M; Schwebke, J

2004-01-01

216

What Are the Key Statistics about Vaginal Cancer?  

MedlinePLUS

... factors for vaginal cancer? What are the key statistics about vaginal cancer? Vaginal cancer is rare. Only ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...

217

[Vaginal contraception. Pt. 1 (author's transl)].  

PubMed

Vaginal contraception is enjoying a revival among women who fear the side effects of the pill or of the IUD. Vaginal contraception by vaginal diaphragm or by cervical cap is totally reversible and never causes complications; there may be short term reversible side effects with the diaphragm, such as cystitis, uretritis, and hemorroids; no side effects are associated with the use of cervical caps. Vaginal contraception has the added advantage of exercising a notable prophylactic actions on the diffusion of verereal diseases and of other vaginal infections such as trichomoniasis and candidosis. It is also possible that vaginal contraception offers protection against cervical neoplasia. Failure rate of diaphragm use is an average 10/100 women years, and for the cervical cap it is about 7.6/100 women years, when both devices are properly used. Vaginal contraception needs to be used in conjunction with spermicidal agents. Spermicidal agents can be used alone and can be very effective; they are, however, not well accepted by most couples, who resent the interruption of the sexual act. Two experimental models of vaginal sponge are now under study; vaginal sponges can be left in place for some time, and insertion is very easy. PMID:12336893

Keith, L; Berger, G S; Jackson, M

1981-04-01

218

Clinical effects of thigh cuffs during a 7-day 6° head-down bed rest  

Microsoft Academic Search

Thigh cuffs are used by Russian cosmonauts to limit the fluid shift induced by space flight. A ground simulation using the head-down bed rest (HDBR) model was performed to assess the effects of thigh cuffs on clinical tolerance and orthostatic adaptation. 8 male healthy volunteers (32.4±1.9 years) participated twice in a 7-day HDBR — one time with thigh cuffs (worm

Anne Pavy-Le Traon; Alain Maillet; Pascale Vasseur Clausen; Marc-Antoine Custaud; Irina Alferova; Claude Gharib; Jacques-Olivier Fortrat

2001-01-01

219

Arthroscopic Removal of Calcium Deposits of the Rotator Cuff: A 7-year Follow-up  

Microsoft Academic Search

Background: Calcium deposits within the tendons of the rotator cuff are common and usually asymptomatic. Symptomatic cases that do not respond to nonoperative measures need removal of the calcium deposits.Purpose: In this study, the results of arthroscopic removal of the calcium deposits within the rotator cuff, without rotator cuff repair, are evaluated after a minimum 7-year follow-up. This may help

Mohamed Taha El Shewy

2011-01-01

220

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures  

Microsoft Academic Search

BACKGROUND: Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff

Helen Razmjou; Andrea Bean; Varda van Osnabrugge; Joy C MacDermid; Richard Holtby

2006-01-01

221

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

2007-01-01

222

Arthroscopic Transosseous Reinsertion of theRotator Cuff  

Microsoft Academic Search

Objective:  Arthroscopic reinsertion of the supraspinatus\\u000a and infraspinatus tendons by means of imitation of\\u000a an open trans osseous reinsertion technique.\\u000a \\u000a \\u000a \\u000a Indications:  Tears in the tendon cuffs of the supraspinatus\\u000a and infraspinatus muscles.\\u000a Patients < 75 years of age.\\u000a \\u000a \\u000a \\u000a Contraindications:  Retracted tendons that cannot be\\u000a sufficiently mobilized to provide a tension-free\\u000a reinsertion.\\u000a Tears of the tendon cuff of the subscapsularis muscle.\\u000a \\u000a \\u000a \\u000a Surgical Technique:  The free

Nicholas Matis; Clemens Hübner; Erwin Aschauer; Herbert Resch

2006-01-01

223

Simultaneous Rotator Cuff Repair and Arthroscopic Biceps Tenodesis Using Lateral Row Anchor  

PubMed Central

Treatment of concomitant long head of the biceps pathology in the setting of rotator cuff repair is often required. When a tenodesis of the biceps is used, additional anchors and surgical dissection are typically required. This adds additional surgical time, morbidity of additional surgical dissection, and additional anchor load and cost. We describe a novel technique for arthroscopic biceps tenodesis that uses the anterior lateral row anchor of a double-row rotator cuff repair to simultaneously secure the biceps tenodesis and rotator cuff tear. This technique provides a simple, reproducible, cost-effective means of performing a simultaneous biceps tenodesis and double-row rotator cuff repair.

Levy, Jonathan C.

2012-01-01

224

All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique  

PubMed Central

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation.

Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

2013-01-01

225

Protocol for the United Kingdom Rotator Cuff Study (UKUFF)  

PubMed Central

This protocol describes a pragmatic multicentre randomised controlled trial (RCT) to assess the clinical and cost effectiveness of arthroscopic and open surgery in the management of rotator cuff tears. This trial began in 2007 and was modified in 2010, with the removal of a non-operative arm due to high rates of early crossover to surgery. Cite this article: Bone Joint Res 2014;3:155–60.

Carr, A. J.; Rees, J. L.; Ramsay, C. R.; Fitzpatrick, R.; Gray, A.; Moser, J.; Dawson, J.; Bruhn, H.; Cooper, C. D.; Beard, D. J.; Campbell, M. K.

2014-01-01

226

Partial-thickness tears of the rotator cuff  

Microsoft Academic Search

Summary. This review is based on 66 patients with partial-thickness tears of the rotator cuff, verified at operation. Their average\\u000a age was 54 years, and all had symptoms of subacromial impingement. The duration of shoulder pain was for between 2 and 108\\u000a months (mean 11.4 months). Ultrasonography, arthrography and bursography were helpful in establishing the diagnosis. On exploration,\\u000a tears were

H. Fukuda; K. Hamada; T. Nakajima; N. Yamada; A. Tomonaga; M. Goto

1996-01-01

227

HDR brachytherapy for anal cancer  

PubMed Central

The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has been a shift from radical surgical treatment with colostomy to conservative treatment. Radiotherapy combined with chemotherapy has an important role in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy (IMRT) have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared to conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment (EBRT) is an established method for primary treatment of anal cancer, brachytherapy (BT) is also an approved method. BT is well known for boost irradiation in combination with EBRT (+/– chemotherapy). Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy (IMBT), BT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy (EBRT) and BT allows the clinician to deliver higher doses to the tumor and to reduce dose to the normal issue. Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this work.

Kovacs, Gyoergy

2014-01-01

228

HDR brachytherapy for anal cancer.  

PubMed

The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has been a shift from radical surgical treatment with colostomy to conservative treatment. Radiotherapy combined with chemotherapy has an important role in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy (IMRT) have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared to conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment (EBRT) is an established method for primary treatment of anal cancer, brachytherapy (BT) is also an approved method. BT is well known for boost irradiation in combination with EBRT (+/- chemotherapy). Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy (IMBT), BT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy (EBRT) and BT allows the clinician to deliver higher doses to the tumor and to reduce dose to the normal issue. Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this work. PMID:24982770

Niehoff, Peter; Kovács, Gyoergy

2014-06-01

229

Intra-Operative Dosimetry in Prostate Brachytherapy.  

National Technical Information Service (NTIS)

Favorable outcome in prostate brachytherapy critically depends on the accurate placement of radioactive sources in their planned locations. Unfortunately, there is variety of mechanical factors that cause the seeds to divert from their planned locations. ...

A. Jain

2006-01-01

230

Rotator cuff degeneration and lateral epicondylitis: a comparative histological study.  

PubMed Central

OBJECTIVES--Rotator cuff tendinitis and lateral epicondylitis are common in clinical practice but the underlying pathology is poorly understood. The study examined both normal and biopsy tendon specimens histologically, to determine the mechanisms involved in tendon degeneration. METHODS--Rotator cuff tendons from 83 cadavers aged 11-94 and tendon biopsy specimens from 20 patients with lateral epicondylitis aged 27-56 years were examined histologically. RESULTS--The microscopic changes found in the tendon biopsies from the elbow were similar to those found in the cadaveric rotator cuff tendons. Abnormalities ranged from minor blood vessel wall changes and loss of tenocytes to calcification. The most frequent abnormality was glycosaminoglycan infiltration and fibrocartilaginous transformation. There appeared to be some sequence in the changes observed which were milder in younger patients. Only 17% of cadaver tendons, below the age of 39 were abnormal but abnormalities increase in later life to around 40-50%. CONCLUSIONS--There was an increasing incidence of degenerative changes in tendons with age. The changes observed in biopsy samples of common extensor tendons were the same as those seen in aged supraspinatus tendons, but these changes were not seen in control common extensor tendons. Images

Chard, M D; Cawston, T E; Riley, G P; Gresham, G A; Hazleman, B L

1994-01-01

231

A novel transosseous button technique for rotator cuff repair.  

PubMed

In an attempt to maximize stability by improving the lateral footprint compression of our repair in rotator cuff tears, we have been using a rotator cuff button (Arthrex, Naples, FL) passed through a transosseous tunnel as an anchor for our transosseous sutures. Our new innovation is to pass a rotator cuff button fully loaded with 4 strands around the central post, with 2 leading strands and 2 trailing strands on either end, through our transosseous tunnel. In this way, we can use the 4 central strands through our tunnel to obtain 2 good mattress sutures as a primary repair and the peripheral 4 strands passed around the lateral humerus as over sew mattress sutures to obtain good compression of the lateral tendon and so improve the footprint area. A double row equivalent is achieved. This technique has a good primary hold in the form of a device with proven history and avoids multiple anchors in the lateral humerus. Because it uses only a single fixation device, it is also significantly more economical. Theoretical risks to the axillary nerve or with osteoporosis have not been seen in practice. Tensioning the repair with suture passage through transosseous tunnels is readily achieved. PMID:18760216

Fox, Michael P; Auffarth, Alexander; Tauber, Mark; Hartmann, Andreas; Resch, Herbert

2008-09-01

232

Palladium103 brachytherapy for prostate carcinoma  

Microsoft Academic Search

Purpose: A report of biochemical outcomes for patients treated with palladium-103 (Pd-103) brachytherapy over a fixed time interval.Methods and Materials: Two hundred thirty patients with clinical stage T1–T2 prostate cancer were treated with Pd-103 brachytherapy and followed with prostate-specific antigen (PSA) determinations. Kaplan-Meier estimates of biochemical failure on the basis of two consecutive elevations of PSA were utilized. Multivariate risk

John C Blasko; Peter D Grimm; John E Sylvester; Kas Ray Badiozamani; David Hoak; William Cavanagh

2000-01-01

233

Current Status of Brachytherapy for Prostate Cancer  

PubMed Central

Brachytherapy was developed to treat prostate cancer 50 years ago. Current advanced techniques using transrectal ultrasonography were established 25 years ago. Transrectal ultrasound (TRUS) has enabled the prostate to be viewed with improved resolution with the use of modern ultrasound machines. Moreover, the development of software that can provide images captured in real time has improved treatment outcomes. Other new radiologic imaging technologies or a combination of magnetic resonance and TRUS could be applied to brachytherapy in the future. The therapeutic value of brachytherapy for early-stage prostate cancer is comparable to that of radical prostatectomy in long-term follow-up. Nevertheless, widespread application of brachytherapy cannot be achieved for several reasons. The treatment outcome of brachytherapy varies according to the skill of the operator and differences in patient selection. Currently, only three radioactive isotopes are available for use in low dose rate prostate brachytherapy: I-125, Pd-103, and Cs-131; therefore, more isotopes should be developed. High dose rate brachytherapy using Ir-192 combined with external beam radiation, which is needed to verify the long-term effects, has been widely applied in high-risk patient groups. Recently, tumor-selective therapy or focal therapy using brachytherapy, which is not possible by surgical extraction, has been developed to maintain the quality of life in selected cases. However, this new application for prostate cancer treatment should be performed cautiously because we do not know the oncological outcome, and it would be an interim treatment method. This technique might evolve into a hybrid of whole-gland treatment and focal therapy.

2012-01-01

234

Treatment of postmenopausal vaginal atrophy with 10-?g estradiol vaginal tablets.  

PubMed

Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-µg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-µg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg. PMID:22393176

Panay, Nick; Maamari, Ricardo

2012-03-01

235

Protocol for the United Kingdom Rotator Cuff Study (UKUFF): a randomised controlled trial of open and arthroscopic rotator cuff repair.  

PubMed

This protocol describes a pragmatic multicentre randomised controlled trial (RCT) to assess the clinical and cost effectiveness of arthroscopic and open surgery in the management of rotator cuff tears. This trial began in 2007 and was modified in 2010, with the removal of a non-operative arm due to high rates of early crossover to surgery. Cite this article: Bone Joint Res 2014;3:155-60. PMID:24845913

Carr, A J; Rees, J L; Ramsay, C R; Fitzpatrick, R; Gray, A; Moser, J; Dawson, J; Bruhn, H; Cooper, C D; Beard, D J; Campbell, M K

2014-05-01

236

Vaginal Laser Doppler Flowmetry Pre and Posthysterectomy  

Microsoft Academic Search

The objective of this study was to demonstrate the applicability of laser doppler flowmetry to pre- and posthysterectomy vaginal blood flow assessment. We used laser Doppler flowmetry to measure pre-and postoperational vaginal blood flow in 8 premenopausal women undergoing benign hysterectomies; we also measured serum E2, FSH, FT and administered a brief sexual function questionnaire. We analyzed data using two

SUSAN M. RICHMAN; PHILIP M. SARREL

2004-01-01

237

Vaginal misoprostol for late first trimester abortion  

Microsoft Academic Search

A group of 120 women with gestations from 64 to 84 days received 800 ?g of vaginal misoprostol every 24 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side effects, and mean time of expulsion and vaginal bleeding. Complete abortion occurred in 104

J. L Carbonell Esteve; L Varela; A Velazco; E Cabezas; R Tanda; C Sánchez

1998-01-01

238

Evaluation of vaginal antifungal formulations in vivo.  

PubMed Central

Relatively simple and rapid procedures have been developed for evaluating the local efficacy of vaginal antifungal agents in vivo in a vaginal candidiasis model in ovariectomized rats. The results of this investigation indicate that the model and methods described are quite suitable for screening potential antifungal substances and for assessing the chemotherapeutic effectiveness of new antifungal agents and formulations before carrying out clinical studies.

McRipley, R. J.; Erhard, P. J.; Schwind, R. A.; Whitney, R. R.

1979-01-01

239

Excision of high vaginal septum  

Microsoft Academic Search

Introduction  Transverse vaginal septum occurs because there is a defect in vertical fusion during embryological development of the vagina.\\u000a It is quite rare and is infrequently encountered by most obstetricians and gynecologists in their practice.\\u000a \\u000a \\u000a \\u000a \\u000a Case report  A 14-year-old unmarried student, Miss AUX, presented to a private gynecologist complaining of absent menses. Initial examination\\u000a and investigation revealed intact hymen, normal uterus but

Fahed Al-Abdulhadi; Michael Fidelis Diejomaoh; Assem El Biaa; Jiri Jirous; Mona Al-Qenae

2010-01-01

240

Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios  

PubMed Central

Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears.

Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

2014-01-01

241

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: bengt.sorbe@orebroll.se [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)

2012-03-01

242

A Review of Comparison of Complications of Vaginal Hysterectomy with and without Concomitant Surgery for SUI: A 5 Years' Experience at a Tertiary Care Hospital of Pakistan  

PubMed Central

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH with repair alone. The basic characteristics like age, BMI, and degree of prolapse showed no statistical difference among two groups. The main comorbidities in both groups were hypertension, diabetes, and bronchial asthma. We observed no significant differences in intraoperative and postoperative complications except for cuff abscess, need for medical intervention, and readmission following discharge from hospital, which were higher in cases with vaginal hysterectomy with concomitant TVT. Conclusions. Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse with a swift recovery, short length of hospital stay, and rare serious complications. The addition of surgery for USI does not appear to increase the morbidity.

Mohsin Rizvi, Raheela; Akhtar, Munnazza; Zuberi, Nadeem Faiyaz

2013-01-01

243

Interstitial brachytherapy for penile carcinoma: a multicentric survey (259 patients)  

Microsoft Academic Search

Although cancer of the penis is a rare disease, we have collected 506 cases through a multicentric study. In the present study we analyse the results obtained from 259 patients treated by interstitial brachytherapy from 1959 to 1989. Among the 259 patients, 184 males had exclusive brachytherapy (group A) while 75 received a combination of surgery and brachytherapy and\\/or external

R. Rozan; E. Albuisson; B. Giraud; D. Donnarieix; M. Delannes; J. Pigneux; S. Hoffstetter; A. Gerbaulet; P. Chinet-Charrot; A. Goupil; J. E. Couette; M. H. Hay; G. Chaplain; B. Castelain; B. Hassel; P. Mere; P. Cellier

1995-01-01

244

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.

2011-05-01

245

In vivo dosimetry in brachytherapy  

SciTech Connect

In vivo dosimetry (IVD) has been used in brachytherapy (BT) for decades with a number of different detectors and measurement technologies. However, IVD in BT has been subject to certain difficulties and complexities, in particular due to challenges of the high-gradient BT dose distribution and the large range of dose and dose rate. Due to these challenges, the sensitivity and specificity toward error detection has been limited, and IVD has mainly been restricted to detection of gross errors. Given these factors, routine use of IVD is currently limited in many departments. Although the impact of potential errors may be detrimental since treatments are typically administered in large fractions and with high-gradient-dose-distributions, BT is usually delivered without independent verification of the treatment delivery. This Vision 20/20 paper encourages improvements within BT safety by developments of IVD into an effective method of independent treatment verification.

Tanderup, Kari [Department of Oncology, Aarhus University Hospital, Aarhus 8000 (Denmark); Department of Clinical Medicine, Aarhus University, Aarhus 8000 (Denmark); Beddar, Sam [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Andersen, Claus E.; Kertzscher, Gustavo [Center of Nuclear Technologies, Technical University of Denmark, Roskilde 4000 (Denmark); Cygler, Joanna E. [Department of Physics, Ottawa Hospital Cancer Centre, Ottawa, Ontario K1H 8L6 (Canada)

2013-07-15

246

Pregnancy interruption by vaginal misoprostol.  

PubMed

A total of 132 pregnant women with average gestational age of 14.2 weeks (range 11-22 weeks) undergoing legal abortion volunteered for a trial utilizing vaginal administration of misoprostol. In 106 women a dose of 800 micrograms was utilized, whilst in 26 women 1,200-1,600 micrograms were given. Nonsurgical expulsion of the fetus was successful in 117 cases (88.6%). Four cases had to be excluded for various social reasons. A total of 11 did not achieve fetal expulsion within 56 h after application of misoprostol. These cases (11/132; 8.3%) were considered failures. Previous reports in the literature of toxicity trials on animals reporting no fetotoxic nor teratogenic effects of misoprostol at doses up to 10,000 micrograms/kg body weight seem to be of no validity in the human since we could demonstrate that almost 80% of pregnancies were interrupted at a dose of 10-15 micrograms/kg body weight. The conclusion is that vaginal administration of this prostaglandin analogue, not requiring cool temperature for storage, is remarkably effective in achieving safe interruption of pregnancy without any significant complications. PMID:8300007

Bugalho, A; Bique, C; Almeida, L; Bergström, S

1993-01-01

247

Biodegradable Cuff an Adjunct to Peripheral Nerve Repair: A Study in Dogs.  

National Technical Information Service (NTIS)

This study on repair of peripheral nerves has demonstrated the following: (a) the biodegradable cuff is readily placed with conventional surgical armamentarium; (b) tissue tolerance to the cuff is high; (c) fibrosis around the nerve is less with use of th...

R. L. Reid J. S. Garrison D. E. Cutright

1977-01-01

248

Acromial shapes and extension of rotator cuff tears: Magnetic resonance imaging evaluation  

Microsoft Academic Search

Magnetic resonance imaging makes it possible to inspect the status of the rotator cuff and the shape of the acromion. To clarify the relationship between acromial shapes and rotator cuff tears, we evaluated magnetic resonance images obtained in 192 shoulders. We classified the acromial shapes into 3 types: type I (flat), type II (curved), and type III (hooked). Among a

Mako Hirano; Junji Ide; Katsumasa Takagi

2002-01-01

249

Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need  

PubMed Central

Background To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. Method In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. Results In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 - 100) cm H2O and the pressure exceeded 30 cm H2O (upper recommended level) for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 - 121) cm H2O and above 60 cm H2O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H2O). There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. Conclusion For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.

2010-01-01

250

Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears  

Microsoft Academic Search

The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the rotator cuff that does

Iosif Gavriilidis; Jörn Kircher; Petra Magosch; Sven Lichtenberg; Peter Habermeyer

2009-01-01

251

Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study  

Microsoft Academic Search

Objective: To determine the prevalence and clinical impact of rotator cuff tears in asymptomatic volunteers. Materials and Methods: Sonographic examinations of the shoulder of 212 asymptomatic individuals between 18 and 85 years old were performed by a single experienced operator. The prevalence and location of complete rotator cuff tears were evaluated. The clinical assessment was based on the Constant Score.

N Schibany; H Zehetgruber; F Kainberger; C Wurnig; A Ba-Ssalamah; A. M Herneth; T Lang; D Gruber; M. J Breitenseher

2004-01-01

252

Arthroscopic Rotator Cuff Repair Using a Suture Bridge Technique: Is the Repair Integrity Actually Maintained?  

Microsoft Academic Search

Background: Suture bridge repair has been recognized to have superior biomechanical characteristics, as shown in previous biomechanical studies. However, it is not clear whether the tendon heals better in vivo after suture bridge repair.Purpose: To evaluate the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique for patients with rotator cuff tears.Study Design: Case

Nam Su Cho; Bong Gun Lee; Yong Girl Rhee

2011-01-01

253

Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions  

Microsoft Academic Search

This study was undertaken to determine whether patients with severe rheumatoid arthritis and irreparable rotator cuff rupture can be treated successfully with the Grammont shoulder arthroplasty. Seven patients with rheumatoid arthritis (8 shoulders) with nonreconstructible rotator cuff lesions and Larsen stage-V radiographic changes of the glenoid and the humeral head underwent a Grammont reverse shoulder arthroplasty. The Constant score improved

Markus Rittmeister; Fridun Kerschbaumer

2001-01-01

254

Rotator cuff tear associated with an acromioclavicular cyst in rheumatoid arthritis  

Microsoft Academic Search

We report two cases of a full-thickness rotator cuff tear followed by acromioclavicular cyst formation in patients with longstanding erosive polyarticular rheumatoid arthritis. One of the consequences of a ratator cuff tear is articular instability with upward migration of the humeral head. The ensuing chronic friction against the undersurface of the acromio-clavicular joint caused by arm movements can lead to

E. Selvi; R. De Stefano; E. Frati; S. Manganelli; S. Manca; R. Marcolongo

1998-01-01

255

Tendon-Bone Interface Motion in Transosseous Suture and Suture Anchor Rotator Cuff Repair Techniques  

Microsoft Academic Search

Background: Although many studies involving rotator cuff repair fixation have focused on ultimate fixation strength and ability to restore the tendon’s native footprint, no studies have characterized the stability of the repair with regard to motion between the tendon and repair site footprint.Hypothesis: Suture anchor fixation for rotator cuff repair has greater interface motion between tendon and bone than does

Christopher S. Ahmad; Andrew M. Stewart; Rolando Izquierdo; Louis U. Bigliani

2005-01-01

256

Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model  

Microsoft Academic Search

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood. A rat model was used to investigate the supraspinatus tendon organizational and

Jonathan A. Gimbel; Jonathan P. Van Kleunen; Samir Mehta; Stephanie M. Perry; Gerald R. Williams; Louis J. Soslowsky

2004-01-01

257

Effectiveness of tendon transfers for massive rotator cuff tears: a simulation study  

Microsoft Academic Search

Objective. To determine what the most effective tendon transfer is in the case of a dysfunctional rotator cuff.Design. A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity.Background. Massive rotator cuff tears are

D. J. Magermans; E. K. J. Chadwick; H. E. J. Veeger; P. M. Rozing; F. C. T van der Helm

2004-01-01

258

Trabecular microstructure and surface changes in the greater tuberosity in rotator cuff tears  

Microsoft Academic Search

Objective. When planning surgery in patients with rotator cuff tear, strength of bone at the tendon insertion and trabecular bone structure in the greater tuberosity are usually taken into consideration. We investigated radiographic changes in bone structure of the greater tuberosity in rotator cuff tears. Design. Twenty-two human cadaveric shoulders from subjects ranging from 55 to 75 years of age

Yebin Jiang; Jenny Zhao; Marnix T. van Holsbeeck; Michael J. Flynn; Xiaolong Ouyang; Harry K. Genant

2002-01-01

259

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

2006-01-01

260

The incidence of rotator cuff disease in smoking and non-smoking patients: a cadaveric study.  

PubMed

The etiology of rotator cuff disease is multifactorial. One theory behind the high incidence of rotator cuff tears in the shoulder is that the supraspinatus/infraspinatus tendon contains a zone of relative avascularity in the area proximal to its insertion at the greater tuberosity. Tobacco smoking is known to contribute to microvascular disease, and it can be hypothesized that smoking tobacco further compromises the vascular supply to the supraspinatus/infraspinatus tendon, thus increasing the incidence of tendinous pathology in the rotator cuff. This article evaluates the rotator cuffs of 72 shoulders in 36 cadavers and compares the incidence of macroscopic and microscopic disease within the rotator cuff tendon. Microscopic evaluation of the accompanying lung tissue from the respective cadaver also was performed. As a result, we were able to determine the presence or absence of a smoking history or emphysema from each cadaver as it related to rotator cuff disease in the shoulder. Of the 36 shoulders that exhibited macroscopic rotator cuff tears, 23 were from cadavers with a history of smoking compared to only 13 from cadavers with no history of smoking. Furthermore, the presence of advanced microscopic rotator cuff pathology (Grade 3 or 4 fibrous degeneration) was more than twice as likely in the cadavers with a history of smoking (22/32) compared to only 10 of 32 shoulders from cadavers with no history of smoking. While none of this data was statistically significant due to the insufficient number of subject cadavers, strong trends were noted in these findings. PMID:16628997

Kane, Steven M; Dave, Amish; Haque, Abida; Langston, Kimber

2006-04-01

261

Swallowing With a Tracheostomy Tube in Place: Does Cuff Inflation Matter?  

Microsoft Academic Search

Patients undergoing tracheostomy may recover enough to be weaned from mechanical ventilation but continue to need the tracheostomy tube for airway toilet. When feeding a patient with a tracheostomy tube in place, it is unclear if the cuff should be inflated or not. This study was undertaken to determine whether cuff status has any impact on aspiration of feedings. Selected

Daniel G. Davis; Sean Bears; James E. Barone; Philip R. Corvo; James B. Tucker

2002-01-01

262

Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears  

PubMed Central

Objective Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear.

Hodgson, R J; O'Connor, P J; Hensor, E M A; Barron, D; Robinson, P

2012-01-01

263

Localization and expression of osteopontin in the rotator cuff tendons in patients with calcifying tendinitis  

Microsoft Academic Search

Calcifying tendinitis of rotator cuff tendons is a common and painful condition caused by ectopic calcification in humans. To examine the involvement of osteopontin (OPN), a potent regulator of calcium deposition on connective tissues, localization and expression of OPN protein and messenger (m)RNA were investigated in human tissue samples of calcified rotator cuff tendons. Immunohistochemistry demonstrated that OPN was localized

Eiji Takeuchi; Kazuomi Sugamoto; Takanobu Nakase; Takashi Miyamoto; Motoharu Kaneko; Tetsuya Tomita; Akira Myoui; Takahiro Ochi; Hideki Yoshikawa

2001-01-01

264

An immunocytochemical analysis of torn rotator cuff tendon taken at the time of repair  

Microsoft Academic Search

During rotator cuff repairs, it is recommended that the hypovascular tissue edge be resected. To investigate rotator cuff tendon histopathology, we performed immunohistochemistry on 8 surgical and 6 cadaveric specimens. Hoechst nuclear stain and standard hematoxylin-eosin were used for morphologic analysis. Antibody to human von Willebrand factor tagged with fluorescein isothiocyanate, conjugated, was used to visualize vascularity, and antibody to

C. W Goodmurphy; J Osborn; E. J Akesson; S Johnson; V Stanescu; W. D Regan

2003-01-01

265

Antimicrobial Activity of Prosthetic Heart Valve Sewing Cuffs Coated With Minocycline and Rifampin  

PubMed Central

Prosthetic heart valve sewing cuffs coated with minocycline and rifampin exhibited in vitro zones of inhibition against all 52 tested clinical isolates responsible for prosthetic valve endocarditis. An in vitro elution study of these coated sewing cuffs demonstrated residual zones of inhibition against Staphylococcus epidermidis for at least 4 weeks.

Darouiche, Rabih O.; Fowler, Vance G.; Adal, Karim; Kielhofner, Marcia; Mansouri, David; Reller, L. Barth

2002-01-01

266

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

PubMed

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 the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion). PMID:16549619

Rutten, Matthieu J C M; Jager, Gerrit J; Blickman, Johan G

2006-01-01

267

The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life  

Microsoft Academic Search

The purposes of this study were to determine the reliability of strength and self-reporting measures, the relationship of different strength measures to function, and the impact of rotator cuff pathology on patients’ quality of life. Patients with nonoperated rotator cuff pathology (n = 36) and unaffected control subjects (n = 48) were assessed by use of the LIDO dynamometer to

Joy C. MacDermid; Joanne Ramos; Darren Drosdowech; Ken Faber; Stuart Patterson

2004-01-01

268

Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries  

Microsoft Academic Search

In the examination and rehabilitation of patients with shoulder injuries it is necessary to isolate the individ ual rotator cuff muscles as much as possible. We subscribe to the belief that, independent of the deltoid, the rotator cuff muscles can become fatigued, injured, or atrophied individually. Accordingly, we feel that these muscles must be considered separately during examination and rehabilitation.This

Frank W. Jobe; Diane Radovich Moynes

1982-01-01

269

Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn  

PubMed Central

Background The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. Methods Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. Results One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. Conclusions One-year postoperative findings for patients in this series indicate that patients with stage II–III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique.

2014-01-01

270

Brachytherapy in the Treatment of Cholangiocarcinoma  

SciTech Connect

Purpose: To examine the role of brachytherapy in the treatment of cholangiocarcinomas in a relatively large group of patients. Methods and Materials: Using the Surveillance, Epidemiology and End Results database, a total of 193 patients with cholangiocarcinoma treated with brachytherapy were identified for the period 1988-2003. The primary analysis compared patients treated with brachytherapy (with or without external-beam radiation) with those who did not receive radiation. To try to account for confounding variables, propensity score and sensitivity analyses were used. Results: There was a significant difference between patients who received radiation (n = 193) and those who did not (n = 6859) with regard to surgery (p < 0.0001), race (p < 0.0001), stage (p < 0.0001), and year of diagnosis (p <0.0001). Median survival for patients treated with brachytherapy was 11 months (95% confidence interval [CI] 9-13 months), compared with 4 months for patients who received no radiation (p < 0.0001). On multivariable analysis (hazard ratio [95% CI]) brachytherapy (0.79 [0.66-0.95]), surgery (0.50 [0.46-0.53]), year of diagnosis (1998-2003: 0.66 [0.60-0.73]; 1993-1997: (0.96 [0.89-1.03; NS], baseline 1988-1992), and extrahepatic disease (0.84 [0.79-0.89]) were associated with better overall survival. Conclusions: To the authors' knowledge, this is the largest dataset reported for the treatment of cholangiocarcinomas with brachytherapy. The results of this retrospective analysis suggest that brachytherapy may improve overall survival. However, because of the limitations of the Surveillance, Epidemiology and End Results database, these results should be interpreted cautiously, and future prospective studies are needed.

Shinohara, Eric T., E-mail: Shinohara@xrt.upenn.ed [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA (United States); Guo Mengye; Mitra, Nandita; Metz, James M. [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States)

2010-11-01

271

[Brachytherapy--own, preliminary experiences in the treatment of head and neck neoplasms with the use of pulsed brachytherapy].  

PubMed

The historical development of brachytherapy from the beginning of the 20th century until nowadays is presented. On the basis of the literature the authors presented indications, advantages and the technical aspects of brachytherapy. Early own experience with the use of pulsed brachytherapy was also reported. PMID:12607412

Zienkiewicz, Józef; Ziemlewski, Adam; Serkies, Krystyna; Oleszkiewicz, Izabela; Nierzwicki, Bart?omiej

2002-01-01

272

Vaginal hysterectomy: a new approach using bicoagulation forceps  

Microsoft Academic Search

This study is to assess the feasibility and outcome of vaginal hysterectomies using bicoagulation forceps. Eighty patients undergoing vaginal hysterectomy for several diagnoses were enrolled. In 40 patients, bicoagulation forceps were used for the entirety of the operation. In 19 patients, only vaginal hysterectomy was performed; in 21 patients, vaginal hysterectomy was part of surgery for pelvic floor repair. Forty

Wolfgang Zubke; Sven Becker; Bernhard Krämer; Diethelm Wallwiener

2004-01-01

273

Throwing the dice for the diagnosis of vaginal complaints?  

Microsoft Academic Search

BACKROUND: Vaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential. METHODS: We evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal

Andreas Schwiertz; David Taras; Kerstin Rusch; Volker Rusch

2006-01-01

274

Vaginitis  

MedlinePLUS

... resources for press Selected Profiles & Interviews Selected biographies & science-focused interviews Multimedia Audio briefings, videos & podcasts related to NICHD research About NICHD Institute Overview ...

275

Histological reaction of sintered nanohydroxyapatite-coated cuff and its fibroblast-like cell hybrid for an indwelling catheter.  

PubMed

Rapid tissue-ingrowth of a sintered hydroxyapatite(HAp)-coated and cell-hybrid subcutaneous cuff equipped with an indwelling catheter was developed. The rod-like HAp nanoparticles were coated by covalent bonding on the surface of the silk fibroin (SF) fibers for about 100 microm of the length. The fibers were transplanted three-dimensionally on a cuff substrate made of silicone elastomer with an adhesive. The fibroblast-like cells, explanted and proliferated from skin tissue containing the epidermis, dermis, and subcutaneous tissue of Japanese white rabbits, were incubated on the three-dimensional cuff for three days. Three types of cuff--polyester, HAp-coated, and cell-hybrid cuffs--were percutaneously implanted into the backs of the same animals for 3 and 7 days. The subcutaneous tissues around the cuffs were stained with hematoxylin-eosin. Immunohistochemical staining to identify macrophages and alpha-smooth muscle actin (alpha-SMA) was also done and examined by light microscopy. The alpha-SMA-positive area was very limited in the polyester cuff group even after 7 days, although many macrophages infiltrated into the fibers. In the cell-hybrid cuff group, on the other hand, an alpha-SMA-positive area was formed extensively after 3 and 7 days, causing severe inflammation. In the HAp-coated cuff group, an alpha-SMA-positive area was formed among the fibers with little inflammation. The extent order of the alpha-SMA-positive area was cell-hybrid cuff > HAp-coated cuff > polyester cuff, while the degree of inflammatory cells order was cell-hybrid cuff > polyester cuff > HAp-coated cuff. PMID:18767065

Furuzono, Tsutomu; Ueki, Mitsuki; Kitamura, Harumi; Oka, Kazumasa; Imai, Enyu

2009-04-01

276

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

PubMed

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

2010-02-01

277

Evaluation of tracheal cuff pressure variation in spontaneously breathing patients  

PubMed Central

Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently.

Plotnikow, Gustavo A; Roux, Nicolas; Feld, Viviana; Gogniat, Emiliano; Villalba, Dario; Ribero, Noelia Vairo; Sartore, Marisa; Bosso, Mauro; Quiroga, Corina; Leiva, Valeria; Scrigna, Mariana; Puchulu, Facundo; Distefano, Eduardo; Scapellato, Jose Luis; Intile, Dante; Planells, Fernando; Noval, Diego; Bunirigo, Pablo; Jofre, Ricardo; Nielsen, Ernesto Diaz

2013-01-01

278

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

2009-01-01

279

[Rehabilitation after rotator cuff repair: developments and recommendations].  

PubMed

Rehabilitation post surgical repair of the rotator cuff is an important determinant of the quality of the healing process, and of the clinical and functional results. Techniques used have been reported to favor certain of those parameters at the expense of others. Several approaches have been proposed; none has reached a consensus yet. The level of evidence in the literature does not allow for definitive recommendations and elaborating a protocol relies on clinical experience as well as expert opinion, incorporating scientific data. An initial period of rest with limited passive motion emerges though as an approach suited to the treatment of most clinical situations. PMID:24693587

Holzer, Nicolas; Cunningham, Gregory; Duthon, Victoria; Graf, Véronique; Ziltener, Jean-Luc; Hoffmeyer, Pierre

2013-12-18

280

Single versus double-row repair of the rotator cuff  

Microsoft Academic Search

Purpose  Several techniques for arthroscopic repair of rotator cuff defects have been introduced over the past years. Besides established\\u000a techniques such as single-row repairs, new techniques such as double-row reconstructions have gained increasing interest.\\u000a The present article therefore provides an overview of the currently available literature on both repair techniques with respect\\u000a to several anatomical, biomechanical, clinical and structural endpoints.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Systematic

Stephan Pauly; Christian Gerhardt; Jianhai Chen; Markus Scheibel

2010-01-01

281

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

2012-01-01

282

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

PubMed

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. PMID:24179329

Littlewood, Chris

2012-11-01

283

Clinical evaluation of econazole nitrate in 1% vaginal cream for treatment of vaginal candidosis.  

PubMed

30 patients with mycologically confirmed vaginal candidosis on culture were treated with econazole vaginal cream (Gyno-Pevaryl) applied intravaginally once a day for 2 wk. 8 days after the end of treatment, mycological and clinical cures were demonstrated in 26 patients. Symptoms generally subsided rapidly, and the drug was well tolerated. This study confirms the efficacy of econazole in the treatment of vaginal candidosis. PMID:264069

Schuerwegh, W

1978-02-01

284

Primary intent vaginal hysterectomy: outcomes for common contraindications to vaginal approach hysterectomy  

Microsoft Academic Search

The objective of this study is, within a broadly inclusive selection strategy for benign vaginal hysterectomy, to determine\\u000a whether the most commonly invoked “contraindications” to vaginal hysterectomy—fibroid enlargement >14 weeks, prior cesarean,\\u000a need for oophorectomy—result in increased risk of complications. This study is of retrospective design within a rural community\\u000a hospital. All vaginal hysterectomies performed by a single practitioner over an

Malcolm W. Mackenzie; Jeffrey D. Johnson

2011-01-01

285

Brachytherapy  

MedlinePLUS

... materials from entering the patient's body. After accurate positioning of the device(s) has been confirmed, the radiation ... may be used to assist the physician in positioning the seeds. Additional imaging tests may be done ...

286

Incidence of familial tendon dysfunction in patients with full-thickness rotator cuff tears  

PubMed Central

Background A familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls. Methods Ninety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P<0.05 was considered significant). Results The average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005). Conclusion Individuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies.

Tashjian, Robert Z; Saltzman, Erik G; Granger, Erin K; Hung, Man

2014-01-01

287

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

PubMed

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

2012-10-01

288

The relevance of long head biceps degeneration in the presence of rotator cuff tears  

PubMed Central

Background Long head biceps (LHB) degeneration in combination with rotator cuff tears can be a source of chronic shoulder pain. LHB tenotomy is an approved surgical procedure for pain reduction and improvement of joint function, however, the pathophysiology of LHB degeneration is not fully understood. In the literature, neoangiogenesis in tendon tissue has previously been shown to be associated with tendon degeneration. Vascular Endothelial Growth Factor (VEGF) is an important inducer of neoangiogenesis. The hypotheses are first that an elevated VEGF expression and vessel density can be found in degenerated LHB tissue and second that there is a relation between VEGF expression, vessel density and the different types of rotator cuff tears. Methods LHB samples of 116 patients with degenerative rotator cuff tears were harvested during arthroscopic tenotomy. The samples were dehydrated and paraffin embedded. VEGF expression was determined using immunohistochemistry. Vessel density and vessel size were determined on Masson-Goldner stained tissue sections. On the basis of intraoperative findings, patients were assigned to 4 different groups (control group, partial thickness rotator cuff tear, full thickness rotator cuff tear and cuff arthropathy). Partial thickness rotator cuff tears were classified according to Ellman grade I-III, full thickness rotator cuff tears according to Bateman's classification (grade I-IV). The control group consisted of eight healthy tendon samples. Results VEGF expression in the LHB was significantly higher in the presence of rotator cuff tears than in healthy tendons (p < 0.05) whereas vessel density and vessel size were significantly higher in the LHB of patients with cuff arthropathy (p < 0.05). Furthermore, there was significantly higher VEGF expression in LHB samples from patients with articular-sided compared to bursal-sided partial thickness rotator cuff tears (p < 0.05). No significant dependence was found between VEGF expression, vessel size and vessel density in LHB of patients with full thickness rotator cuff tears and the extent of the cuff tear following Bateman's classification. Conclusion Elevated VEGF expression can be detected in degenerated LHB tissue. The quantity of VEGF expression and vessels are related to the extent of LHB degeneration.

2010-01-01

289

Interstitial hyperthermia in combination with brachytherapy  

SciTech Connect

Flexible coaxial cables were modified to serve as microwave antennas operating at a frequency of 915 MHz. These antennas were inserted ito nylon afterloading tubes that had been implanted in tumors using conventional interstitial implantation techniques for iridium-192 seed brachytherapy. The tumor volume was heated to 42 to 45/sup 0/C within 15 minutes and heating was continued for a total of 1 hour per treatment. Immediately following a conventional brachytherapy dose and removal of the iridium seeds the tumors were heated again in a second treatment. This interstitial technique for delivering local hyperthermia should be compatible with most brachytherapy methods. The technique has proved so far to be practical and without complications. Temperature distributions obtained in tissue phantoms and a patient are described.

Coughlin, C.T.; Douple, E.B.; Strohbehn, J.W.; Eaton, W.L. Jr.; Trembly, B.S.; Wong, T.Z.

1983-07-01

290

Vaginal involvement in genital erosive lichen planus.  

PubMed

A specialized Vulva Clinic with dedicated gynecologists and dermatologists was established in Oslo, Norway, in 2003. Fifty-eight women referred to the clinic in 2003-2009 were diagnosed with genital erosive lichen planus. All patients filled out a questionnaire. Gynecological examination, including vaginal inspection, was performed, if necessary in general anesthesia. Median age at symptom start was 51 years (range 17-78 years) with 15 women (26%) being younger than 40 years old. Sexual abstinence was reported by 36 women and dyspareunia by another 10. On examination, vaginal involvement was seen in 49 women, including vaginal synechiae in 29 and total obliteration of the vagina in 9. Of 56 women treated with topical corticosteroids for at least three months, two had complete response and 36 partial responses. Similarly, of 22 women treated with tacrolimus, three had complete and six partial response. We conclude that vaginal involvement is more common in genital erosive lichen planus than previously reported. PMID:20583940

Helgesen, Anne Lise Ording; Gjersvik, Petter; Jebsen, Peter; Kirschner, Rolf; Tanbo, Tom

2010-07-01

291

Symptoms of Vaginal and Vulvar Cancers  

MedlinePLUS

... Announcements Radio Public Service Announcements Print Materials Campaign Research Doctors Who Use Social Media Poster Presentation Buttons and Badges Related Resources Gynecologic Cancer Symptoms Diary [PDF-503KB] Vaginal and Vulvar Cancer fact sheet [ ...

292

Vaginal childbirth and pelvic floor disorders  

PubMed Central

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.

Memon, Hafsa U; Handa, Victoria L

2013-01-01

293

Urinary incontinence - tension-free vaginal tape  

MedlinePLUS

... vaginal tape is surgery to help control stress urinary incontinence . This is urine leakage that happens when you ... Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education ...

294

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

2013-01-01

295

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

2004-01-01

296

Determinants of outcome in the treatment of rotator cuff disease.  

PubMed

One hundred thirty-six patients with impingement syndrome and rotator cuff disease who were treated nonoperatively from 1987 to 1991 were reviewed to identify findings at initial presentation that correlated with final outcome. Mean followup was 20 months (range, 6-41 months). All patients received initial conservative treatment. The results were analyzed in 2 groups. Group I consisted of the entire 136 patients with a minimum 6-month followup. Group II consisted of a subgroup of 68 patients with at least an 18-month followup. The overall results in Group I were 66% excellent and good and 34% fair and poor. For Group II, the overall results were 76% excellent and good and 24% fair and poor. For the Group II patients, a distribution of clinical findings at the 6-month followup demonstrated only 46% excellent and good results, indicating that the clinical result improves significantly as followup duration increased. Patient characteristics and prognostic factors that were associated with an unfavorable clinical outcome included a rotator cuff tear > 1 cm2, a history of pretreatment clinical symptoms for > 1-year duration, and significant functional impairment at initial presentation. Factors not associated with clinical outcome included patient age, occupation, gender, associated instability, dominance, chronicity of onset, active range of motion, or specific treatment modalities. Early operative intervention is recommended for patients with poor prognostic factors to avoid a protracted clinical course. PMID:7955708

Bartolozzi, A; Andreychik, D; Ahmad, S

1994-11-01

297

Portable device for vaginal thermal conductance studies.  

PubMed

Design and development of a portable and self-contained vaginal probe, consisting of an acetone-filled silver cylinder attached to a pressure gauge, is described. Qualitative changes in vaginal thermal conductance were inferred from rates of thermal expansion of precooled acetone measured as a pressure rise. Administration of 10 mg estradiol-17 beta i.v. to ovariectomized heifers resulted in significant increases in rate of thermal expansion. PMID:1176036

Abrams, R M; Thatcher, W W; Gwazdauskas, F C; Sharp, D C; Bazer, F W; Wilcox, C J; Stolwijk, J A

1975-01-01

298

Vaginal Bleeding during Pregnancy and Preterm Birth  

Microsoft Academic Search

This study investigated the relation between self-reported vaginal bleeding during pregnancy and preterm birth in a prospective cohort of 2,829 pregnant women enrolled from prenatal clinics between 1995 and 2000 in central North Carolina. The overall association between vaginal bleeding and preterm birth was modest (risk ratio (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.6). Bleeding in the first

Juan Yang; Katherine E. Hartmann; David A. Savitz; Amy H. Herring; Nancy Dole; Andrew F. Olshan; John M. Thorp

299

Preactivated thiomers for vaginal drug delivery vehicles.  

PubMed

It was the purpose of this study to design and evaluate a chitosan derivative as mucoadhesive excipient for vaginal drug delivery systems. The chemical modification of chitosan was achieved by conjugation of thioglycolic acid (TGA) resulting in 1594 ?mol thiol groups per gram of polymer followed by the linkage of mercaptonicotinic acid (MNA) to the immobilized thiol groups via disulfide bonding leading to 702 ?mol ligand per gram of preactivated polymer. The mucoadhesive properties of these polymers within newly designed vaginal formulations (Chitosan-TGA and Chitosan-TGA-MNA) and commercially available vaginal formulations (Candibene®, Daktarin®, Dalacin®, GynoPevaryl®) were tested over a time period of 24 h via a mucoadhesion test system simulating vaginal conditions, tensile studies and mucus polymer interaction studies via viscosity measurements. Within the vaginal test system simulating vaginal in situ conditions, a 1.5-fold increase in mucoadhesion could be observed for preactivated thiomer formulations after 24 h in comparison to commercially available formulations. Similar results were achieved for tensile studies, as the chitosan-TGA-MNA containing formulation resulted in a 4.9-fold increase in total work of adhesion (TWA) in comparison to Candibene which showed the highest TWA value of all tested commercial formulations. Also in terms of rheology investigations of mucus/formulation mixtures, a 5.8-fold increase in dynamic viscosity for chitosan-TGA-MNA containing mixtures could be observed in comparison to the mucus-free control. In contrast, commercially available formulations achieved a maximum enhancement of 1.9-fold. These outcomes confirm that the newly developed polymer is a promising tool for vaginal drug delivery likely providing a prolonged vaginal residence time due to its comparatively high mucoadhesive properties. PMID:23886732

Friedl, Heike E; Dünnhaupt, Sarah; Waldner, Claudia; Bernkop-Schnürch, Andreas

2013-10-01

300

The phylogeny of permanent prostate brachytherapy  

PubMed Central

Permanent prostate brachytherapy has been practiced for more than a century. This review examines the influence of earlier procedures on the modern transperineal ultrasound-directed technique. A literature review was conducted to examine the origin of current clinical practice. The dimensions of the modern brachytherapy seed, the prescription dose, and implant/teletherapy sequencing are vestigial features, which may be suboptimal in the current era of low-energy photon-emitting radionuclides and computerized dose calculations. Although the modern transperineal permanent prostate implant procedure has proven to be safe and effective, it should undergo continuous re-evaluation and evolution to ensure that its potential is maximized.

Aronowitz, Jesse N.

2013-01-01

301

The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair.  

PubMed

Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthroscopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author's practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS) technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001). This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique. PMID:25002932

Vopat, Bryan G; Murali, Jothi; Gowda, Ashok L; Kaback, Lee; Blaine, Theodore

2014-04-22

302

The Role of Acromioplasty for Management of Rotator Cuff Problems: Where Is the Evidence?  

PubMed Central

The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease.

Shi, Lewis L.; Edwards, T. Bradley

2012-01-01

303

MRI quantification of fatty infiltration and muscle atrophy in a mouse model of rotator cuff tears.  

PubMed

Rotator cuff pathology is the most common shoulder problem seen by orthopedic surgeons. Rotator cuff muscle fatty infiltration and muscle atrophy are common in larger tears and are considered predicting factors for the prognosis of cuff repair. Clinically, MRI is the gold standard in determining fatty infiltration and muscle atrophy; however, analysis for MRI imaging is primarily qualitative in nature with the results lacking further validation. We have recently developed a mouse model of rotator cuff tears. The goal of this study is to quantify and verify rotator cuff muscle atrophy and fatty infiltration using high-resolution MRI in our mouse model. The rotator cuff muscles were analyzed for fat using a triglyceride quantification assay (TQA), muscle volume was measured through water displacement (WD), and histology. The study revealed that MRI had a high correlation with fat as measured with histology and TQA (R(2) ?=098). MRI also correlated well with atrophy measured with WD and wet weight. This suggests that MRI is a reliable modality in evaluating the progression of fatty infiltration and muscle atrophy following rotator cuff tears in a small animal model. PMID:22991068

Samagh, Sanjum P; Kramer, Erik J; Melkus, Gerd; Laron, Dominique; Bodendorfer, Blake M; Natsuhara, Kyle; Kim, Hubert T; Liu, Xuhui; Feeley, Brian T

2013-03-01

304

Tissue Engineering for Rotator Cuff Repair: An Evidence-Based Systematic Review  

PubMed Central

The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month follow up. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup.

Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Spiezia, Filippo; Denaro, Vincenzo

2012-01-01

305

Delivered growth factor therapy to improve healing after rotator cuff repair  

PubMed Central

Background Degenerative rotator cuff tears are a significant cause of shoulder pain in the aging population. Rotator cuff repair surgery may be more successful when growth factors are delivered to the repair site. This study was designed to determine the cellular processes involved in normal bone-to-tendon healing and the current approaches used for biologic augmentation of rotator cuff repair. Methods This review focuses on animal studies of rotator cuff repair and early human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is markedly different from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for endogenous fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells. However, research in extracellular matrices is not conclusive due to intermanufacturer variation and the lack of human subject research. Growth factors and platelet-rich plasma are established in other fields of research and show promise, but have not yet been rigorously tested in rotator cuff repair augmentation. Conclusions Rotator cuff repair can benefit from biologic augmentation. However, research in this field is still young and has not yet demonstrated that the benefits in healing rates are significant enough to merit regular clinical use. Randomized controlled trials will elucidate the use of biologic augmentation in rotator cuff repairs.

Cheung, Emilie V; Silverio, Luz; Yao, Jeffrey

2010-01-01

306

Rotator cuff tear reduces muscle fiber specific force production and induces macrophage accumulation and autophagy.  

PubMed

Full-thickness tears to the rotator cuff can cause severe pain and disability. Untreated tears progress in size and are associated with muscle atrophy and an infiltration of fat to the area, a condition known as "fatty degeneration." To improve the treatment of rotator cuff tears, a greater understanding of the changes in the contractile properties of muscle fibers and the molecular regulation of fatty degeneration is essential. Using a rat model of rotator cuff injury, we measured the force generating capacity of individual muscle fibers and determined changes in muscle fiber type distribution that develop after a full thickness rotator cuff tear. We also measured the expression of mRNA and miRNA transcripts involved in muscle atrophy, lipid accumulation, and matrix synthesis. We hypothesized that a decrease in specific force of rotator cuff muscle fibers, an accumulation of type IIb fibers, and an upregulation in fibrogenic, adipogenic, and inflammatory gene expression occur in torn rotator cuff muscles. Thirty days following rotator cuff tear, we observed a reduction in muscle fiber force production, an induction of fibrogenic, adipogenic, and autophagocytic mRNA and miRNA molecules, and a dramatic accumulation of macrophages in areas of fat accumulation. PMID:22696414

Gumucio, Jonathan P; Davis, Max E; Bradley, Joshua R; Stafford, Patrick L; Schiffman, Corey J; Lynch, Evan B; Claflin, Dennis R; Bedi, Asheesh; Mendias, Christopher L

2012-12-01

307

Rotator cuff tear reduces muscle fiber specific force production and induces macrophage accumulation and autophagy  

PubMed Central

Summary Full-thickness tears to the rotator cuff can cause severe pain and disability. Untreated tears progress in size and are associated with muscle atrophy and an infiltration of fat to the area, a condition known as “fatty degeneration.” To improve the treatment of rotator cuff tears, a greater understanding of the changes in the contractile properties of muscle fibers and the molecular regulation of fatty degeneration is essential. Using a rat model of rotator cuff injury, we measured the force generating capacity of individual muscle fibers and determined changes in muscle fiber type distribution that develop after a full thickness rotator cuff tear. We also measured the expression of mRNA and miRNA transcripts involved in muscle atrophy, lipid accumulation, and matrix synthesis. We hypothesized that a decrease in specific force of rotator cuff muscle fibers, an accumulation of type IIb fibers, an upregulation in fibrogenic, adipogenic, and inflammatory gene expression occur in torn rotator cuff muscles. Thirty days following rotator cuff tear, we observed a reduction in muscle fiber force production, an induction of fibrogenic, adipogenic and autophagocytic mRNA and miRNA molecules, and a dramatic accumulation of macrophages in areas of fat accumulation.

Gumucio, Jonathan P; Davis, Max E; Bradley, Joshua R; Stafford, Patrick L; Schiffman, Corey J; Lynch, Evan B; Claflin, Dennis R; Bedi, Asheesh; Mendias, Christopher L

2012-01-01

308

The Global Percutaneous Shuttling Technique Tip for Arthroscopic Rotator Cuff Repair  

PubMed Central

Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthroscopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS) technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001). This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

Vopat, Bryan G.; Murali, Jothi; Gowda, Ashok L.; Kaback, Lee; Blaine, Theodore

2014-01-01

309

Overview: Five decades of brachytherapy  

SciTech Connect

Brachytherapy started in 1930. Ra-226 was the radioisotope for cancer therapy at that time and much has been learned about its properties since then. One of the major findings at that time was output. When the author started, there was no T factor. People did not know how many R units were produced by 1.0 mg of radium filtered by 0.5 mm of platinum at 1.0 cm. So one was in a bit of chaos from that point of view. Eventually, that was settled in the 1930's. It was very exciting to find out that, although the national laboratories of the U.S., England, France and Germany had had values of this T factor varying from about five to seven (when they're only supposed to have less than 1% error); the value was really 8.3 and it was quite a landmark. This led to an improved knowledge of dose and effects. Developments over the next five decades are discussed in detail.

Ellis, F.

1986-01-01

310

Gadolinium neutron capture brachytherapy (GdNCB), a new treatment method for intravascular brachytherapy  

Microsoft Academic Search

Restenosis is a major problem after balloon angioplasty and stent implantation. The aim of this study is to introduce gadolinium neutron capture brachytherapy (GdNCB) as a suitable modality for treatment of stenosis. The utility of GdNCB in intravascular brachytherapy (IVBT) of stent stenosis is investigated by using the GEANT4 and MCNP4B Monte Carlo radiation transport codes. To study capture rate,

Hans Lundqvist; Per Munck af Rosenschoeld; Arash Rezaei; Shirin A. Enger

2006-01-01

311

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)

2009-12-01

312

Isokinetic Muscle Performance Test Can Predict the Status of Rotator Cuff Muscle  

Microsoft Academic Search

Background  The isokinetic muscle performance test (IMPT) is a validated and objective method used to evaluate muscle function but it\\u000a is unknown whether it correlates with severity of rotator cuff tears.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We asked whether peak torque and total work deficit on the IMPT correlated with the preoperative manual muscle test (MMT),\\u000a tear size, fatty degeneration (FD) of cuff, and postoperative cuff

Joo Han Oh; Jong Pil Yoon; Jae Yoon Kim; Chung Hee Oh

2010-01-01

313

Biologically enhanced healing of the human rotator cuff: 8-month postoperative histological evaluation.  

PubMed

Given the high percentage of persistent rotator cuff defects, investigators have begun exploring techniques that use biologic adjuvants to recreate a biomechanically equivalent layer of connective tissue. To evaluate the efficacy of a mesenchymal stem cell, platelet-rich plasma, and dermal allograft construct, a histological comparison of native rotator cuff tissue and biologically enhanced rotator cuff tissue was performed. The evaluation indicated that this treatment modality in conjunction with an adjusted rehabilitation protocol may successfully recreate a transition zone and restore a synovial lining similar to native tissue. PMID:23276334

Protzman, Nicole M; Stopyra, Gary A; Hoffman, James K

2013-01-01

314

Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer  

SciTech Connect

Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure adequate tumor coverage while minimizing the D2cc to the rectum.

Lee, Larissa J. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)

2012-12-01

315

Thromboprophylaxis post vaginal delivery: are we forgetting it? Audit on thromboprophylaxis prescription post vaginal births.  

PubMed

Pulmonary thromboembolism is the leading direct cause of maternal deaths in the UK. The majority of deaths occur in the puerperium. Caesarean section has been recognised as a risk factor but there is concern that more attention to thromboprophylaxis after vaginal births is needed. The hospital maternity unit in Dumfries has written guidelines on thromboprophylaxis after vaginal births. This audit assessed the compliance with these guidelines within this maternity unit. The case notes relating to spontaneous vaginal births over a 2-month period (n=148) and instrumental vaginal births over a 7-month period (n=29) were reviewed. Information concerning venous thromboembolism risk and any thromboprophylaxis given was extracted. The audit showed that 9% of spontaneous vaginal births and 62% of instrumental vaginal births required specific thromboprophylaxis. However, only 31% of the spontaneous vaginal births and 22% of the instrumental vaginal births in which thromboprophylaxis was indicated did indeed receive the required treatment. Failure to respond to venous thromboembolism risk factors was common. Measures to increase the awareness of maternity staff to these factors are suggested. PMID:16390705

Tan, E K; Wisdom, S J

2006-01-01

316

Tension–Free Vaginal Mesh Repair for Anterior Vaginal Wall Prolapse  

Microsoft Academic Search

Objectives: We determined the efficacy of the use of a tension free prolene mesh to correct a grade III anterior vaginal wall prolapse recurrence.Methods: Twelve women (mean age 65.6 years) with stress urinary incontinence (SUI) (4 type II and 1 type III) and bladder prolapse entered the study. After vaginal incision a pretailored polypropylene mesh was fixed to its four

Roberto Migliari; Michele De Angelis; Giuliana Madeddu; Tiziano Verdacchi

2000-01-01

317

EMAS clinical guide: low-dose vaginal estrogens for postmenopausal vaginal atrophy.  

PubMed

Vaginal atrophy is common in postmenopausal women. This clinical guide provides the evidence for the clinical use of vaginal estrogens for this condition focussing on publications since the 2006 Cochrane systematic review. Use after breast cancer, before assessment of cervical cytology and prolapse surgery is also discussed. PMID:22818886

Rees, Margaret; Pérez-López, Faustino R; Ceasu, Iuliana; Depypere, Herman; Erel, Tamer; Lambrinoudaki, Irene; Schenck-Gustafsson, Karin; Simoncini, Tommaso; van der Schouw, Yvonne; Tremollieres, Florence

2012-10-01

318

Removal of a vaginal leiomyoma presenting as tumor previa allowing vaginal birth.  

PubMed

Leiomyomas of the vagina are very rare tumors of the female genital tract with only 300 cases reported so far. A case of removal of the vaginal leiomyoma presenting as tumor previa in advanced pregnancy is described. Removal of the tumor allowed vaginal birth three weeks after surgery. PMID:22873113

Boskovic, V; Vrzic-Petronijevic, S; Petronijevic, M; Atanackovic, J; Bratic, D

2012-01-01

319

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

2012-01-01

320

The cuff leak test is not predictive of successful extubation.  

PubMed

In intubated patients the presence of a cuff leak (CL) is used as a predictor of successful extubation. CL is proposed to indicate laryngeal edema and predict which patients may develop complications such as postextubation stridor and eventual reintubation. Our objective was to evaluate the reliability of CL in our population of critically ill trauma patients. A retrospective chart review was performed of patients admitted to the trauma service who required mechanical ventilation. All patients undergo the CL test by a single respiratory therapist team before attempted extubation. Data collected included body mass index (BMI), endotracheal tube (ETT) size, length of time of mechanical ventilation, tidal volumes (Vt), and the size of the patient's trachea based on CT scan. The test is performed by the respiratory therapists and involves measuring expired Vt before and after the ETT cuff has been deflated and listening for an audible leak. A positive test result is defined as a CL greater than 10 per cent of Vt or, when volumes are not available, as audible air expired. From October 2005 to May 2006, 150 mechanically ventilated patients were identified and 49 charts were available for review. Forty-one patients had a cuff leak (+CL), whereas eight did not (-CL). The two cohorts were similar in age (+CL = 36.5 years, -CL = 38.1 years, P = 0.82), male gender (+CL = 70%, -CL = 50%, P = 0.25) ETT size (+CL = 7.4, -CL = 7.4, P = 0.57), and BMI (+CL = 28 kg/m2, -CL = 27 kg/m2, P = 0.71). The average tracheal diameter (+CL = 17.4 mm, -CL = 17.5 mm, P = 0.90) as well as the ratio of ETT and tracheal diameter was similar for the two cohorts (+CL = 0.65, -CL = 0.64, P = 0.73). Four patients (10%) in the +CL cohort failed extubation, whereas none of the -CL cohort failed (0%) (P = 0.40). The CL test does not reliably identify those patients who will require reintubation in our trauma population. In addition, the ratio of ETT and tracheal diameter is not predictive of successful extubation. PMID:19097533

Shin, Susanna H; Heath, Kirk; Reed, Scott; Collins, Jay; Weireter, L J; Britt, L D

2008-12-01

321

Gadolinium-153 as a brachytherapy isotope  

NASA Astrophysics Data System (ADS)

The purpose of this work was to present the fundamental dosimetric characteristics of a hypothetical 153Gd brachytherapy source using the AAPM TG-43U1 dose-calculation formalism. Gadolinium-153 is an intermediate-energy isotope that emits 40-100 keV photons with a half-life of 242 days. The rationale for considering 153Gd as a brachytherapy source is for its potential of patient specific shielding and to enable reduced personnel shielding requirements relative to 192Ir, and as an isotope for interstitial rotating shield brachytherapy (I-RSBT). A hypothetical 153Gd brachytherapy source with an active core of 0.84 mm diameter, 10 mm length and specific activity of 5.55 TBq of 153Gd per gram of Gd was simulated with Geant4. The encapsulation material was stainless steel with a thickness of 0.08 mm. The radial dose function, anisotropy function and photon spectrum in water were calculated for the 153Gd source. The simulated 153Gd source had an activity of 242 GBq and a dose rate in water 1 cm off axis of 13.12 Gy h-1, indicating that it would be suitable as a low-dose-rate or pulsed-dose-rate brachytherapy source. The beta particles emitted have low enough energies to be absorbed in the source encapsulation. Gadolinium-153 has an increasing radial dose function due to multiple scatter of low-energy photons. Scattered photon dose takes over with distance from the source and contributes to the majority of the absorbed dose. The anisotropy function of the 153Gd source decreases at low polar angles, as a result of the long active core. The source is less anisotropic at polar angles away from the longitudinal axes. The anisotropy function increases with increasing distance. The 153Gd source considered would be suitable as an intermediate-energy low-dose-rate or pulsed-dose-rate brachytherapy source. The source could provide a means for I-RSBT delivery and enable brachytherapy treatments with patient specific shielding and reduced personnel shielding requirements relative to 192Ir.

Enger, Shirin A.; Fisher, Darrell R.; Flynn, Ryan T.

2013-02-01

322

Gadolinium-153 as a brachytherapy isotope.  

PubMed

The purpose of this work was to present the fundamental dosimetric characteristics of a hypothetical (153)Gd brachytherapy source using the AAPM TG-43U1 dose-calculation formalism. Gadolinium-153 is an intermediate-energy isotope that emits 40-100 keV photons with a half-life of 242 days. The rationale for considering (153)Gd as a brachytherapy source is for its potential of patient specific shielding and to enable reduced personnel shielding requirements relative to (192)Ir, and as an isotope for interstitial rotating shield brachytherapy (I-RSBT). A hypothetical (153)Gd brachytherapy source with an active core of 0.84 mm diameter, 10 mm length and specific activity of 5.55 TBq of (153)Gd per gram of Gd was simulated with Geant4. The encapsulation material was stainless steel with a thickness of 0.08 mm. The radial dose function, anisotropy function and photon spectrum in water were calculated for the (153)Gd source. The simulated (153)Gd source had an activity of 242 GBq and a dose rate in water 1 cm off axis of 13.12 Gy h(-1), indicating that it would be suitable as a low-dose-rate or pulsed-dose-rate brachytherapy source. The beta particles emitted have low enough energies to be absorbed in the source encapsulation. Gadolinium-153 has an increasing radial dose function due to multiple scatter of low-energy photons. Scattered photon dose takes over with distance from the source and contributes to the majority of the absorbed dose. The anisotropy function of the (153)Gd source decreases at low polar angles, as a result of the long active core. The source is less anisotropic at polar angles away from the longitudinal axes. The anisotropy function increases with increasing distance. The (153)Gd source considered would be suitable as an intermediate-energy low-dose-rate or pulsed-dose-rate brachytherapy source. The source could provide a means for I-RSBT delivery and enable brachytherapy treatments with patient specific shielding and reduced personnel shielding requirements relative to (192)Ir. PMID:23339848

Enger, Shirin A; Fisher, Darrell R; Flynn, Ryan T

2013-02-21

323

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)

2011-11-15

324

Evolution of rotator cuff repair techniques: are our patients really benefiting?  

PubMed

The repair integrity of rotator cuff tears, which are a common disorder, is influenced by many biologic, environmental, and surgical factors. Surgery for rotator cuff repairs has evolved significantly over the past decade. The technical goals of rotator cuff repair include achieving high initial fixation strength, minimizing gap formation, and maintaining mechanical stability until biologic healing occurs. A variety of surgical techniques have been established to capitalize on certain aspects of these tenets and have been shown to provide biomechanical and biologic benefits; however, overall clinical outcomes may be dependent on certain tear characteristics. It is important for orthopaedic surgeons to be familiar with the natural history of rotator cuff disease to understand the various repair strategies and techniques and the outcomes associated with these procedures. PMID:21553768

Provencher, Matthew T; Kercher, James S; Galatz, Leesa M; Elattrache, Neal S; Frank, Rachel M; Cole, Brian J

2011-01-01

325

Comparative Effectiveness of Interventions for Rotator Cuff Tears in Adults. Clinician Guide.  

National Technical Information Service (NTIS)

Partial or full tears of the rotator cuff (RC) result from injury or degeneration, and the incidence increases with age. Patients may experience significant disability, including work absenteeism and lost productivity. Patients who seek treatment for RC t...

2010-01-01

326

The coracoacromial ligament: the morphology and relation to rotator cuff pathology.  

PubMed

We dissected 80 shoulders from 44 fresh cadavers to define variants of the coracoacromial ligament and their relationship to rotator cuff degeneration. The shapes and the geometric data of the ligaments were investigated, and the rotator cuffs of the cadavers were evaluated macroscopically. Five main types of coracoacromial ligaments were found: Y-shaped, broad band, quadrangular, V-shaped, and multiple-banded. The Y-shaped ligament was the most frequent type, with a frequency of 41.3%, and the V-shaped ligament (11.2%) has not been previously reported. Of the cadavers that were dissected bilaterally, 64% showed the same type of ligament. There was no statistical significance between rotator cuff degeneration and the type or geometric measurement of the ligament. However, the coracoacromial ligaments with more than 1 bundle showed significant association with rotator cuff degeneration with a longer lateral border and larger coracoid insertion. PMID:18036840

Kesmezacar, Hayrettin; Akgun, Isik; Ogut, Tahir; Gokay, Selim; Uzun, Ibrahim

2008-01-01

327

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

2001-01-01

328

Intramuscular fluid collections and their association with longitudinal rotator cuff tears.  

PubMed

This study draws attention to the association between intramuscular fluid collections occurring at the myo-tendinous junction of the rotator cuff secondary to longitudinal tears of their tendons. PMID:11903172

Coates, M H; Breidahl, W H; Marks, P

2001-11-01

329

In vitro evaluation of a nitinol based vein cuff for external valvuloplasty.  

PubMed

This study shows first in vitro tests of a nitinol based vein cuff developed for external valvuloplasty. In contrary to currently existing vein cuffs the tested model enables minimal invasive implantation and also maintains its round pre-shaped profile at body temperature (37 degrees C). The examination of the cuff surface structure by scanning electron microscopy, profilometry and X-ray photoelectron spectroscopy after sterilization with ethylene oxide and before cyto-compatibility testing revealed a nearly smooth surface (mean square roughness Rq 66 +/- 33 nm) which was primarily composed of nickel, oxygen, titanium, carbon and silicon where nickel was the least fraction (Ni: 0.7%, Ti: 1.7%, Si: 15.8%, O: 29.5%, C: 52.3%) of the surface elements. Si and C are supposed to be contaminations caused by a final cuff polishing with silicon carbide at the end of the manufacturing process. To evaluate cyto-compatibility initial cell adherence and cell activity were assessed. The results showed good initial cell adherence of L929 fibroblast-like cells on the cuff surface already after 24 h. The results also revealed no inhibitory effects on the activity of these cells (MTS test) later on. The test setup developed to analyse functionality in a dynamic mode was shown to be suited at blood pressures up to 300 mmHg. The cuff successfully limited dilation of varicose veins (Vena saphena magna) at physiological blood pressures (< 120 mmHg) and also in cases of hypertonia (300 mmHg) to the diameter determined by the cuff (4.0 mm) over thecomplete testing period. This indicates that the clasp based cuff closure mechanism is suited to close the cuff under variable physiological and pathological blood pressure conditions. The cuff structure only allowed minimal adaptation on the inhomogenously dilating vein profile in the both peripheral cuff modules. Both peripheral modules followed the vessel dilation in correlation to the applied pressure. At pressures within the physiological range cuff also maintained the pre-shaped round profile in the central and peripheral modules during the pressure increase and the consecutive cuff expansion. The study showed that the first nitinol based vein cuff for external valvuloplasty was processed well enough by electropolishing and sterilization to allow culturing of L929 fibroblast-like cells on the cuff surface as a test of general biocompatibility. The cuff also proved to limit dilation of varicose veins at physiological and pathological blood pressures in vitro. Further tests with primary cells from the venous wall will follow to test the specific biocompatibility before tests in vivo can be envisaged. PMID:20675918

Hiebl, B; Jung, F; Schossig, M; Scharnagl, N; Richau, K; Niehues, S

2010-01-01

330

Calcific Tendonitis of the Rotator Cuff: An Unusual Case  

PubMed Central

Few case reports have described the surgical treatment of calcifying tendonitis of the subscapularis tendon. We present a case of symptomatic diffuse calcifying tendonitis involving the subscapularis and infraspinatus insertions that was difficult to detect arthroscopically. The patient was treated with arthroscopic incision of the tendinous insertions thorough removal of the calcific deposits and subsequent repair using a suture-anchor technique. Two years after the surgical procedure, the patient was completely pain-free and attained full range of motion. Radiographic evaluation performed 2 years after the procedure revealed no calcific deposits. We conclude that the combination of incision of the subscapularis and infraspinatus insertions, complete removal of the calcific deposits, and subsequent suture-anchor repair in an all-arthroscopic manner can lead to an excellent clinical outcome without compromising the functional integrity of the rotator cuff tendons.

Mitsui, Yasuhiro; Gotoh, Masafumi; Tanesue, Ryo; Shirachi, Isao; Shibata, Hideaki; Nakama, Kenjiro; Okawa, Takahiro; Higuchi, Fujio; Nagata, Kensei

2012-01-01

331

[Microbial contamination of cuffs lab coats during health care].  

PubMed

The study aimed to evaluate the bacterial contamination in lab coats worn by nursing students, before and after being worn in health care practices. A quantitative and descriptive study was carried out, in which the students' coats were collected, washed and ironed in a standardized way and wore for four hours in assistance activities. Subsequently, samples from the cuffs were collected with sterile cotton swabs in order to be incubated in order to analyze microbial growth through morphological analysis by Gram's Method and antibiogram. There was bacterial growth of Staphylococcus aureus and Staphylococcus epidermidis in 50% of the collected samples and Staphylococcus aureus, found in patients with wounds in outpatient care, showed resistance to antibiotics such as Vancomycin, Chloramphenicol and Sulfonamides. The data demonstrated that the lab coats wore during assistance activities, even in short periods, are effectively contaminated by strains resistant to antibiotics and can potentially cause infection related to health care. PMID:24676079

Margarido, Carla Auxiliadora; Villas Boas, Tamires Monteiro; Mota, Valeria Siqueira; da Silva, Cristiane Karina Malvezzi; Poveda, Vanessa de Brito

2014-01-01

332

Time to surgery in acute rotator cuff tear  

PubMed Central

Aims We performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes. Methods The MEDLINE, Embase, CINAHL, Web of Science, Cochrane Libraries, controlled-trials.com and clinicaltrials.gov databases were searched using the terms: ‘rotator cuff’, or ‘supraspinatus’, or ‘infraspinatus’, or ‘teres minor’, or ‘subscapularis’ AND ‘surgery’ or ‘repair’. This gave a total of 15 833 articles. After deletion of duplicates and the review of abstracts and full texts by two independent assessors, 15 studies reporting time to surgery for ARCT repair were included. Studies were grouped based on time to surgery < 3 months (group A, seven studies), or > 3 months (group B, eight studies). Weighted means were calculated and compared using Student’s t-test. Results Group B had a significantly higher pre-operative Constant score (CS) (p < 0.001), range of movement in external rotation (p = 0.003) and abduction (p < 0.001) compared with group A. Both groups showed clinical improvement with surgical repair; group A had a significantly improved Constant score, University of California, Los Angeles (UCLA) shoulder score, abduction and elevation post-operatively (all p < 0.001). Group B had significantly improved Constant score (p < 0.001) and external rotation (p < 0.001) post-operatively. The mean Constant score improved by 33.5 for group A and by 27.5 for group B. Conclusion These findings should be interpreted with caution due to limitations and bias inherent to case-series. We suggest a trend that earlier time to surgery may be linked to better Constant score, and active range of movement in abduction and elevation. Additional prospective studies are required.

Mukovozov, I.; Byun, S.; Farrokhyar, F.; Wong, I.

2013-01-01

333

Transverse vaginal septum associated with tubal atresia.  

PubMed

Transverse vaginal septum is a defect of vertical fusion during embryogenesis of the vagina. The estimated incidence is 1 per 30,000 to 84,000 women. It is infrequently associated with genitourinary tract, gastrointestinal tract, musculoskeletal, and cardiac malformations. Previous reports of transverse vaginal septum have included unilateral absence of the fallopian tube and ovary and absence of the proximal portion of the fallopian tube. This report describes bilateral tubal atresia associated with a transverse vaginal septum. A 17-year-old nulligravida sought medical assessment because of primary amenorrhea and cyclic pelvic pain. Physical examination revealed a blind vaginal pouch and a tender pelvic mass. Radiologic studies showed a transverse vaginal septum 1.5 cm distal to the cervix. The septum was resected with laparoscopic guidance, and bilateral fallopian tubal atresia was noted. The pelvis was otherwise normal. Patients commonly have a pelvic or abdominal mass, pain, and amenorrhea at time of expected menarche. Surgical resection is the treatment of choice. Postoperative dilation may be necessary to prevent restenosis. Outlook for pregnancy is encouraging despite a higher than normal incidence of spontaneous abortion and endometriosis in such patients. PMID:7564549

Polasek, P M; Erickson, L D; Stanhope, C R

1995-10-01

334

Breech vaginal delivery at or near term.  

PubMed

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

2003-02-01

335

Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study  

Microsoft Academic Search

Objective To compare the effectiveness of ultrasound guided corticosteroid injection in the subacromial bursa with systemic corticosteroid injection in patients with rotator cuff disease.Design Double blind randomised clinical trial.Setting Outpatient clinic of a physical medicine and rehabilitation department in Oslo, Norway.Patients 106 patients with rotator cuff disease lasting at least three months.Interventions Ultrasound guided corticosteroid and lidocaine injection in the

Ole M Ekeberg; Erik Bautz-Holter; Einar K Tveitå; Niels G Juel; Synnøve Kvalheim; Jens I Brox

2009-01-01

336

Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears  

Microsoft Academic Search

The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable\\u000a anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either\\u000a the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the\\u000a rotator cuff that does

Iosif Gavriilidis; Jörn Kircher; Petra Magosch; Sven Lichtenberg; Peter Habermeyer

2010-01-01

337

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis  

Microsoft Academic Search

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11 mJ\\/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session,

Biagio Moretti; Raffaele Garofalo; Stefania Genco; Vittorio Patella; Elyazid Mouhsine

2005-01-01

338

2D SPLASH: a new method to determine the fatty infiltration of the rotator cuff muscles  

Microsoft Academic Search

The objective of this paper is to quantify the fatty degeneration (infiltration) of rotator cuff muscles with a new spectroscopic FLASH (SPLASH) sequence. Before planned surgery (reconstruction or muscle transfer), 20 patients (13 men, 7 women; 35–75 years) with different stages of rotator cuff disease underwent an MR examination in a 1.5-T unit. The protocol consists of imaging sequences and

Werner Kenn; Dirk Böhm; Frank Gohlke; Christian Hümmer; Herbert Köstler; Dietbert Hahn

2004-01-01

339

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity  

Microsoft Academic Search

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior\\u000a tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator\\u000a cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as

M. J. Tuite; John R. Turnbull; John F. Orwin

1998-01-01

340

Estimation of Total Collagen and Types I and III Collagen in Canine Rotator Cuff Tendons  

Microsoft Academic Search

.   The collagen composition of the supraspinatus, infraspinatus, and subscapularis tendons, which form part of the rotator cuff\\u000a of the shoulder, was determined. Tendons were obtained from adult, male beagle dogs and total collagen was estimated by measurement\\u000a of hydroxyproline. There was little variation in collagen content among the three major cuff tendons and the quantity approximated\\u000a that cited in

L. Fan; K. Sarkar; D. J. Franks; H. K. Uhthoff

1997-01-01

341

Latissimus dorsi transfer for primary treatment of irreparable rotator cuff tears  

Microsoft Academic Search

Transfer of the musculotendinous unit of the latissimus dorsi was performed in seven patients (5 men and 2 women, with a\\u000a mean age of 57 years) with irreparable rotator cuff tear who had had no previous surgery for cuff repair. Preoperatively,\\u000a the mean active shoulder motion was 86? in flexion, 74? in abduction and 22? in external rotation. One patient

F. Postacchini; S. Gumina; P. De Santis; R. Di Virgilio

2002-01-01

342

The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology  

Microsoft Academic Search

The relative prevalence of various acromial shapes, appearance of the coracoacromial ligament and enthesophytes along the\\u000a inferior aspect of the acromioclavicular joint in patients with and without rotator cuff tears were evaluated. Of 76 patients\\u000a with clinical instability and impingement, 31 had a normal rotator cuff and 45 demonstrated a partial or full tear of the\\u000a supraspinatus tendon at surgery.

Timothy E. Farley; Christian H. Neumann; Lynne S. Steinbach; Steve A. Petersen

1994-01-01

343

Humeral head cysts and rotator cuff tears: an MR arthrographic study  

Microsoft Academic Search

Objective  Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age.Design and patients  Shoulder MR arthrograms were reviewed in 120 consecutive patients—83 males (mean

Martin Williams; Robert G. W. Lambert; Gian S. Jhangri; Michael Grace; Jay Zelaso; Ben Wong; Sukhvinder S. Dhillon

2006-01-01

344

Factors Affecting Healing Rates After Arthroscopic Double-Row Rotator Cuff Repair  

Microsoft Academic Search

Background: Double-row arthroscopic rotator cuff repairs were developed to improve initial biomechanical strength of repairs to improve healing rates. Despite biomechanical improvements, failure of healing remains a clinical problem.Purpose: To evaluate the anatomical results after double-row arthroscopic rotator cuff repair with ultrasound to determine postoperative repair integrity and the effect of various factors on tendon healing.Study Design: Case series; Level

Robert Z. Tashjian; Anthony M. Hollins; Hyun-Min Kim; Sharlene A. Teefey; William D. Middleton; Karen Steger-May; Leesa M. Galatz; Ken Yamaguchi

2010-01-01

345

Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures  

Microsoft Academic Search

The aim of this study was to compare the efficacy of indirect MR arthrography images obtained following intravenous contrast\\u000a injection and conventional MR imaging in the diagnosis of rotator cuff tears. Twenty-four patients with clinically suspected\\u000a rotator cuff disease were examined. Conventional MR images and post-contrast indirect MR arthrography images were obtained.\\u000a All images were evaluated in a blinded fashion

B. Ya?c?; M. Manisal?; E. Yilmaz; M. Özkan; A. Ekin; D. Özaksoy; I. Kovanl?kaya

2001-01-01

346

Living with a symptomatic rotator cuff tear 'bad days, bad nights': a qualitative study  

PubMed Central

Background Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients’ perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. Methods An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. Results The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. Conclusions Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient’s lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment.

2014-01-01

347

Correlation of acromial morphology with impingement syndrome and rotator cuff tears  

PubMed Central

Background and purpose Indications for acromioplasty are based on clinical symptoms and are generally supported by typical changes in acromial morphology on standard radiographs. We evaluated 5 commonly used radiographic parameters of acromial morphology and assessed the association between different radiographic characteristics on the one hand and subacromial impingement or rotator cuff tears on the other. Patients and methods We measured acromial type (Bigliani), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), and acromion index (AI) on standard radiographs from 50 patients with full-thickness supraspinatus tendon tears, 50 patients with subacromial impingement, and 50 controls without subacromial pathology. Results The acromial type according to Bigliani was not associated with any particular cuff lesion. A statistically significant difference between controls and impingement patients was found for AS. AT of controls was significantly smaller than that of impingement patients and cuff-tear patients. LAA of cuff-tear patients differed significantly from that of controls and impingement patients, but LAA of controls was not significantly different from that of impingement patients. Differences between impingement patients and cuff-tear patients were also significant. AI of controls was significantly lower than of impingement patients and of cuff-tear patients. A good correlation was found between acromial type and AS. Interpretation A low lateral acromial angle and a large lateral extension of the acromion were associated with a higher prevalence of impingement and rotator cuff tears. An extremely hooked anterior acromion with a slope of more than 43° and an LAA of less than 70° only occurred in patients with rotator cuff tears.

2013-01-01

348

Protective activity of geranium oil and its component, geraniol, in combination with vaginal washing against vaginal candidiasis in mice.  

PubMed

In order to evaluate an effective administration method of essential oils for vaginal candidiasis, efficacy of vaginal application of essential oils against murine experimental candidiasis was investigated. The effect on vaginal inflammation and Candida growth form was also studied. Vaginal candidiasis was established by intravaginal infection of C. albicans to estradiol-treated mice. These mice intravaginally received essential oils such as geranium and tea tree singly or in combination with vaginal washing. Vaginal administration of clotrimazole significantly decreased the number of viable C. albicans cells in the vaginal cavity by itself. In contrast, these essential oils did not lower the cell number. When application of geranium oil or geraniol was combined with vaginal washing, the cell number was decreased significantly. The myeloperoxidase activity assay exhibited the possibility that essential oils worked not only to reduce the viable cell number of C. albicans, but also to improve vaginal inflammation. The smear of vaginal washing suspension suggested that more yeast-form cells appeared in vaginal smears of these oil-treated mice than in control mice. In vitro study showed that a very low concentration (25 microg/ml) of geranium oil and geraniol inhibited mycelial growth, but not yeast growth. Based on these findings, it is estimated that vaginal application of geranium oil or its main component, geraniol, suppressed Candida cell growth in the vagina and its local inflammation when combined with vaginal washing. PMID:18670079

Maruyama, Naho; Takizawa, Toshio; Ishibashi, Hiroko; Hisajima, Tatsuya; Inouye, Shigeharu; Yamaguchi, Hideyo; Abe, Shigeru

2008-08-01

349

Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement  

PubMed Central

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013

Jacobson, Jon A.; Benson, Carol B.; Bancroft, Laura W.; Bedi, Asheesh; McShane, John M.; Miller, Theodore T.; Parker, Laurence; Smith, Jay; Steinbach, Lynne S.; Teefey, Sharlene A.; Thiele, Ralf G.; Tuite, Michael J.; Wise, James N.; Yamaguchi, Ken

2013-01-01

350

Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting.  

PubMed

The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented. PMID:24041864

Arce, Guillermo; Bak, Klaus; Bain, Gregory; Calvo, Emilio; Ejnisman, Benno; Di Giacomo, Giovanni; Gutierrez, Vicente; Guttmann, Dan; Itoi, Eiji; Ben Kibler, W; Ludvigsen, Tom; Mazzocca, Augustus; de Castro Pochini, Alberto; Savoie, Felix; Sugaya, Hiroyuki; Uribe, John; Vergara, Francisco; Willems, Jaap; Yoo, Yon Sik; McNeil, John W; Provencher, Matthew T

2013-11-01

351

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

2013-01-01

352

Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse  

PubMed Central

Introduction and hypothesis To estimate the risk of repeat surgery for recurrent prolapse or mesh removal after vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Methods We utilized longitudinal, adjudicated, healthcare claims from 2005 to 2010 to identify women ?18 years who underwent an anterior colporrhaphy (CPT 57420) with or without concurrent vaginal mesh (CPT 57267). The primary outcome was repeat surgery for anterior or apical prolapse or for mesh removal/revision; these outcomes were also analyzed separately. We utilized Kaplan–Meier curves to estimate the cumulative risk of each outcome after vaginal mesh versus native tissue repair. Cox proportional hazards models were used to estimate the hazard ratio (HR) for vaginal mesh versus native tissue repair, adjusted for age, concurrent hysterectomy, and concurrent or recent sling. Results We identified 27,809 anterior prolapse surgeries with 49,658 person-years of follow-up. Of those, 6,871 (24.7%) included vaginal mesh. The 5-year cumulative risk of any repeat surgery was significantly higher for vaginal mesh versus native tissue (15.2 % vs 9.8 %, p<0.0001) with a 5-year risk of mesh revision/removal of 5.9%. The 5-year risk of surgery for recurrent prolapse was similar between vaginal mesh and native tissue groups (10.4 % vs 9.3 %, p=0.70. The results of the adjusted Cox model were similar (HR 0.93, 95%CI: 0.83, 1.05). Conclusions The use of mesh for anterior prolapse was associated with an increased risk of any repeat surgery, which was driven by surgery for mesh removal. Native tissue and vaginal mesh surgery had similar 5-year risks for surgery for recurrent prolapse.

Funk, Michele Jonsson; Visco, Anthony G.; Weidner, Alison C.; Pate, Virginia

2013-01-01

353

Intermittent local prophylaxis against recurrent vaginal candidosis.  

PubMed Central

Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised.

Bushell, T E; Evans, E G; Meaden, J D; Milne, J D; Warnock, D W

1988-01-01

354

Vaginal Leiomyoma with Heterologous Paragangliomatous Elements.  

PubMed

A vaginal leiomyoma with heterologous paragangliomatous elements is reported. The patient was a 62-year-old woman who presented with uterovaginal prolapse and an asymptomatic vaginal mass that had been present for many years. Histology of the excised mass showed a leiomyoma in a submucosal location, with irregularly shaped islands of chief cells scattered throughout the lesion. These cells were arranged in nests and were surrounded by S100 protein-positive sustentacular cells. The chief cells showed immunoreactivity with chromogranin, synaptophysin, and neuron-specific enolase. Although various heterologous elements are commonly encountered within uterine leiomyomata, such elements have not been described within vaginal leiomyomata. Furthermore, the occurrence of paragangliomatous tissue within leiomyomata has not been reported to date. Int J Surg Pathol 8(4):359-365, 2000 PMID:11494018

Naidoo, Prabha

2000-10-01

355

Canine vaginal leiomyoma diagnosed by CT vaginourethrography.  

PubMed

A 13 yr old female spayed Labrador retriever presented for vulvar bleeding. Abdominal radiographs revealed a soft tissue mass in the ventral pelvic canal. A computed tomography (CT) exam and a CT vaginourethrogram localized the mass to the vagina, helped further characterize the mass, and aided in surgical planning. A total vaginectomy was performed and the histologic diagnosis was leiomyoma. Vaginal tumors make up 1.9-3% of all tumors. Seventy-three percent of vaginal tumors are benign, and 83% of those are leiomyomas. Leiomyomas often have a good long-term prognosis with surgical resection. The diagnostic investigation of this case report utilized a multimodal imaging approach to determine the extent and respectability of the vaginal mass. To the best of the authors' knowledge, this is the first report describing a CT vaginourethrogram. PMID:24051257

Weissman, Andrea; Jiménez, David; Torres, Brian; Cornell, Karen; Holmes, Shannon P

2013-01-01

356

Fasciocutaneous flap for vaginal and perineal reconstruction  

SciTech Connect

A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

1987-07-01

357

Pregnancy's Stronghold on the Vaginal Microbiome  

PubMed Central

Objective To assess the vaginal microbiome throughout full-term uncomplicated pregnancy. Methods Vaginal swabs were obtained from twelve pregnant women at 8-week intervals throughout their uncomplicated pregnancies. Patients with symptoms of vaginal infection or with recent antibiotic use were excluded. Swabs were obtained from the posterior fornix and cervix at 8–12, 17–21, 27–31, and 36–38 weeks of gestation. The microbial community was profiled using hypervariable tag sequencing of the V3–V5 region of the 16S rRNA gene, producing approximately 8 million reads on the Illumina MiSeq. Results Samples were dominated by a single genus, Lactobacillus, and exhibited low species diversity. For a majority of the patients (n?=?8), the vaginal microbiome was dominated by Lactobacillus crispatus throughout pregnancy. Two patients showed Lactobacillus iners dominance during the course of pregnancy, and two showed a shift between the first and second trimester from L. crispatus to L. iners dominance. In all of the samples only these two species were identified, and were found at an abundance of higher than 1% in this study. Comparative analyses also showed that the vaginal microbiome during pregnancy is characterized by a marked dominance of Lactobacillus species in both Caucasian and African-American subjects. In addition, our Caucasian subject population clustered by trimester and progressed towards a common attractor while African-American women clustered by subject instead and did not progress towards a common attractor. Conclusion Our analyses indicate normal pregnancy is characterized by a microbiome that has low diversity and high stability. While Lactobacillus species strongly dominate the vaginal environment during pregnancy across the two studied ethnicities, observed differences between the longitudinal dynamics of the analyzed populations may contribute to divergent risk for pregnancy complications. This helps establish a baseline for investigating the role of the microbiome in complications of pregnancy such as preterm labor and preterm delivery.

Walther-Antonio, Marina R. S.; Jeraldo, Patricio; Berg Miller, Margret E.; Yeoman, Carl J.; Nelson, Karen E.; Wilson, Brenda A.; White, Bryan A.; Chia, Nicholas; Creedon, Douglas J.

2014-01-01

358

Simultaneous Strain Measurements of Rotator Cuff Tendons at Varying Arm Positions and The Effect of Supraspinatus Tear: A Cadaveric Study  

Microsoft Academic Search

Aim: This study aims to measure strains on the different rotator cuff tendons simultaneously and demonstrate the effect of\\u000a supraspinatus tear on other cuff tendons with an intact glenohumeral joint.\\u000a \\u000a Methodology: Four fresh-frozen shoulders were tested on a purpose-built rig in preliminary tests. With 10 kg loaded at the\\u000a rotator cuff muscles, displacement variable reluctance transducers (DVRTs) were used to

J. M. Sheng; S. M. Chou; S. H. Tan; D. T. T. Lie; K. S. A. Yew

359

Vaginal sensitivity to electric stimuli: Theoretical and practical implications  

Microsoft Academic Search

Vaginal sensitivity was investigated in a group of 60 volunteers by means of an electric stimulus and under nonerotic conditions. In comparison to the dorsum of the hand, the genital area has a low sensitivity for electric stimuli (p 0.001). Of the genital area, the vaginal wall measured 2 to 4 cm from the vaginal introitus was found to be

W. C. M. Weijmar Schultz; J. A. Klatter; B. E. Sturm; J. Nauta

1989-01-01

360

Transverse vaginal septum. A case report.  

PubMed

A case occurred of imperforate, complete transverse vaginal septum in the lower third of the vagina. The patient presented at 16 years of age with primary amenorrhea and was found to have hematocolpos. The clinical impression was an imperforate hymen because of the very low position of the septum in the vagina. After excision the diagnosis of transverse vaginal septum was made histologically because of the presence of müllerian duct (mesodermal origin) tissue in the septum. The patient also had syndactyly of the second and third toes on her right foot. The association of these two congenital abnormalities has not been reported previously. PMID:7738932

Wang, J; Ezzat, W; Davidson, M

1995-02-01

361

Fractionated stereotactic radiotherapy boost for gynecologic tumors: An alternative to brachytherapy?  

SciTech Connect

Purpose: A brachytherapy (BT) boost to the vaginal vault is considered standard treatment for many endometrial or cervical cancers. We aimed to challenge this treatment standard by using stereotactic radiotherapy (SRT) with a linac-based micromultileaf collimator technique. Methods and Materials: Since January 2002, 16 patients with either endometrial (9) or cervical (7) cancer have been treated with a final boost to the areas at higher risk for relapse. In 14 patients, the target volume included the vaginal vault, the upper vagina, the parametria, or (if not operated) the uterus (clinical target volume [CTV]). In 2 patients with local relapse, the CTV was the tumor in the vaginal stump. Margins of 6-10 mm were added to the CTV to define the planning target volume (PTV). Hypofractionated dynamic-arc or intensity-modulated radiotherapy techniques were used. Postoperative treatment was delivered in 12 patients (2 x 7 Gy to the PTV with a 4-7-day interval between fractions). In the 4 nonoperated patients, a dose of 4 Gy/fraction in 5 fractions with 2 to 3 days' interval was delivered. Patients were immobilized in a customized vacuum body cast and optimally repositioned with an infrared-guided system developed for extracranial SRT. To further optimize daily repositioning and target immobilization, an inflated rectal balloon was used during each treatment fraction. In 10 patients, CT resimulation was performed before the last boost fraction to assess for repositioning reproducibility via CT-to-CT registration and to estimate PTV safety margins around the CTV. Finally, a comparative treatment planning study between BT and SRT was performed in 2 patients with an operated endometrial Stage I cancer. Results: No patient developed severe acute urinary or low-intestinal toxicity. No patient developed urinary late effects (>6 months). One patient with a vaginal relapse previously irradiated to the pelvic region presented with Grade 3 rectal bleeding 18 months after retreatment. A second patient known to suffer from irritable bowel syndrome presented with Grade 1 abdominal pain after treatment. The estimated PTV margins around the CTV were 9-10 mm with infrared marker registration. External SRT succeeded in improving dose homogeneity to the PTV and in reducing the maximum dose to the rectum, when compared to BT. Conclusion: These results suggest that the use of external SRT to deliver a final boost to the areas at higher risk for relapse in endometrial or cervical cancer is feasible, well tolerated, and may well be considered an acceptable alternative to BT.

Molla, Meritxell [Servei de Radio-oncologia, Instituto Oncologico Teknon, Barcelona (Spain); Escude, Lluis D. [Servei de Radio-oncologia, Instituto Oncologico Teknon, Barcelona (Spain); Nouet, Philippe [Service de Radio-oncologie, Hopitaux Universitaires, Geneva (Switzerland); Popowski, Youri D.Sc. [Service de Radio-oncologie, Hopitaux Universitaires, Geneva (Switzerland); Hidalgo, Alberto [Servei de Radiodiagnostic, Instituto Oncologico Teknon, Barcelona (Spain); Rouzaud, Michel [Service de Radio-oncologie, Hopitaux Universitaires, Geneva (Switzerland); Linero, Dolores [Servei de Radio-oncologia, Instituto Oncologico Teknon, Barcelona (Spain); Miralbell, Raymond [Servei de Radio-oncologia, Instituto Oncologico Teknon, Barcelona (Spain) and Service de Radio-oncologie, Hopitaux Universitaires, Geneva (Switzerland)]. E-mail: Raymond.Miralbell@hcuge.ch

2005-05-01

362

Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique  

PubMed Central

Background We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. Results Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and musculotendinous junction in 20 cases (66.7%; p = 0.006). Conclusions Suture bridge repair technique for rotator cuff tear showed improved clinical results. Cuff integrity after repair did not affect clinical results. Age of over 60 years and size of cuff tear larger than 1 cm were factors influencing rotator cuff retear after arthroscopic suture bridge repair technique.

Lee, Kwang Won; Bae, Kyoung Wan; Choy, Won Sik

2013-01-01

363

Neutron induced brachytherapy: a combination of neutron capture therapy and brachytherapy.  

PubMed

Brachytherapy is a widely used radiation therapy modality while neutron capture therapy is being intensely studied. These methods provide some advantages, but also have limitations that might be ameliorated by combining them. A technique that uses stable solid seeds or needles of Gd which are irradiated in vivo with neutrons has been evaluated. Monte Carlo calculations show that 5000 cGy of prompt gamma dose can be delivered to a treatment volume of 40 cm3 with a three-plane implant of 9-Gd needles. The tumor to normal tissue advantage of this method is as good as brachytherapy using 60Co seeds. Measurements of prompt gamma dose with films and TLD-700s in a lucite phantom verify the Monte Carlo evaluation. Dose measurements of a Gd needle in air also show that Gd is promising for this form of brachytherapy. PMID:1584135

Shih, J L; Brugger, R M

1992-01-01

364

Development and in vitro evaluation of an acid buffering bioadhesive vaginal gel for mixed vaginal infections.  

PubMed

An acid buffering bioadhesive vaginal (ABBV) gel was developed for the treatment of mixed vaginal infections. Different bioadhesive polymers were evaluated on the basis of their bioadhesive strength, stability and drug release properties. Bioadhesion and release studies showed that guar gum, xanthan gum and hydroxypropyl methylcelullose K4M formed a good combination of bioadhesive polymers to develop the ABBV gel. Monosodium citrate was used as an acid buffering agent to provide acidic pH (4.4). The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as antibacterial) were used in the formulation along with Lactobacillus spores to treat mixed vaginal infections. The ex vivo retention study showed that the bioadhesive polymers hold the gel for 12-13 hours inside the vaginal tube. Results of the in vitro antimicrobial study indicated that the ABBV gel had better antimicrobial action than the commercial intravaginal drug delivery systems and retention was prolonged in an ex vivo retention experiment. PMID:19103575

Ahmad, Farhan Jalees; Alam, Mohd Aftab; Khan, Zeenat Iqbal; Khar, Roop Krishen; Ali, Mushir

2008-12-01

365

Rectal dosimetric analysis following prostate brachytherapy  

Microsoft Academic Search

Purpose: To retrospectively assess the rectal tolerance dose in transperineal ultrasound-guided prostate brachytherapy using easily measured point doses.Methods and Materials: Forty-five consecutive patients who underwent prostate seed implantation from January 1996 to October 1996, using either 125I or 103Pd as monotherapy or as a boost following 45 Gy of external beam radiotherapy (XRT), were evaluated. For monotherapy using 125I, the

Gregory S Merrick; Wayne M Butler; Anthony T Dorsey; Jonathan H Lief; Holly L Walbert; Heather J Blatt

1999-01-01

366

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.

367

Development and evaluation of acid-buffering bioadhesive vaginal tablet for mixed vaginal infections  

Microsoft Academic Search

An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion\\u000a experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for\\u000a an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4),\\u000a which is an attribute of a healthy vagina.

Mohd Aftab Alam; Farhan Jalees Ahmad; Zeenat Iqbal Khan; Roop Krishen Khar; Mushir Ali

2007-01-01

368

Three-dimensional dosimetric considerations from different point A definitions in cervical cancer low-dose-rate brachytherapy  

PubMed Central

Purpose To investigate the dosimetric difference due to the different point A definitions in cervical cancer low-dose-rate (LDR) intracavitary brachytherapy. Material and methods Twenty CT-based LDR brachytherapy plans of 11 cervical patients were retrospectively reviewed. Two plans with point As following the modified Manchester system which defines point A being 2 cm superior to the cervical os along the tandem and 2 cm lateral (Aos), and the American Brachytherapy Society (ABS) guideline definition in which the point A is 2 cm superior to the vaginal fornices instead of os (Aovoid) were generated. Using the same source strength, two plans prescribed the same dose to Aos and Aovoid. Dosimetric differences between plans including point A dose rate, treatment volume encompassed by the prescription isodose line (TV), and dose rate of 2 cc of the rectum and bladder to the prescription dose were measured. Results On average Aovoid was 8.9 mm superior to Aos along the tandem direction with a standard deviation of 5.4 mm. With the same source strength and arrangement, Aos dose rate was 19% higher than Aovoid dose rate. The average TV(Aovoid) was 118.0 cc, which was 30% more than the average TV(Aos) of 93.0 cc. D2cc/D(Aprescribe) increased from 51% to 60% for rectum, and increased from 89% and 106% for bladder, if the prescription point changed from Aos to Aovoid. Conclusions Different point A definitions lead to significant dose differences. Careful consideration should be given when changing practice from one point A definition to another, to ensure dosimetric and clinical equivalency from the previous clinical experiences.

Chen, Ting; Kim, Leonard H.; Nelson, Carl; Gabel, Molly; Narra, Venkat; Haffty, Bruce; Yue, Ning J.

2013-01-01

369

Disability and satisfaction after Rotator Cuff decompression or repair: a sex and gender analysis  

PubMed Central

Background Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment. Results and Discussion One hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength. Conclusions The results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals.

2011-01-01

370

Mononuclear cell therapy reverts cuff-induced thrombosis in apolipoprotein E-deficient mice  

PubMed Central

Background Stem/progenitor cell-based therapy has successfully been used as a novel therapeutic strategy for vascular diseases triggered by endothelial dysfunction. The aim of this study was to investigate the effects of mononuclear cell (MNC) therapy in situ on carotid cuff-induced occlusive thrombus in the apolipoprotein E knockout (apoE-/-) mouse. Methods Spleen-derived MNCs were isolated from green fluorescent protein (GFP)-transgenic mice for cell treatment. A cuff-induced thrombus model was produced by placing a nonconstrictive silastic collar around the left common carotid artery in 20-week-old female apoE-/- mice. After 10 days, the cuff was removed, and the animals received in situ MNCs (Cuff-MNC) or vehicle (Cuff-Vehicle) and were compared with sham-operated animals (Sham). Results The histological analysis showed that the MNC treatment reverted occlusive thrombus formation compared to the vehicle and the vessel lumen area to that observed in the Sham group (MNC, 50?±?4; Vehicle, 20?±?4; Sham, 55?±?2 x103 ?m2; p?cuff placement developed compensatory vessel enlargement, which was reduced by the MNC therapy. In addition, the treatment was able to reduce superoxide anion production, which likely contributed to the reduced apoptosis that was observed. Lastly, the immunofluorescence analysis revealed the presence of endothelial progenitor cells (EPCs) in the carotid endothelia of the apoE-/- mice. Conclusion In situ short-term MNC therapy was able to revert cuff-induced occlusive thrombi in the carotid arteries of apoE-/- mice, possibly through the homing of EPCs, reduction of oxidative stress and decreased apoptosis.

2012-01-01

371

Clinical effects of thigh cuffs during a 7-day 6° head-down bed rest  

NASA Astrophysics Data System (ADS)

Thigh cuffs are used by Russian cosmonauts to limit the fluid shift induced by space flight. A ground simulation using the head-down bed rest (HDBR) model was performed to assess the effects of thigh cuffs on clinical tolerance and orthostatic adaptation. 8 male healthy volunteers (32.4±1.9 years) participated twice in a 7-day HDBR — one time with thigh cuffs (worm daily from 9 am to 7 pm) (TC) and one time without (WTC). Orthostatic tolerance was assessed by a 10 minute stand test and by a LBNP test (5 min at -15, -30, -45 mmHg) before (BDC-1) and at the end of the HDBR period (R+1). Plasma volume was measured before and at the end of HDBR by the Evans blue dye dilution technique. Thigh cuffs limits headache due to fluid shift, as well as the loss in plasma volume (TC: -5.85±0.95%; WTC: -9.09±0.82%, p<0.05). The mean duration of the stand test (R+1) did not differ in the two group (TC 7.1±1.3 min; WTC 7.0±1.0 min). The increase in HR and decrease in diastolic blood pressure were slightly but significantly larger without thigh cuffs. Duration of the LBNP tests did not differ with thigh cuffs. Thigh cuffs limit the symptoms due to fluid shift and the loss in plasma volume. They partly reduced the increase in HR during orthostatic stress but had no effect on duration of orthostatic stress tests.

Pavy-Le Traon, Anne; Maillet, Alain; Vasseur Clausen, Pascale; Custaud, Marc-Antoine; Alferova, Irina; Gharib, Claude; Fortrat, Jacques-Olivier

2001-08-01

372

Elevated plasma levels of TIMP-1 in patients with rotator cuff tear  

PubMed Central

Background and purpose Extracellular matrix remodeling is altered in rotator cuff tears, partly due to altered expression of matrix metalloproteinases (MMPs) and their inhibitors. It is unclear whether this altered expression can be traced as changes in plasma protein levels. We measured the plasma levels of MMPs and their tissue inhibitors (TIMPs) in patients with rotator cuff tears and related changes in the pattern of MMP and TIMP levels to the extent of the rotator cuff tear. Methods Blood samples were collected from 17 patients, median age 61 (39–77) years, with sonographically verified rotator cuff tears (partial- or full-thickness). These were compared with 16 age- and sex-matched control individuals with sonographically intact rotator cuffs. Plasma levels of MMPs and TIMPs were measured simultaneously using Luminex technology and ELISA. Results The plasma levels of TIMP-1 were elevated in patients with rotator cuff tears, especially in those with full-thickness tears. The levels of TIMP-1, TIMP-3, and MMP-9 were higher in patients with full-thickness tears than in those with partial-thickness tears, but only the TIMP-1 levels were significantly different from those in the controls. Interpretation The observed elevation of TIMP-1 in plasma might reflect local pathological processes in or around the rotator cuff, or a genetic predisposition in these patients. That the levels of TIMP-1 and of certain MMPs were found to differ significantly between partial and full-thickness tears may reflect the extent of the lesion or different etiology and pathomechanisms.

2012-01-01

373

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

2010-06-01

374

[Prostate brachytherapy: current states and future prospects].  

PubMed

The paper presents the characteristics, the place and the limits of brachytherapy in prostate radiotherapy. While sparing the rectal wall, erectile function as well as urinary continence, I(125) and Pd(103) permanent implants represent interesting approaches for good prognosis tumours in comparison to surgery or conformal external beam radiotherapy with similar cure rates. Overcoming easily the problems of organ motion and patient positioning while allowing doses per fraction as high as 10 Gy, brachytherapy is an excellent boosting method in the treatment of intermediate or unfavourable prognosis tumours of which alpha/beta is 1,5 Gy. Encouraging biological control rates of 80-90% have been published in phase II trials. Compared to external beam radiotherapy, the heterogeneity of irradiation inside the clinical target volume should increase the probability of cure as for a specific dose, a significant part will be overdosed. So far, 120-130% of the prescribed doses are delivered to the peripheral zone at the origin of 70% of tumours. On the opposite, this heterogeneity is inducing an overdosage of the urethral bed at the price of higher toxicity levels in situations of previous obstructive syndrome and urethral stenosis. A better integration of the therapeutic modalities available, brachytherapy included, should increase our curative possibilities in the radiation treatment of prostatic cancer. PMID:12914859

Nickers, P; Deneufbourg, J M

2003-08-01

375

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. Methods:…

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

2011-01-01

376

The tension-free vaginal tape procedure.  

PubMed

This article discusses the tension-free vaginal tape (TVT) procedure, which attempts to recreate urethral support at the level of the pubourethral ligaments by placing a polypropylene sling at the midurethra as opposed to the bladder neck. The procedure has the proposed advantage of being done under local anesthesia and being an outpatient surgery and can be performed transvaginally or suprapubically. PMID:21353078

Kleeman, Steven D; Karram, Mickey M

2011-02-01

377

Characteristics of vaginal bleeding during pregnancy  

Microsoft Academic Search

Objective: To describe vaginal bleeding and associated pain in pregnancies terminated by childbirth. Design: A descriptive study based on information obtained by questionnaires administered during pregnancy. Setting: Antenatal care clinic at the Obstetrical Department, Aarhus University Hospital, Denmark. Subjects: Women (n = 8714) with singleton pregnancies attending routine antenatal care at the Department during a 2-year period from 1989 to

Susanne Maigaard Axelsen; Tine Brink Henriksen; Morten Hedegaard; Niels Jørgen Secher

1995-01-01

378

Vaginal Douching and Intimate Partner Violence  

Microsoft Academic Search

Findings. Six percent of the sample reported experiencing any type of IPV in the past year, and 23% reported douching in the past year. IPV is significantly associated with douching after controlling for sociodemographic and health-related covariates. This finding holds for women with and without current reproductive capacity. Conclusions. This is the first study to identify an association between vaginal

Carol S. Weisman; Diane M. Grimley; Lucy Annang; Marianne M. Hillemeier; Gary A. Chase; Anne-Marie Dyer

2007-01-01

379

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

2000-01-01

380

Monte Carlo iodine brachytherapy dosimetry: study for a clinical application  

Microsoft Academic Search

At present, all clinical algorithms used in brachytherapy are based on the TG-43 algorithm, which has the advantage to offer very fast calculation time. However, this formalism has many simplifications, assuming for example the patient tissue composition equivalent to water. For low energy brachytherapy seeds such as iodine seeds, it is of interest to evaluate the dosimetric differences between calculations

C. Furstoss; B. Reniers; E. Poon; M. D'Amours; J. F. Carrier; L. Beaulieu; J. F. Williamson; F. Verhaegen

2008-01-01

381

10 CFR 35.406 - Brachytherapy sources accountability.  

Code of Federal Regulations, 2010 CFR

(b) As soon as possible after removing sources from a patient or a human research subject, a licensee shall return brachytherapy sources to a secure storage area. (c) A licensee shall maintain a record of the brachytherapy source accountability in accordance with §...

2009-01-01

382

On the use of VIP gel dosimetry in HDR brachytherapy  

Microsoft Academic Search

An experimental procedure is discussed with regard to its potential in 192Ir HDR brachytherapy dosimetry. Two samples of VIP normoxic gel formulation are used; one for gel response calibration and the other for acquiring experimental data. Using the same irradiation method for both calibration and experimental purposes (an 192Ir HDR brachytherapy source) and treating the two samples identically (i.e. the

L. Petrokokkinos; A. Moutsatsos; P. Karaiskos; V. Kouridou; E. Pantelis; P. Papagiannis; I. Seimenis

2009-01-01

383

Bladder–Rectum Spacer Balloon in High-Dose-Rate Brachytherapy in Cervix Carcinoma  

SciTech Connect

Purpose: To compare bladder and rectum doses with the use of a bladder–rectum spacer balloon (BRSB) versus standard gauze packing in the same patient receiving 2 high-dose-rate intracavitary brachytherapy fractions. Methods and Materials: This was a randomized study to compare the reduction in bladder and rectum doses with the use of a BRSB compared with standard gauze packing in patients with carcinoma of the cervix being treated with high-dose-rate intracavitary brachytherapy. The patients were randomized between 2 arms. In arm A, vaginal packing was done with standard gauze packing in the first application, and BRSB was used in the second application. Arm B was the reverse of arm A. The International Commission for Radiation Units and Measurement (ICRU) point doses and doses to 0.1-cm{sup 3}, 1-cm{sup 3}, 2-cm{sup 3}, 5-cm{sup 3}, and 10-cm{sup 3} volumes of bladder and rectum were compared. The patients were also subjectively assessed for the ease of application and the time taken for application. Statistical analysis was done using the paired t test. Results: A total of 43 patients were enrolled; however, 3 patients had to be excluded because the BRSB could not be inserted owing to unfavorable local anatomy. Thus 40 patients (80 plans) were evaluated. The application was difficult in 3 patients with BRSB, and in 2 patients with BRSB the application time was prolonged. There was no significant difference in bladder doses to 0.1 cm{sup 3}, 1 cm{sup 3}, 2 cm{sup 3}, 5 cm{sup 3}, and 10 cm{sup 3} and ICRU bladder point. Statistically significant dose reductions to 0.1-cm{sup 3}, 1-cm{sup 3}, and 2-cm{sup 3} volumes for rectum were observed with the BRSB. No significant differences in 5-cm{sup 3} and 10-cm{sup 3} volumes and ICRU rectum point were observed. Conclusion: A statistically significant dose reduction was observed for small high-dose volumes in rectum with the BRSB. The doses to bladder were comparable for BRSB and gauze packing. Transparent balloons of variable sizes are recommended for patients with a less spacious vaginal cavity.

Rai, Bhavana [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India)] [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Patel, Firuza D., E-mail: firuzapatel@gmail.com [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Chakraborty, Santam; Sharma, Suresh C.; Kapoor, Rakesh [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India)] [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Aprem, Abi Santhosh [Corporate R and D Division, HLL Lifecare Limited, Karamana, Trivandrum (India)] [Corporate R and D Division, HLL Lifecare Limited, Karamana, Trivandrum (India)

2013-04-01

384

Detection of brachytherapy seeds using 3-D transrectal ultrasound.  

PubMed

Detection of brachytherapy seeds plays a key role in dosimetry for prostate brachytherapy. However, seed localization using B-mode transrectal ultrasound (TRUS) still remains a challenge for prostate brachytherapy, mainly due to the small size of brachytherapy seeds in the relatively low-quality B-mode TRUS images. In this paper, we propose a new solution for brachytherapy seed detection using 3-D ultrasound. A 3-D reflected power image is computed from ultrasound RF signals, instead of conventional B-mode images. Then, implanted seeds are segmented in 3-D local search spaces that are determined by a priori knowledge, e.g., needle entry points and seed placements. Needle insertion tracks are also detected locally by the Hough transform. Experimental results show that the proposed solution works well for seed localization in a prostate phantom implanted according to a realistic treatment plan with 136 seeds from 26 needles. PMID:20595088

Wen, Xu; Salcudean, Septimiu Tim E; Lawrence, Peter D

2010-10-01

385

[How to prepare the brachytherapy of the future].  

PubMed

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

2013-10-01

386

Vaginal Douching Among Latinas: Practices and Meaning  

PubMed Central

Objectives Vaginal douching is widely practiced by American women, particularly among minority groups, and is associated with increased risk of pelvic and vaginal infections. This research sought to investigate vaginal hygiene practices and meaning associated with them among Latina women and adolescents. Study results would guide development of an intervention to decrease douching among Latinas. Methods In depth qualitative interviews conducted with English- and Spanish-speaking women aged 16–40, seeking care for any reason who reported douching within the last year (n = 34). Interviews were audiotaped, transcribed and analyzed using qualitative methods. One-third of interviews were conducted in Spanish. Results Two explanatory models for douching motives emerged: one stressed cosmetic benefits; the other, infection prevention and control. Most women reported douching to eliminate menstrual residue; a small number reported douching in context of sexual intercourse or vaginal symptoms. Many were unaware of associated health risks. Respondents typically learned about douching from female family members and friends. Male partners were described as having little to no involvement in the decision to douche. Women varied in their willingness to stop douching. Two-thirds reported receiving harm reduction messages about “overdouching”. About half indicated previous discussion about douching with health care providers; some had reduced frequency in response to counseling. A number of previously unreported vaginal hygiene practices and products were described, including use of a range of traditional hygiene practices, and products imported from outside the US. Conclusions Respondents expressed a range of commitment to douching. Counseling messages acknowledging benefits women perceive as well as health risks should be developed and delivered tailored to individual beliefs. Further research is needed to assess prevalence and safety of previously unreported practices.

Baquero, Maria; Anderson, Matthew R.; Alvarez, Adelyn; Karasz, Alison

2009-01-01

387

Long-term outcome and structural integrity following open repair of massive rotator cuff tears  

PubMed Central

Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years. Level of evidence: Level IV

Bartl, Christoph; Kouloumentas, Pannos; Holzapfel, Konstantin; Eichhorn, Stefan; Wortler, Klaus; Imhoff, Andreas; Salzmann, Gian M

2012-01-01

388

Blood flow restriction: Effects of cuff type on fatigue and perceptual responses to resistance exercise.  

PubMed

Blood flow restriction (BFR) combined with low load resistance training has been shown to result in muscle hypertrophy similar to that observed with higher loads. However, not all studies have found BFR efficacious, possibly due to methodological differences. It is presently unclear whether there are differences between cuffs of similar size (5 cm) but different material (nylon vs. elastic). The purpose was to determine if there are differences in repetitions to fatigue and perceptual ratings of exertion (RPE) and discomfort between narrow elastic and narrow nylon cuffs. Sixteen males and females completed three sets of BFR knee extension exercise in a randomized cross-over design using either elastic or nylon restrictive cuffs applied at the proximal thigh. There were no differences in repetitions to fatigue (marker of blood flow) or perceptual ratings between narrow elastic and narrow nylon cuffs. This data suggests that either elastic or nylon cuffs of the same width should cause similar degrees of BFR at the same pressure during resistance exercise. PMID:24901077

Loenneke, Jeremy Paul; Thiebaud, R S; Fahs, C A; Rossow, L M; Abe, T; Bemben, M G

2014-06-01

389

Surgical referral criteria for degenerative rotator cuff tears: a delphi questionnaire study.  

PubMed

Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23949892

Griffiths, Stephanie; Yohannes, A M

2014-06-01

390

Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes.  

PubMed

A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn rotator cuff undersurface is held in a reduced position with a grasper through an anterolateral rotator interval portal while viewing intra-articularly. Two spinal needles are then placed percutaneously through the full thickness of the torn and intact rotator cuff. A polydioxanone suture is passed through each needle, retrieved out the anterior portal, and used to shuttle a single nonabsorbable No. 2 suture through the tissue, creating a mattress suture. Multiple mattress sutures can be placed as dictated by tear size and morphology, with suture retrieval and knot securing then proceeding in the subacromial space. We have adopted this approach with the goals of anatomically re-establishing the rotator cuff insertion and sealing the area of intratendinous delamination while preventing significant alteration to the anatomy of the rotator cuff insertion, which could lead to motion deficits, internal impingement, and potential tear recurrence. PMID:18657747

Brockmeier, Stephen F; Dodson, Christopher C; Gamradt, Seth C; Coleman, Struan H; Altchek, David W

2008-08-01

391

Glenoid Cartilage Mechanical Properties Decrease after Rotator Cuff Tears in a Rat Model  

PubMed Central

Summary Rotator cuff repairs are commonly performed to reduce pain and restore function. Tears are also treated successfully without surgical intervention; however, the effect that a torn tendon has on the glenohumeral cartilage remains unknown. Clinically, a correlation between massive rotator cuff tears and glenohumeral arthritis has often been observed. This may be due to a disruption in the balance of forces at the shoulder, resulting in migration of the humeral head and subsequently, abnormal loading of the glenoid. Our lab previously demonstrated changes in ambulation and intact tendon mechanical properties following supraspinatus and infraspinatus rotator cuff tendon tears in a rat model. Therefore, the purpose of this study was to investigate the effects of supraspinatus and infraspinatus rotator cuff tears on the glenoid cartilage. Nine rats underwent unilateral detachment of the supraspinatus and infraspinatus tendons and were sacrificed after four weeks. Cartilage thickness significantly decreased in the antero-inferior region of injured shoulders. In addition, equilibrium elastic modulus significantly decreased in the center, antero-superior, antero-inferior, and superior regions. These results suggest that altered loading after rotator cuff injury may lead to damage to the joint with significant pain and dysfunction. Clinically, understanding the mechanical processes involved with joint damage will allow physicians to better advise patients.

Reuther, Katherine E.; Sarver, Joseph J.; Schultz, Susan M.; Lee, Chang Soo; Sehgal, Chandra M.; Glaser, David L.; Soslowsky, Louis J.

2012-01-01

392

Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears  

PubMed Central

Background Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair. Purposes To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera. Results During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05). Conclusion RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides.

2011-01-01

393

Possibilities offered by implantable miniaturized cuff-electrodes for insect neurophysiology  

PubMed Central

Recent advances in microsystems technology led to a miniaturization of cuff-electrodes, which suggests these electrodes not just for long-term neuronal recordings in mammalians, but also in medium-sized insects. In this study we investigated the possibilities offered by cuff-electrodes for neuroethology using insects as a model organism. The implantation in the neck of a tropical bushcricket resulted in high quality extracellular nerve recordings of different units responding to various acoustic, vibratory, optical and mechanical stimuli. In addition, multi-unit nerve activity related to leg movements was recorded in insects walking on a trackball. A drawback of bi-polar nerve recordings obtained during tethered flight was overlay of nerve activity with large amplitude muscle potentials. Interestingly, cuff-electrode recordings were robust to withstand walking and flight activity so that good quality nerve recordings were possible even three days after electrode implantation. Recording multi-unit nerve activity in intact insects required an elaborate spike sorting algorithm in order to discriminate neuronal units responding to external stimuli from background activity. In future, a combination of miniaturized cuff-electrodes and light-weight amplifiers equipped with a wireless transmitter will allow the investigation of neuronal processes underlying natural behavior in freely moving insects. By this means cuff-electrodes may contribute to the development of realistic neuronal models simulating neuronal processes underlying natural insect behavior, such like mate choice and predator avoidance.

Hartbauer, Manfred; Kruger, Thilo B.; Stieglitz, Thomas

2012-01-01

394

Latissimus dorsi tendon transfer: A comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears  

Microsoft Academic Search

On the basis of a modified Constant scoring system, we compared outcomes for 16 patients who underwent latissimus dorsi transfer as a salvage reconstruction for a failed prior rotator cuff repair with outcomes for 6 patients who underwent a primary reconstruction for an irreparable cuff defect. There was a statistically significant difference in Constant score between groups, which measured 55%

Jon J. P. Warner; I. M. Parsons

2001-01-01

395

Time-Related Cuff Pressures of the Laryngeal Tube With and Without the Use of Nitrous Oxide  

Microsoft Academic Search

The Laryngeal tube (VBM Medizintechnik, Sulz, Ger- many), a new supraglottic airway, consists of an airway tube, two cuffs, and two distal apertures between the two cuffs. One concern with the use of this device is ischemic change to the oropharyngeal mucosa. We studied the time-course change of the intracuff pressure (which reflects the pharyngeal pressure) of the laryn- geal

Takashi Asai; Koh Shingu

2004-01-01

396

Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging  

Microsoft Academic Search

Forty-one patients scheduled for shoulder surgery underwent computed tomography (CT) and magnetic resonance imaging (MRI) examination of their affected shoulder to verify whether fatty degeneration of the rotator cuff muscles could reproducibly be assessed by CT or by MRI and whether the grading with the 2 methods was comparable. In addition, rotator cuff muscle cross-sectional areas were measured on parasagittal

Bruno Fuchs; Dominik Weishaupt; Marco Zanetti; Juerg Hodler; Christian Gerber

1999-01-01

397

Triapine, Cisplatin, and Radiation Therapy in Treating Patients With Cervical Cancer or Vaginal Cancer  

ClinicalTrials.gov

Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer; Therapy-related Toxicity

2014-04-21

398

Development of generic models for ambulatory vaginal surgery — a preliminary report  

Microsoft Academic Search

Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from

P. E. Papa Petros

1998-01-01

399

[The postsurgical rotator cuff: surgical techniques, clinical outcome, and MRI evaluation].  

PubMed

Surgical treatment of rotator cuff tears significantly reduces painful symptoms and improves functional capacity in many patients. However, despite recent advances, up to 25% of patients remain symptomatic after surgery. This has led to research into the reasons for these poor outcomes, including how to identify them with imaging methods and how to avoid them through new therapeutic approaches. Based on our clinical experience, we review the available treatment alternatives for rotator cuff tears, analyzing the main areas of controversy and the possible causes of unsatisfactory outcome after surgery. Furthermore, we review the expectations, difficulties, and requirements of diagnostic imaging in the follow-up of surgically treated rotator cuffs, with special emphasis on the MRI findings and their clinical impact. PMID:18275784

Mellado, J M; Calmet, J

2008-01-01

400

Fabrication and performance analysis of a DEA cuff designed for dry-suit applications  

NASA Astrophysics Data System (ADS)

A method for manufacturing a cylindrical dielectric elastomer actuator (DEA) is presented. The cylindrical DEA can be used in fabricating the cuff area of dry-suits where the garment is very tight and wearing the suit is difficult. When electrically actuated, the DEA expands radially and the suit can be worn more comfortably. In order to study the performance of the DEA, a customized testing setup was designed, and silicone-made cuff samples with different material stiffnesses were tested. Analytical and FEM modeling were considered to evaluate the experimental output. The results revealed that although the stiffness of the DEA material has a direct relationship with the radial constrictive pressure caused by mechanically stretching the DEA, it has a minor effect on the actuation pressure. It was also found that stacking multiple layers of the DEA to fabricate a laminated structure enabled the attainment of a desired variation of pressure required for the implementation of an electrically tunable cuff.

Ahmadi, S.; Camacho Mattos, A.; Barbazza, A.; Soleimani, M.; Boscariol, P.; Menon, C.

2013-03-01

401

Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?  

PubMed Central

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.

Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

2014-01-01

402

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study  

PubMed Central

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.

Bhatia, M; Singh, B; Nicolaou, N; Ravikumar, KJ

2009-01-01

403

Ultra-low-dose vaginal estrogen tablets for the treatment of postmenopausal vaginal atrophy.  

PubMed

Vaginal atrophy is a common chronic condition affecting up to 57% of postmenopausal women. The decrease in estrogen following cessation of menses can lead to bothersome symptoms that include vaginal dryness and irritation, pain and burning during urination (dysuria), urinary tract infections, and pain (dyspareunia) and bleeding during sexual activities. These symptoms can be safely and effectively managed with the use of local estrogen therapy, which reduces the risks associated with long-term systemic hormone therapy. The ultra-low-dose 10 ?g estradiol vaginal tablet is the lowest approved dose available and has an annual estradiol exposure of only 1.14 mg. Its development addresses recommendations from regulatory agencies and women's health societies regarding the use of the lowest hormonal dose. The 10 ?g vaginal tablet displays minimal estradiol absorption, causes no increased risk of endometrial hyperplasia or carcinoma, and provides significant symptom relief. The clinical evidence presented here may offer greater reassurance to health-care professionals and postmenopausal women that vaginal atrophy can be treated safely and effectively. PMID:23848490

Simon, J A; Maamari, R V

2013-08-01

404

Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice  

PubMed Central

It is widely accepted that alterations in vascular shear stress trigger the expression of inflammatory genes in endothelial cells and thereby induce atherosclerosis (reviewed in 1 and 2). The role of shear stress has been extensively studied in vitro investigating the influence of flow dynamics on cultured endothelial cells 1,3,4 and in vivo in larger animals and humans 1,5,6,7,8. However, highly reproducible small animal models allowing systematic investigation of the influence of shear stress on plaque development are rare. Recently, Nam et al. 9 introduced a mouse model in which the ligation of branches of the carotid artery creates a region of low and oscillatory flow. Although this model causes endothelial dysfunction and rapid formation of atherosclerotic lesions in hyperlipidemic mice, it cannot be excluded that the observed inflammatory response is, at least in part, a consequence of endothelial and/or vessel damage due to ligation. In order to avoid such limitations, a shear stress modifying cuff has been developed based upon calculated fluid dynamics, whose cone shaped inner lumen was selected to create defined regions of low, high and oscillatory shear stress within the common carotid artery 10. By applying this model in Apolipoprotein E (ApoE) knockout mice fed a high cholesterol western type diet, vascular lesions develop upstream and downstream from the cuff. Their phenotype is correlated with the regional flow dynamics 11 as confirmed by in vivo Magnetic Resonance Imaging (MRI) 12: Low and laminar shear stress upstream of the cuff causes the formation of extensive plaques of a more vulnerable phenotype, whereas oscillatory shear stress downstream of the cuff induces stable atherosclerotic lesions 11. In those regions of high shear stress and high laminar flow within the cuff, typically no atherosclerotic plaques are observed. In conclusion, the shear stress-modifying cuff procedure is a reliable surgical approach to produce phenotypically different atherosclerotic lesions in ApoE-deficient mice.

Kuhlmann, Michael T.; Cuhlmann, Simon; Hoppe, Irmgard; Krams, Rob; Evans, Paul C.; Strijkers, Gustav J.; Nicolay, Klaas; Hermann, Sven; Schafers, Michael

2012-01-01

405

Operatively treated traumatic versus non-traumatic rotator cuff ruptures: A registry study  

PubMed Central

Backround Operative treatment of traumatic rotator cuff ruptures, i.e. ruptures with a predisposing traumatic event, is reported to yield superior results compared to operative treatment of non-traumatic, degenerative ruptures. Aim The purpose of this study was to evaluate the difference of outcome, peroperative findings, and demographics after operative treatment of traumatic versus non-traumatic rotator cuff rupture. Methods A total of 306 consecutive shoulders with an operated rotator cuff rupture (124 traumatic and 182 non-traumatic) were followed up. Constant and Murley score, size of the rupture, and age of the patients were used as an outcome measure. Results A total of 112 traumatic and 167 non-traumatic rotator cuff rupture shoulders were available for 1-year follow-up (91%). Mean Constant and Murley score was preoperatively lower in the traumatic group (46 versus 52, P = 0.01). At 3 months postoperatively, Constant and Murley scores were 61 and 60 (P = 0.72) and at 1 year 73 and 77 (P = 0.03), respectively. Altogether 91% of the patients in the traumatic and 93% in the non-traumatic group were satisfied with the final outcome (P = 0.45). In 94% of traumatic and 95% of a non-traumatic cases the rupture involved the supraspinatus tendon. In the traumatic group the rupture was larger and involved more frequently the whole supraspinatus insertion area (41% versus 17%, P < 0.0001). Mean age of patients was 58 and 57 years, respectively. Conclusion Operative treatment of both traumatic and non-traumatic rotator cuff ruptures gives essentially good results. In our cohort, patients' recollection of predisposing trauma reflects the size of the rotator cuff rupture, but does not reflect the age of the patients.

Joukainen, Antti; Itala, Ari; Aarimaa, Ville

2013-01-01

406

Arterial pressure: agreement between a brachial cuff-based device and radial tonometry  

PubMed Central

Objectives: Aortic (central) blood pressure (BP) differs from brachial BP and may be a superior predictor of cardiovascular events. However, its measurement is currently restricted to research settings, owing to a moderate level of operator dependency. We tested a new noninvasive device in a large UK cohort. The device estimates central BP using measurements obtained with an upper arm cuff inflated to suprasystolic pressure. We compared these estimates with those obtained using radial tonometry as well as with invasively acquired measurements of aortic BP in a limited number of individuals. Methods: Consecutive cuff-based and tonometry-based estimates of the pressure waveform and the central BP were obtained from 1107 individuals (70?±?6 years). Short-term and long-term reproducibility studies were performed on 28 individuals. Simultaneous cuff-based and invasively measured pressure traces were acquired and compared in an additional six individuals (65?±?20 years). Results: Central systolic BP, as estimated by the cuff-based device, was found to be highly reproducible (coefficient of variation 4 and 8% for short and long-term reproducibility, respectively) and was comparable to that estimated by tonometry (average difference 3?±?6?mmHg, intraclass correlation coefficient?=?0.91). The cuff-based pressure waveforms were similar to those acquired invasively (cross-correlation coefficient 0.93), and the difference in the estimated central systolic BP was ?5?±?8?mmHg (P?=?0.2). Conclusion: Cuff-based devices show promise to simplify the measurement of central BP, whilst maintaining a similar fidelity to tonometry. This could lead to improved adoption of estimates of central BP in clinical practice.

Park, Chloe M.; Korolkova, Olga; Davies, Justin E.; Parker, Kim H.; Siggers, Jennifer H.; March, Katherine; Tillin, Therese; Chaturvedi, Nish; Hughes, Alun D.

2014-01-01

407

Treatment planning methodology for the Miami Multichannel Applicator following the American Brachytherapy Society recently published guidelines: the Lahey Clinic experience.  

PubMed

The objective of this study was to develop a standardized procedure from simulation to treatment delivery for the multichannel Miami applicator, in order to increase planning consistency and reduce errors. A plan is generated prior to the 1st treatment using the CT images acquired with the applicator in place, and used for all 3 fractions. To confirm the application placement before each treatment fraction, an AP image is acquired and compared with the AP baseline image taken at simulation. A preplanning table is generated using the EBRT doses and is used to compute the maximum allowable D2cc for bladder, rectum, and sigmoid, and the mean allowable dose for the upper vaginal wall per HDR brachytherapy fraction. These data are used to establish the criteria for treatment planning dose optimization. A step-by-step treatment planning approach was developed to ensure appropriate coverage for the tumor (D90 > 100% prescribed dose of 700 cGy/fraction) and the uninvolved vaginal surface (dose for the entire treatment length > 600 cGy/fraction), while keeping the organs at risk below the tolerance doses. The equivalent dose 2 Gy (EQD2) tolerances for the critical structures are based on the American Brachytherapy Society (ABS) recently published guidelines. An independent second check is performed before the 1st treatment using an in-house Excel spreadsheet. This methodology was successfully applied for our first few cases. For these patients: the cumulative tumor dose was 74-79 EQD2 Gy10 (ABS recommended range 70-85); tumor D90 was >100% of prescribed dose (range 101%-105%); cumulative D2cc for bladder, rectum, and sigmoid were lower than the tolerances of 90, 75, and 75 EQD2 Gy3, respectively; cumulative upper vaginal wall mean dose was below the tolerance of 120 EQD2 Gy3; the second check agreement was within 5%. By using a standardized procedure the planning consistency was increased and all dosimetric criteria were met. PMID:23318396

Iftimia, Ileana; Cirino, Eileen T; Mower, Herbert W; McKee, Andrea B

2013-01-01

408

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

1999-01-01

409

Murine models of vaginal trichomonad infections.  

PubMed

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 10(6), 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. PMID:21976570

Cobo, Eduardo R; Eckmann, Lars; Corbeil, Lynette B

2011-10-01

410

Vaginal Bleeding and Gestational Trophoblastic Disease  

Microsoft Academic Search

\\u000a Molar pregnancy and gestational trophoblastic neoplasia (GTN) comprise a group of interrelated diseases, including complete\\u000a and partial molar pregnancy, placental-site trophoblastic tumor (PSTT), and choriocarcinoma, that have varying propensities\\u000a for local invasion and distal spread. Vaginal bleeding is a common presenting sign, seen in as many as 97% of women with a\\u000a complete molar pregnancy; it is also a frequent

Lisa M. Barroilhet; Donald Peter Goldstein; Ross S. Berkowitz

411

The effect of multiple channeling on the structural integrity of repaired rotator cuff  

Microsoft Academic Search

Purpose  The purpose of this study was to investigate the effect of adding multiple channeling of the greater tuberosity on the structural\\u000a integrity of the repaired rotator cuff tendon.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Fifty-six consecutive patients who underwent arthroscopic rotator cuff repair and postoperative computed tomography arthrography\\u000a (CTA) were included in this study; 31 consecutive patients that underwent conventional repair and 25 subsequent patients that

Chris Hyunchul Jo; Kang Sup Yoon; Ji Ho Lee; Seung Baik Kang; Jae Hyup Lee; Hyuk Soo Han; Seung Hwan Rhee; Ji Sun Shin

412

Arthroscopic treatment of ruptures of the rotator cuff.  

PubMed

566 patients with shoulder disease were treated at the Clinic of Orthopaedics at the University Hospital Olomouc. Of these, 181 were operated for ruptures of the rotator cuff (RC). They were categorised according to the Gschwend classification, age and gender(1). Laterality of the operated limb was also evaluated. Patients with ruptures larger than 4 cm were treated by open operation. 84 shoulders with ruptures classified as Gschwend I, II and IIIa -52 males and 32 females-were treated arthroscopically. The age of the operated patients ranged from 40-60 years. In both genders, the right shoulder was more often affected. Two operating techniques were used: 1) Transosseal refixation of the RC muscle tendons, using RC MITEK anchor implants, 2) "End to end" sutures, without implants(2-4). Operating time was reduced to 30-40 min. The operating results were evaluated according to the UCLA criteria- University of California Shoulder Rating Score(2). 45 patients achieved excellent results (53 %), 35 patients had good results (42 %), and 4 patients (5 %) obtained satisfactory results. None of the patients obtained poor results- a score of less than 20 was poor. Patients felt comfortable following the operation and none had any post-operational complications. The author is convinced, along with others, that arthroscopic suturing of RC ruptures classified I-IIIa allows for rupture treatment that in the past had to be treated by open technique(2-5). The deltoid muscle is not affected by arthroscopy. There is normalisation of the patient's movement, pain, force, and rotational stability is comparable to the healthy limb. Treatment time is reduced to a minimum and the patient may soon return to normal daily life. PMID:16601771

Holibka, Radomír; Kalina, Radim; Pach, Miroslav; R?zicková, Katherine

2005-12-01

413

Vaginitis: Making Sense of Over-the-Counter Treatment Options  

PubMed Central

Background. The FDA approved over-the-counter (OTC) use of vaginal antifungals in 1990. Subsequently, a plethora of OTC products have become available to women on drugstore shelves. Objectives. The purpose of this study was to determine the availability of OTC products marketed for the treatment of vaginitis and to determine if their efficacy had been confirmed by published prospective randomized control trials (RCTs). Materials and methods. The authors chose four retail locations frequented by women seeking vaginitis treatment. All products deemed a viable treatment option were purchased. Results. All intravaginal imidazoles purchased, regardless of treatment duration or active ingredient, were found to be of proven efficacy. We were unable to find an RCT confirming the effectiveness of vaginal anti-itch creams and homeopathic treatments for vaginitis. Conclusion. 45% of products available to women in the feminine hygiene section of the stores surveyed could not be confirmed to be effective for treating infectious vaginitis.

B. Angotti, Lauren; C. Lambert, Lara; E. Soper, David

2007-01-01

414

Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli  

PubMed Central

Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards) procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC) with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 ?g/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 ?g/mL vancomycin and all of them were resistant to 1000 ?g/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora.

Ocana, Virginia; Silva, Clara; Nader-Macias, Maria Elena

2006-01-01

415

Herbal vaginal pessary induced acute renal failure  

PubMed Central

In Africa, the use of traditional herbal remedy is widespread. Acute renal failure (ARF) is one of the most serious complications. The use of herbal remedies (mostly orally) accounts for nearly 35% of all cases of acute renal failure in Africa. Development of renal failure following herbal vaginal pessary is rarely reported. In November 2003, a 35-year-old Nigerian female who is a petty trader and a primary school leaver with three children (all males) presented to us in the renal unit with oliguric ARF induced by herbal vaginal pessary. She had sought this alternative medicine in an attempt to have a female child as all her three children are males. Her condition was managed accordingly and required three sessions of hemodialysis. She started diuresing on the eighth day of admission. This case presentation highlights the potential tragedies of herbal preparation, of note, that herbal vaginal pessaries are as deleterious as the oral preparations, and that the dilemma of ignorance is still prevalent in our society.

Onyemekeihia, U. R.; Esume, C. O.; Oladele, C. O.; Oviasu, E.

2009-01-01

416

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.

2013-01-01

417

Anti-STD vaginal contraceptive sponges.  

PubMed

Vaginal sponges offer women control over protection against both pregnancy and sexually transmitted diseases (STDs), including HIV. Spermicide-impregnated sponges combine the actions of a physical barrier that blocks the cervix with a material that absorbs the ejaculate and a spermicide. Commercially available spermicides contain 1-5% of nonoxynol-9, shown to inhibit organisms responsible for gonorrhea, chlamydia, candidiasis, genital herpes, syphilis, trichomoniasis, and HIV. On the other hand, nonoxynol-9 is associated with a significantly higher risk of vaginal colonization with bacterial agents, ulcerative genital diseases, and vulvitis. A lower dose of nonoxynol-9 appears to avert vaginal irritation without compromising contraceptive efficacy. Use of chlorhexidene, a spermicide less irritating to mucosal cells than nonoxynol-9 but active against HIV in vivo and in vitro, is under investigation. Also promising are initial findings regarding the Protectaid contraceptive sponge with F-5 gel. Epidemiologic studies and clinical trials should provide quantitative estimates of the level of protection offered by barrier methods and identify the method that combines the highest protection, ease of use, and user acceptability. PMID:9238301

Hassan, E; Creatsas, G; Gravanis, A; Georgoulias, V; Psychoyos, A

1997-06-17

418

Herbal vaginal pessary induced acute renal failure.  

PubMed

In Africa, the use of traditional herbal remedy is widespread. Acute renal failure (ARF) is one of the most serious complications. The use of herbal remedies (mostly orally) accounts for nearly 35% of all cases of acute renal failure in Africa. Development of renal failure following herbal vaginal pessary is rarely reported. In November 2003, a 35-year-old Nigerian female who is a petty trader and a primary school leaver with three children (all males) presented to us in the renal unit with oliguric ARF induced by herbal vaginal pessary. She had sought this alternative medicine in an attempt to have a female child as all her three children are males. Her condition was managed accordingly and required three sessions of hemodialysis. She started diuresing on the eighth day of admission. This case presentation highlights the potential tragedies of herbal preparation, of note, that herbal vaginal pessaries are as deleterious as the oral preparations, and that the dilemma of ignorance is still prevalent in our society. PMID:20535252

Onyemekeihia, U R; Esume, C O; Oladele, C O; Oviasu, E

2009-10-01

419

Vaginal agenesis: Experience with sigmoid colon neovaginoplasty  

PubMed Central

Aim: Objective of this study is to report our experience with sigmoid vaginoplasty in adolescents. Materials and Methods: A retrospective study of children with vaginal atresia and Mayer–Rokitansky–Kuster–Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the cases. Results: Eight children were studied over a period of 7 years. The postoperative complications were ileus in 2, mucosal prolapse of the neovagina in 1, and minor wound infection in 1 patient. Seven patients are on regular follow-up. All the neovaginas were patent and functional. One patient had unacceptable perineal appearance, that is, badly scarred perineum as a late complication. None of the patients had vaginal stenosis or excessive mucus discharge, during follow-up visits. Out of the 7 patients, 2 patients are sexually active and satisfied. Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, and short recovery time.

Rawat, Jiledar; Ahmed, Intezar; Pandey, Anand; Khan, Tanvir R.; Singh, Sarita; Wakhlu, Ashish; Kureel, Shiv N.

2010-01-01

420

Brachytherapy in the treatment of cervical cancer: a review  

PubMed Central

Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Consequently, advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This review provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer.

Banerjee, Robyn; Kamrava, Mitchell

2014-01-01

421

Differential tissue-specific protein markers of vaginal carcinoma  

Microsoft Academic Search

The objective was to identify proteins differentially expressed in vaginal cancer to elucidate relevant cancer-related proteins. A total of 16 fresh-frozen tissue biopsies, consisting of 5 biopsies from normal vaginal epithelium, 6 from primary vaginal carcinomas and 5 from primary cervical carcinomas, were analysed using two-dimensional gel electrophoresis (2-DE) and MALDI-TOF mass spectrometry. Of the 43 proteins identified with significant

K Hellman; A A Alaiya; S Becker; M Lomnytska; K Schedvins; W Steinberg; A-C Hellström; S Andersson; U Hellman; G Auer

2009-01-01

422

Vaginal adhesions in a woman with the history of dystocia.  

PubMed

Postpartum genital tract adhesions are unusual, and their cause has not been evaluated. However, severe dystocia and numerous pelvic examinations have been suggested as possible causes. Here, we report a case of vaginal adhesions following a difficult labor that presented as dyspareunia for 5 months. Pelvic examination and ultrasonography revealed a transverse vaginal septum that obstructed the vaginal cavity, and fluid collection proximal to this septum. The patient was successfully treated with surgical resection and administration of antibiotics. PMID:24596821

Kim, Hyun Mi; Bae, Jin Young; Cho, Yoo Jin; Kim, Mi Ju; Cha, Hyun-Hwa; Cha, Hyun Wha; Seong, Won Joon

2014-01-01

423

Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer.  

PubMed

Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brach