Sample records for vaginal cuff brachytherapy

  1. Assessment of air pockets in high-dose-rate vaginal cuff brachytherapy using cylindrical applicators

    PubMed Central

    Hassouna, Ashraf; Constantinescu, Camelia

    2014-01-01

    Purpose To retrospectively assess the incidence and magnitude of air pockets around vaginal cylinders and its impact on dose distribution in vaginal cuff image-guided high-dose-rate (HDR) brachytherapy. Material and methods Fifty endometrial carcinoma patients treated by postoperative HDR vaginal cuff brachytherapy were included in the study. The average age of patients was 58.3 ± 11.8 years (range: 31-87 years). Brachytherapy was performed using cylindrical applicators, and the dose prescribed to 0.5 cm from the applicator's surface, over a length of 5 cm from the applicator's tip. Computed tomography (CT) simulation was used for each brachytherapy fraction. The incidence, vaginal mucosa displacement, volume, and dosimetric effect of air pockets around the vaginal cylinder were evaluated. Results A total of 78 air pockets were found in 29/50 patients (58%) and 45/135 (33%) brachytherapy plans. They were located at the apex: 16/78 (20%) and lateral to the applicator: 62/78 (80%). The volume of air pockets ranged between 0.01 and 2.1 cm3 (mean: 0.15 cm3 ± 0.36 cm3), and the maximum displacement of vaginal mucosa from cylinder surface was between 0.1 and 1.09 cm (mean: 0.34 cm ± 0.2 cm). The dose reduction to the vaginal mucosa generated by the air pockets ranged from 0.5 to 66% (mean: 26.4% ± 13.9%). Conclusions The presence of air pockets around vaginal cylinder applicators is frequently noticed in post-operative vaginal cuff brachytherapy. The dose to the vaginal mucosa is reduced, as a result of displacement generated by air pockets. The effect on the clinical outcome of this dose reduction is yet to be determined. PMID:25337128

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

    SciTech Connect

    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

    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.

  3. Vaginal Treatment of Vaginal Cuff Dehiscence with Visceral Loop Prolapse: A New Challenge in Reparative Vaginal Surgery?

    PubMed Central

    Di Naro, Edoardo; Schonauer, Luca Maria; Loverro, Maria Teresa; Indellicati, Beatrice; Barnaba, Mario; Loverro, Giuseppe

    2014-01-01

    Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication. PMID:25525534

  4. Rate of Vaginal Cuff Separation Following Laparoscopic or Robotic Hysterectomy

    PubMed Central

    Nick, Alpa M.; Lange, Jimena; Frumovitz, Michael; Soliman, Pamela T.; Schmeler, Kathleen M.; Schlumbrecht, Matthew P.; dos Reis, Ricardo; Ramirez, Pedro T.

    2015-01-01

    Objective Vaginal cuff separation is a rare but serious complication following hysterectomy. The goal of our study was to determine the rate of vaginal cuff separation and associated risk factors in patients undergoing laparoscopic or robotic hysterectomy. Methods We retrospectively identified patients who underwent a minimally invasive simple or radical hysterectomy at one institution between January 2000 and 2009. Fisher's exact test, Wilcoxon rank sum test and multiple logistic regression was used to determine associations between variables and increased risk of separation. Results A total of 417 patients underwent laparoscopic (n=285) or robotic (n=132) hysterectomy during the study period. Three hundred and sixty-two underwent simple hysterectomy (249 laparoscopic, 113 robotic) and 57 underwent radical hysterectomy (36 laparoscopic, 19 robotic). Seven (1.7%) patients developed a cuff complication and all had a diagnosis of malignancy. Three (1.1%) patients in the laparoscopy group suffered a vaginal cuff evisceration (n=2) or separation (n=1). Four patients in the robotic group (3.0%) had a vaginal evisceration (n=1) or separation (n=3). There was no difference based on surgical approach (p=0.22). Vaginal cuff complications were 9.46-fold higher among patients who had a radical hysterectomy (p<0.01). Median time to presentation of vaginal cuff complication was 128 days (58–175) in the laparoscopy group and 37 days (range: 32–44) in the robotic group. Conclusions The overall risk of vaginal cuff complication was 1.7%. There appears to be no difference in cuff complication rates based on surgical approach. Radical hysterectomy, however, was associated with a 9-fold increase in vaginal cuff complications. PMID:20869763

  5. 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

    PubMed Central

    Patel, Mehul K.; Cote, Michele L.; Ali-Fehmi, Rouba; Buekers, Thomas; Munkarah, Adnan R.; Elshaikh, Mohamed A.

    2013-01-01

    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. PMID:22014953

  6. 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

    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

    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.

  7. Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy

    PubMed Central

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

    2014-01-01

    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. PMID:24680149

  8. Vaginal Cuff Dehiscence: Risk Factors and Associated Morbidities

    PubMed Central

    Fuchs Weizman, Noga; Einarsson, Jon I.; Wang, Karen C.; Vitonis, Allison F.

    2015-01-01

    Background and Objectives: To evaluate whether the route and surgical technique by which hysterectomy is performed influence the incidence of vaginal cuff dehiscence. Methods: We performed a retrospective analysis of total hysterectomy cases performed at Brigham and Woman's Hospital or Faulkner Hospital during 2009 through 2011. Results: During the study period, 2382 total hysterectomies were performed; 23 of these (0.96%) were diagnosed with cuff dehiscence, and 4 women had recurrent dehiscence. Both laparoscopic (odds ratio, 23.4; P = .007) and robotic (odds ratio, 73; P = .0006) hysterectomies were associated with increased odds of cuff dehiscence in a multivariate regression analysis. The type of energy used during colpotomy, mode of closure (hand sewn, laparoscopic suturing, or suturing assisted by a device), and suture material did not differ significantly between groups; however, continuous suturing of the cuff was a protective factor (odds ratio, 0.24; P = .03). Women with dehiscence had more extensive procedures, as well as an increased incidence of additional major postoperative complications (17.4% vs 3%, P = .004). Conclusion: The rate of cuff dehiscence in our cohort correlates with the current literature. This study suggests that the risk of dehiscence is influenced mainly by the scope and complexity of the surgical procedure. It seems that different colpotomy techniques do not influence the rate of cuff dehiscence; however, continuous suturing of the cuff may be superior to interrupted suturing.

  9. Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning

    PubMed Central

    Constantinescu, Camelia; Hassouna, Ashraf H.; Eltaher, Maha M.; Ghassal, Noor M.; Awad, Nesreen A.

    2014-01-01

    Purpose To retrospectively compare the potential dosimetric advantages of a multichannel vaginal applicator vs. a single channel one in intracavitary vaginal high-dose-rate (HDR) brachytherapy after hysterectomy, and evaluate the dosimetric advantage of fractional re-planning. Material and methods We randomly selected 12 patients with endometrial carcinoma, who received adjuvant vaginal cuff HDR brachytherapy using a multichannel applicator. For each brachytherapy fraction, two inverse treatment plans (for central channel and multichannel loadings) were performed and compared. The advantage of fractional re-planning was also investigated. Results Dose-volume-histogram (DVH) analysis showed limited, but statistically significant difference (p = 0.007) regarding clinical-target-volume dose coverage between single and multichannel approaches. For the organs-at-risk rectum and bladder, the use of multichannel applicator demonstrated a noticeable dose reduction, when compared to single channel, but statistically significant for rectum only (p = 0.0001). For D2cc of rectum, an average fractional dose of 6.1 ± 0.7 Gy resulted for single channel vs. 5.1 ± 0.6 Gy for multichannel. For D2cc of bladder, an average fractional dose of 5 ± 0.9 Gy occurred for single channel vs. 4.9 ± 0.8 Gy for multichannel. The dosimetric benefit of fractional re-planning was demonstrated: DVH analysis showed large, but not statistically significant differences between first fraction plan and fractional re-planning, due to large inter-fraction variations for rectum and bladder positioning and filling. Conclusions Vaginal HDR brachytherapy using a multichannel vaginal applicator and inverse planning provides dosimetric advantages over single channel cylinder, by reducing the dose to organs at risk without compromising the target volume coverage, but at the expense of an increased vaginal mucosa dose. Due to large inter-fraction dose variations, we recommend individual fraction treatment plan optimization.

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

    Microsoft Academic Search

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

    2000-01-01

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

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

    SciTech Connect

    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

    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.

  12. MCNP modelling of vaginal and uterine applicators used in intracavitary brachytherapy and comparison with radiochromic film measurements

    Microsoft Academic Search

    E. Ceccolini; I. Gerardy; J. Ródenas; M. van Dycke; S. Gallardo; D. Mostacci

    2009-01-01

    Brachytherapy is an advanced cancer treatment that is minimally invasive, minimising radiation exposure to the surrounding healthy tissues. Microselectron© Nucletron devices with 192Ir source can be used for gynaecological brachytherapy, in patients with vaginal or uterine cancer. Measurements of isodose curves have been performed in a PMMA phantom and compared with Monte Carlo calculations and TPS (Plato software of Nucletron

  13. High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma

    PubMed Central

    Higgins, Susan A.; Ratner, Elena; De Leon, Maria C.; Mani, Sheida; Silasi, Dan-Arin; Azodi, Masoud; Santin, Alessandro; Rutherford, Thomas; Schwartz, Peter E.

    2015-01-01

    Purpose To evaluate our institutional experience combining carboplatin-paclitaxel (C/T) chemotherapy with high-dose-rate (HDR) intra-vaginal brachytherapy (IVB) following comprehensive surgical staging in localized uterine serous carcinoma (USC). Material and methods Institutional chart review identified 56 patients with FIGO 2009 stage I-II USC treated between 2000-2010. Patients underwent total hysterectomy, bilateral salpingo-oopherectomy, and comprehensive surgical staging including pelvic and para-aortic lymph node dissection, omentectomy, and peritoneal cytology. Chemotherapy was 6 cycles of C/T, and the IVB dose was 14 Gy in 2 fractions, prescribed to 0.5 cm from the cylinder surface. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS) and overall survival (OS). Results The median follow-up time was 49 months (range: 9-145). The 5-yr RFS and OS were 85% and 93%, respectively. In all cases of recurrence (n = 8), the first site of failure was extra-pelvic. There were no isolated vaginal recurrences, however, there was one vaginal apex recurrence recorded at 19 months in a patient with simultaneous lung metastases. Thus, the 2-year vaginal RFS was 98%. Conclusions Excellent vaginal/pelvic control rates were observed. Further study of HDR brachytherapy dose and fractionation in combination with chemotherapy is worthwhile. PMID:25829935

  14. High-dose-rate Intracavitary Brachytherapy in the Management of Cervical and Vaginal Intraepithelial Neoplasia

    Microsoft Academic Search

    Ichiro Ogino; Tatsuo Kitamura; Hiroyuki Okajima; Sho Matsubara

    1998-01-01

    Purpose: To assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with grade 3 cervical intraepithelial neoplasia (CIN-3) and grade 3 vaginal intraepithelial neoplasia (VAIN-3).Methods and Materials: This was a retrospective analysis in 20 patients with CIN-3 (n = 14) or VAIN-3 (n = 6), average age 61.9 years, managed with HDR-ICR at Kanagawa Cancer Center. Two patients

  15. High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia

    PubMed Central

    Song, Jin Ho; Lee, Joo Hwan; Lee, Jong Hoon; Park, Jong Sup; Hong, Sook Hee; Jang, Hong Seok; Kim, Yeon Sil; Choi, Byung Ock

    2014-01-01

    Purpose Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy. Materials and Methods We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa. Results Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097). Conclusion HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity. PMID:24520226

  16. Selective perturbation of in vivo linear energy transfer using high- Z vaginal applicators for Cf-252 brachytherapy

    NASA Astrophysics Data System (ADS)

    Rivard, M. J.; Evans, K. E.; Leal, L. C.; Kirk, B. L.

    2004-01-01

    Californium-252 ( 252Cf) brachytherapy sources emit both neutrons and photons, and have the potential to vastly improve the current standard-of-practice for brachytherapy. While hydrogenous materials readily attenuate the 252Cf fission energy neutrons, high- Z materials are utilized to attenuate the 252Cf gamma-rays. These differences in shielding materials may be exploited when treating with a vaginal applicator to possibly improve patient survival through perturbation of the in vivo linear energy transfer radiation.

  17. High-dose-rate brachytherapy for vaginal rhabdomyosarcoma using a personalized mold in a 20-month old patient.

    PubMed

    Hathout, Lara; Cohn, Jamie; Voros, Laszlo; Kim, Sae Hee; Heaton, Todd; Wolden, Suzanne

    2015-03-01

    Treatment of vaginal rhabdomyosarcoma (RMS) with conservative approaches is presently the standard of care. Intravaginal high-dose rate brachytherapy is a very effective treatment while sparing the normal tissue to preserve growth, fertility and prevent organ dysfunction. In this report, we describe the management of an infant with Stage I vaginal RMS, treated with chemotherapy, maximal safe resection and intravaginal brachytherapy using a customized mold and MRI and CT-based three-dimensional (3D) conformal planning, followed by a critical review of the literature. PMID:25284601

  18. Vaginitis

    MedlinePLUS

    ... serious diseases. The most common vaginal infections are Bacterial Vaginosis Trichomoniasis Vaginal Yeast Infection Some vaginal infections are ... most vaginal infections in women are due to bacterial vaginosis, trichomoniasis, or yeast, there may be other causes ...

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

    SciTech Connect

    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

    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.

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

    SciTech Connect

    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

    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.

  1. Effects of bladder distension on dose distribution of vaginal vault brachytherapy in patients with endometrial cancer

    PubMed Central

    Guler, Ozan C.; Acibuci, Ibrahim

    2014-01-01

    Purpose To investigate dosimetric effects of bladder distention on organs at risk (OARs) during treatment of endometrial cancer using 3D image-based planning of postoperative vaginal vault brachytherapy (BRT). Material and methods Fifteen patients with early-stage endometrial cancer were studied, each undergoing adjuvant BRT of vaginal vault via 3.5 cm diameter cylinder. As treatment, 25 Gy in 5 fractions were delivered to 5 mm depth of the vaginal mucosa. Dose-volume histograms of OARs were generated individually with bladder empty and with bladder inflated by sterile saline (180 ml), to compare doses received. Results Bladder distention appreciably impacted dosimetry of bladder, sigmoid colon, and small bowel, but dosimetry of rectum was unaffected. With bladder inflated, mean cylinder-to-bowel distance increased significantly (1.69 cm vs. 1.20 cm; p = 0.006). Mean minimum dose to most exposed 2 cc (D2cc) volume also rose significantly at bladder (5.40 Gy vs. 4.55 Gy [18.7%]; p < 0.001), as opposed to near-significant reductions in D2cc at sigmoid colon (15.1%; p = 0.11) and at small bowel (10.5%; p = 0.14). A full bladder had no effect on dose to 50% volume (D50%) of bladder or rectum, and declines seen in mean D50% values of sigmoid colon (22.7%; p = 0.12) and small bowel (19.0%; p = 0.13) again fell short of statistical significance. Conclusions The combination of a full bladder and an empty rectum may cause significant unwanted increases in BRT dosing of bladder, without significantly impacting sigmoid colon and small bowel exposures. These findings should be validated through further clinical studies.

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

    Microsoft Academic Search

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

    1999-01-01

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

  3. Administration of Concurrent Vaginal Brachytherapy During Chemotherapy for Treatment of Endometrial Cancer

    SciTech Connect

    Nagar, Himanshu; Boothe, Dustin; Parikh, Amar; Yondorf, Menachem; Parashar, Bhupesh [Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York (United States); Gupta, Divya; Holcomb, Kevin; Caputo, Thomas [Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College of Cornell University, New York, New York (United States); Chao, K. S. Clifford; Nori, Dattatreyudu [Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York (United States); Wernicke, A. Gabriella, E-mail: gaw9006@med.cornell.edu [Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York (United States)

    2013-11-15

    Purpose: To evaluate the tolerability and toxicity of administering vaginal brachytherapy (VB) concurrently during chemotherapy compared with the sequential approach for patients with endometrial cancer. Methods and Materials: A retrospective analysis of 372 surgically staged patients with endometrial cancer American Joint Committee on Cancer 2009 stages I to IV treated with adjuvant postoperative radiation therapy (RT) at our institution from 2001 to 2012 was conducted. All patients received VB + external beam RT (EBRT) + 6 cycles of adjuvant carboplatin- and paclitaxel-based chemotherapy. The VB mean dose was 15.08 Gy (range, 15-20 Gy), with 3 to 4 weekly applications, and the EBRT mean dose was 45 Gy delivered with 3-dimensional or intensity modulated RT techniques. Hematologic, gastrointestinal (GI), and genitourinary (GU) toxicities were assessed by Common Toxicity Criteria (CTC) and compared between sequential and concurrent chemotherapy and VB schedules. Results: Among patients who received RT and adjuvant chemotherapy, 180 of 372 patients (48%) received RT sandwiched between cycles 3 and 4 of chemotherapy. A separate group of 192 patients (52%) were treated with VB during the first 3 cycles of chemotherapy, with a weekly application on nonchemotherapy days, and received the EBRT portion in a sandwiched fashion. Patients treated with VB during chemotherapy had a decreased overall treatment time by 4 weeks (P<.001; 95% confidence interval: 3.99-4.02) and sustained no difference in CTC-graded acute hematologic, GI, or GU toxicities in comparison with the patients treated with VB and chemotherapy in a sequential manner (P>.05). CTC grade 3 or 4 hematologic, GI, and GU toxicities were zero. Conclusions: VB during chemotherapy is well tolerated, decreases overall treatment time, and does not render more toxicity than the sequential regimen.

  4. The Role of Vaginal Brachytherapy in the Treatment of Surgical Stage I Papillary Serous or Clear Cell Endometrial Cancer

    SciTech Connect

    Barney, Brandon M., E-mail: barney.brandon@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)] [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Mariani, Andrea; Dowdy, Sean C.; Bakkum-Gamez, Jamie N. [Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota (United States)] [Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota (United States); Haddock, Michael G. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)] [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2013-01-01

    Objectives: The optimal adjuvant therapy for International Federation of Gynecology and Obstetrics (FIGO) stage I papillary serous (UPSC) or clear cell (CC) endometrial cancer is unknown. We report on the largest single-institution experience using adjuvant high-dose-rate vaginal brachytherapy (VBT) for surgically staged women with FIGO stage I UPSC or CC endometrial cancer. Methods and Materials: From 1998-2011, 103 women with FIGO 2009 stage I UPSC (n=74), CC (n=21), or mixed UPSC/CC (n=8) endometrial cancer underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant high-dose-rate VBT. Nearly all patients (n=98, 95%) also underwent extended lymph node dissection of pelvic and paraortic lymph nodes. All VBT was performed with a vaginal cylinder, treating to a dose of 2100 cGy in 3 fractions. Thirty-five patients (34%) also received adjuvant chemotherapy. Results: At a median follow-up time of 36 months (range, 1-146 months), 2 patients had experienced vaginal recurrence, and the 5-year Kaplan Meier estimate of vaginal recurrence was 3%. The rates of isolated pelvic recurrence, locoregional recurrence (vaginal + pelvic), and extrapelvic recurrence (including intraabdominal) were similarly low, with 5-year Kaplan-Meier estimates of 4%, 7%, and 10%, respectively. The estimated 5-year overall survival was 84%. On univariate analysis, delivery of chemotherapy did not affect recurrence or survival. Conclusions: VBT is effective at preventing vaginal relapse in women with surgical stage I UPSC or CC endometrial cancer. In this cohort of patients who underwent comprehensive surgical staging, the risk of isolated pelvic or extrapelvic relapse was low, implying that more extensive adjuvant radiation therapy is likely unnecessary.

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

    SciTech Connect

    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

    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.

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

    SciTech Connect

    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

    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.

  7. 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

    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

    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.

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

    SciTech Connect

    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

    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.

  9. Optimized Dose Distribution of Gammamed Plus Vaginal Cylinders

    SciTech Connect

    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

    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.

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

    SciTech Connect

    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

    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.

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

    SciTech Connect

    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

    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.

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

    Microsoft Academic Search

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

    2000-01-01

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

  13. 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

    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

    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.

  14. Rotator Cuff Injuries

    MedlinePLUS

    ... cuff are common. They include tendinitis, bursitis, and injuries such as tears. Rotator cuff tendons can become ... cuff depends on age, health, how severe the injury is, and how long you've had the ...

  15. Clindamycin Vaginal

    MedlinePLUS

    ... an infection caused by an overgrowth of harmful bacteria in the vagina). Clindamycin is in a class ... works by slowing or stopping the growth of bacteria. Vaginal clindamycin cannot be used to treat vaginal ...

  16. Rotator cuff repair

    MedlinePLUS

    ... Three common techniques are used to repair a rotator cuff tear: During open repair, surgical incision is made and ... when: You have a large or a complete rotator cuff tear. A tear was caused by a recent injury. ...

  17. Rotator cuff problems

    MedlinePLUS

    ... a normally smooth layer) lining these tendons. A rotator cuff tear occurs when one of the tendons is torn ... carpentry Poor posture over many years Aging TEARS Rotator cuff tears may occur in two ways: A sudden, acute ...

  18. Vaginal Cancer

    MedlinePLUS

    Vaginal cancer is a rare type of cancer. It is more common in women 60 and older. You are also more likely to get it if you have had a human ... test can find abnormal cells that may be cancer. Vaginal cancer can often be cured in its ...

  19. Rotator cuff exercises

    MedlinePLUS

    ... is irritation and swelling of these tendons A rotator cuff tear, which occurs when one of the tendons is ... 17. O'Brien MJ, Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, Osterman AL, ...

  20. Apoptosis in rotator cuff tendonopathy

    Microsoft Academic Search

    Jun Yuan; George A. C. Murrell; Ai-Qun Wei; Min-Xia Wang

    2002-01-01

    The aim of this study was to investigate the involvement of apoptosis (programmed cell death) in the pathogenesis of rotator cuff disorders. The edges of torn supraspinatus rotator cuff tendons were collected from patients with rotator cuff tear (n=25). Samples of the intra-articular portion of subscapularis tendons were collected from patients without rotator cuff tear as control (n=6). To minimize

  1. 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 ...

  2. 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 ...

  3. Vaginal Bleeding

    MedlinePLUS

    Menstruation, or period, is a woman's monthly bleeding. Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods, lasts several weeks, or happens before ...

  4. Vaginal Discharge

    MedlinePLUS

    ... on the lookout for symptoms of yeast infections, bacterial vaginosis and trichomoniasis, 3 infections that can cause changes ... vulva Intense itching Painful sexual intercourse Signs of bacterial vaginosis A white, gray or yellowish vaginal discharge A ...

  5. Vaginal reconstruction

    SciTech Connect

    Lesavoy, M.A.

    1985-05-01

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.

  6. Vaginal Cancer

    Microsoft Academic Search

    Nitika Thawani; Subhakar Mutyala; Aaron H. Wolfson

    \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a The vagina can be a common site of secondary involvement, either through direct extension from the cervix and vulva or by\\u000a lymphatic and vascular spread.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Invasive cancers most commonly present with irregular vaginal bleeding or discharge (often postcoital), followed by vaginal\\u000a discharge or dysuria. Vaginal intraepithelial neoplasia (VaIN) is diagnosed on routine screening.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Diagnostic workup should include

  7. Rotator Cuff Repair

    MedlinePLUS

    ... 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 ...

  8. Vaginal Birth

    NSDL National Science Digital Library

    Patient Education Institute

    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.

  9. Rotator Cuff Injuries.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    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…

  10. Interstitial radiotherapy for early stage vaginal cancer. A new method of tumor localization.

    PubMed

    Finan, M A; Hoffman, M S; Greenberg, H; Roberts, W S; Cavanagh, D; Fiorica, J V

    1993-03-01

    Carcinoma of the vagina is optimally treated primarily with teletherapy, followed by interstitial needle brachytherapy. Following teletherapy, identification of the original tumor site is frequently difficult. We describe a method of marking the tumor with an india ink "tattoo" at initial presentation, followed by placement of a purse-string suture and titanium hemoclips at the time of brachytherapy. A stable marker is created so that the location of the original vaginal tumor can be easily identified on dosimetric films. PMID:7683723

  11. Special report: Occlusive cuff controller

    NASA Technical Reports Server (NTRS)

    Baker, J. T.

    1975-01-01

    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.

  12. Rolling cuff flexible bellows

    DOEpatents

    Lambert, Donald R. (Livermore, CA)

    1985-01-01

    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.

  13. Rotator Cuff Injuries

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses rotator cuff injuries, their causes, symptoms, diagnosis, prevention, and options for their treatment including physiotherapy and surgery. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This 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.

  14. Vaginal and Vulvar Cancer

    MedlinePLUS

    ... sixth type of gynecologic cancer is the very rare fallopian tube cancer.) This fact sheet about vaginal ... get them. Vaginal and vulvar cancers are very rare. Together, they account for 6-7 percent of ...

  15. What Is Vaginal Cancer?

    MedlinePLUS

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

  16. Rotator cuff repair - series (image)

    MedlinePLUS

    Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure is less predictable at returning strength to the shoulder. Recovery time often depends on the extent of the tear.

  17. Advanced brachytherapy dosimetric considerations

    E-print Network

    Melhus, Christopher S. (Christopher Scott), 1974-

    2008-01-01

    The practice of brachytherapy and brachytherapy dosimetry was investigated with emphasis on evaluations of dose distributions and shielding considerations for both photon- and neutron-emitting radionuclides. Monte Carlo ...

  18. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  19. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  20. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  1. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  2. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  3. Management of persistent vaginitis.

    PubMed

    Nyirjesy, Paul

    2014-12-01

    With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis. PMID:25415165

  4. 20-year retrospective review of medium dose rate intracavitary brachytherapy in VAIN3

    Microsoft Academic Search

    Kathryn Graham; Kathryn Wright; Barbara Cadwallader; Nicholas S. Reed; R. Paul Symonds

    2007-01-01

    Background and aims.Vaginal intraepithelial neoplasia (VAIN) is an uncommon premalignant condition which can be difficult to eradicate. In view of the low incidence worldwide and lack of published work available there is no gold standard treatment. The aim of this study was to assess the outcome of VAIN 3 treated by brachytherapy at a single institution over a 20-year period.

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

    Microsoft Academic Search

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

    1984-01-01

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

  6. 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, ...

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

    Microsoft Academic Search

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

    2004-01-01

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

  8. Effect of radiotherapeutic technique on local control in primary vaginal carcinoma.

    PubMed

    Eddy, G.L.; Jenrette, J.M.; Creasman, W.T.

    1993-11-01

    A retrospective analysis of 73 patients treated for primary vaginal carcinoma with radiation therapy was performed to evaluate the effect of radiotherapeutic technique on local control. Local control was achieved in five of 22 patients (23%) treated with pelvic external beam therapy alone, three of four patients (75%) treated with intracavitary cylinder or Bloedorn applicator alone, and 30 of 47 patients (64%) treated with combination of external beam and brachytherapy. Radiation therapy complications requiring hospitalization occurred in six patients (8%). A statistically significant difference in local control was achieved only when patients receiving external beam and brachytherapy were compared with patients receiving external beam therapy alone (P < 0.005). Total mid-tumor dose was defined as the sum of midplane tumor dose from external beam therapy, mid-tumor dose from interstitial radium needles, and the vaginal surface dose from intracavitary radium systems. Total mid-tumor doses ranged from 16 to 121.7 Gy. Only two of 16 patients receiving less than 55 Gy total mid-tumor dose achieved local control. As a result, dividing doses of 45, 55, 65 and 75 Gy produced a statistically significant superior local control rate in the patients receiving the higher dose (P < 0.01). None of the 16 patients receiving less than 55 Gy total mid-tumor dose had received brachytherapy. We conclude that the combination of external beam therapy and brachytherapy is essential to achieve optimal control of primary vaginal carcinoma. PMID:11578376

  9. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 2014-04-01 2014-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  10. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 2013-04-01 2013-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  11. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 2012-04-01 2012-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  12. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food... § 868.5750 Inflatable tracheal tube cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an...

  13. 21 CFR 868.5750 - Inflatable tracheal tube cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Inflatable tracheal tube cuff. 868.5750 Section 868.5750 Food... § 868.5750 Inflatable tracheal tube cuff. (a) Identification. An inflatable tracheal tube cuff is a device used to provide an...

  14. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 2011-04-01 2011-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  15. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  16. Vaginal yeast infection

    MedlinePLUS

    ... help prevent and treat vaginal discharge: Keep your genital area clean and dry. Avoid soap and rinse ... feminine hygiene sprays, fragrances, or powders in the genital area. Avoid wearing tight-fitting pants or shorts, ...

  17. Vaginal birth - series (image)

    MedlinePLUS

    This presentation illustrates key stages of a normal vaginal delivery. Please keep in mind that every birth is unique, ... fluid, blood, and mucus from his nose and mouth. More contractions and pushing help deliver the baby's ...

  18. Vaginal sponge and spermicides

    MedlinePLUS

    Birth control - over the counter; Contraceptives - over the counter ... Spermicides and vaginal sponges do not work as well at preventing ... control at all. SPERMICIDES Spermicides are chemicals that stop ...

  19. How Is Vaginitis Treated?

    MedlinePLUS

    ... to learn the specific type of vaginitis. 1 Bacterial Vaginosis Bacterial vaginosis (BV) is treated with an antibiotic that gets ... Date: 05/21/2013 Related A-Z Topics Bacterial Vaginosis Contraception and Birth Control Sexually Transmitted Diseases (STDs) ...

  20. Biologic augmentation of rotator cuff repair

    Microsoft Academic Search

    Scott R. Montgomery; Frank A. Petrigliano; Seth C. Gamradt

    Rotator cuff repair is a common orthopedic procedure. Despite advances in surgical technique, the rotator cuff tendons often\\u000a fail to heal after surgery. In recent years, a number of biologic strategies have been developed and tested to augment healing\\u000a after rotator cuff repair. These strategies include allograft, extracellular matrices (ECMs), platelet rich plasma (PRP),\\u000a growth factors, stem cells, and gene

  1. Effect of brachytherapy technique and patient characteristics on cervical cancer implant dosimetry.

    PubMed

    Anker, Christopher J; O'Donnell, Kristen; Boucher, Kenneth M; Gaffney, David K

    2013-01-01

    Our purpose was to evaluate the relationship between brachytherapy technique and patient characteristics on dose to organs-at-risk (OARs) in patients undergoing high dose rate (HDR) brachytherapy for cervical cancer. From 1998 to 2008, 31 patients with cervical cancer with full dosimetric data were identified who received definitive external-beam radiation and HDR brachytherapy with tandem and ovoid applicators. Doses were recorded at point A, the International Commission on Radiation Units and Measurements (ICRU)-38 rectal point, the ICRU-38 bladder point, the vaginal surface, and the pelvic sidewall. Generalized estimating equations were used to determine the significance of changes in OAR to point A dose ratios with differences in brachytherapy technique or patient characteristics. Patients underwent a median of 5 brachytherapy procedures (range, 3 to 5), with a total of 179 procedures for 31 patients. For all brachytherapy treatments, the average ratios between the doses for the rectal, bladder, vaginal surface, and pelvic sidewall reference points to those at point A were 0.49, 0.59, 1.15, and 0.17, respectively. In general, decreased OAR dose was associated with a lower stage, younger age, increased ovoid size, increased tandem length, and earlier implant number. Increased tandem curvature significantly increased bladder dose and decreased rectal dose. Intravenous anesthesia usage was not correlated with improved dosimetry. This study allowed identification of patient and procedure characteristics influencing OAR dosing. Although the advent of 3-dimensional (3D) image-guided brachytherapy will bring new advances in treatment optimization, the actual technique involved at the time of the brachytherapy implant procedure will remain important. PMID:23973016

  2. Effect of brachytherapy technique and patient characteristics on cervical cancer implant dosimetry

    SciTech Connect

    Anker, Christopher J., E-mail: chris.anker@hci.utah.edu [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT (United States); O'Donnell, Kristen [Department of Radiation Oncology, The University of Arizona, Tucson, AZ (United States); Boucher, Kenneth M. [Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (United States); Gaffney, David K. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT (United States)

    2013-01-01

    Our purpose was to evaluate the relationship between brachytherapy technique and patient characteristics on dose to organs-at-risk (OARs) in patients undergoing high dose rate (HDR) brachytherapy for cervical cancer. From 1998 to 2008, 31 patients with cervical cancer with full dosimetric data were identified who received definitive external-beam radiation and HDR brachytherapy with tandem and ovoid applicators. Doses were recorded at point A, the International Commission on Radiation Units and Measurements (ICRU)-38 rectal point, the ICRU-38 bladder point, the vaginal surface, and the pelvic sidewall. Generalized estimating equations were used to determine the significance of changes in OAR to point A dose ratios with differences in brachytherapy technique or patient characteristics. Patients underwent a median of 5 brachytherapy procedures (range, 3 to 5), with a total of 179 procedures for 31 patients. For all brachytherapy treatments, the average ratios between the doses for the rectal, bladder, vaginal surface, and pelvic sidewall reference points to those at point A were 0.49, 0.59, 1.15, and 0.17, respectively. In general, decreased OAR dose was associated with a lower stage, younger age, increased ovoid size, increased tandem length, and earlier implant number. Increased tandem curvature significantly increased bladder dose and decreased rectal dose. Intravenous anesthesia usage was not correlated with improved dosimetry. This study allowed identification of patient and procedure characteristics influencing OAR dosing. Although the advent of 3-dimensional (3D) image-guided brachytherapy will bring new advances in treatment optimization, the actual technique involved at the time of the brachytherapy implant procedure will remain important.

  3. 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.

  4. Vaginal Toxic Shock Reaction Triggering Desquamative Inflammatory Vaginitis

    PubMed Central

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

    2012-01-01

    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. PMID:23222054

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

    PubMed

    Stute, Petra

    2013-12-01

    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

  6. A Novel Device for Intravaginal Electronic Brachytherapy

    SciTech Connect

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

    2009-07-15

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

  7. Vaginitis in adolescents.

    PubMed

    Syed, Tahniat S; Braverman, Paula K

    2004-06-01

    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

  8. Rolling-cuff flexible bellows

    DOEpatents

    Lambert, D.R.

    1982-09-27

    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.

  9. Current biomechanical concepts for rotator cuff repair.

    PubMed

    Lee, Thay Q

    2013-06-01

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

  10. Vaginal dilator therapy for women receiving pelvic radiotherapy

    PubMed Central

    Miles, Tracie; Johnson, Nick

    2014-01-01

    Background Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum. Objectives To review the benefits and harms of vaginal dilation therapy associated with pelvic radiotherapy for cancer. Search methods Searches included the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE (1950 to 2008), EMBASE (1980 to 2008) and CINAHL (1982 to 2008). Selection criteria Any comparative randomised controlled trials (RCT) or data of any type which compared dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer. Data collection and analysis The review authors independently abstracted data and assessed risk of bias. We analysed the mean difference in sexual function scores and the risk ratio for non-compliance at six weeks and three months in single trial analyses. No trials met the inclusion criteria. Main results Dilation during or immediately after radiotherapy can, in rare cases, cause damage and there is no persuasive evidence from any study to demonstrate that it prevents stenosis. Data from one RCT showed no improvement in sexual scores in women who were encouraged to practice dilation. Two case series and one comparative study using historical controls suggest that dilation might be associated with a longer vaginal length but these data cannot reasonably be interpreted to show that dilation caused the change in the vagina. Authors’ conclusions Routine dilation during or soon after cancer treatment may be harmful. There is no reliable evidence to show that routine regular vaginal dilation during or after radiotherapy prevents the late effects of radiotherapy or improves quality of life. Gentle vaginal exploration might separate the vaginal walls before they can stick together and some women may benefit from dilation therapy once inflammation has settled but there are no good comparative supporting data. PMID:20824858

  11. Pyomyositis after vaginal delivery

    PubMed Central

    Gaughan, Eve; Eogan, Maeve; Holohan, Mary

    2011-01-01

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted. PMID:22693277

  12. Vaginal Vault Prolapse

    PubMed Central

    Uzoma, Azubuike; Farag, K. A.

    2009-01-01

    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. PMID:19936123

  13. Rotator cuff tear measurement by arthropneumotomography

    SciTech Connect

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

    1983-02-01

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

  14. [Safety in brachytherapy].

    PubMed

    Marcié, S; Marinello, G; Peiffert, D; Lartigau, É

    2013-04-01

    No technique can now be used without previously considering the safety of patients, staff and public and risk management. This is the case for brachytherapy. The various aspects of brachytherapy are discussed for both the patient and the staff. For all, the risks must be minimized while achieving a treatment of quality. It is therefore necessary to establish a list as comprehensive as possible regardless of the type of brachytherapy (low, high, pulsed dose-rate). Then, their importance must be assessed with the help of their criticality. Radiation protection of personnel and public must take into account the many existing regulation texts. Four axes have been defined for the risk management for patients: organization, preparation, planning and implementation of treatment. For each axis, a review of risks is presented, as well as administrative, technical and medical dispositions for staff and the public. PMID:23465784

  15. Vaginal immunity in bacterial vaginosis

    Microsoft Academic Search

    Sabina Cauci

    2004-01-01

    Vaginal immunity in response to microbial perturbation is still poorly understood and may be crucial for protection from adverse\\u000a outcomes associated with bacterial vaginosis (BV). BV is the most prevalent vaginal disorder in adult women worldwide. However,\\u000a its pathogenesis is still elusive. In BVpositive women, inflammatory signs are scant—approximately 50% of women are asymptomatic.\\u000a The number of vaginal neutrophils in

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

    MedlinePLUS

    ... Dealing With Anger Vaginal Discharge: What's Normal, What's Not KidsHealth > Teens > Sexual Health > For Girls > Vaginal Discharge: What's Normal, What's Not Print A A A Text Size Normal vaginal ...

  17. Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy?

    PubMed

    Tuntiviriyapun, P; Panyakhamlerd, K; Triratanachat, S; Chatsuwan, T; Chaikittisilpa, S; Jaisamrarn, U; Taechakraichana, N

    2015-04-01

    Objectives The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. Study design A cross-sectional descriptive study. Methods Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters (vaginal atrophy score, vaginal pH, the number of lactobacilli, vaginal maturation index, and vaginal maturation value) were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. Results A total of 132 naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p < 0.001) and a weak correlation with the vaginal atrophy score (r = 0.230, p < 0.001). History of sexual intercourse within 3 months was associated with a better correlation between vaginal atrophy symptoms and the objective parameters. Conclusion Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem. PMID:25374401

  18. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    PubMed

    Peters, Joost H; Hoogerwerf, Nico

    2013-10-01

    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

  19. Treatment of vaginal atrophy.

    PubMed

    Domoney, Claudine

    2014-03-01

    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

  20. Vaginal vein thrombosis in pregnancy.

    PubMed Central

    Gitstein, S.; Ballas, S.; Peyser, M. R.

    1983-01-01

    Vaginal vein thrombosis in a pregnant woman is reported. This entity should be differentiated from vaginal arteriovenous fistula which may cause severe antepartum, intrapartum and post-partum haemorrhage. The humoral and mechanical factors which favour the occurrence of varicosities and thrombosis are briefly described. Surgical management is suggested as being both simple and effective. Images Fig. 1 PMID:6634550

  1. Predictors of the vaginal microflora

    Microsoft Academic Search

    Edward R. Newton; Jeanna M. Piper; Rochelle N. Shain; Sondra T. Perdue; William Peairs

    2001-01-01

    Objective: Our purpose was to define influences on the patterns of the vaginal microflora. Study Design: We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to

  2. Single row rotator cuff repair with modified technique.

    PubMed

    Ko, Sang-Hun; Shin, Seung-Myeong

    2012-12-18

    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. PMID:23362463

  3. Primary anterior shoulder dislocation and rotator cuff tears

    Microsoft Academic Search

    Roger Berbig; Dominik Weishaupt; Jürg Prim; Osama Shahin

    1999-01-01

    In a prospective controlled study 167 patients with 167 primary traumatic anterior shoulder dislocations underwent early ultrasonographic evaluation for rotator cuff tears. We found 53 (31.7%) full-thickness cuff tears in this group. Compared with a group of 93 healthy volunteers, we found with statistical significance more cuff tears in the patients aged

  4. Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear

    Microsoft Academic Search

    Naoki Suenaga; Akio Minami; Kiyoshi Kaneda

    2000-01-01

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

  5. Rotator cuff tears in anterior dislocation of the shoulder

    Microsoft Academic Search

    E. Itoi; S. Tabata

    1992-01-01

    We diagnosed 16 rotator cuff tears in 109 shoulders in 104 patients with a traumatic anterior dislocation. Twelve of these were followed up for an average of 32 months. A surgical repair of the cuff was carried out in eleven and the results were satisfactory in eight (73%) regardless of a Bankart lesion. The repair of a torn cuff seems

  6. Comparison of Open and Arthroscopically Assisted Rotator Cuff Repairs

    Microsoft Academic Search

    Champ L. Baker; Stephen H. Liu

    1995-01-01

    Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Re cently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with re gard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were

  7. Forearm rescue cuff improves tourniquet tolerance during intravenous regional anesthesia

    Microsoft Academic Search

    Anahi Perlas; Philip W. H. Peng; Miguel Barrera Plaza; William J. Middleton; Vincent W. S. Chan; Khashayar Sanandaji

    2003-01-01

    Background and Objectives: Tourniquet pain during intravenous regional anesthesia (IVRA) of the upper limb is common and can limit tourniquet inflation time. We hypothesize that a forearm rescue cuff is better tolerated than the traditional rescue cuff of a double-cuff tourniquet. Methods: After Institutional Review Board (IRB) approval and informed consent, 10 healthy unmedicated volunteers took part in a prospective,

  8. Mechanisms of rotator cuff tendinopathy: Intrinsic, extrinsic, or both?

    Microsoft Academic Search

    Amee L. Seitz; Philip W. McClure; Sheryl Finucane; N. Douglas Boardman; Lori A. Michener

    2011-01-01

    The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased

  9. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section 868.5800 Food...868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed...

  10. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section 868.5800 Food...868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed...

  11. Episiotomy for vaginal birth

    PubMed Central

    Carroli, Guillermo; Mignini, Luciano

    2014-01-01

    Background Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. Objectives The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2008). Selection criteria Randomized trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. Data collection and analysis The two review authors independently assessed trial quality and extracted the data. Main results We included eight studies (5541 women). In the routine episiotomy group, 75.15% (2035/2708) of women had episiotomies, while the rate in the restrictive episiotomy group was 28.40% (776/2733). Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma (relative risk (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91), less suturing (RR 0.71, 95% CI 0.61 to 0.81) and fewer healing complications (RR 0.69, 95% CI 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (RR 1.84, 95% CI 1.61 to 2.10). There was no difference in severe vaginal/perineal trauma (RR 0.92, 95% CI 0.72 to 1.18); dyspareunia (RR 1.02, 95% CI 0.90 to 1.16); urinary incontinence (RR 0.98, 95% CI 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. Authors’ conclusions Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy. PMID:19160176

  12. Attenuation of intracavitary applicators in 192Ir-HDR brachytherapy.

    PubMed

    Ye, Sung-Joon; Brezovich, Ivan A; Shen, Sui; Duan, Jun; Popple, Richard A; Pareek, Prem N

    2004-07-01

    Unlike the penetrating monoenergetic 662 keV gamma rays emitted by 137Cs LDR sources, the spectrum of 192Ir used in HDR brachytherapy contains low-energy components. Since these are selectively absorbed by the high-atomic number materials of which intracavitary applicators are made, the traditional neglect of applicator attenuation can lead to appreciable dose errors. We investigated the attenuation effects of a uterine applicator, and of a set of commonly used vaginal cylinders. The uterine applicator consists of a stainless steel source guide tube with a wall thickness of 0.5 mm and a density of 8.02 g/cm3, whereas the vaginal cylinders consist of the same stainless steel tube plus concentric polysulfone cylinders with a radius of 1 or 2 cm and a density of 1.40 g/cm3. Monte Carlo simulations were performed to compute dose distributions for a bare 192Ir-HDR source, and for the same source located within the applicators. Relative measurements of applicator attenuation using ion-chambers (0.125 cm3) confirmed the Monte Carlo results within 0.5%. We found that the neglect of the applicator attenuation overestimates the dose along the transverse plane by up to 3.5%. At oblique angles, the longer photon path within applicators worsens the error. We defined attenuation-corrected radial dose and anisotropy functions, and applied them to a treatment having multiple dwell positions inside a vaginal cylinder. PMID:15305463

  13. Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult.

    PubMed

    Bonfield, Christopher M; Weiner, Gregory M; Bradley, Megan S; Engh, Johnathan A

    2015-01-01

    Ventriculo-peritoneal shunts (VPS) are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet's syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters. PMID:25552862

  14. Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult

    PubMed Central

    Bonfield, Christopher M.; Weiner, Gregory M.; Bradley, Megan S.; Engh, Johnathan A.

    2015-01-01

    Ventriculo-peritoneal shunts (VPS) are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet's syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters. PMID:25552862

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

    Microsoft Academic Search

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

    1997-01-01

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

  16. Pressure-pain function in desensitized and hypersensitized muscle and skin assessed by cuff algometry

    Microsoft Academic Search

    Romanas Polianskis; Thomas Graven-Nielsen; Lars Arendt-Nielsen

    2002-01-01

    This study assessed a newly developed cuff pressure algometry during discrete leg skin\\/muscle sensitization and anesthesia. Experimental setup consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor, and an electronic visual analog scale (VAS). The first experiment assessed cuff algometry before and after selective anesthesia of the skin and the muscle under the cuff. The second experiment assessed cuff

  17. Drugs Approved for Vaginal Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) to prevent vaginal cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  18. Vaginal itching and discharge - child

    MedlinePLUS

    ... girl has a sexually transmitted vaginal infection, however, sexual abuse must be considered and addressed. A foreign body ... abdominal pain or has a fever. You suspect sexual abuse. Also call if: There are blisters or ulcers ...

  19. 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 ...

  20. Can Vaginal Cancer Be Prevented?

    MedlinePLUS

    ... can be spread during sex – including vaginal intercourse, anal intercourse, and oral sex – but sex doesn’t ... not letting others come in contact with your anal or genital area, but even then there could ...

  1. Vaginal films for drug delivery.

    PubMed

    Machado, Rita M; Palmeira-de-Oliveira, Ana; Martinez-De-Oliveira, José; Palmeira-de-Oliveira, Rita

    2013-07-01

    Vaginal dosage forms have been studied in relation to many drugs as the vagina presents several advantages as a site for drug delivery, such as large surface area, rich blood supply, avoidance of the first-pass effect, relatively high permeability to several drugs, and self-insertion. Traditional vaginal dosage forms have been associated with disadvantages such as low residence time and discomfort and have been surpassed by newly designed drug delivery systems, particularly those based on bioadhesive polymers. Vaginal films are solid dosage forms that rapidly dissolve in contact with vaginal fluids and are unlikely to be associated with leakage and messiness. They have been studied for some female genital problems, aiming either contraceptive, antimicrobial, or microbicide effects. Precise and complex processes of manufacturing and characterization are required to achieve successful film formulation. Although scarce, the available user's acceptability studies show promising results. Vaginal films gather a lack of opportunities for both therapeutic and prophylactic actions, and therefore should be considered when designing and developing new vaginal drug delivery systems. PMID:23649325

  2. Partial-Thickness Rotator Cuff Tears

    Microsoft Academic Search

    Matthew J. Matava; Derek B. Purcell; Jonas R. Rudzki

    2005-01-01

    Partial-thickness tears of the rotator cuff have been diagnosed with increased frequency because of a heightened awareness of the condition by clinicians and improved diagnostic methods. Research into the causes, natural history, and optimal treatment of this condition lags behind that of full-thickness tears. However, despite the limitations in the existing literature, there has emerged a consensus among shoulder experts

  3. Control device for prosthetic urinary sphincter cuff

    NASA Technical Reports Server (NTRS)

    Reinicke, Robert H. (Inventor)

    1983-01-01

    A device for controlling flow of fluid to and from a resilient inflatable cuff implanted about the urethra to control flow of urine therethrough. The device comprises a flexible bulb reservoir and a control unit that includes a manually operated valve that opens automatically when the bulb is squeezed to force fluid into the cuff for closing the urethra. The control unit also includes a movable valve seat member having a relatively large area exposed to pressure of fluid in a chamber that is connected to the cuff and which moves to a position in which the valve member is unseated by an abutment when fluid pressure in the chamber exceeds a predetermined value to thereby relieve excess fluid pressure in the cuff. The arrangement is such that the valve element is held closed against the seat member by the full differential in fluid pressures acting on both sides of the valve element until the seat member is moved away from the valve element to thus insure positive closing of the valve element until the seat member is moved out of engagement with the valve element by excess pressure differential.

  4. Regenerative Medicine in Rotator Cuff Injuries

    PubMed Central

    Randelli, Pietro; Ragone, Vincenza; Menon, Alessandra; Cabitza, Paolo; Banfi, Giuseppe

    2014-01-01

    Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research. PMID:25184132

  5. NERVE CUFF ELECTRODES FOR PROSTHETIC AND RESEARCH APPLICATIONS

    Microsoft Academic Search

    J. A. Hoffer; K. Kallesøe

    A new generation of nerve cuffs suitable for stimulation, recording and modulation of nerve activity has been tested in our laboratory and elsewhere. The walls are molded of low-durometer silicone and incorporate flexible electrodes, Teflon? -coated stainless steel leads and an interlocking opening\\/closing system. Stimulation and recording cuffs can be either single-channel or multi- channel. Single-channel cuffs have coiled circumferential

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

    Microsoft Academic Search

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

    2001-01-01

    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

  7. Vaginitis: current microbiologic and clinical concepts.

    PubMed Central

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed. PMID:3510698

  8. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  9. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  10. 21 CFR 884.3575 - Vaginal pessary.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Prosthetic Devices § 884.3575 Vaginal pessary. (a) Identification. A vaginal pessary is a removable structure...

  11. A Universal Combination Treatment for Vaginitis

    Microsoft Academic Search

    Jacob Bornstein; Doron Zarfati

    2008-01-01

    Background: We compared a novel vaginal tablet consisting of 100 mg of clotrimazole and 100 mg of metronidazole (‘Clo-Met’) to a 100-mg clotrimazole tablet in the treatment of vaginitis. Methods: A multicenter, double-blind, randomized controlled study. Women with vaginal discharge and diagnosed as suffering from vaginitis caused by Trichomonas vaginalis, bacterial vaginosis or Candida albicans, or any combination of the

  12. Anomalous biceps origin from the rotator cuff

    PubMed Central

    Banerjee, Samik; Patel, Vipul R

    2015-01-01

    Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. PMID:25593361

  13. Anomalous biceps origin from the rotator cuff.

    PubMed

    Banerjee, Samik; Patel, Vipul R

    2015-01-01

    Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. PMID:25593361

  14. Sphygmomanometer cuffs: a potential source of infection!

    PubMed

    Zargaran, David; Hardwick, Sarah; Adel, Reeja; Hill, George; Stubbins, Daniel; Salmasi, Abdul Majeed

    2015-02-01

    We evaluated the potential pathogenic hazard of sphygmomanometer blood pressure cuffs (BPCs) in a hospital setting. Prospectively, the presence of bacterial organisms on 120 BPCs in 14 medical wards and outpatient clinics in a district general hospital in London was assessed. Swabs taken from the inner aspect of the cuffs were cultured using standard microbiological techniques. Bacterial organisms were found in 85% (102) of the 120 BPCs assessed. The highest rates of contamination were found in the outpatients department (90%). There were differences in the most common bacterial species isolated between the samples obtained from the outpatient clinics and the wards, with coagulase-negative Staphylococcus and diphtheroids being the most prevalent species in the wards and outpatient clinics, respectively. These findings highlight the necessity to eliminate this potential risk of infection. PMID:24569512

  15. Biological Augmentation of Rotator Cuff Tendon Repair

    Microsoft Academic Search

    David Kovacevic; Scott A. Rodeo

    2008-01-01

    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

  16. Cerebrovascular effects of the thigh cuff maneuver.

    PubMed

    Panerai, R B; Saeed, N P; Robinson, T G

    2015-04-01

    Arterial hypotension can be induced by sudden release of inflated thigh cuffs (THC), but its effects on the cerebral circulation have not been fully described. In nine healthy subjects [aged 59 (9) yr], bilateral cerebral blood flow velocity (CBFV) was recorded in the middle cerebral artery (MCA), noninvasive arterial blood pressure (BP) in the finger, and end-tidal CO2 (ETCO2 ) with nasal capnography. Three THC maneuvers were performed in each subject with cuff inflation 20 mmHg above systolic BP for 3 min before release. Beat-to-beat values were extracted for mean CBFV, BP, ETCO2 , critical closing pressure (CrCP), resistance-area product (RAP), and heart rate (HR). Time-varying estimates of the autoregulation index [ARI(t)] were also obtained using an autoregressive-moving average model. Coherent averages synchronized by the instant of cuff release showed significant drops in mean BP, CBFV, and RAP with rapid return of CBFV to baseline. HR, ETCO2 , and ARI(t) were transiently increased, but CrCP remained relatively constant. Mean values of ARI(t) for the 30 s following cuff release were not significantly different from the classical ARI [right MCA 5.9 (1.1) vs. 5.1 (1.6); left MCA 5.5 (1.4) vs. 4.9 (1.7)]. HR was strongly correlated with the ARI(t) peak after THC release (in 17/22 and 21/24 recordings), and ETCO2 was correlated with the subsequent drop in ARI(t) (19/22 and 20/24 recordings). These results suggest a complex cerebral autoregulatory response to the THC maneuver, dominated by myogenic mechanisms and influenced by concurrent changes in ETCO2 and possible involvement of the autonomic nervous system and baroreflex. PMID:25659488

  17. Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound

    SciTech Connect

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

    2009-09-01

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

  18. Identifying vaginitis in general practice.

    PubMed

    Smail, J

    Clinicians conducted a study of 154 women who presented themselves at a health center of the University of Wales College of Medicine with symptoms of vaginitis. A nurse examined the vagina with a speculum to note the appearance of the cervix, the color and amount of discharge, and the presence of odor and inquired about soreness during the examination. The nurse took 3 endocervical swabs and 2 high vaginal swabs. Upon microscopic examination, any vaginal discharge with epithelial cells stippled with small coccobacilli indicated a possible Gardnerella vaginalis infection. Laboratory personnel identified G. vaginalis either alone or in combination with other organisms in 53% of the women. Those with G. vaginalis alone or in combination with anaerobes reported more symptoms than those women who had negative cultures. In addition, women with G. vaginalis alone and those G. vaginalis in combination with other organisms had more discharge, described as yellow and runny, than those with negative cultures. 77% of the women infected with G. vaginalis had a high cheese or fishy odor. 75% of the women with G. vaginalis came to the health center between 2-4 weeks or even longer after they 1st noticed symptoms. On the other hand, women who were infected with C. albicans presented to the health center within a week of the start of the symptoms. Clinicians had previously treated erroneously many of the women with G. vaginalis with an antifungal agent. These women should be treated with metronidazole or, if a yeast infection is also present, with an antifungal agent and metronidazole. All women who present themselves to a nurse or physician with vaginal symptoms should have a history taken, an examination, and vaginal discharge samples taken and evaluated in the laboratory. PMID:3498151

  19. Repair of rotator cuff tears in tennis players

    Microsoft Academic Search

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

    1992-01-01

    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

  20. Shoulder function after surgical repair of rotator cuff tears

    Microsoft Academic Search

    M Kronberg; P Wahlström; L-Å Broström

    1997-01-01

    Shoulder function was assessed in 37 patients with a mean age of 57 years after acromioplasty and repair of full-thickness rotator cuff tears were performed. The cuff tears were closed without transfer of other muscles or use of synthetic materials. At review 2 years after surgery 32 patients had significant pain relief and improved shoulder function. Range of motion, muscle

  1. Arthroscopic Rotator Cuff Repair: 4- to 10Year Results

    Microsoft Academic Search

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

    2004-01-01

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

  2. Shockwave therapy under ultrasonographic guidance in rotator cuff calcific tendinitis

    Microsoft Academic Search

    Jeanne Elisabeth Charrin; Eric Robert Noël

    2001-01-01

    Objectives. This is the first efficacy evaluation in patients with rotator cuff calcific tendinitis treated with shockwave therapy delivered using a dedicated extracorporeal lithotripter and ultrasonographic guidance. Patients and methods. Thirty-two patients with rotator cuff calcific tendinitis received shockwave therapy delivered using a lithotripter specifically designed for the musculoskeletal system (DORNIER EPOS ULTRA), under ultrasonography guidance (which is not part of

  3. Rotator Cuff Damage: Reexamining the Causes and Treatments.

    ERIC Educational Resources Information Center

    Nash, Heyward L.

    1988-01-01

    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)

  4. New designs of cuff seals for rotating shafts

    Microsoft Academic Search

    V. V. Burenin

    2008-01-01

    The reliability of hydraulic machine tools, automatic lines, industrial robots, and other machines and mechanisms largely depends on the safe operation of seals for rotary joints (in rotating shafts). In such cases, cuff seals (cuffs), usually made of rubber, plastic, and other rubbery materials are widely used as contact seals [1, 2]. The quality requirements on seals are rising sharply,

  5. Rotator Cuff Disease and Injury--Evaluation and Management.

    ERIC Educational Resources Information Center

    Williams, Randy

    This presentation considers the incidence, evaluation, and management of rotator cuff disease and injury. Pathogenesis, symptoms, physical findings, treatment (therapeutic and surgical), and prevention are discussed. It is noted that rotator cuff problems, common in athletes, are usually related to an error in training or lack of training. They…

  6. Biomechanical analysis of bursal-sided partial thickness rotator cuff tears

    E-print Network

    Makhsous, Mohsen

    Biomechanical analysis of bursal-sided partial thickness rotator cuff tears Scott Yang, BSa , Hyung of Shoulder and Elbow Surgery Board of Trustees. Keywords: Rotator cuff; rotator cuff tear; supraspinatus abductor of the arm, and is most commonly torn in partial thickness rotator cuff tears.8 Partial thickness

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

    Microsoft Academic Search

    Craig A. Cummins; George A. C. Murrell

    2003-01-01

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

  8. Magnetic resonance-guided interstitial therapy for vaginal recurrence of endometrial cancer

    SciTech Connect

    Viswanathan, Akila N. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States)]. E-mail: aviswanathan@partners.org; Cormack, Robert [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Holloway, Caroline L. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Tanaka, Cynthia [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); O'Farrell, Desmond C. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Devlin, Phillip M. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Tempany, Clare [Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States)

    2006-09-01

    Purpose: To evaluate the feasibility and to describe the acute toxicity of a real-time intraoperative magnetic resonance (MR)-image guided interstitial approach to treating vaginal recurrence of endometrial cancer. Methods and Materials: From February 2004 to April 2005, 10 patients with recurrent endometrial cancer underwent MR-guided interstitial brachytherapy. Parameters evaluated included needle placement, dose-volume histograms (DVH), and complications. Results: Magnetic resonance-image guidance resulted in accurate needle placement. Tumor DVH values included median volume, 47 cc; V100, 89%; V150, 61%; V200, 38%; D90, 71 Gy; and D100, 60 Gy. DVH of organs at risk resulted in a median D2cc of external beam and brachytherapy dose (% of brachytherapy prescription): bladder, 75Gy{sub 3} (88%); rectum, 70Gy{sub 3} (87%); and sigmoid, 56Gy{sub 3} (41%). All patients experienced either a Grade 1 or 2 acute toxicity related to the radiation; only 1 patient had Grade 3 toxicity. No toxicities were attributable to the use of MR guidance. Conclusions: Real-time MR guidance during the insertion of interstitial needles reduces the likelihood of an inadvertent insertion of the needles into the bladder and the rectum. Three-dimensional dosimetry allows estimation of the dose to organs at risk. Toxicities are limited.

  9. Impact of chemoradiotherapy on vaginal and sexual function of patients with FIGO IIb cervical cancer

    PubMed Central

    Ljuca, Dženita; Maroševi?, Goran

    2011-01-01

    The opinion regarding sexual and vaginal function of patients with advanced cervical cancer treated primarily by chemoradiotherapy has still not been formed, mainly due to inappropriate methodology as the control group was comprised of healthy women. The aim of this study is to, by means of interview, evaluate vaginal and sexual function of patients with advanced cervical cancer before and after chemoradiotherapy and compare the results. A number of 35 patients were irradiated by teleradiotherapy dose of 45 Gy in 25 fractions over 5 weeks to the pelvis and additional 20-24 Gy in 4-6 fractions were given by intracavitary HDR brachytherapy. Patients received 40 mg/m2 of cisplatin once a week, which is a total of 4-6 cycles of cisplatin. Patients answered the questions in a form of a questionnaire specifically created for cervical cancer (EORTC-QLQ-Cx 24), for the period immediately before diagnosed cervical cancer (thus being a control group). They also answered the same questions for the period starting 12 months after the completion of concomitant chemoradiotherapy, and were an experimental group at the time. For the testing of statistical significance of differences among the examined groups parameter and non-parameter tests were used (the Wilcoxon signed ranks test and Student’s t-test). The difference p<0.05 was considered statistically significant. Vaginal problems of patients after chemoradiotherapy were statistically reduced (44 versus 0; p<0.0001). There is no statistical significance in the vaginal function among the analyzed groups but weaker pain during intercourse was registered after chemoradiotherapy (p=0.009). After chemoradiotherapy, patients’ vaginal function is extremely improved whereas there is no difference in the sexual function. Pain during intercourse is statistically reduced after chemoradiotherapy. PMID:21342145

  10. Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate

    PubMed Central

    Kanayama, Naoyuki; Isohashi, Fumiaki; Yoshioka, Yasuo; Baek, Sungjae; Chatani, Masashi; Kotsuma, Tadayuki; Tanaka, Eiichi; Yoshida, Ken; Seo, Yuji; Suzuki, Osamu; Mabuchi, Seiji; Shiki, Yasuhiko; Tatsumi, Keiji; Kimura, Tadashi; Teshima, Teruki; Ogawa, Kazuhiko

    2015-01-01

    The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1–169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III–IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge. PMID:25614068

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  12. Management of Rotator Cuff and Impingement Injuries in the Athlete

    PubMed Central

    Williams, Gerald R.; Kelley, Martin

    2000-01-01

    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. PMID:16558644

  13. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

    PubMed

    Seitz, Amee L; McClure, Philip W; Finucane, Sheryl; Boardman, N Douglas; Michener, Lori A

    2011-01-01

    The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes. PMID:20846766

  14. The vaginal microbiome: rethinking health and diseases

    PubMed Central

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

    2013-01-01

    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. PMID:22746335

  15. Primary Vaginal Cancer Treated With Concurrent Chemoradiation Using Cis-Platinum

    SciTech Connect

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

    2007-11-01

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

  16. Fluconazole Susceptibility of Vaginal Isolates Obtained from Women with Complicated Candida Vaginitis: Clinical Implications

    Microsoft Academic Search

    J. D. Sobel; M. Zervos; B. D. Reed; T. Hooton; D. Soper; P. Nyirjesy; M. W. Heine; J. Willems; H. Panzer

    2003-01-01

    Despite considerable evidence of azole resistance in oral candidiasis due to Candida species, little is known about the azole susceptibilities of the genital tract isolates responsible for vaginitis. The fluconazole suscep- tibilities of vaginal isolates obtained during a multicenter study of 556 women with complicated Candida vaginitis were determined by evaluating two fluconazole treatment regimens. Of 393 baseline isolates of

  17. Results of tension-free vaginal tape in patients with or without vaginal hysterectomy

    Microsoft Academic Search

    Louis Jeffry; Bruno Deval; Anca Birsan; Olivier Kadoch; David Soriano

    2002-01-01

    Objective: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. Study design: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under

  18. The changing landscape of the vaginal microbiome.

    PubMed

    Huang, Bernice; Fettweis, Jennifer M; Brooks, J Paul; Jefferson, Kimberly K; Buck, Gregory A

    2014-12-01

    Deep sequence analysis of the vaginal microbiome is revealing an unexpected complexity that was not anticipated as recently as several years ago. The lack of clarity in the definition of a healthy vaginal microbiome, much less an unhealthy vaginal microbiome, underscores the need for more investigation of these phenomena. Some clarity may be gained by the careful analysis of the genomes of the specific bacteria in these women. Ongoing studies will clarify this process and offer relief for women with recurring vaginal maladies and hope for pregnant women to avoid the experience of preterm birth. PMID:25439274

  19. 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 ...

  20. Is a Vaginal Birth Possible After a Cesarean Delivery?

    MedlinePLUS

    ... Resources and Publications En Español Is a vaginal birth possible after a cesarean delivery? Skip sharing on social media links Share this: Page Content Vaginal birth after cesarean (VBAC) describes vaginal delivery by a ...

  1. Multicatheter Device for Brachytherapy Treatment

    NASA Astrophysics Data System (ADS)

    Velasco, Carlos; Gueye, Paul; Keppel, Cynthia

    2007-03-01

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

  2. Thromboembolic events following brachytherapy: case reports

    PubMed Central

    Guy, Jean-Baptiste; Chargari, Cyrus; Bertoletti, Laurent; Magné, Nicolas

    2015-01-01

    Pulsed-dose-rate (PDR) brachytherapy is a recent brachytherapy modality combining the radiobiological advantages of low-dose-rate (LDR) brachytherapy with increased possibilities of dose optimization and radiation safety. However, treatment duration remains protracted, as the prescribed dose is typically delivered through pulses that do not exceed 0.5 Gy/h for critical organs. It is frequently used for the treatment of gynaecological malignancies. Although, the relationship between thrombosis and cancer is well known, specific data on thromboembolic events during brachytherapy are scarce. We report two cases of major thromboembolic events during brachytherapy treatment for gynaecological malignancies. We discuss the possible causal relationship between brachytherapy procedures and the occurrence of thromboembolic events, drawing a preventive practical attitude.

  3. Dual-camera technique for arthroscopic rotator cuff repair.

    PubMed

    Tuttle, John R; Ramos, Paul; DaSilva, Manuel F

    2014-12-01

    An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications. PMID:25685668

  4. Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

    PubMed Central

    Tuttle, John R.; Ramos, Paul; DaSilva, Manuel F.

    2014-01-01

    An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications. PMID:25685668

  5. CT-Based Interstitial HDR Brachytherapy

    Microsoft Academic Search

    Christos Kolotas; Dimos Baltas; Nikolaos Zamboglou

    1999-01-01

    Purpose: Development, application and evaluation of a CT-guided implantation technique and a fully CT-based treatment planning procedure for brachytherapy. Methods and Materials: A brachytherapy procedure based on CT-guided implantation technique and CT-based treatment planning has been developed and clinical evaluated. For this purpose a software system (PROMETHEUS) for the 3D reconstruction of brachytherapy catheters and patient anatomy using only CT

  6. Image-based brachytherapy for cervical cancer.

    PubMed

    Vargo, John A; Beriwal, Sushil

    2014-12-10

    Cervical cancer is the third most common cancer in women worldwide; definitive radiation therapy and concurrent chemotherapy is the accepted standard of care for patients with node positive or locally advanced tumors > 4 cm. Brachytherapy is an important part of definitive radiotherapy shown to improve overall survival. While results for two-dimensional X-ray based brachytherapy have been good in terms of local control especially for early stage disease, unexplained toxicities and treatment failures remain. Improvements in brachytherapy planning have more recently paved the way for three-dimensional image-based brachytherapy with volumetric optimization which increases tumor control, reduces toxicity, and helps predict outcomes. Advantages of image-based brachytherapy include: improved tumor coverage (especially for large volume disease), decreased dose to critical organs (especially for small cervix), confirmation of applicator placement, and accounting for sigmoid colon dose. A number of modalities for image-based brachytherapy have emerged including: magnetic resonance imaging (MRI), computed tomography (CT), CT-MRI hybrid, and ultrasound with respective benefits and outcomes data. For practical application of image-based brachytherapy the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology Working Group and American Brachytherapy Society working group guideline serve as invaluable tools, additionally here-in we outline our institutional clinical integration of these guidelines. While the body of literature supporting image-based brachytherapy continues to evolve a number of uncertainties and challenges remain including: applicator reconstruction, increasing resource/cost demands, mobile four-dimensional targets and organs-at-risk, and accurate contouring of "grey zones" to avoid marginal miss. Ongoing studies, including the prospective EMBRACE (an international study of MRI-guided brachytherapy in locally advanced cervical cancer) trial, along with continued improvements in imaging, contouring, quality assurance, physics, and brachytherapy delivery promise to perpetuate the advancement of image-based brachytherapy to optimize outcomes for cervical cancer patients. PMID:25493230

  7. Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy

    Microsoft Academic Search

    Ioannis K. Sarris; Nicholas G. Papadimitriou; Dean G. Sotereanos

    2003-01-01

    Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24–48 months), and the average age was 71 years (range, 57–84 years). Of these 14 patients, 9

  8. Advances in biology and mechanics of rotator cuff repair.

    PubMed

    Lorbach, Olaf; Baums, Mike H; Kostuj, Tanja; Pauly, Stephan; Scheibel, Markus; Carr, Andrew; Zargar, Nasim; Saccomanno, Maristella F; Milano, Giuseppe

    2015-02-01

    High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair. Level of evidence Expert opinion, Level V. PMID:25573661

  9. Supracervical hysterectomy – the vaginal route

    PubMed Central

    Cie?lak, Jaros?aw; Malinowski, Andrzej

    2014-01-01

    Removal of the cervix during hysterectomy is not mandatory. There has been no irrefutable evidence so far that total hysterectomy is more beneficial to patients in terms of pelvic organ function. The procedure that leaves the cervix intact is called a subtotal hysterectomy. Traditional approaches to this surgery include laparoscopic and abdominal routes. Vaginal total hysterectomy has been proven to present many advantages over the other approaches. Therefore, it seems that this route should also be applied in the case of subtotal hysterectomy. We present 9 cases of patients who underwent subtotal hysterectomy performed through the vagina for benign gynecological diseases. PMID:25097688

  10. [Rotator cuff tear of the hip].

    PubMed

    Jeanneret, Luc; Kurmann, Patric T; van Linthoudt, Daniel

    2008-05-14

    We report the observations of two women with a recurrent periarthritis of the hip complicated by a spontaneous rupture of the tendons of the gluteus medius and minimus. These patients usually complain from an acute lateral hip pain and show a Trendelenburg gait. When the rupture is complete, clinical evaluation reveals a drop of the pelvis on the non-stance side and resisted rotation starting from the extreme external rotation position is weak. MRI plays a key role in the diagnosis and the evaluation of a possible surgical repair. Hip rotator-cuff rupture is probably insufficiently diagnosed by ignorance. Nonetheless, optimized handling could relieve the pain of most these patients and improve the disability of some of them. PMID:18561829

  11. Management of complications after rotator cuff surgery.

    PubMed

    Parada, Stephen A; Dilisio, Matthew F; Kennedy, Colin D

    2015-03-01

    Rotator cuff repair (RCR) is a common procedure performed by orthopedic surgeons via arthroscopic, open, or mini-open techniques. While this surgery is considered to be of low morbidity, several potential complications can arise either intraoperatively or during the postoperative time period. Some of these complications are related to the surgical approach (arthroscopic or open), while others are patient dependent. Many of these complications can be managed through nonoperative means; however, early recognition and timely treatment is essential in limiting the long-term sequela and improving patient outcome. There are several different ways to classify complications after RCR repair: timing, severity, preventability, whether or not the pathology is intra- or extra-articular, and the type of treatment necessary. It is essential that the surgeon is cognizant of the etiology contributing to the failed RCR surgery in order to provide timely and proper management. PMID:25532916

  12. Improved apparatus for predictive diagnosis of rotator cuff disease

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  13. Suprascapular Nerve: Is It Important in Cuff Pathology?

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

    2014-01-01

    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. PMID:24973955

  15. Effect of vaginal or systemic estrogen on dynamics of collagen assembly in the rat vaginal wall.

    PubMed

    Montoya, T Ignacio; Maldonado, P Antonio; Acevedo, Jesus F; Word, R Ann

    2015-02-01

    The objective of this study was to compare the effects of systemic and local estrogen treatment on collagen assembly and biomechanical properties of the vaginal wall. Ovariectomized nulliparous rats were treated with estradiol or conjugated equine estrogens (CEEs) either systemically, vaginal CEE, or vaginal placebo cream for 4 wk. Low-dose local CEE treatment resulted in increased vaginal epithelial thickness and significant vaginal growth without uterine hyperplasia. Furthermore, vaginal wall distensibility increased without compromise of maximal force at failure. Systemic estradiol resulted in modest increases in collagen type I with no change in collagen type III mRNA. Low-dose vaginal treatment, however, resulted in dramatic increases in both collagen subtypes whereas moderate and high dose local therapies were less effective. Consistent with the mRNA results, low-dose vaginal estrogen resulted in increased total and cross-linked collagen content. The inverse relationship between vaginal dose and collagen expression may be explained in part by progressive downregulation of estrogen receptor-alpha mRNA with increasing estrogen dose. We conclude that, in this menopausal rat model, local estrogen treatment increased total and cross-linked collagen content and markedly stimulated collagen mRNA expression in an inverse dose-effect relationship. High-dose vaginal estrogen resulted in downregulation of estrogen receptor-alpha and loss of estrogen-induced increases in vaginal collagen. These results may have important clinical implications regarding the use of local vaginal estrogen therapy and its role as an adjunctive treatment in women with loss of vaginal support. PMID:25537371

  16. Vaginitis

    MedlinePLUS

    ... itching, burning, and pain on the vulva. What causes it? » Last Updated Date: 11/15/2013 Last Reviewed Date: 05/21/2013 Related A-Z Topics Bacterial Vaginosis Contraception and Birth Control Sexually Transmitted Diseases (STDs) ...

  17. Local anesthesia for prostate brachytherapy

    Microsoft Academic Search

    Kent Wallner; Colleen Simpson; James Roof; Sandy Arthurs; Tammy Korssjoen; Steven Sutlief

    1999-01-01

    Purpose: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only.Methods and Materials: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5\\/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic

  18. The use of improved radiochromic film for in vivo quality assurance of high dose rate brachytherapy.

    PubMed

    Pai, S; Reinstein, L E; Gluckman, G; Xu, Z; Weiss, T

    1998-07-01

    GAFChromic film has become increasingly popular for radiation dosimetry. In this study we explore the use of GAFChromic film as an in vivo dosimeter for quality assurance (QA) of fractionated high dose rate 192Ir treatments. Accuracy of dose distribution is explored for the simple vaginal cylinder geometry for which the dose can be easily calculated for comparison. Source dwell times for several patients were optimized to deliver 500 cGy at 0.5 cm from the surface of the vaginal cylinder applicator using a commercial treatment planning system. GAFChromic film was taped to the vaginal cylinder applicator and was enclosed in a leak proof rubber sleeve prior to its insertion. Optical densities were measured along the film at 2 mm spacing, using a densitometer with filtered red light. Density corrections for transient film darkening effects were made and optical densities were converted to absorbed dose in cGy. In vivo patient dose distribution measured for different patients and different fractions were compared with the calculated values along the applicator surface. The variation between the calculated and measured dose was +/- 10%. the reproducibility of dose measurement for different fraction was within +/- 5%. This study demonstrates the potential usefulness of the film as an in vivo for brachytherapy QA. PMID:9682209

  19. The behavior of rotator cuff tendon cells in three-dimensional culture

    E-print Network

    Gill, Harmeet (Harmeet Kaur)

    2007-01-01

    The rotator cuff is composed of the supraspinatus, infraspinatus, subcapularis, and teres minor tendons. Rotator cuff injuries are common athletic and occupational injuries that surgery cannot fully repair. Therefore tendon ...

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

    SciTech Connect

    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

    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.

  1. Large posterior vaginal cyst in pregnancy.

    PubMed

    Lallar, Meenakshi; Nandal, Rajesh; Sharma, Deepak; Shastri, Sweta

    2015-01-01

    A 20-year-old primigravida presented in labour with a mass protruding from her vagina during uterine contractions. The mass was a large tense cyst measuring 8 × 8 cm arising from the posterior vaginal wall. The cyst was present since puberty but increased in size during pregnancy. It collapsed following aspiration and uneventful vaginal delivery was conducted. Following delivery, the cyst was excised and vaginal wall repaired. On histopathology the cyst was identified as a Müllerian cyst. The patient recovered and remained asymptomatic on follow-up. PMID:25604504

  2. Vaginal rings for delivery of HIV microbicides

    PubMed Central

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

    2012-01-01

    Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing. PMID:23204872

  3. Angiomyofibroblastoma of the Vaginal Portion

    PubMed Central

    Fatusic, Jasenko; Hudic, Igor; Fatusic, Zlatan; Mustedanagic-Mujanovic, Jasminka

    2014-01-01

    Introduction: Angiomyofibroblastoma is a tumor which is consists of two components: blood vessels and stromal cells, with always prominent vascular component. Angiomyofibroblastoma is benign tumor, but in literature is reported a case of recurrence and one case with sarcomatous transformation, which shoved that these tumors may rarely be associated with malignant component. Case report: A 78-year-old multiparous housewife was hospitalized at University Clinical Center because of painless, asymptomatic tumor of vaginal portion (posterior side). Tumor size was 7 millimeters in diameter. Internal genital organs did not present abnormalities. The patient underwent operative removal of the tumor and went to home at some day. At the histological examination the tumor presented as a angiomyofibroblastoma cervices uteri. PMID:25648716

  4. Dynamic rotating-shield brachytherapy

    PubMed Central

    Liu, Yunlong; Flynn, Ryan T.; Kim, Yusung; Yang, Wenjun; Wu, Xiaodong

    2013-01-01

    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 D90 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 192Ir-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 D2cc 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 Ci192Ir source, and the average HR-CTV D90 was 78.9 Gy. In order to match the HR-CTV D90 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 D90 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 D90 over IS + ICBT and S-RSBT without violating the tolerance doses to the bladder, rectum, or sigmoid. The D90 improvements from D-RSBT depend on the patient, the delivery time budget, and the applicator structure. PMID:24320489

  5. Dynamic rotating-shield brachytherapy

    SciTech Connect

    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

    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.

  6. High dose rate brachytherapy for oral cancer.

    PubMed

    Yamazaki, Hideya; Yoshida, Ken; Yoshioka, Yasuo; Shimizutani, Kimishige; Furukawa, Souhei; Koizumi, Masahiko; Ogawa, Kazuhiko

    2013-01-01

    Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer. PMID:23179377

  7. The Results of Repair of Massive Tears of the Rotator Cuff

    Microsoft Academic Search

    CHRISTIAN GERBER; BRUNO FUCHS; JUERG HODLER

    2000-01-01

    Background: Massive tears of the tendons of the ro- tator cuff cause atrophy and fatty degeneration of the rotator cuff muscles and painful loss of function of the shoulder. Repair of massive rotator cuff tears is often followed by retears of the tendons, additional muscular degeneration, and a poor clinical outcome. The pur- poses of this study were to determine

  8. Cyclic Loading of Transosseous Rotator Cuff Repairs" Tension Overload as a Possible Cause of Failure

    E-print Network

    Athanasiou, Kyriacos

    failed first and by the largest magnitude. This study suggests that rotator cuff tears that are repairedCyclic Loading of Transosseous Rotator Cuff Repairs" Tension Overload as a Possible Cause. Athanasiou, Ph.D. Summary: Previous experimental studies of failure of rotator cuff repair have involved

  9. Cyclic Loading of Anchor-Based Rotator Cuff Repairs" Confirmation of the Tension Overload Phenomenon and

    E-print Network

    Athanasiou, Kyriacos

    Cyclic Loading of Anchor-Based Rotator Cuff Repairs" Confirmation of the Tension Overload experimental studies of failure of rotator cuff repair have involved single pull to ultimate load rotator cuff defects in 16 cadaver shoulders, repaired each defect with three Mitek- RC suture anchors

  10. An arthroscopic stitch for massive rotator cuff tears: the mac stitch

    Microsoft Academic Search

    John D. MacGillivray; C. Benjamin Ma

    2004-01-01

    Arthroscopic repair of rotator cuff tears has become popular with the advancement in technology and arthroscopic technique. As we attempt to arthroscopically repair larger rotator cuff tears, we are relying more on tissue fixation. The tendon–suture interface has been recognized as the weak link in rotator cuff repair. In this article, we propose the use of the Mac stitch—a simple

  11. Novel Nanofiber-Based Scaffold for Rotator Cuff Repair and Augmentation

    E-print Network

    Lu, Helen H.

    and Helen H. Lu, Ph.D.1,4 The debilitating effects of rotator cuff tears and the high incidence of failure and actively control shoulder kine- matics. Rotator cuff tears are among the most common in- juries afflictingNovel Nanofiber-Based Scaffold for Rotator Cuff Repair and Augmentation Kristen L. Moffat, M.S.,1

  12. Limited sensitivity of ultrasound for the detection of rotator cuff tears

    Microsoft Academic Search

    Cynthia L. Miller; David Karasick; Alfred B. Kurtz; John M. Fenlin

    1989-01-01

    Bilateral rotator cuff sonography was performed on 56 patients referred for shoulder arthrography to detect rotator cuff tears. Since one patient had bilateral arthrography there were 57 arthrograms. Twenty-seven shoulders had rotator cuff tears shown on arthrography, 15 of which were detected by sonography. Eleven were false negative by sonography, and one was indeterminate. Of the 30 shoulders with negative

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

    Microsoft Academic Search

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

    2002-01-01

    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

  14. Subacromial Internal Spacer for Rotator Cuff Tendon Repair: “The Balloon Technique”

    Microsoft Academic Search

    Alexandre S. Kilinc; Mohammad H. Ebrahimzadeh; Laurent Lafosse

    2009-01-01

    Lateral reattachment of the rotator cuff and the more recent introduction of the double-row rotator cuff repair technique require adequate visualization to define the rotator cuff footprint and the greater tuberosity. In many cases extensive debridement in this area is required to remove the overlying subdeltoid bursa, which can impair visualization laterally on the proximal humerus. Inadequate visualization laterally may

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

    Microsoft Academic Search

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

    2004-01-01

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

  16. Blood flow in a brachial artery compressed externally by a pneumatic cuff.

    PubMed

    Shimizu, M

    1992-02-01

    Blood flow in human brachial arteries, compressed by a pneumatic cuff for blood pressure measurement, is examined using several different noninvasive techniques. From the experimental results it is shown that, when arterial pressure distal to the cuff is always lower than cuff pressure, flow in the artery under the cuff becomes supercritical near the cuff downstream margin and no reflection occurs there and the reflected wave from the peripheral vascular system of the arm does not propagate beyond the cuff downstream margin. Therefore an unsteady transition from supercritical to subcritical flow occurs near the cuff downstream margin. When the peak value of distal arterial pressure exceeds cuff pressure, a reflection occurs near the cuff downstream margin. The reflection becomes stronger corresponding to decrement of the cuff pressure and the whole artery segment under the cuff inflates fully at systole. At diastole, however, the artery segment under the cuff does not collapse completely and, hence, the phenomenon becomes that of pressure wave propagation in a partially collapsed artery segment. PMID:1491590

  17. Vaginal indicators of amniotic fluid infection in preterm labor

    Microsoft Academic Search

    Jane Hitti; Sharon L Hillier; Kathy J Agnew; Marijane A Krohn; Dale P Reisner; David A Eschenbach

    2001-01-01

    Objective: To determine whether vaginal interleukin-6, interleukin-8, neutrophils, bacterial vaginosis, and selected vaginal bacteria are predictors of amniotic fluid (AF) infection among women in preterm labor.Methods: One hundred ninety-seven afebrile women in preterm labor with intact membranes had vaginal and AF samples collected for Gram stain, culture, and interleukin-8 and interleukin-6 determinations. Vaginal interleukin-6, interleukin-8, neutrophils, and vaginal flora were

  18. Leakage of fluid around endotracheal tube cuffs: a cadaver study

    PubMed Central

    Lucius, Ralph; Ewald, Kristian

    2013-01-01

    Background The aim of the study was to evaluate the leakage of liquid past the cuffs of tracheal tubes in fresh frozen human heads. Methods Six truncated fresh frozen heads were used and intubated with 8.0 mm endotracheal tubes. The intracuff pressures tested were 30 and 100 cmH2O. Subsequently, 20 ml of each of two oral antiseptic rinses (0.2% chlorhexidine and octenidine [octenidol®, Schülke & Mayr GmbH, Norderstedt, Germany]) was applied for thirty seconds in the mouth. During the trial, leakage of the cuffs was examined. Results The sealing between the tracheal cuff and tracheal wall was leakage-proof for all tested intracuff pressures and all tested antiseptic rinses. However, approximately 5.6 ml and 1.8 ml leaked into the esophagus and remained as a cuff-puddle, respectively. Conclusions The sealing between an endotracheal tube cuff with an intracuff pressure of 30 cmH2O and the tracheal wall is leakage-proof during oral care with antiseptic rinsing. An increase of intracuff pressure to 100 cmH2O does not appear to be required. PMID:24363847

  19. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...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 (performance...

  20. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...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 (performance...

  1. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...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 (performance...

  2. Vaginal childbirth and pelvic floor disorders

    PubMed Central

    Memon, Hafsa U; Handa, Victoria L

    2013-01-01

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

  3. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears

    Microsoft Academic Search

    Lawrence Bryant; Ron Shnier; Carl Bryant; George A. C Murrell

    2002-01-01

    This prospective study was undertaken to compare the ability of clinical estimation, diagnostic ultrasonography, magnetic resonance imaging, and arthroscopy to estimate the size of rotator cuff tears. Estimates of rotator cuff tear size were compared with the findings at open operation in 33 consecutive patients with a presumptive diagnosis of rotator cuff tear. Arthroscopy estimates of rotator cuff tear size

  4. Subacromial Spacer Placement for Protection of Rotator Cuff Repair

    PubMed Central

    Szöllösy, Gregor; Rosso, Claudio; Fogerty, Simon; Petkin, Kalojan; Lafosse, Laurent

    2014-01-01

    Rotator cuff repairs have a high failure rate proportional to the tear size. Various techniques have been described to improve the repair strength and failure rate. The described surgical technique uses a biodegradable subacromial balloon-shaped spacer (InSpace; OrthoSpace, Caesarea, Israel) that is implanted arthroscopically to protect our tendon repair. We describe the introduction technique and suggest some hints and tricks. The spacer is placed under direct vision in the subacromial space after the rotator cuff repair is finished. Correct placement is verified by moving the arm freely. The subacromial spacer may help to protect the rotator cuff repair by centering the humeral head and reducing friction between suture knots and the acromion. It may also help to flatten dog-ear formations. PMID:25473615

  5. An Augmentation Suture Technique for Arthroscopic Rotator Cuff Repair

    PubMed Central

    Omae, Hiromichi; Yamamoto, Susumu; Mochizuki, Yu; Ochi, Mitsuo

    2014-01-01

    The double-row suture technique and the suture-bridge technique have been used for rotator cuff repair to decrease the occurrence of retears. However, when only the degenerated tendon end is sutured, the risk of retear remains. The augmentation suture technique is a new procedure that connects the intact medial tendon to the lateral greater tuberosity, and this approach may protect the initial repair site. The procedures for this technique are as follows: 2 sutures are placed through the medial intact tendon, the cuff tear is repaired by the single-row technique, 2 sutures are pulled laterally over the single-row repair site, and 2 sutures are fixed at the lateral greater tuberosity with a push-in–type anchor. This technique is simple and easy and does not require special equipment. Moreover, this approach can augment the single-row repair technique without creating high tension at the cuff end. PMID:25126493

  6. Subacromial spacer placement for protection of rotator cuff repair.

    PubMed

    Szöllösy, Gregor; Rosso, Claudio; Fogerty, Simon; Petkin, Kalojan; Lafosse, Laurent

    2014-10-01

    Rotator cuff repairs have a high failure rate proportional to the tear size. Various techniques have been described to improve the repair strength and failure rate. The described surgical technique uses a biodegradable subacromial balloon-shaped spacer (InSpace; OrthoSpace, Caesarea, Israel) that is implanted arthroscopically to protect our tendon repair. We describe the introduction technique and suggest some hints and tricks. The spacer is placed under direct vision in the subacromial space after the rotator cuff repair is finished. Correct placement is verified by moving the arm freely. The subacromial spacer may help to protect the rotator cuff repair by centering the humeral head and reducing friction between suture knots and the acromion. It may also help to flatten dog-ear formations. PMID:25473615

  7. Effects of Wing-Cuff on NACA 23015 Aerodynamic Performances

    NASA Astrophysics Data System (ADS)

    Meftah, S. M. A.; Belhenniche, M.; Madani Fouatih, O.; Imine, B.

    2014-03-01

    The main subject of this work is the numerical study control of flow separation on a NACA 23015 airfoil by using wing cuff. This last is a leading edge modification done to the wing. The modification consists of a slight extension of the chord on the outboard section of the wings. Different numerical cases are considered for the baseline and modified airfoil NACA 23015 according at different angle of incidence. The turbulence is modeled by two equations k-epsilon model. The results of this numerical investigation showed several benefits of the wing cuff compared with a conventional airfoil and an agreement is observed between the experimental data and the present study. The most intriguing result of this research is the capability for wing cuff to perform short take-offs and landings.

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

    Microsoft Academic Search

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

    1999-01-01

    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

  9. Perivascular fluid cuffs decrease lung compliance by increasing tissue resistance

    PubMed Central

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

    2010-01-01

    Objective Lung inflammation causes perivascular fluid cuffs to form around extra-alveolar blood vessels; however, the physiologic consequences of such cuffs remain poorly understood. Herein, we tested the hypothesis that perivascular fluid cuffs, without concomitant alveolar edema, are sufficient to decrease lung compliance. Design Prospective, randomized, controlled study. Setting Research laboratory. Subjects One hundred twenty male CD40 rats. Interventions To test this hypothesis, the plant alkaloid thapsigargin was used to activate store-operated calcium entry and increase cytosolic calcium in endothelium. Thapsigargin was infused into a central venous catheter of intact, sedated, and mechanically ventilated rats. Measurements Static and dynamic lung mechanics and hemodynamics were measured continuously. Main Results Thapsigargin produced perivascular fluid cuffs along extra-alveolar vessels but did not cause alveolar flooding or blood gas abnormalities. Lung compliance dose-dependently decreased after thapsigargin infusion, attributable to an increase in tissue resistance that was attributed to increased tissue damping and tissue elastance. Airway resistance was not changed. Neither central venous pressure nor left ventricular end diastolic pressure was altered by thapsigargin. Heart rate did not change, although thapsigargin decreased pressure over time sufficient to reduce cardiac output by 50%. Infusion of the type 4 phosphodiesterase inhibitor, rolipram, prevented thapsigargin from inducing perivascular cuffs and decreasing lung compliance. Rolipram also normalized pressure over time and corrected the deficit in cardiac output. Conclusions Our findings resolve for the first time that perivascular cuff formation negatively impacts mechanical coupling between the bronchovascular bundle and the lung parenchyma, decreasing lung compliance without impacting central venous pressure. PMID:20400904

  10. Decision-making in massive rotator cuff tear.

    PubMed

    Thès, André; Hardy, Philippe; Bak, Klaus

    2015-02-01

    Treatment of massive rotator cuff tears has developed over many years ranging from conservative treatment to open and arthroscopic repair, muscle transfers and reversed arthroplasty. The evolution of more advanced techniques in arthroscopic repair has changed the treatment approach and improved the prognosis for functional outcome despite low healing rates. Due to this rapid development, our evidence-based knowledge today is mainly founded in Level 3 and Level 4 studies. Based on the literature, the current knowledge on treatment of symptomatic massive rotator cuff tears is proposed in an algorithm. Level of evidence V. PMID:25502477

  11. Adherence of Human Vaginal Lactobacilli to Vaginal Epithelial Cells and Interaction with Uropathogens

    Microsoft Academic Search

    SOLEDAD BORIS; JUAN E. SUAREZ; FERNANDO VAZQUEZ; COVADONGA BARBES

    1985-01-01

    Three strains of Lactobacillus, identified as Lactobacillus acidophilus, Lactobacillus gasseri, and Lactobacillus jensenii, were selected from among 70 isolates from the vaginas of healthy premenopausal women for properties relevant to mucosal colonization or antagonism. All three self-aggregated and adhered to epithelial vaginal cells, displacing well-known vaginal pathogens, such as G. vaginalis, and inhibiting the growth in vitro of Escherichia coli

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

    PubMed

    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

    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

  13. Semaphorin 4D induces vaginal epithelial cell apoptosis to control mouse postnatal vaginal tissue remodeling.

    PubMed

    Ito, Takuji; Bai, Tao; Tanaka, Tetsuji; Yoshida, Kenji; Ueyama, Takashi; Miyajima, Masayasu; Negishi, Takayuki; Kawasaki, Takahiko; Takamatsu, Hyota; Kikutani, Hitoshi; Kumanogoh, Atsushi; Yukawa, Kazunori

    2015-02-01

    The opening of the mouse vaginal cavity to the skin is a postnatal tissue remodeling process that occurs at approximately five weeks of age for the completion of female genital tract maturation at puberty. The tissue remodeling process is primarily composed of a hormonally triggered apoptotic process predominantly occurring in the epithelium of the distal section of the vaginal cavity. However, the detailed mechanism underlying the apoptotic induction remains to be elucidated. In the present study, it was observed that the majority of BALB/c mice lacking the class 4 semaphorin, semaphorin 4D (Sema4D), developed imperforate vagina and hydrometrocolpos resulting in a perpetually unopened vaginal cavity regardless of a normal estrogen level comparable with that in wild?type (WT) mice. Administration of ??estradiol to infant Sema4D?deficient (Sema4D?/?) mice did not induce precocious vaginal opening, which was observed in WT mice subjected to the same ??estradiol administration, excluding the possibility that the closed vaginal phenotype was due to insufficient estrogen secretion at the time of vaginal opening. In order to assess the role of Sema4D in the postnatal vaginal tissue remodeling process, the expression of Sema4D and its receptor, plexin?B1, was examined as well as the level of apoptosis in the vaginal epithelia of five?week?old WT and Sema4D?/? mice. Immunohistochemical analyses confirmed the localization of Sema4D and plexin?B1 in the mouse vaginal epithelia. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay and immunohistochemistry detecting activated caspase?3 revealed significantly fewer apoptotic cells in situ in the vaginal mucosa of five?week?old Sema4D?/? mice compared with WT mice. The addition of recombinant Sema4D to Sema4D?/? vaginal epithelial cells in culture significantly enhanced apoptosis of the vaginal epithelial cells, demonstrating the apoptosis?inducing activity of Sema4D. The experimental reduction of plexin?B1 expression in vaginal epithelial cells demonstrated the integral role of plexin?B1 in Sema4D?induced apoptotic cell death. These results suggest a non?redundant role of Sema4D in the postnatal tissue remodeling process in five?week?old BALB/c mice, which involves the induction of vaginal epithelial cell apoptosis through Sema4D binding to plexin?B1. PMID:25351707

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

    PubMed

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

    2013-01-01

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

  15. HDR brachytherapy for anal cancer

    PubMed Central

    Kovács, Gyoergy

    2014-01-01

    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

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

    SciTech Connect

    Maruyama, Y.

    1986-01-01

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

  17. Brachytherapy in India – a long road ahead

    PubMed Central

    Mahantshetty, Umesh; Shrivastava, Shyamkishore

    2014-01-01

    Brachytherapy can play a very important role in the definitive cure by radiation therapy in India. However, except for in a handful of centres, the majority of hospitals use it only for intracavitary treatment. The most probable reasons for such are the lack of logistical resources in terms of trained personal and supporting staff, rather than lack of radiotherapy machines and equipment. In this article, the authors look into the various aspects of brachytherapy in India: from its beginning to present days. The authors point out the resources available, shortcomings, and some possible solutions to make use of brachytherapy more popular and effective. Apart from presenting a picture of the present scenario, the article pays attention to the positive signs of brachytherapy becoming more popular in the near future. PMID:25337139

  18. Current Status of Brachytherapy for Prostate Cancer

    PubMed Central

    2012-01-01

    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. PMID:23185664

  19. A comprehensive review of vaginitis phytotherapy.

    PubMed

    Azimi, Hanieh; Fallah-Tafti, Mehrnaz; Karimi-Darmiyan, Maliheh; Abdollahi, Mohammad

    2011-11-01

    To overview phytotherapy of vaginitis in order to identify new approaches for new pharmacological treatments. All related literature databases were searched for herbal medicinal treatment in vaginitis. The search terms were plant, herb, herbal therapy, phytotherapy, vaginitis, vaginal, anti-candida, anti-bacterial and anti-trichomonas. All of the human, animal and in vitro studies were included. Anti-candida, anti-bacterial and anti-trichomonas effects were the key outcomes. The plants including carvacrol, 1,8-cineole, geranial, germacrene-D, limonene, linalool, menthol, terpinen-4-ol and thymol exhibited anti-candida effects. A very low concentration of geranium oil and geraniol blocked mycelial growth, but not yeast. Tea tree oil including terpinen-4-ol, alpha-terpinene, gamma-terpinene and alpha-terpineol showed anti-bacterial, anti-fungal and anti-protozoal properties against trichomonas. Allium hirtifolium (persian shallot) comparable to metronidazole exhibited anti-trichomonas activity due to its components such as allicin, ajoene and other organosulfides. The plants having beneficial effects on vaginitis encompass essential oils that clear the pathway that future studies should be focused to standardize theses herbs. PMID:22514885

  20. Diagnosis and treatment of anterosuperior rotator cuff tears

    Microsoft Academic Search

    Jon J. P. Warner; Laurence Higgins; I. M. Parsons; Paul Dowdy

    2001-01-01

    Nineteen of 407 patients who underwent rotator cuff repair surgery over a 6-year period were found to have a tear of the subscapularis in combination with the supraspinatus and infraspinatus tendons. Nine of these patients had an unsuccessful prior surgery, which failed to recognize the extent of the subscapularis component. Surgical repair of the subscapularis tendon required a deltopectoral approach,

  1. Muscle progenitor cell regenerative capacity in the torn rotator cuff.

    PubMed

    Meyer, Gretchen A; Farris, Ashley L; Sato, Eugene; Gibbons, Michael; Lane, John G; Ward, Samuel R; Engler, Adam J

    2015-03-01

    Chronic rotator cuff (RC) tears affect a large portion of the population and result in substantial upper extremity impairment, shoulder weakness, pain, and limited range of motion. Regardless of surgical or conservative treatment, persistent atrophic muscle changes limit functional restoration and may contribute to surgical failure. We hypothesized that deficits in the skeletal muscle progenitor (SMP) cell pool could contribute to poor muscle recovery following tendon repair. Biopsies were obtained from patients undergoing arthroscopic RC surgery. The SMP population was quantified, isolated, and assayed in culture for its ability to proliferate and fuse in vitro and in vivo. The SMP population was larger in muscles from cuffs with partial tears compared with no tears or full thickness tears. However, SMPs from muscles in the partial tear group also exhibited reduced proliferative ability. Cells from all cuff states were able to fuse robustly in culture and engraft when injected into injured mouse muscle, suggesting that when given the correct signals, SMPs are capable of contributing to muscle hypertrophy and regeneration regardless of tear severity. The fact that this does not appear to happen in vivo helps focus future therapeutic targets for promoting muscle recovery following rotator cuff repairs and may help improve clinical outcomes. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:???-???, 2015. PMID:25410765

  2. Reversed arthroscopic subacromial decompression for massive rotator cuff tears

    Microsoft Academic Search

    Markus Scheibel; Sven Lichtenberg; Peter Habermeyer

    2004-01-01

    This prospective study evaluates the results of a procedure for massive rotator cuff tears that we term reversed arthroscopic subacromial decompression (ASD). The procedure includes an arthroscopic debridement of the subacromial space and glenohumeral joint, an arthroscopic tuberoplasty, and depending on the pathologic condition of the long head of the biceps, a biceps tendon tenotomy. Reversed ASD avoids a classic

  3. The Factors Affecting Pain Pattern after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Kim, Chang-Wan; Kim, Dong-Gyun

    2014-01-01

    Background We evaluated the factors that affect pain pattern after arthroscopic rotator cuff repair. Methods From June 2009 to October 2010, 210 patients underwent arthroscopic rotator cuff repair operations. Of them, 84 patients were enrolled as subjects of the present study. The evaluation of postoperative pain was conducted by visual analog scale (VAS) scores during postoperative outpatient interviews at 6 weeks, 3 months, 6 months, and 12 months. The factors that were thought to affect postoperative pain were evaluated by dividing into three categories: preoperative, operative, and postoperative. Results Pain after arthroscopic rotator cuff repair surgery showed a strictly decreasing pain pattern. In single analysis and multiple regression tests for factors influencing the strictly decreasing pain pattern, initial VAS and pain onset were shown to be statistically significant factors (p = 0.012, 0.012, 0.044 and 0.028, respectively). With regard to the factors influencing lower than average intensity pain pattern for each period, the stiffness of internal rotation at 3 months postoperatively was shown to be a statistically significant factor in single and multiple regression tests (p = 0.017 and p = 0.004, respectively). Conclusions High initial VAS scores and the acute onset of pain affected the strictly decreasing postoperative pain pattern. Additionally, stiffness of internal rotation at postoperative 3 months affected the higher than average intensity pain pattern for each period after arthroscopic rotator cuff repair. PMID:25436062

  4. Rotator cuff tear —Relationship between clinical and anatomopathological findings

    Microsoft Academic Search

    N. Gschwend; D. Ivoševi?-Radovanovi?; D. Patte

    1987-01-01

    Rotator cuff tears (RCT) are frequent and increase with age. Why do only a relatively small percentage cause a permanent severe handicap justifying surgery? Is there a relationship between size and site of the tear and the clinical symptoms? How do they influence the postoperative result? These questions were answered in a prospective study of 76 operated patients. We adopted

  5. Anatomical Considerations of the Suprascapular Nerve in Rotator Cuff Repairs

    PubMed Central

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

    2014-01-01

    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. PMID:24724030

  6. The influence of acromioclavicular joint morphology on rotator cuff tears

    Microsoft Academic Search

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

    1998-01-01

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

  7. Arthroscopic Technique for Patch Augmentation of Rotator Cuff Repairs

    Microsoft Academic Search

    Marc R. Labbé

    2006-01-01

    The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a “T” or an “L.” The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the

  8. Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: appearance of lactobacillus in vaginal flora followed by term delivery.

    PubMed

    Otsuki, Katsufumi; Tokunaka, Mayumi; Oba, Tomohiro; Nakamura, Masamitsu; Shirato, Nahoko; Okai, Takashi

    2014-02-01

    Lactoferrin (LF) is one of the prebiotics present in the human body. A 38-year-old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared. PMID:24118573

  9. Clinical implementation of a new electronic brachytherapy system for skin brachytherapy

    PubMed Central

    Ballester-Sánchez, Rosa; Celada-Álvarez, Francisco Javier; Candela-Juan, Cristian; García-Martínez, Teresa; Llavador-Ros, Margarita; Botella-Estrada, Rafael; Barker, Christopher A.; Ballesta, Antonio; Tormo-Micó, Alejandro; Rodríguez, Silvia; Perez-Calatayud, Jose

    2014-01-01

    Although surgery is usually the first-line treatment for nonmelanoma skin cancers, radiotherapy (RT) may be indicated in selected cases. Radiation therapy as primary therapy can result in excellent control rates, cosmetics, and quality of life. Brachytherapy is a radiation treatment modality that offers the most conformal option to patients. A new modality for skin brachytherapy is electronic brachytherapy. This involves the placement of a high dose rate X-ray source directly in a skin applicator close to the skin surface, and therefore combines the benefits of brachytherapy with those of low energy X-ray radiotherapy. The Esteya electronic brachytherapy system is specifically designed for skin surface brachytherapy procedures. The purpose of this manuscript is to describe the clinical implementation of the new Esteya electronic brachytherapy system, which may provide guidance for users of this system. The information covered includes patient selection, treatment planning (depth evaluation and margin determination), patient marking, and setup. The justification for the hypofractionated regimen is described and compared with others protocols in the literature. Quality assurance (QA) aspects including daily testing are also included. We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment. We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers.

  10. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Records of brachytherapy source accountability...Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2406 Records of brachytherapy source...

  11. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Records of brachytherapy source accountability...Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2406 Records of brachytherapy source...

  12. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Records of brachytherapy source accountability...Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2406 Records of brachytherapy source...

  13. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Records of brachytherapy source accountability...Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2406 Records of brachytherapy source...

  14. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Records of brachytherapy source accountability...Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2406 Records of brachytherapy source...

  15. Optimization of intravascular brachytherapy treatment planning in peripheral arteries

    E-print Network

    Paris-Sud XI, Université de

    Optimization of intravascular brachytherapy treatment planning in peripheral arteries Zhengdong brachytherapy (IVB) in peripheral arteries. The objective is both to quantitatively study the validity solution to avoid iterative redilations practiced after minimally invasive treatment of peripheral arterial

  16. What Should You Ask Your Doctor about Vaginal Cancer?

    MedlinePLUS

    ... for vaginal cancer? What should you ask your doctor about vaginal cancer? It’s important to have honest, ... cancer care team. Keep in mind, too, that doctors are not the only ones who can provide ...

  17. Vaginitis: How Many Women Are Affected/at Risk?

    MedlinePLUS

    ... and Publications How many women are affected/at risk? Skip sharing on social media links Share this: ... trichomoniasis. Who gets vaginitis and who is at risk? Vaginitis affects women of all ages, races, and ...

  18. Necrotizing ruptured vaginal leiomyoma mimicking a malignant neoplasm

    PubMed Central

    Sim, Chae Hee; Lee, Jin Hee; Kwak, Jyung Sik

    2014-01-01

    Leiomyomas are common benign uterine tumors. However, the incidence of vaginal myoma is very rare and may be confused with a variety of vaginal tumors. We report a case of 43-year-old nulligravida who presented with a protruding painful vaginal mass for 7 days. The mass had initially appeared 3 years prior, as 2 to 3 cm that had not subsequently increased. However suddenly, there was rapid severe enlargement over the course of 7 days. Physical exam revealed a monstrous shaped, black color with focal necrosis, odorous protruding vaginal mass about 7 cm in size. The vaginal mass was infected and degenerated. And vaginal wall was also destroyed by the enlarged mass. Because of the clinical features and radiologic findings, the preoperative diagnosis was a vaginal malignancy. We reported an extremely rare case of vaginal myoma that had several characteristics of malignancy, with a brief review of the literature. PMID:25469351

  19. [Vaginal sonography versus vaginal palpation: initial experiences in 120 pregnant patients with suspected cervix insufficiency].

    PubMed

    Böhmer, S; Degenhardt, F; Gerlach, C; Jagla, K; Schneider, J

    1989-01-01

    In a clinical study a group of pregnant women with suspected cervical incompetence was examined by vaginal sonography. Aim of the investigation was to compare results of performed vaginal palpation with results of sonography. 120 pregnant women with cervical insufficiency between 16th and 33rd week of gestation were examined by a 5-MHz vaginal sectorscanner probe. After focussing sagittal projection of uterine cervix and lower uterine segment the cervical length and opening of the internal os were assessed prior to cerclage. Postoperative vaginal sonography was performed to ascertain lengthening and stabilization of the incompetent cervix. Another group of 50 pregnant women with unsuspicious obstetrical findings were also examined to gain information about normal sonographical morphology and length of the competent uterine cervix. Comparing results of vaginal palpation and vaginal sonography showed, that the cervical length obtained by sonography was constantly higher in all patients than the results obtained by palpation. This difference became more distinct in the group of patients with extreme cervical incompetence. We are of the opinion that vaginal sonography is an objective method revealing the extent of cervical incompetence. Exact measurement of the cervical length and assessment of the internal os are efficient diagnostic criteria. They complete results of cervical palpation and offer precise information concerning an intended cerclage. In case of suspected cervical incompetence continuous sonographical examination can supervise the development of the uterine cervix during pregnancy. In future the number of prophylactic cerclage-operations perhaps decreases by using the technique of transvaginal sonography. PMID:2669397

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

    PubMed Central

    Köse, Osman; Sa?lam, Hasan S.; Kumsar, ?ükrü; Budak, Salih; Adsan, Öztu?

    2013-01-01

    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. PMID:23476121

  1. Isolated subscapularis repair for massive rotator cuff tear.

    PubMed

    Austin, Luke; Chang, Edward S; Zmistowski, Benjamin; Nydick, Jason; Lazarus, Mark

    2014-11-01

    The best surgical treatment for an irreparable rotator cuff tear is controversial. In such cases, partial rotator cuff repair, primarily involving the posterior cuff in most reports, has been shown to be beneficial. The authors retrospectively investigated 41 patients who underwent arthroscopic subscapularis-only repair and greater tuberoplasty between April 2003 and August 2009 for massive 3-tendon cuff tears with irreparable supraspinatus and infraspinatus tendons after 3 months of conservative management was unsuccessful. Twenty-five patients (61%) underwent biceps tenotomy, and the remaining 39% had preexisting biceps tenotomy or rupture. The patients were assessed with American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Of the 41 patients, 34 (83%) were available for a follow-up telephone questionnaire after a minimum of 12 months (mean, 35 months; range, 12-84 months). Mean ASES and SANE scores were 76% and 63%, respectively. Mean postoperative passive range of motion was 156° of forward flexion and 39° of external rotation. Of the patients queried, 74% (25 of 34) were able to actively raise their arms above shoulder level. For those with a positive belly-press test result preoperatively, 22 of 27 patients had a negative test result postoperatively. A total of 3 complications (7.3%) occurred. Workers' compensation claim was a strong predictor of lower shoulder scores. Arthroscopic subscapularis-only repair and greater tuberoplasty may offer a promising and safe method for treating massive rotator cuff tears when the supra-spinatus and infraspinatus tendons are irreparable. Workers' compensation claim may predict lower outcome scores. PMID:25361371

  2. Dose-Response Evaluation of Braslet-M Occlusion Cuffs

    NASA Technical Reports Server (NTRS)

    Ebert, Douglas; Garcia, Kathleen; Sargsyan, Ashot E.; Ham, David; Hamilton, Douglas; Dulchavsky, Scott A.

    2010-01-01

    Introduction: Braslet-M is a set of special elasticized thigh cuffs used by the Russian space agency to reduce the effects of the head-ward fluid shift during early adaptation to microgravity by sequestering fluid in the lower extremities. Currently, no imaging modalities are used in the calibration of the device, and the pressure required to produce a predictable physiological response is unknown. This investigation intends to relate the pressure exerted by the cuffs to the extent of fluid redistribution and commensurate physiological effects. Materials and Methods: Ten healthy subjects with standardized fluid intake participated in the study. Data collection included femoral and internal jugular vein imaging in two orthogonal planes, pulsed Doppler of cervical and femoral vessels and middle cerebral artery, optic nerve imaging, and echocardiography. Braslet-M cuff pressure was monitored at the skin interface using pre-calibrated pressure sensors. Using 6 and 30 head-down tilt in two separate sessions, the effect of Braslet-M was assessed while incrementally tightening the cuffs. Cuffs were then simultaneously released to document the resulting hemodynamic change. Results: Preliminary analysis shows correlation between physical pressure exerted by the Braslet-M device and several parameters such as jugular and femoral vein cross-sections, resistivity of the lower extremity vascular bed, and others. A number of parameters reflect blood redistribution and will be used to determine the therapeutic range of the device and to prevent unsafe application. Conclusion: Braslet-M exerts a physical effect that can be measured and correlated with many changes in central and peripheral hemodynamics. Analysis of the full data set will be required to make definitive recommendations regarding the range of safe therapeutic application. Objective data and subjective responses suggest that a safer and equally effective use of Braslet can be achieved when compared with the current non-imaging calibration techniques.

  3. Biofilm formation by vaginal Lactobacillus in vivo.

    PubMed

    Ventolini, G; Mitchell, E; Salazar, M

    2015-05-01

    Biofilm formation by nonpathogenic bacteria is responsible for their stable maintenance in vivo ecosystems as it promotes long-term permanence on the host's vaginal mucosa. Biofilm formation by Lactobacilli has been reported in vitro but not in vivo. We hypothesize the presence of biofilm formation in vivo could be also documented by microscope photographs (MP) of wet mounts obtained from uninfected vaginal samples satisfying rigorous scientific identification criteria. We analyzed 400 MP from our database, and we were able to determine that 12 MP from 6 different patients contained clues of the formation of biofilm by Lactobacilli. The most probable lactobacillus involved is presumed to be Lactobacillus jensenii. The documentation of biofilm formation by vaginal Lactobacilli at fresh wet mount preparation is significant and has several important clinical preventive and therapeutic implications. PMID:25725906

  4. Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure

    PubMed Central

    Woods, Tom C; Carroll, Michael J; Nelson, Atiba A; More, Kristie D; Berdusco, Randa; Sohmer, Stephen; Boorman, Richard S; Lo, Ian KY

    2014-01-01

    Purpose The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA) lesions. Patients and methods Patients in the senior author’s practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8) and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months) postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test). All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram. Results There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2) and Simple Shoulder Test (4.6±3.2 to 10.1±3.8) scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect. Conclusion Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair. PMID:25114604

  5. A Comparison of Conventional Ultrasonography and Arthrosonography in the Assessment of Cuff Integrity after Rotator Cuff Repair

    PubMed Central

    Lee, Kwang Won; Chun, Tong Jin; Bae, Kyoung Wan; Choy, Won Sik; Park, Hyeon Jong

    2014-01-01

    Background This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard. Methods We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography. Results The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear. Conclusions It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography. PMID:25177461

  6. The preterm prediction study: Significance of vaginal infections

    Microsoft Academic Search

    Paul J. Meis; Robert L. Goldenberg; Brian Mercer; Atef Moawad; Anita Das; Donald McNellis; Francee Johnson; Jay D. Iams; Elizabeth Thom; William W. Andrews

    1995-01-01

    OBJECTIVE: Our purpose was to evaluate the association of bacterial vaginosis, trichomonas vaginitis, and monilial vaginitis with spontaneous preterm birth at<35 weeks 0 days.STUDY DESIGN: A total of 2929 women at 10 centers were studied at 24 and 28 weeks' gestation by Gram stain of vaginal smear, wet mount, and 10% potassium hydroxide preparations to detect vaginal infections.RESULTS: The rates

  7. Anaerobes and Gardnerella vaginalis in non-specific vaginitis

    Microsoft Academic Search

    L V Hill

    1985-01-01

    Clinical evidence of bacterial vaginosis was present in 25 (35%) of 72 patients attending a London venereology clinic and correlated significantly with abnormal organic acids in vaginal secretions (24\\/25), with Gardnerella vaginalis on culture (17\\/25), with complaints of vaginal malodour (15\\/25), and with a relative scarcity of white blood cells in vaginal secretions. Anaerobic vaginal flora were presumptively identified by

  8. Pregnancy's Stronghold on the Vaginal Microbiome

    PubMed Central

    Walther-António, 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

    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. PMID:24896831

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

    Microsoft Academic Search

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

    2007-01-01

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

  10. The use of tetrahedral mesh geometries in Monte Carlo simulation of applicator based brachytherapy dose distributions.

    PubMed

    Fonseca, Gabriel Paiva; Landry, Guillaume; White, Shane; D'Amours, Michel; Yoriyaz, Hélio; Beaulieu, Luc; Reniers, Brigitte; Verhaegen, Frank

    2014-10-01

    Accounting for brachytherapy applicator attenuation is part of the recommendations from the recent report of AAPM Task Group 186. To do so, model based dose calculation algorithms require accurate modelling of the applicator geometry. This can be non-trivial in the case of irregularly shaped applicators such as the Fletcher Williamson gynaecological applicator or balloon applicators with possibly irregular shapes employed in accelerated partial breast irradiation (APBI) performed using electronic brachytherapy sources (EBS). While many of these applicators can be modelled using constructive solid geometry (CSG), the latter may be difficult and time-consuming. Alternatively, these complex geometries can be modelled using tessellated geometries such as tetrahedral meshes (mesh geometries (MG)). Recent versions of Monte Carlo (MC) codes Geant4 and MCNP6 allow for the use of MG. The goal of this work was to model a series of applicators relevant to brachytherapy using MG. Applicators designed for (192)Ir sources and 50?kV EBS were studied; a shielded vaginal applicator, a shielded Fletcher Williamson applicator and an APBI balloon applicator. All applicators were modelled in Geant4 and MCNP6 using MG and CSG for dose calculations. CSG derived dose distributions were considered as reference and used to validate MG models by comparing dose distribution ratios. In general agreement within 1% for the dose calculations was observed for all applicators between MG and CSG and between codes when considering volumes inside the 25% isodose surface. When compared to CSG, MG required longer computation times by a factor of at least 2 for MC simulations using the same code. MCNP6 calculation times were more than ten times shorter than Geant4 in some cases. In conclusion we presented methods allowing for high fidelity modelling with results equivalent to CSG. To the best of our knowledge MG offers the most accurate representation of an irregular APBI balloon applicator. PMID:25210788

  11. The use of tetrahedral mesh geometries in Monte Carlo simulation of applicator based brachytherapy dose distributions

    NASA Astrophysics Data System (ADS)

    Paiva Fonseca, Gabriel; Landry, Guillaume; White, Shane; D'Amours, Michel; Yoriyaz, Hélio; Beaulieu, Luc; Reniers, Brigitte; Verhaegen, Frank

    2014-10-01

    Accounting for brachytherapy applicator attenuation is part of the recommendations from the recent report of AAPM Task Group 186. To do so, model based dose calculation algorithms require accurate modelling of the applicator geometry. This can be non-trivial in the case of irregularly shaped applicators such as the Fletcher Williamson gynaecological applicator or balloon applicators with possibly irregular shapes employed in accelerated partial breast irradiation (APBI) performed using electronic brachytherapy sources (EBS). While many of these applicators can be modelled using constructive solid geometry (CSG), the latter may be difficult and time-consuming. Alternatively, these complex geometries can be modelled using tessellated geometries such as tetrahedral meshes (mesh geometries (MG)). Recent versions of Monte Carlo (MC) codes Geant4 and MCNP6 allow for the use of MG. The goal of this work was to model a series of applicators relevant to brachytherapy using MG. Applicators designed for 192Ir sources and 50?kV EBS were studied; a shielded vaginal applicator, a shielded Fletcher Williamson applicator and an APBI balloon applicator. All applicators were modelled in Geant4 and MCNP6 using MG and CSG for dose calculations. CSG derived dose distributions were considered as reference and used to validate MG models by comparing dose distribution ratios. In general agreement within 1% for the dose calculations was observed for all applicators between MG and CSG and between codes when considering volumes inside the 25% isodose surface. When compared to CSG, MG required longer computation times by a factor of at least 2 for MC simulations using the same code. MCNP6 calculation times were more than ten times shorter than Geant4 in some cases. In conclusion we presented methods allowing for high fidelity modelling with results equivalent to CSG. To the best of our knowledge MG offers the most accurate representation of an irregular APBI balloon applicator.

  12. [HPV contamination of endocavity vaginal ultrasound probes].

    PubMed

    Heard, I; Favre, M

    2015-02-01

    While the use of endovaginal ultrasound probes is increasing, the risk of contamination of women with endocavity vaginal probes was not assessed. In particular, the clinical significance of detection of human papillomavirus (HPV) infection, the most common sexually transmitted viral infection, on endovaginal ultrasound probes is uncertain. The recommendations of good practice for decontamination of these probes developed by the High Council for Public Health and the Academy of Medicine have not been evaluated. The objective of this article was to review recent publications concluding to the detection of HPV and human cellular DNA after gynecological examination and disinfection of vaginal ultrasound probes. PMID:24930727

  13. Reviewing the options for local estrogen treatment of vaginal atrophy

    PubMed Central

    Lindahl, Sarah H

    2014-01-01

    Background Vaginal atrophy is a chronic condition with symptoms that include vaginal dryness, pain during sex, itching, irritation, burning, and discharge, as well as various urinary problems. Up to 45% of postmenopausal women may be affected, but it often remains underreported and undertreated. This article aims to review the current recommendations for treatment of vaginal atrophy, and current data on the effectiveness and safety of local vaginal estrogen therapies. Methods Literature regarding vaginal atrophy (2007–2012) was retrieved from PubMed and summarized, with emphasis on data related to the treatment of vaginal atrophy with local vaginal estrogen therapy. Results Published data support the effectiveness and endometrial safety of low-dose local estrogen therapies. These results further support the general recommendation by the North American Menopause Society that a progestogen is not needed for endometrial protection in patients using low-dose local vaginal estrogen. Benefits of long-term therapy for vaginal atrophy include sustained relief of symptoms as well as physiological improvements (eg, decreased vaginal pH and increased blood flow, epithelial thickness, secretions). Conclusion Currently available local vaginal estrogen therapies are well tolerated and effective in relieving symptoms of vaginal atrophy. Recent data support the endometrial safety of low-dose regimens for up to 1 year. PMID:24648775

  14. Correlation of Behaviors with Microbiological Changes in Vaginal Flora

    Microsoft Academic Search

    1999-01-01

    Bacterial vaginosis (BV) is characterized by dramatic changes in the vaginal ecosystem. Women without evidence of vaginal infection may exhibit transient changes in their flora. We prospectively followed up women by using diaries and self-obtained vaginal smears to correlate behaviors with changes in flora. The majority of women (38\\/51, 78%) had significant, although transient, changes. Behaviors associated with unstable flora

  15. Dosimetric Characteristics for Brachytherapy Sources

    NASA Astrophysics Data System (ADS)

    DeWerd, Larry A.; Davis, Stephen D.

    2011-05-01

    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.

  16. Dosimetric Characteristics for Brachytherapy Sources

    SciTech Connect

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

    2011-05-05

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

  17. In vivo dosimetry in brachytherapy

    SciTech Connect

    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

    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.

  18. {sup 106}Ruthenium Brachytherapy for Retinoblastoma

    SciTech Connect

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

    2008-07-01

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

  19. Brachytherapy in the Treatment of Cholangiocarcinoma

    SciTech Connect

    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

    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.

  20. Adherence of Human Vaginal Lactobacilli to Vaginal Epithelial Cells and Interaction with Uropathogens

    PubMed Central

    Boris, Soledad; Suárez, Juan E.; Vázquez, Fernando; Barbés, Covadonga

    1998-01-01

    Three strains of Lactobacillus, identified as Lactobacillus acidophilus, Lactobacillus gasseri, and Lactobacillus jensenii, were selected from among 70 isolates from the vaginas of healthy premenopausal women for properties relevant to mucosal colonization or antagonism. All three self-aggregated and adhered to epithelial vaginal cells, displacing well-known vaginal pathogens, such as G. vaginalis, and inhibiting the growth in vitro of Escherichia coli and Streptococcus agalactiae. The surface components involved in self-aggregation appeared to be proteins for L. gasseri and lipoproteins for L. acidophilus and L. jensenii, as judged by susceptibility to treatment with appropriate degrading enzymes. The factors responsible for adherence to epithelial vaginal cells seemed to be glycoproteins (L. acidophilus and L. gasseri) and carbohydrate (L. jensenii). The receptors of the vaginal cells were glycolipids, which presumably were the targets of the competition observed between the lactobacilli and the pathogenic microbes. PMID:9573080

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

    Microsoft Academic Search

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

    2007-01-01

    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

  2. Self-assessment questionnaires document substantial variability in the clinical expression of rotator cuff tears

    Microsoft Academic Search

    David G Duckworth; Kevin L Smith; Barry Campbell; Frederick A Matsen

    1999-01-01

    The goal of this investigation was to document the variability in the clinical expression of full-thickness rotator cuff tears with practical and standardized patient self-assessment tools. One-hundred twenty-three consecutive patients with full-thickness cuff tears diagnosed by standard cuff-imaging methods (sonography, arthrography, or magnetic resonance imagery) assessed their own shoulder function and health status with the Simple Shoulder Test and the

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

    Microsoft Academic Search

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

    2006-01-01

    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

  4. A Validated Model of Calf Compression and Deep Vessel Collapse During External Cuff Inflation

    Microsoft Academic Search

    A. J. Narracott; G. W. John; R. J. Morris; J. P. Woodcock; D. R. Hose; P. V. Lawford

    2009-01-01

    This paper presents a validated model of calf compression with an external pressure cuff as used for deep vein thrombosis. Magnetic resonance (MR) images of calf geometry were used to generate subject-specific finite-element (FE) models of the calf cross section. Ultrasound images of deep vessel collapse obtained through a water-filled cuff were used to validate model behavior. Calf\\/cuff pressure interface

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

    Microsoft Academic Search

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

    2005-01-01

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

  6. Phenotypic and Functional Characterization of Vaginal Dendritic Cells in a Rat Model of Candida albicans Vaginitis

    Microsoft Academic Search

    Flavia De Bernardis; Roberta Lucciarini; Maria Boccanera; Consuelo Amantini; Silvia Arancia; Stefania Morrone; Michela Mosca; Antonio Cassone; Giorgio Santoni

    2006-01-01

    This study analyzes the phenotype of vaginal dendritic cells (VDCs), their antigenic presentation and activation of T-cell cytokine secretion, and their protective role in a rat model of Candida vaginitis. Histological observation demonstrated a significant accumulation of OX62 VDCs in the mucosal epithelium of Candida albicans-infected rats at the third round of infection. We identified two subsets of OX62 VDCs

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

    Microsoft Academic Search

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

    2007-01-01

    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.

  8. Vaginal Lactobacillus: biofilm formation in vivo – clinical implications

    PubMed Central

    Ventolini, Gary

    2015-01-01

    Vaginal lactobacilli provide protection against intrusive pathogenic bacteria. Some Lactobacillus spp. produce in vitro a thick, protective biofilm. We report in vivo formation of biofilm by vaginal Lactobacillus jensenii. The biofilm formation was captured in fresh wet-mount microscopic samples from asymptomatic patients after treatment for recurrent bacterial vaginitis. In vivo documentation of biofilm formation is in our opinion noteworthy, and has significant clinical implications, among which are the possibility to isolate, grow, and therapeutically utilize lactobacilli to prevent recurrent vaginal infections and preterm labor associated with vaginal microbial pathogens. PMID:25733930

  9. Vaginal mesh erosion after abdominal sacral colpopexy

    Microsoft Academic Search

    Anthony G. Visco; Alison C. Weidner; Matthew D. Barber; Evan R. Myers; Geoffrey W. Cundiff; Richard C. Bump; W. Allen Addison

    2001-01-01

    Objective: Our goal was to compare the prevalence of vaginal mesh erosion between abdominal sacral colpopexy and various sacral colpoperineopexy procedures. Study Design: We undertook a retrospective analysis of all sacral colpopexies and colpoperineopexies performed between March 1, 1992, and February 28, 1999. The patients were divided into the following 4 groups: abdominal sacral colpopexy, abdominal sacral colpoperineopexy, and 2

  10. Aggressive vaginal angiomyxoma mimicking urethral tumor

    Microsoft Academic Search

    Lucio F. Gonzaga; Fernando C. M. Freitas; Jose M. Tavares

    2005-01-01

    This is a case report of a 32-year-old female patient with a neoplasia mimicking a urethral tumor. Following anterior pelvic exanteration, vulvectomy, bilateral inguinal lymphadenectomy, the pathological study established the diagnosis of aggressive vaginal angiomyxoma, CD-34 labeled.

  11. Vaginal Lacerations from Consensual Intercourse in Adolescents

    ERIC Educational Resources Information Center

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

    2011-01-01

    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:…

  12. Vaginal itching and discharge - Adult and adolescent

    MedlinePLUS

    ... or thin Clear, cloudy, bloody, white, yellow, or green Odorless or have a bad odor Itching of the skin of the vagina and the surrounding area (vulva) may be present along with vaginal discharge. It can also occur on its own.

  13. Primary vaginal adenocarcinoma arising in vaginal adenosis after CO2 laser vaporization and 5-fluorouracil therapy.

    PubMed

    Paczos, Tamera A; Ackers, Stacey; Odunsi, Kunle; Lele, Shashikant; Mhawech-Fauceglia, Paulette

    2010-03-01

    We present a case of a 45-year-old woman with a long-standing history of persistent cervical dysplasia that resulted in a hysterectomy. Subsequent vaginal smears revealed high-grade vaginal intraepithelial neoplasia (VAIN III) on Pap smear with positive human papilloma virus (HPV) testing. Over the course of 2 years, the patient underwent 2 CO(2) laser vaporization procedures of the upper vagina and intermittent 5-fluorouracil therapy. A biopsy performed at the time of the second laser procedure revealed endocervical-type well-differentiated adenocarcinoma, associated with VAIN III. HPV in situ hybridization for HPV types 16 and 18 was positive in both the glandular and squamous mucosa. The patient has no known history of intrauterine diethylstilbestrol exposure or mullerian developmental abnormalities. Subsequently, the patient underwent a radical upper vaginetcomy with bilateral pelvic lymph nodes dissection and bilateral salpingo-oophorectomy. The vaginectomy specimen showed residual adenocarcinoma associated with VAIN-III and extensive vaginal adenosis with free resection margins. This is the second reported case in the literature of adenocarcinoma arising in vaginal adenosis after 5-fluorouracil. Herein, we highlight these important findings and shed some light on the pathogenesis of vaginal adenosis and the subsequent development of vaginal adenocarcinoma. PMID:20173507

  14. Cervix cancer brachytherapy: high dose rate.

    PubMed

    Miglierini, P; Malhaire, J-P; Goasduff, G; Miranda, O; Pradier, O

    2014-10-01

    Cervical cancer, although less common in industrialized countries, is the fourth most common cancer affecting women worldwide and the fourth leading cause of cancer death. In developing countries, these cancers are often discovered at a later stage in the form of locally advanced tumour with a poor prognosis. Depending on the stage of the disease, treatment is mainly based on a chemoradiotherapy followed by uterovaginal brachytherapy ending by a potential remaining tumour surgery or in principle for some teams. The role of irradiation is crucial to ensure a better local control. It has been shown that the more the delivered dose is important, the better the local results are. In order to preserve the maximum of organs at risk and to allow this dose escalation, brachytherapy (intracavitary and/or interstitial) has been progressively introduced. Its evolution and its progressive improvement have led to the development of high dose rate brachytherapy, the advantages of which are especially based on the possibility of outpatient treatment while maintaining the effectiveness of other brachytherapy forms (i.e., low dose rate or pulsed dose rate). Numerous innovations have also been completed in the field of imaging, leading to a progress in treatment planning systems by switching from two-dimensional form to a three-dimensional one. Image-guided brachytherapy allows more precise target volume delineation as well as an optimized dosimetry permitting a better coverage of target volumes. PMID:25151650

  15. Vaginal Douching Among Latinas: Practices and Meaning

    PubMed Central

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

    2009-01-01

    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. PMID:18297379

  16. Biologically based strategies to augment rotator cuff tears

    PubMed Central

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

    2012-01-01

    Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor. PMID:22787334

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

    PubMed

    Solá, J; Proença, M; Chételat, O

    2013-01-01

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

  18. Brachytherapy

    MedlinePLUS

    ... leaving them there permanently. After several months, the radioactivity level of the implants eventually diminishes to nothing. ... seeds are implanted permanently in the body, the radioactivity of the seeds decays very quickly with time. ...

  19. Arthroscopic assessment of full-thickness rotator cuff tears

    Microsoft Academic Search

    Hervé Thomazeau; Pascal Gleyze; Laurent Lafosse; Gilles Walch; François Kelbérine; Henri Coudane

    2000-01-01

    To evaluate the reliability of the arthroscopic assessment of full-thickness rotator cuff tears, 117 cases were prospectively investigated by imaging, arthroscopy, and open surgery. The confidence of the surgeon, his accuracy, and the surgeon-dependent character of arthroscopic assessment were evaluated in terms of the description of the main anatomic parameters. The surgeons were confident and accurate in diagnosing a full-thickness

  20. Humeral head osteonecrosis following arthroscopic rotator cuff repair.

    PubMed

    Beauthier, V; Sanghavi, S; Roulot, E; Hardy, P

    2010-10-01

    Humeral head chondrolysis and osteonecrosis of the glenoid have been reported; however, there is no report to date about humeral head osteonecrosis following arthroscopic shoulder procedure. We report a case of osteonecrosis of the humeral head following arthroscopic rotator cuff repair what we believe is probably secondary to disruption of its blood supply after placement of multiple metallic suture anchors. The surgical records were also reviewed in an attempt to identify the cause of the humeral head osteonecrosis. PMID:20033673

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

    PubMed

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

    2011-06-01

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

  2. Feasibility assessment of shear wave elastography to rotator cuff muscle.

    PubMed

    Itoigawa, Yoshiaki; Sperling, John W; Steinmann, Scott P; Chen, Qingshan; Song, Pengfei; Chen, Shigao; Itoi, Eiji; Hatta, Taku; An, Kai-Nan

    2015-03-01

    Pre-surgical measurement of supraspinatus muscle extensibility is important for rotator cuff repair. The purpose of the present study was to explore the potential feasibility of a shear wave ultrasound elastography (SWE)-based method, combined with B-mode ultrasound, to measure the in vivo stiffness of the supraspinatus muscle non-invasively and thus obtain key information about supraspinatus muscle extensibility. Our investigation comprised two steps. First, we determined the orientation of the supraspinatus muscle fibers in cadaveric shoulders without rotator cuff tear in order to optimize the ultrasound probe positions for SWE imaging. Second, we investigated the feasibility of quantifying the stiffness of the normal supraspinatus muscle by SWE in vivo. The supraspinatus muscle was divided into four anatomical regions: anterior superficial (AS), posterior superficial (PS), anterior deep (AD), and posterior deep (PD). Each region was examined by SWE. The SWE stiffnesses of AD, AS, PD, and PS were 40.0?±?12.4, 34.0?±?9.9, 32.7?±?12.7, 39.1?±?15.7 kPa, respectively. SWE combined with B-Mode ultrasound imaging could be a feasible method for quantifying the local stiffness of the rotator cuff muscles. Clin. Anat. 28:213-218, 2015. © 2014 Wiley Periodicals, Inc. PMID:25557287

  3. Latissimus dorsi tendon transfers for rotator cuff deficiency

    PubMed Central

    Donaldson, James; Pandit, Adam; Noorani, Ali; Douglas, Tania; Falworth, Mark; Lambert, Simon

    2011-01-01

    Purpose: Latissimus dorsi tendon transfers are increasingly being used around the shoulder. We aim to assess any improvement in pain and function following a latissimus dorsi tendon transfer for massive, irreparable postero-superior cuff deficiency. Materials and Methods: At our institution, between 1996 and 2009, 38 latissimus dorsi tendon transfer procedures were performed. Sixteen of these were for massive irreparable rotator cuff deficiency associated with pain and impaired function. All patients were evaluated by means of interview or postal questionnaire and case note review. Pain and function were assessed using the Stanmore percentage of normal shoulder assessment (SPONSA) score, visual analogue scale and Oxford Shoulder Score. Forward elevation was also assessed and a significant improvement was thought to correlate with the success of the procedure at stabilizing the humeral head upon elevation. Results: Mean follow-up time was 70 months. There was a significant reduction in pain on the visual analogue scale from 6.4 to 3.4 (P < 0.05), an improved SPONSA score from 32.5 to 57.5 (P < 0.05), and an improved Oxford Shoulder Score from 40.75 to 29.6 (P < 0.05). Forward elevation improved from 40° preoperatively to 75° postoperatively (P < 0.05). Conclusion: Our results add to the body of evidence that latissimus dorsi tendon transfers for irreparable postero-superior cuff deficiency in selected patients reduce pain and improve shoulder function in the medium term. Level of Evidence: Level 4. PMID:22223959

  4. Arthroscopic Repair of Rotator Cuff Tears Using Extracellular Matrix Graft

    PubMed Central

    Gilot, Gregory J.; Attia, Ahmed K.; Alvarez, Andres M.

    2014-01-01

    Despite advances in surgical technology, as well as generally good outcomes, repairs of full-thickness rotator cuff tears show a retear rate of 25% to 57% and may fail to provide full return of function. The repairs tend to fail at the suture-tendon junction, which is due to several factors, including tension at the repair site, quality of the tendon, and defective tissue repair. One strategy to augment repair of large to massive rotator cuff tears is the development of biological scaffold materials, composed of extracellular matrix (ECM). The goal is to strengthen and evenly distribute the mechanical load across the repair site, thus minimizing the rupture risk of the native tendon while providing the biological elements needed for healing. The promising results of ECM-derived materials and their commercial availability have increased their popularity among shoulder surgeons. In contrast to a traditional open or arthroscopically assisted mini-open approach, this completely arthroscopic technique offers the full advantages warranted by the use of a minimally invasive approach. This technical guide describes arthroscopic rotator cuff repair using an ECM graft technique. PMID:25276607

  5. Intracavitary combined with CT-guided interstitial brachytherapy for locally advanced uterine cervical cancer: introduction of the technique and a case presentation.

    PubMed

    Wakatsuki, Masaru; Ohno, Tatsuya; Yoshida, Daisaku; Noda, Shin-ei; Saitoh, Jun-ichi; Shibuya, Kei; Katoh, Hiroyuki; Suzuki, Yoshiyuki; Takahashi, Takeo; Nakano, Takashi

    2011-01-01

    We report a new technique of brachytherapy consisting of intracavitary combined with computed tomography (CT)-guided interstitial brachytherapy for locally advanced cervical cancer. A Fletcher-Suit applicator and trocar point needles were used for performing high-dose rate brachytherapy under in-room CT guidance. First, a tandem and ovoids were implanted into the patient's vagina and uterus by conventional brachytherapy method. Based on clinical examination and MRI/CT imaging, operating radiation oncologists decided the positions of insertion in the tumor and the depth of the needles from the upper surface of the ovoid. Insertion of the needle applicator was performed from the vaginal vault inside the ovoid within the tumor under CT guidance. In treatment planning, dwell positions and time adaptations within the tandem and ovoids were performed first for optimization based on the Manchester system, and then stepwise addition of dwell positions within the needle was continued. Finally, dwell positions and dwell weights were manually modified until dose-volume constraints were optimally matched. In our pilot case, the dose of D90 to high-risk clinical target volume was improved from 3.5 Gy to 6.1 Gy by using our hybrid method on the dose-volume histogram. D1cc of the rectum, bladder and sigmoid colon by our hybrid method was 4.8 Gy, 6.4 Gy and 3.5 Gy, respectively. This method consists of advanced image-guided brachytherapy that can be performed safely and accurately. This approach has the potential of increasing target coverage, treated volume, and total dose without increasing the dose to organs at risk. PMID:21293072

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

    SciTech Connect

    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

    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.

  7. Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios

    PubMed Central

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

    2014-01-01

    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. PMID:24733553

  8. 78 FR 41125 - Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ...Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting...occurring under an NRC licensee's permanent implant brachytherapy program. This interim policy...that are authorized to perform permanent implant brachytherapy. DATES: This policy...

  9. 10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 2011-01-01 false Records of calibration measurements of brachytherapy sources... Records § 35.2432 Records of calibration measurements of brachytherapy sources...licensee shall maintain a record of the calibrations of brachytherapy sources required...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 2010-01-01 false Records of calibration measurements of brachytherapy sources... Records § 35.2432 Records of calibration measurements of brachytherapy sources...licensee shall maintain a record of the calibrations of brachytherapy sources required...

  11. 10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2014-01-01 false Records of calibration measurements of brachytherapy sources... Records § 35.2432 Records of calibration measurements of brachytherapy sources...licensee shall maintain a record of the calibrations of brachytherapy sources required...

  12. 10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 2012-01-01 false Records of calibration measurements of brachytherapy sources... Records § 35.2432 Records of calibration measurements of brachytherapy sources...licensee shall maintain a record of the calibrations of brachytherapy sources required...

  13. 10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  14. The phylogeny of permanent prostate brachytherapy

    PubMed Central

    Aronowitz, Jesse N.

    2013-01-01

    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. PMID:23878553

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

    SciTech Connect

    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

    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.

  16. The vaginal microflora in relation to gingivitis

    PubMed Central

    2009-01-01

    Background Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. Methods Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ? 20% of tooth sites. Results A Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8–7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001). Conclusion Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections. PMID:19161595

  17. Overview: Five decades of brachytherapy

    SciTech Connect

    Ellis, F.

    1986-01-01

    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.

  18. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results

    Microsoft Academic Search

    Ian K. Y Lo; Stephen S Burkhart

    2004-01-01

    Purpose: The purpose of this study is to describe the technique and review the preliminary results of arthroscopic repair of massive, contracted, immobile rotator cuff tears using an interval slide technique. Type of Study: Case series. Methods: From January 1999 to December 2000, the senior author (S.S.B.) performed arthroscopic rotator cuff repair on 94 massive rotator cuff tears. Of these,

  19. Rotator Cuff Repair in Upper Extremity Ambulators! Andrew Zganjar, 1Steven Grindel MD, 1Dara Mickschl PA-C!

    E-print Network

    or female patients with shoulder impingement or rotator cuff tear who rely on AWDs for mobility. 2Rotator Cuff Repair in Upper Extremity Ambulators! ! Andrew Zganjar, 1Steven Grindel MD, 1Dara! ! Introduction · Patients who rely on their upper extremities for mobility are particularly prone to rotator cuff

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

    ClinicalTrials.gov

    2014-04-21

    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

  1. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles.

    PubMed

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-10-10

    Background: The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05). Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment. PMID:25317769

  2. Vaginal Evisceration: An Unexpected Complication of Conization

    PubMed Central

    Ghassani, Ali; Andre, Benoit; Simon-Toulza, Caroline; Tanguy le Gac, Yann; Martinez, Alejandra; Vidal, Fabien

    2014-01-01

    Background. Large loop excision of the transformation zone (LLETZ) is routinely performed for the management of high grade intracervical neoplasia (CIN). Several uncommon complications have been described, including postoperative peritonitis, pseudoaneurysm of uterine artery, and bowel fistula. We report a unique case of postoperative vaginal evisceration and the subsequent management. Case. A 73-years-old woman underwent LLETZ for high grade CIN. On postoperative day 3, she was admitted for small bowel evisceration through the vagina. Surgical management was based on combined laparoscopic and transvaginal approach and consisted in bowel inspection and reinstatement, peritoneal washing, and dehiscence repair. Conclusions. Vaginal evisceration is a rare but potentially serious complication of pelvic surgery. This case report is to make clinicians aware of such complication following LLETZ and its management. PMID:25506010

  3. Instrumental vaginal delivery--back to basics.

    PubMed

    Keriakos, R; Sugumar, S; Hilal, N

    2013-11-01

    Assisted vaginal delivery using forceps or a vacuum extractor is an essential part of obstetric practice. Operative vaginal delivery rates in the UK have remained stable between 10% and 15%, yielding safe and satisfactory outcomes for the majority of mothers and their babies. However, there has been an increase in medico-legal cases due to an increasing awareness of the potential morbidity for both the mother and the baby. There are many factors that can play a part in both the maternal and fetal complications resulting from instrumental deliveries. The aim of this educational review is to address these factors and identify measures to reduce them by adherence to the basics and relevant evidence. PMID:24219713

  4. Adolescent Experiences with the Vaginal Ring

    PubMed Central

    Epstein, Laura B.; Sokal-Gutierrez, Karen; Ivey, Susan L.; Raine, Tina; Auerswald, Colette

    2011-01-01

    Purpose To understand racial/ethnic minority adolescent females’ experiences with the vaginal ring. Methods We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15–24 years who had used the vaginal ring. Results Qualitative analysis using grounded theory revealed that adolescents undergo a multi-stage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. Conclusions The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered. PMID:18565439

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

    Microsoft Academic Search

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

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

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

    Microsoft Academic Search

    LEESA M. GALATZ; CRAIG M. BALL; SHARLENE A. TEEFEY; WILLIAM D. MIDDLETON; KEN YAMAGUCHI

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

  7. Histological analysis of the coracoacromial arch: Correlation between age-related changes and rotator cuff tears

    Microsoft Academic Search

    Alfredo Schiavone Panni; Giuseppe Milano; Luciano Lucania; Carlo Fabbriciani; Carlo A. Logroscino

    1996-01-01

    The purpose of this study was to analyze age-related changes in the coracoacromial arch and correlate these degenerative changes with rotator cuff tears. We obtained 80 shouldes from 40 cadavers. The mean age at death was 58.4 years. We performed a gross examination of the rotator cuff and the acromion and histological examination of the coracoacromial ligament. The statistical significance

  8. Association of osteopenia of the humeral head with full-thickness rotator cuff tears

    Microsoft Academic Search

    Dominik C Meyer; Sandro F Fucentese; Bruno Koller; Christian Gerber

    2004-01-01

    Rotator cuff tendon repair may fail for various reasons. Although the role of repair techniques and of the musculotendinous unit has been studied, there is little information on the quality of the bone to which the tendon is to be repaired. Therefore, 14 cadaveric humeral heads, 7 specimens without and 7 with a full-thickness rotator cuff tendon tear, were quantitatively

  9. Age-related prevalence of rotator cuff tears in asymptomatic shoulders

    Microsoft Academic Search

    Siegbert Tempelhof; Stefan Rupp; Romain Seil

    1999-01-01

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

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

    Microsoft Academic Search

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

    2004-01-01

    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

  11. Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears

    Microsoft Academic Search

    Ali R Motamedi; Luis H Urrea; Robert E Hancock; Richard J Hawkins; Charles Ho

    2002-01-01

    We attempted to assess the accuracy of magnetic resonance imaging (MRI) in determining the size of recurrent cuff tears in correlation with size measured at surgery. Thirty-seven shoulders in 33 patients who had reoperation for a presumed failed rotator cuff repair were retrospectively evaluated. All patients had preoperative MRI, the results of which were read by a musculoskeletal radiologist to

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

    Microsoft Academic Search

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

    2004-01-01

    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

  13. Repair of massive rotator cuff tears in patients older than 70 years

    Microsoft Academic Search

    Richard L Worland; Jorge Arredondo; Francesc Angles; Francisco Lopez-Jimenez

    1999-01-01

    Major ruptures of the rotator cuff are common in elderly patients, and their management has been a challenge for orthopaedic surgeons. This study was undertaken to evaluate the results obtained in patients older than 70 years who were treated with open surgical repair for massive ruptures of the rotator cuff tendons and to correlate the functional outcomes with the quality

  14. Modified Impingement Test Can Predict the Level of Pain Reduction After Rotator Cuff Repair

    Microsoft Academic Search

    Joo Han Oh; Sae Hoon Kim; Kyung Hwan Kim; Chung Hee Oh; Hyun Sik Gong

    2010-01-01

    Background: Most patients experience a significant reduction in pain after rotator cuff repair. However, there is currently no method to predict the level of pain reduction that each patient will experience. This report explores the usefulness of the modified impingement test for prognosis in cases of rotator cuff repair.Hypothesis: The amount of pain reduction after injection of lidocaine into the

  15. The influence of variations of the coracoacromial arch on the development of rotator cuff tears

    Microsoft Academic Search

    F. Gohlke; T. Barthel; A. Gandorfer

    1993-01-01

    In order to define the geometry of the coracoacromial arch in both its bony and soft parts and to bring it into relationship with rotator cuff tears, 54 cadaver shoulders (from subjects aged 47–90 years) were dissected And X-rayed (anteroposterior projection and supraspinatus outlet view). Partial rotator cuff tears were assessed additionally by transillumination and polarized microscopy. After transfixation of

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

    Microsoft Academic Search

    Frank W. Jobe; Diane Radovich Moynes

    1982-01-01

    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

  17. REHABILITATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: CURRENT CONCEPTS REVIEW AND EVIDENCE-BASED GUIDELINES

    PubMed Central

    Westgard, Paul; Chandler, Zachary; Gaskill, Trevor R.; Kokmeyer, Dirk; Millett, Peter J.

    2012-01-01

    Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion. Methods: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities. Results: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data. Conclusion: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation. PMID:22530194

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

    Microsoft Academic Search

    Warren M. Grill; J. Thomas Mortimer

    1998-01-01

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

  19. Vaginal Intercourse Frequency and Heart Rate Variability

    Microsoft Academic Search

    STUART BRODY; RAGNAR PREUT

    2003-01-01

    We examined the relationship between recalled and diary recorded frequency of penile-vaginal intercourse (FSI) and both resting heart rate variability (HRV; an index of cardiac autonomic control and parasympathetic tone associated with cardiovascular health outcomes) and resting diastolic blood pressure (DBP) in 120 healthy adults aged 19-38 (subjects scoring above the 87th percentile on the Lie scale of the Eysenck

  20. Posterior vaginal prolapse and bowel function

    Microsoft Academic Search

    Anne M. Weber; Mark D. Walters; Lester A. Ballard; Delbert L. Booher; Marion R. Piedmonte

    1998-01-01

    Objective: This study’s objectives were to describe symptoms related to bowel dysfunction in women with uterovaginal prolapse and to compare these symptoms according to extent of posterior vaginal prolapse. Study Design: One hundred forty-three women completed a questionnaire assessment of bowel function and underwent standardized physical examination according to the International Continence Society’s system for grading uterovaginal prolapse. Results: The

  1. VARIATION AND PREDICTORS OF VAGINAL DOUCHING BEHAVIOR

    PubMed Central

    Misra, Dawn P.; Trabert, Britton; Atherly-Trim, Shelly

    2007-01-01

    Introduction Vaginal douching is a widespread practice among American women. Little research has been done examining variation in the practice or identifying risk factors. Methods We collected data on douching, as well as hypothesized predictors of vaginal douching, as part of a cohort study on preterm birth. African-American women residing in Baltimore City, Maryland, were enrolled if they received prenatal care or delivered at The Johns Hopkins Medical Institution. Interview data were collected on 872 women between March 2001 and July 2004, with a response rate of 68%. Logistic regression analysis was selected to identify factors associated with douching in the 6 months prior to pregnancy. Results Almost two thirds of women reported ever douching and more than two thirds of those women reported douching in the 6 months prior to pregnancy. Variation was seen in the practice of douching with regard to frequency as well as technique. After adjusting for several confounders, prenatal enrollment (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.29, 2.53), more unmet needs for time for “nonessentials” (OR, 1.83; 95% CI, 1.27, 2.63), smoking in the year prior to the birth (OR, 1.78; 95% CI, 1.22, 2.60), and age > 19 years (OR, 2.60; 95% CI, 1.36, 4.97) were significant predictors of douching in the 6 months prior to pregnancy. Discussion We identified considerable heterogeneity in the practice of vaginal douching in a cohort of low income African-American women. Conclusions Future studies should incorporate measures of the predictors of douching and detailed exposure information to determine the independent contribution of vaginal douching to health outcomes. PMID:17055380

  2. Vaginal Drug Delivery Systems for HIV Prevention

    Microsoft Academic Search

    Lisa Cencia Rohan; Alexandra B. Sassi

    2009-01-01

    Microbicides have become a principal focus for HIV prevention strategies. The successful design of drug delivery systems for\\u000a vaginal microbicide drug candidates brings with it a multitude of challenges. It is imperative that the chemical and physical\\u000a characteristics of the drug candidate and its mechanism of action be clearly understood and considered to successfully deliver\\u000a and target drug candidates efficiently.

  3. Complications of anterior compartment vaginal surgery

    Microsoft Academic Search

    Eric S. Rovner

    2007-01-01

    Many complications can be associated with anterior compartment surgery of the vagina. With the integration of synthetic materials\\u000a into the surgical armamentarium for the repair of stress urinary incontinence in the form of midurethral slings, and for the\\u000a repair of vaginal prolapse as a primary procedure or to augment an existing repair, the spectrum of complications related\\u000a to this type

  4. Strength of Preference for Vaginal Birth as a Predictor of Delivery Mode Among Women who Attempt a Vaginal Delivery

    PubMed Central

    WU, Erica; KAIMAL, Anjali; HOUSTON, Kathryn; YEE, Lynn; NAKAGAWA, Sanae; KUPPERMANN, Miriam

    2014-01-01

    OBJECTIVE To assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. STUDY DESIGN We conducted a longitudinal study of mode of delivery preferences among women who were less than 36 weeks pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode was obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. RESULTS Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (IQR 0.50–0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (aOR 0.08, CI 0.02–0.39) or who delivered an infant ?4000 grams (aOR 0.04, CI 0.01–0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR 1.54, CI 1.01–2.34 for every 0.2 increase on the 0-to-1 scale). CONCLUSION Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone. PMID:24246523

  5. Urinary tract infection in vaginitis: a condition often overlooked.

    PubMed

    Amatya, R; Bhattarai, S; Mandal, P K; Tuladhar, H; Karki, B M S

    2013-03-01

    Despite the differences between the organisms that cause vaginitis and urinary tract infections (UTI), it is possible that women with vaginitis develop UTI. The main objective of the study was to find the association of the common types of infectious vaginitis with UTI. Cross sectional study was conducted for six months in a referral hospital at Lalitpur, Nepal. Three hundred and sixmid-stream urine samples and high vaginal swabs (HVS) collected from non pregnant women were investigated by standard microbiological techniques. Among the women with bacterial vaginosis (BV), 75% also had UTI. Similarly, 46% and 13% of those with vaginal candidiasis and trichomoniasis respectively had concurrent UTI. Considering this strong association of UTI and vaginitis, women with either of these conditions should be tested for the other. PMID:24592798

  6. Glenoid damage from articular protrusion of metal suture anchor after arthroscopic rotator cuff repair.

    PubMed

    Kim, Yang-Soo; Ok, Ji-Hoon; Garzon-Muvdi, Juan; McFarland, Edward G

    2015-03-01

    Arthroscopic repair of rotator cuff tears has been shown to be effective and safe. The use of suture anchors has increased the ability to perform rotator cuff repairs arthroscopically. However, the use of suture anchors for any surgery around the shoulder can result in complications if the devices are not used and inserted properly. Complications that have been reported with the use of suture anchors for rotator cuff surgery include prominent anchors in the tuberosities, dislodged anchors secondary to pull-out or improper insertion, and osteolysis around the anchors. We report a case of articular cartilage damage secondary to a suture anchor protruding through the humeral head because of improper anchor insertion. Our patient's case reminds surgeons not only to be careful of the depth of insertion of suture anchors when performing rotator cuff surgery but also to obtain radiographs to evaluate the anchor position if patients continue to have symptoms after rotator cuff repair using these devices. PMID:25750956

  7. Differential tissue-specific protein markers of vaginal carcinoma

    Microsoft Academic Search

    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

    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

  8. Vaginal surgery for pelvic organ prolapse using mesh and a vaginal support device

    PubMed Central

    Carey, M; Slack, M; Higgs, P; Wynn-Williams, M; Cornish, A

    2008-01-01

    Objectives To describe a new surgical procedure for pelvic organ prolapse using mesh and a vaginal support device (VSD) and to report the results of surgery. Design A prospective observational study Setting Two tertiary referral Urogynaecology practices. Population Ninety-five women with International Continence Society pelvic organ prolapse quantification stage 2 or more pelvic organ prolapse who underwent vaginal surgery using mesh augmentation and a VSD. Methods Surgery involved a vaginal approach with mesh reinforcement and placement of a VSD for 4 weeks. At 6 and 12 months, women were examined for prolapse recurrence, and visual analogue scales for satisfaction were completed. Women completed quality-of-life (QOL) questionnaires preoperatively and at 6 and 12 months. Main outcome measures Objective success of surgery at 6 and 12 months following surgery. Secondary outcomes were subjective success, complications, QOL outcomes and patients’ satisfaction. Results Objective success rate was 92 and 85% at 6 and 12 months, respectively. Subjective success rate was 91 and 87% at 6 and 12 months, respectively. New prolapse in nonrepaired compartments accounted for 7 of 12 (58%) failures at 12 months. Two of 4 mesh exposures required surgery. Sexual dysfunction was reported by 58% of sexually active women preoperatively and 23% at 12 months. QOL scores significantly improved at 12 months compared with baseline (P < 0.0001). Conclusion Vaginal surgery using mesh and a VSD is an effective procedure for pelvic organ prolapse. However, further studies are required to establish the role of the surgery described in this study. Please cite this paper as:Carey M, Slack M, Higgs P, Wynn-Williams M, Cornish A. Vaginal surgery for pelvic organ prolapse using mesh and a vaginal support device. BJOG 2008;115:391–397. PMID:18190377

  9. Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

    PubMed

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

    2015-02-01

    Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup. PMID:24870932

  10. Protocols for Vaginal Inoculation and Sample Collection in the Experimental Mouse Model of Candida vaginitis

    PubMed Central

    Yano, Junko; Fidel, Jr., Paul L.

    2011-01-01

    Vulvovaginal candidiasis (VVC), caused by Candida species, is a fungal infection of the lower female genital tract that affects approximately 75% of otherwise healthy women during their reproductive years18,32-34. Predisposing factors include antibiotic usage, uncontrolled diabetes and disturbance in reproductive hormone levels due to pregnancy, oral contraceptives or hormone replacement therapies33,34. Recurrent VVC (RVVC), defined as three or more episodes per year, affects a separate 5 to 8% of women with no predisposing factors33. An experimental mouse model of VVC has been established and used to study the pathogenesis and mucosal host response to Candida3,4,11,16,17,19,21,25,37. This model has also been employed to test potential antifungal therapies in vivo13,24. The model requires that the animals be maintained in a state of pseudoestrus for optimal Candida colonization/infection6,14,23. Under such conditions, inoculated animals will have detectable vaginal fungal burden for weeks to months. Past studies show an extremely high parallel between the animal model and human infection relative to immunological and physiological properties3,16,21. Differences, however, include a lack of Candida as normal vaginal flora and a neutral vaginal pH in the mice. Here, we demonstrate a series of key methods in the mouse vaginitis model that include vaginal inoculation, rapid collection of vaginal specimens, assessment of vaginal fungal burden, and tissue preparations for cellular extraction/isolation. This is followed by representative results for constituents of vaginal lavage fluid, fungal burden, and draining lymph node leukocyte yields. With the use of anesthetics, lavage samples can be collected at multiple time points on the same mice for longitudinal evaluation of infection/colonization. Furthermore, this model requires no immunosuppressive agents to initiate infection, allowing immunological studies under defined host conditions. Finally, the model and each technique introduced here could potentially give rise to use of the methodologies to examine other infectious diseases of the lower female genital tract (bacterial, parasitic, viral) and respective local or systemic host defenses. PMID:22215135

  11. Radiochemotherapy plus 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP, NSC #663249) in Advanced-Stage Cervical and Vaginal Cancers

    PubMed Central

    Kunos, Charles A.; Radivoyevitch, Tomas; Waggoner, Steven; Debernardo, Robert; Zanotti, Kristine; Resnick, Kimberly; Fusco, Nancy; Adams, Ramon; Redline, Raymond; Faulhaber, Peter; Dowlati, Afshin

    2013-01-01

    Objective Cervical and vaginal cancers have virally-mediated or mutated defects in DNA damage repair responses, making these cancers sensible targets for ribonucleotide reductase inhibition during radiochemotherapy. Methods We conducted a phase II study evaluating 3x weekly 2-hour intravenous 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP, 25 mg/m2) co-administered with 1x weekly intravenous cisplatin (40 mg/m2) and daily pelvic radiation (45 Gy) in women with stage IB2-IVB cervical (n = 22) or stage II-IV vaginal (n = 3) cancers. Brachytherapy followed (40 Gy). Toxicity was monitored by common terminology criteria for adverse events (version 3.0). The primary end point of response was assessed by 3-month posttherapy 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (PET/CT) and clinical examination. Results 3-AP radiochemotherapy achieved clinical responses in 24 (96% [95% confidence interval: 80-99%]) of 25 patients (median follow-up 20 months, range 2-35 months). 23 (96% [95% confidence interval: 80-99%]) of 24 patients had 3-month posttherapy PET/CT scans that recorded metabolic activity in the cervix or vagina equal or less than that of the cardiac blood pool, suggesting complete metabolic responses. The most frequent 3-AP radiochemotherapy-related adverse events included fatigue, nausea, diarrhea, and reversible hematological and electrolyte abnormalities. Conclusions The addition of 3-AP to cisplatin radiochemotherapy was tolerable and produced high rates of clinical and metabolic responses in women with cervical and vaginal cancers. Future randomized phase II and III clinical trials of 3-AP radiochemotherapy are warranted. PMID:23603372

  12. Systemic Effects of Vaginally Administered Estrogen Therapy: A Review

    PubMed Central

    Krause, Megan; Wheeler, Thomas L.; Richter, Holly E.; Snyder, Thomas E.

    2015-01-01

    Hormone Therapy (HT) was considered the standard of care prior to the publication of the Women’s Health Initiative (WHI). After the study was published, the use of systemic HT dramatically decreased resulting in an increased incidence of menopausal symptoms such as hot flashes, vaginal dryness and dyspareunia experienced by women. Use of vaginal estrogen offers women a unique alternative for relief of these symptoms. This article reviews the systemic effects of vaginally administered estrogen. Effects on serum hormone levels, vasomotor symptoms, lipid profiles and use in women with breast cancer are reviewed. An accompanying review examines the local effects of vaginally administered estrogen. PMID:22453284

  13. Automated intraoperative calibration for prostate cancer brachytherapy

    SciTech Connect

    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

    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.

  14. 21 CFR 884.5940 - Powered vaginal muscle stimulator for therapeutic use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false Powered vaginal muscle stimulator for therapeutic use. 884...Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic use. (a) Identification. A powered vaginal muscle stimulator is an electrically...

  15. 75 FR 3745 - NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights; Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-22

    ...Consensus Development Conference on Vaginal Birth After Cesarean: New Insights; Notice...Consensus Development Conference on Vaginal Birth After Cesarean: New Insights'' to be...it will be open to the public. Vaginal birth after cesarean (VBAC) is the...

  16. Vault Prolapse II: Restoration of Dynamic Vaginal Supports by Infracoccygeal Sacropexy, an Axial Day-Case Vaginal Procedure

    Microsoft Academic Search

    P. E. Papa Petros

    2001-01-01

    :   Our objective was to present and critically analyze the first 75 infracoccygeal sacropexy (ICS) operations for cure of vault\\u000a prolapse. Level 1 reconstruction was achieved by the insertion of a tension-free vaginal tape (nylon) via the ischiorectal\\u000a fossa into a transversely incised posterior vaginal fornix. Level 2 defects were repaired by cutting a central ‘bridge’ in\\u000a the posterior vaginal

  17. Classification of rotator cuff tendinopathy using high definition ultrasound

    PubMed Central

    Hinsley, Hannah; Nicholls, Alex; Daines, Michael; Wallace, Gemma; Arden, Nigel; Carr, Andrew

    2014-01-01

    Summary Background: ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles. Methods: 464 women, aged 65–87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings. Results: there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon. Conclusion: the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0–2.5cm); Multi-tendon full-thickness tears (>2.5cm). PMID:25489559

  18. Vaginal fold histology reduces the variability introduced by vaginal exfoliative cytology in the classification of mouse estrous cycle stages

    PubMed Central

    Arnon, Gal; Po-Ching, Lin; Anne M, Barger; Amy L, MacNeill; CheMyong, Ko

    2015-01-01

    Vaginal exfoliative cytology is commonly used in biomedical and toxicological research to classify the stages of the rodent estrous cycle. However, mouse vaginal exfoliative cytology is commonly used as a stand-alone tool and has not been evaluated in reference to vaginal histology and serum sex hormone levels. In this study, the direct and Giemsa-stained methods of vaginal exfoliative cytology were compared in reference to vaginal fold histology and serum sex hormone levels. Both methods predicted the estrous stages similarly with mean discordance rates of 55%, 77%, 46% and 31%, for diestrus, proestrus, estrus and metestrus, respectively. From these results we conclude that vaginal exfoliative cytology may be used as a general guide to determine the desired estrous stage endpoint, and that a definitive confirmation of the estrous stage should obtained from evaluation of vaginal fold histology. Confirmation of the stage of the estrous cycle by vaginal fold histology will decrease the variability otherwise introduced by misclassification of estrous cycle stages with vaginal exfoliative cytology. PMID:24705880

  19. Cuff electrodes for very small diameter nerves -- prototyping and first recordings in vivo.

    PubMed

    Ordonez, Juan S; Pikov, Victor; Wiggins, Harvey; Patten, Craig; Stieglitz, Thomas; Rickert, J; Schuettler, Martin

    2014-01-01

    A fabrication method for cuff electrodes to interface small nerves was developed. Medical grade silicone rubber conforms the body of the cuff and insulation of the wires, platinum was used as metal for the embedded wiring and contacts. Planar electrode arrays where fabricated using a picosecond laser and then positioned into a carrying tube to provide the third dimension with the desired inner diameter (Ø 0.3-0.5 mm). The post preparation of the cuffs after structuring allows the fabrication of a stable self-closing flap that insulates the opening slit of the cuff without the need of extra sutures. Basic for the success of the cuff is the laser-based local thinning of both the silicone rubber and the metal at defined sections. This is critical to permit the PDMS' body to dominate the mechanical properties. Finite element modeling was applied to optimize the displacement ability of the cuff, leading to design capable of withstanding multiple implantation procedures without wire damage. Furthermore, the contact's surface was roughened by laser patterning to increase the charge injection capacity of Pt to 285 ?C/cm(2) measured by voltage transient detection during pulse testing. The cuff electrodes were placed on a small sympathetic nerve of an adult female Sprague-Dawley rat for recording of spontaneous and evoked neural activity in vivo. PMID:25571569

  20. The Global Percutaneous Shuttling Technique Tip for Arthroscopic Rotator Cuff Repair

    PubMed Central

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

    2014-01-01

    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

  1. Delivered growth factor therapy to improve healing after rotator cuff repair

    PubMed Central

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

    2010-01-01

    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. PMID:24198519

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

    PubMed Central

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

    2012-01-01

    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. PMID:25098365

  3. Fibroepithelial vaginal polyp in a newborn

    PubMed Central

    Alotay, Abdulhakim A.; Sarhan, Osama; Alghanbar, Mustafa; Nakshabandi, Ziyad

    2015-01-01

    A fibroepithelial polyp of the vagina (FEPV) is a mucosal polypoid lesion with a connective tissue core covered by a benign squamous epithelium. A vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls. This article describes a newborn girl with an interlabial mass that the histological analysis revealed to be an FEPV. Surgical excision of the mass was performed, and the patient has not experienced recurrence after 1-year of follow-up. A review of the literature revealed that our case was the third reported case of a fibroepithelial polyp in a neonate.

  4. Pathology Case Study: Bloody Vaginal Discharge

    NSDL National Science Digital Library

    Dickson, H.

    This is a case study presented by the University of Pittsburgh Department of Pathology in which an elderly woman experienced bloody vaginal discharge long after menopause. Visitors are given both the microscopic pap smear and biopsy findings, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in gynecologic pathology.

  5. Update in management of vaginal mesh erosion.

    PubMed

    Cornu, Jean-Nicolas; Peyrat, Laurence; Haab, François

    2013-10-01

    Mesh erosion is one of the major complications of prolapse surgery conducted by transvaginal approach. Following the extensive use of meshes and warning about potential complications, a new classification of mesh-related adverse events has been proposed. Due to the wide scope of clinical features, no standardized approach has been proposed. Surgery is required after failure of conservative management, mostly based on mesh partial or total excision by transvaginal route, following the classic rules of re-do vaginal surgery. Complex cases are best managed in tertiary reference centers. PMID:23873511

  6. Microbiology of vaginal discharge in Nairobi, Kenya.

    PubMed Central

    Mirza, N B; Nsanze, H; D'Costa, L J; Piot, P

    1983-01-01

    Among women attending a sexually transmitted disease (STD) clinic in Nairobi with vaginal discharge, Neisseria gonorrhoeae and Chlamydia trachomatis were isolated from the cervix in 32 (26%) of 122 and four (7%) of 58 women respectively. Infection with Trichomonas vaginalis, Candida albicans, Gardnerella vaginalis, and Mycoplasma spp were diagnosed in 42 of 122 (34%), 26 of 110 (24%), 75 of 100 (75%), and 42 of 89 (47%) women respectively. Mixed infections with at least two pathogens were found in 23 (26%) of 89 women examined for all microorganisms. Infection with N gonorrhoeae was significantly associated with abdominal pain. PMID:6405973

  7. Vaginal mass following uncemented total hip arthroplasty

    PubMed Central

    Shin, Young-Soo; Jung, Tae-Wan; Han, Seung-Beom

    2014-01-01

    A 53-year-old woman developed a vaginal mass following an uncemented total hip arthroplasty. The mass was in direct communication with the hip through an acetabular medial wall defect after loosening of the acetabular component. The mass formation was caused simultaneously by changes secondary to polyethylene wear, a tiny delamination of the porous titanium mesh coating and a broken antirotational tab on the acetabular cup, all of which may have served as sources of metal particles. A careful evaluation of the patient's history, symptoms, X-ray findings and computed tomography scans should always be performed to ensure accurate diagnosis. PMID:25404779

  8. Vaginal "fisting" as a cause of death.

    PubMed

    Fain, D B; McCormick, G M

    1989-03-01

    We describe the death of a young girl that resulted from the insertion of a clenched hand and forearm into her vagina during heterosexual activity. (The male homosexual practice of rectal fist insertion has been described previously.) We believe this death to be the first reported case of a "fisting" death due to vaginal fist insertion during heterosexual activity. This death is reported to alert forensic pathologists, medicolegal death investigators, and coroners aware of the role of aberrant sexual activity and its potential to cause death. PMID:2929548

  9. Pharmacological profiling of neuropeptides on rabbit vaginal wall and vaginal artery smooth muscle in vitro

    PubMed Central

    Aughton, K L; Hamilton-Smith, K; Gupta, J; Morton, J S; Wayman, C P; Jackson, V M

    2008-01-01

    Background and purpose: Hypothalamic neuropeptides centrally modulate sexual arousal. However, the role of neuropeptides in peripheral arousal has been ignored. Vascular and non-vascular smooth muscle relaxation in the vagina is important for female sexual arousal. To date, in vitro studies have focused on vaginal strips with no studies on vaginal arteries. The aim of this study was to compare the effects of sexual hypothalamic neuropeptides on rabbit vaginal wall strips and arteries. Experimental approach: Tissue bath and wire myography techniques were used to measure isometric tension from strips and arteries, respectively. Key results: Pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) relaxed both preparations, effects that were only antagonized by the VIP/PACAP antagonist VIP6–28 (10?nM) and the PAC1 antagonist PACAP 6–38 (1??M). The melanocortin agonist ?-melanocortin-stimulating hormone (1??M), but not bremelanotide (1??M), also relaxed both preparations. Oxytocin and vasopressin contracted vaginal preparations, which could be antagonized by the V1A antagonist SR 49059. Neuropeptide Y (NPY) and the NPY Y1 agonist Leu31, Pro34 NPY only contracted arteries, which was antagonized by the NPY Y1 receptor antagonist BIBP 3226. Melanin-concentrating hormone (MCH; 1??M) contracted arteries. Conclusion and implications: Hypothalamic neuropeptides can exert contractile and relaxant effects on vaginal strips and arteries. NPY Y1, V1A, MCH1 antagonists as well as VIP/PAC1 agonists may have therapeutic potential in both central and peripheral female sexual arousal. Differences in effect of neuropeptides between preparations raise the question of which preparation is important for female sexual arousal. PMID:18587425

  10. Fluconazole Susceptibility of Vaginal Isolates Obtained from Women with Complicated Candida Vaginitis: Clinical Implications

    PubMed Central

    Sobel, J. D.; Zervos, M.; Reed, B. D.; Hooton, T.; Soper, D.; Nyirjesy, P.; Heine, M. W.; Willems, J.; Panzer, H.

    2003-01-01

    Despite considerable evidence of azole resistance in oral candidiasis due to Candida species, little is known about the azole susceptibilities of the genital tract isolates responsible for vaginitis. The fluconazole susceptibilities of vaginal isolates obtained during a multicenter study of 556 women with complicated Candida vaginitis were determined by evaluating two fluconazole treatment regimens. Of 393 baseline isolates of Candida albicans, 377 (96%) were highly susceptible to fluconazole (MICs, <8 ?g/ml) and 14 (3.6%) were resistant (MICs, ?64 ?g/ml). Following fluconazole therapy, one case of in vitro resistance developed during 6 weeks of monitoring. In accordance with the NCCLS definition, in vitro fluconazole resistance correlated poorly with the clinical response, although a trend of a higher mycological failure rate was found (41 versus 19.6% on day 14). By using an alternative breakpoint of 1 ?g/ml, based upon the concentrations of fluconazole achievable in vaginal tissue, no significant differences in the clinical and mycological responses were observed when isolates (n = 250) for which MICs were ?1 ?g/ml were compared with isolates (n = 30) for which MICs were >1 ?g/ml, although a trend toward an improved clinical outcome was noted on day 14 (odds ratio, >2.7; 95% confidence interval, 0.91, 8.30). Although clinical failure was uncommon, symptomatic recurrence or mycological relapse almost invariably occurred with highly sensitive strains (MICs, <1.0 ?g/ml). In vitro fluconazole resistance developed in 2 of 18 initially susceptible C. glabrata isolates following fluconazole exposure. Susceptibility testing for women with complicated Candida vaginitis appears to be unjustified. PMID:12499165

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

    SciTech Connect

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

    2010-06-01

    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.

  12. Vaginal Eroticism and Female Orgasm: A Current Appraisal

    Microsoft Academic Search

    Heli Alzate

    1985-01-01

    In the light of very recent studies, this paper reviews two controversial issues in the area of female sexuality: vaginal eroticism and female orgasm. From the available evidence, it is concluded that most (and probably all) women possess vaginal zones, mainly located on the anterior wall, whose tactile stimulation can lead to orgasm. The apparent contradiction between this finding and

  13. Gestational trophoblastic disease: the significance of vaginal metastases.

    PubMed

    Bloch, B; Atad, J

    1983-10-01

    Six patients with gestational trophoblastic disease whose presenting symptom was hemorrhage from vaginal metastases are discussed. The clinical features, management, and response to treatment are outlined and it is suggested that the presence of vaginal metastases should be regarded as a poor prognostic factor and an indication for multiple cytotoxic agent chemotherapy. PMID:6313492

  14. What Are the Risk Factors for Vaginal Cancer?

    MedlinePLUS

    ... know what causes vaginal cancer? What are the risk factors for vaginal cancer? A risk factor is anything that affects your chance of getting ... disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is ...

  15. Vaginal delivery in patients with a prior cesarean section.

    PubMed

    Lavin, J P; Stephens, R J; Miodovnik, M; Barden, T P

    1982-02-01

    To assess the risks and benefits of vaginal delivery in patients with prior cesarean section, the English literature on this subject from 1950 to 1980 was reviewed. The following conclusions were reached: 1) Properly conducted vaginal delivery after cesarean section is relatively safe, with a 0.7% incidence of uterine rupture, 0.93 perinatal mortality, and no maternal deaths due to uterine rupture. 2) Of those patients allowed a trial of labor, 66.7% were successfully delivered vaginally. Successful vaginal delivery occurred in 74.2% of those patients with a nonrecurrent indication for their previous cesarean section and in 33.3% of those patients whose indication for previous cesarean section was cephalopelvic disproportion. Sixty-seven percent of those patients with a prior vaginal delivery versus 47.1% of those patients without a prior vaginal delivery subsequently delivered vaginally. 3) A classic uterine scar clearly increases the probability of uterine rupture. However, the precise magnitude of the increased risk cannot be accurately determined. 4) Certain basic safety requirements such as available operating room facilities and adequate personnel for careful observation are mandatory, but other management policies that remain controversial include use of regional anesthesia, oxytocin administration, timing of hospital admission, artificial rupture of membranes, mode of delivery, proper method to evaluate the uterine scar, and delivery of fetuses in breech presentation and twins. 5) A policy of selective vaginal deliveries among patients with prior cesarean sections will result in cost reductions due to decreased postpartum hospitalization. PMID:7078857

  16. Women's Psychological Adjustment Following Emergency Cesarean versus Vaginal Delivery.

    ERIC Educational Resources Information Center

    Padawer, Jill A.; And Others

    1988-01-01

    Investigated psychological adjustment and satisfaction in women who had given birth vaginally or by cesarean section. Cesarean mothers reported significantly less satisfaction with the delivery than did vaginal mothers; however no differences were found in postpartum psychological adjustment as measured by depression, anxiety, and confidence in…

  17. Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears

    PubMed Central

    Dilisio, Matthew F.; Neyton, Lionel

    2014-01-01

    The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign–directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion. PMID:25685676

  18. Calcific Tendinitis of the Rotator Cuff: A Review

    PubMed Central

    Kachewar, Sushil G; Kulkarni, Devidas S

    2013-01-01

    Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102

  19. Murine cervical heart transplantation model using a modified cuff technique.

    PubMed

    Oberhuber, Rupert; Cardini, Benno; Kofler, Markus; Ritschl, Paul; Oellinger, Robert; Aigner, Felix; Sucher, Robert; Schneeberger, Stefan; Pratschke, Johann; Brandacher, Gerald; Maglione, Manuel

    2014-01-01

    Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice(1-3). This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates(4). Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient(5). Herein, we provide additional details of this technique to supplement the video. PMID:25350682

  20. Factors affecting healing after arthroscopic rotator cuff repair

    PubMed Central

    Abtahi, Amir M; Granger, Erin K; Tashjian, Robert Z

    2015-01-01

    Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.

  1. Factors affecting healing after arthroscopic rotator cuff repair.

    PubMed

    Abtahi, Amir M; Granger, Erin K; Tashjian, Robert Z

    2015-03-18

    Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. PMID:25793161

  2. Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy

    PubMed Central

    2014-01-01

    Intensity modulated brachytherapy (IMBT) is a modern development of classical interventional radiation therapy (brachytherapy), which allows the application of a high radiation dose sparing severe adverse events, thereby further improving the treatment outcome. Classical indications in head and neck (H&N) cancers are the face, the oral cavity, the naso- and oropharynx, the paranasal sinuses including base of skull, incomplete resections on important structures, and palliation. The application type can be curative, adjuvant or perioperative, as a boost to external beam radiation as well as without external beam radiation and with palliative intention. Due to the frequently used perioperative application method (intraoperative implantation of inactive applicators and postoperative performance of radiation), close interdisciplinary cooperation between surgical specialists (ENT-, dento-maxillary-facial-, neuro- and orbital surgeons), as well interventional radiotherapy (brachytherapy) experts are obligatory. Published results encourage the integration of IMBT into H&N therapy, thereby improving the prognosis and quality of life of patients.

  3. The evolution of brachytherapy treatment planning

    SciTech Connect

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

    2009-06-15

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

  4. Vaginal breech delivery: results of a prospective registration study

    PubMed Central

    2013-01-01

    Background Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. Methods A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. Results Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar?vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p?vaginal delivery group (p?vaginal group without long-term sequelae. PMID:23883361

  5. Rectal dosimetric analysis following prostate brachytherapy

    Microsoft Academic Search

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

    1999-01-01

    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

  6. Design and optimization of a brachytherapy robot

    NASA Astrophysics Data System (ADS)

    Meltsner, Michael A.

    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.

  7. Endovascular brachytherapy — Treatment planning and radiation protection

    Microsoft Academic Search

    Ulrich Quast; Dirk Flühs; Markus Bambynek

    1998-01-01

    The risk of restenosis, main late effect limiting the success of percutaneous transluminal coronary artery angioplasty, can\\u000a be reduced significantly by vascular radiotherapy, subsequent to PTCA. This discovery lead to the development of new irradiation\\u000a techniques. Endovascular brachytherapy is the choice in treatment of coronary artery stenosis. Successful irradiation, however,\\u000a requires precise treatment planning. This review addresses the physical possibilities

  8. Erectile Function Durability Following Permanent Prostate Brachytherapy

    SciTech Connect

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

    2009-11-01

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

  9. Brachytherapy needle deflection evaluation and correction

    SciTech Connect

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

    2005-04-01

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

  10. Rotating-shield brachytherapy for cervical cancer

    NASA Astrophysics Data System (ADS)

    Yang, Wenjun; Kim, Yusung; Wu, Xiaodong; Song, Qi; Liu, Yunlong; Bhatia, Sudershan K.; Sun, Wenqing; Flynn, Ryan T.

    2013-06-01

    In this treatment planning study, the potential benefits of a rotating shield brachytherapy (RSBT) technique based on a partially-shielded electronic brachytherapy source were assessed for treating cervical cancer. Conventional intracavitary brachytherapy (ICBT), intracavitary plus supplementary interstitial (IS+ICBT), and RSBT treatment plans for azimuthal emission angles of 180° (RSBT-180) and 45° (RSBT-45) were generated for five patients. For each patient, high-risk clinical target volume (HR-CTV) equivalent dose in 2 Gy fractions (EQD2) (?/? = 10 Gy) was escalated until bladder, rectum, or sigmoid colon tolerance EQD2 values were reached. External beam radiotherapy dose (1.8 Gy × 25) was accounted for, and brachytherapy was assumed to have been delivered in 5 fractions. IS+ICBT provided a greater HR-CTV D90 (minimum EQD2 to the hottest 90%) than ICBT. D90 was greater for RSBT-45 than IS+ICBT for all five patients, and greater for RSBT-180 than IS+ICBT for two patients. When the RSBT-45/180 plan with the lowest HR-CTV D90 that was greater than the D90 the ICBT or IS+ICBT plan was selected, the average (range) of D90 increases for RSBT over ICBT and IS+ICBT were 16.2 (6.3-27.2)and 8.5 (0.03-20.16) Gy, respectively. The average (range) treatment time increase per fraction of RSBT was 34.56 (3.68-70.41) min over ICBT and 34.59 (3.57-70.13) min over IS+ICBT. RSBT can increase D90 over ICBT and IS+ICBT without compromising organ-at-risk sparing. The D90 and treatment time improvements from RSBT depend on the patient and shield emission angle.

  11. Myths and fallacies in permanent prostate brachytherapy

    SciTech Connect

    Butler, Wayne M.; Merrick, Gregory S

    2003-09-30

    Because there are competing modalities to treat early-stage prostate cancer, the constraints or deficiencies of one modality may be erroneously applied to others. Some valid concerns arising from surgery and external beam therapy, which have been falsely transferred to brachytherapy, are constraints based on patient age, clinical and pathological parameters, patient weight, and size of prostate. Although the constraints have a valid basis in one modality, knowledge of the origin and mechanism of the constraint has provided a means to circumvent or overcome it in brachytherapy. Failures as measured by biochemical no-evidence of disease (bNED) survival may be attributed to extracapsular disease extension. Such extension often expresses itself in surrogate parameters such as a high percentage of positive biopsies, perineural invasion, or the dominant pattern in Gleason score histology. Failures due to such factors may be prevented by implanting with consistent extracapsular dosimetric margins. Some presumed limitations on prostate brachytherapy originated from data on patients implanted in the first few years the procedure was being developed. Most of the urinary morbidity and a significant part of the decrease in sexual function observed may be avoided by controlling the dosimetry along the prostatic and membranous urethra and at the penile bulb.

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

    PubMed

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

    2012-01-01

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

  13. An investigation of a PRESAGE® in vivo dosimeter for brachytherapy

    NASA Astrophysics Data System (ADS)

    Vidovic, A. K.; Juang, T.; Meltsner, S.; Adamovics, J.; Chino, J.; Steffey, B.; Craciunescu, O.; Oldham, M.

    2014-07-01

    Determining accurate in vivo dosimetry in brachytherapy treatment with high dose gradients is challenging. Here we introduce, investigate, and characterize a novel in vivo dosimeter and readout technique with the potential to address this problem. A cylindrical (4 mm × 20 mm) tissue equivalent radiochromic dosimeter PRESAGE® in vivo (PRESAGE®-IV) is investigated. Two readout methods of the radiation induced change in optical density (OD) were investigated: (i) volume-averaged readout by spectrophotometer, and (ii) a line profile readout by 2D projection imaging utilizing a high-resolution (50 micron) telecentric optical system. Method (i) is considered the gold standard when applied to PRESAGE® in optical cuvettes. The feasibility of both methods was evaluated by comparison to standard measurements on PRESAGE® in optical cuvettes via spectrophotometer. An end-to-end feasibility study was performed by a side-by-side comparison with TLDs in an 192Ir HDR delivery. 7 and 8 Gy was delivered to PRESAGE®-IV and TLDs attached to the surface of a vaginal cylinder. Known geometry enabled direct comparison of measured dose with a commissioned treatment planning system. A high-resolution readout study under a steep dose gradient region showed 98.9% (5%/1 mm) agreement between PRESAGE®-IV and Gafchromic® EBT2 Film. Spectrometer measurements exhibited a linear dose response between 0-15 Gy with sensitivity of 0.0133 ± 0.0007 ?OD/(Gy???cm) at the 95% confidence interval. Method (ii) yielded a linear response with sensitivity of 0.0132 ± 0.0006 (?OD/Gy), within 2% of method (i). Method (i) has poor spatial resolution due to volume averaging. Method (ii) has higher resolution (˜1 mm) without loss of sensitivity or increased noise. Both readout methods are shown to be feasible. The end-to-end comparison revealed a 2.5% agreement between PRESAGE®-IV and treatment plan in regions of uniform high dose. PRESAGE®-IV shows promise for in vivo dose verification, although improved sensitivity would be desirable. Advantages include high-resolution, convenience and fast, low-cost readout.

  14. Arthroscopic treatment of rotator cuff tear and greater tuberosity fracture nonunion

    Microsoft Academic Search

    Gary M. Gartsman; Ettore Taverna

    1996-01-01

    The association of full-thickness rotator cuff tear combined with a nonunion of the greater tuberosity is uncommon. We present one case, describing management of both lesions using arthroscopic technique

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

    PubMed

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

    2008-01-01

    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

  16. Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs

    PubMed Central

    Pitts, Todd C.; Knight, Alex N.; Burkhead, Wayne Z.

    2014-01-01

    Abstract The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced. PMID:25371862

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

    PubMed

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

    2013-01-01

    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

  18. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery

    PubMed Central

    Petricevic, Ljubomir; Domig, Konrad J.; Nierscher, Franz Josef; Sandhofer, Michael J.; Fidesser, Maria; Krondorfer, Iris; Husslein, Peter; Kneifel, Wolfgang; Kiss, Herbert

    2014-01-01

    The presence of an abnormal vaginal microflora in early pregnancy is a risk factor for preterm delivery. There is no investigation on vaginal flora dominated by lactic acid bacteria and possible association with preterm delivery. We assessed the dominant vaginal Lactobacillus species in healthy pregnant women in early pregnancy in relation to pregnancy outcome. We observed 111 low risk pregnant women with a normal vaginal microflora 11 + 0 to 14 + 0 weeks of pregnancy without subjective complaints. Vaginal smears were taken for the identification of lactobacilli using denaturing gradient gel electrophoresis (DGGE). Pregnancy outcome was recorded as term or preterm delivery (limit 36 + 6 weeks of gestation). The diversity of Lactobacillus species in term vs. preterm was the main outcome measure. L. iners alone was detected in 11 from 13 (85%) women who delivered preterm. By contrast, L. iners alone was detected in only 16 from 98 (16%) women who delivered at term (p < 0.001). Fifty six percent women that delivered at term and 8% women that delivered preterm had two or more vaginal Lactobacillus spp. at the same time. This study suggests that dominating L. iners alone detected in vaginal smears of healthy women in early pregnancy might be associated with preterm delivery. PMID:24875844

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

    Microsoft Academic Search

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

    1998-01-01

    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

  20. Comparison of the Clinical Outcomes of Single and Double-row Repairs in Rotator Cuff Tears

    Microsoft Academic Search

    Jin-Young Park; Sang-Hoon Lhee; Jin-Hyung Choi; Hong-Keun Park; Je-Wook Yu; Joong-Bae Seo

    2008-01-01

    Background: Although research has demonstrated the superiority of double-row rotator cuff repair over single-row methods from a biological and mechanical point of view, few studies have compared clinical outcome of the 2 methods, and no articles have been published describing the superiority of double-row methods in clinical aspects.Hypothesis: Arthroscopic double-row repair of a rotator cuff tear has superior clinical outcome

  1. Shoulder ultrasound: Diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology

    Microsoft Academic Search

    John W Read; Mark Perko

    1998-01-01

    We sought to determine the accuracy of ultrasound for the preoperative evaluation of shoulder impingement syndrome, rotator cuff tear, and abnormalities of the long head of the biceps tendon. The findings in 42 consecutive surgical cases were compared with the preoperative sonographic readings. Ultrasound detected all of the 10 full-thickness cuff tears identified at surgery (sensitivity 1.0, specificity 0.97) but

  2. The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears

    Microsoft Academic Search

    Gary M. Gartsman; Ettore Taverna

    1997-01-01

    To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major

  3. Living with a symptomatic rotator cuff tear ‘bad days, bad nights’: a qualitative study

    PubMed Central

    2014-01-01

    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. PMID:25008095

  4. Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube

    Microsoft Academic Search

    Alexander Dullenkopf; Andreas Gerber; Markus Weiss

    2003-01-01

    ObjectiveThis study compared the recently introduced Microcuff endotracheal tube HVLP ICU featuring an ultrathin (7-µm) polyurethane cuff membrane with endotracheal tubes from different manufacturers regarding fluid leakage past the tube cuff.DesignIn vitro setup.Measurements and resultsThe following endotracheal tubes (ID 7.5 mm) were compared: Mallinckrodt HiLo, Microcuff HVLP ICU, Portex Profile Soft Seal, Rüsch Super Safety Clear, and Sheridan CF. A vertical

  5. Improved treatment planning for the Syed-Neblett template using endorectal-coil magnetic resonance and intraoperative (laparotomy/laparoscopy) guidance: a new integrated technique for hysterectomized women with vaginal tumors.

    PubMed

    Corn, B W; Lanciano, R M; Rosenblum, N; Schnall, M; King, S; Epperson, R

    1995-02-01

    The Syed template (Alpha-Omega Services, Bellflower, CA) represents an advance in interstitial gynecologic brachytherapy; however, its appeal is diminished by inaccuracies in target definition secondary to suboptimal imaging of gynecologic tumors and the risk of viscus perforation during a "blind" procedure. Magnetic resonance (MR) scanning with an endorectal coil and computed tomography were studied as a possible tool to improve target definition and maximize treatment planning with Syed templates. Abdominopelvic contents could be visualized directly through a laparotomy incision or indirectly with a laparoscopic video display to allow further target definition and minimize complications associated with blind procedures after hysterectomy. The synthesis of these techniques with Syed template applications was attempted to potentiate the utility of this brachytherapy system. Five patients with apical vaginal tumors which arose after previous hysterectomies (two endometrial cancer recurrences, one recurrent uterine sarcoma, two primary vaginal cancers) were referred for radiotherapy. In three cases, external beam pelvic radiotherapy (median dose, 45 Gy; range, 45-50.4 Gy) was delivered initially. In all cases, the Syed applicator was used for the brachytherapy component of the treatment. In two cases, high-resolution MR images (400 x 400 microns) of the vaginal apex were obtained after insertion of an endorectal surface coil. The images defined the relationships between the template, target volume, bladder, rectum, and intestine. The other three cases were planned with computerized tomography (CT). In all cases, intraoperative examination of the abdominopelvic contents was provided when laparotomy and/or laparoscopy was performed by the surgical team. The median brachytherapy dose prescribed to the isodose envelope covering the target volume was 40 Gy (range, 31-50 Gy). In all cases, the target volumes could be encompassed by the 60 cGy/hr isodose line. Tumor volume estimation was better with MR than CT. Procedure time was shorter with laparoscopy than with laparotomy. In two cases, bowel displacement was performed (one tissue expander, one omental sling) to prevent viscus perforation by interstitial needles. Four of five patients responded completely to the treatment. In three cases, local control was maintained at a median follow-up of 11 months. In conclusion, endorectal coil MRI may be advantageous to CT of the pelvis in that it allows preplanning to be achieved with greater precision and with less planning time. Major intraoperative complications (i.e., perforation of hollow viscus organs) can be avoided when the course of interstitial catheters is visualized from above by the surgical team.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7896194

  6. Effects of estroprogestins containing natural estrogen on vaginal flora.

    PubMed

    De Seta, Francesco; Restaino, Stefano; Banco, Rubina; Conversano, Ester; De Leo, Rossella; Tonon, Maddalena; Maso, Gianpaolo; Barbati, Giulia; Lello, Stefano

    2014-11-01

    Estroprogestins with "natural oestrogen" has represented a new option in terms of combined hormonal contraception. So, the aim of this study is to investigate how estroprogestins with natural estrogen may modify the vaginal niche. In literature, very few studies focused on the interaction between hormonal contraception and vaginal milieu. This is a prospective comparative study. We enrolled 60 women from January 2013 to September 2013, 30 of them were administered estradiol valerate dienogest (E2V+DNG - Klaira®) in a quadriphasic regimen, while the other 30 women were administered 17-? estradiol with nomestrol acetate (EV+NOMAC - Zoely®) in a monophasic regimen. After a baseline study of vaginal milieu at recruitment of patients (Gram stain with Nugent score, vaginal pH, vaginal wet mount for the quantification of leukocytes, Lactobacilli and/or presence of Candida), we performed the same follow-up after six months of estroprogestin therapy. Our results showed that the women treated with E2V+DNG had a trend of an improvement of vaginal health in terms of increase of lactobacillar flora and reduction of vaginal pH in place of women treated with EV+NOMAC that showed a reduction of cervical mucus. Finally, our data about the effects on vaginal flora exerted by two estroprogestin pills (EPs) containing a natural estrogen suggest slight, but interesting differences in terms of vaginal ecology. These differences could be related to the type of estrogen, type of progestin, regimen of administration and, after all, to the net balance between estrogenic and progestin component of the EPs. PMID:24993504

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

    PubMed

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

    2014-01-01

    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

  8. A comparative study of Neo Sampoon, Ortho Vaginal Tablets and Emko Vaginal Tablets in Accra, Ghana.

    PubMed

    Lamptey, P; Klufio, C; Smith, S C; Feldblum, P J

    1985-11-01

    Neo Sampoon is an effervescent contraceptive vaginal tablet manufactured in Japan that contains 60 mg of the spermicide menfegol. Ortho Vaginal Tablets (OVT) and Emko Vaginal Tablets (EVT), both containing 100 mg of the spermicide nonoxynol-9, were manufactured in the USA. The three products were compared in a randomized clinical trial conducted at the family planning clinics of the Korle-Bu Teaching Hospital and the Kotobaabi Polyclinic in Accra, Ghana. Three-hundred volunteers participated. At 12 months, the life-table pregnancy rates were 9.6, 11.3 and 12.5 per 100 women in the Neo Sampoon, OVT and EVT groups, respectively (p greater than 0.10). More EVT than Neo Sampoon or OVT users discontinued because of discomfort as well as for other product-related reasons (p less than 0.01). The most common reason for discontinuation was the temporary absence of sexual partner, with more than 40% of the women overall terminating for this reason. The 12-month life-table continuation rates per 100 women were higher for the Neo Sampoon group (62.4) than the OVT group (48.6) or the EVT group (38.5) (p less than 0.01). The effectiveness of the three products seems to be similar, but Neo Sampoon and OVT appear to be more acceptable than EVT in this Ghanaian population. PMID:3002720

  9. A new tear pattern of the rotator cuff and its treatment: Fosbury flop tears

    PubMed Central

    Lädermann, Alexandre; Denard, Patrick J.; Kolo, Frank C.

    2015-01-01

    Purpose: The purpose of this report is to describe a new full-thickness tear pattern of the posterosuperior rotator cuff with reversal healing. We describe the specific radiologic signs associated with this tear pattern and the arthroscopic rotator cuff repair technique. Materials and Methods: A prospective radiologic and clinical study collected all patients with a magnetic resonance imaging arthrogram that underwent an arthroscopic rotator cuff repair over a 1 year period. Results: Among 97 patients, five demonstrated a tear of the posterosuperior rotator cuff with reversal healing. Characteristic radiographic findings included a thicker tendon than normal, the presence of a stump and accumulation of liquid in the superior-medial part of the subacromial bursa, and adhesions between the supraspinatus tendon and the wall of the subacromial bursa. Conclusion: Avulsion of the posterosuperior rotator cuff with reversal healing on its bursal-side is a less common condition. This type of lesion and distinct radiographic signs that can be recognized to facilitate anatomic repair of the rotator cuff. Level of evidence: Level IV. PMID:25709239

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

    PubMed

    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

    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

  11. Optimal tracheal tube cuff inflation in infants: implications for mechanical ventilation and respiratory mechanics.

    PubMed

    Habib, R H

    2001-11-01

    Uncuffed tracheal tubes (TT) are used to intubate infants and children to avoid laryngotracheal tissue injury. The geometric mismatch resulting from such intubation limits the efficacy of mechanical ventilation, and reliability of derived respiratory mechanical properties. This study tested the hypotheses that (1) normal stresses applied to the cuff surface by leak flows during ventilation result in intracuff pressure (Pcuff) fluctuations proportionate to leak magnitudes, and (2) these fluctuations reach a steady minimum when cuff volume reaches a critical value (Vcrit) at which the TT-airway mismatch is removed. Physical model and piglet measurements showed that, during simultaneous cuff inflation and mechanical ventilation, Pcuff consisted of a leak-dependent (Pcuff,l) component that cycles with the ventilator superimposed on a ramp rise due to cuff inflation. The breath-to-breath peak Pcuff,l (max Pcuff,l) decreased as leak flows are reduced, and these were relatively greater for higher ventilator flows and when the load impedance is increased such as by disease. These results describe a reproducible method of TT cuff inflation that removes leaks without increased risk of laryngotracheal tissue injury. Moreover, inflation of the TT cuff more securely improved ventilation efficacy and allowed for accurate respiratory mechanics. PMID:11791682

  12. A system-wide initiative to prevent retained vaginal sponges.

    PubMed

    Chagolla, Brenda A; Gibbs, Verna C; Keats, John P; Pelletreau, Barbara

    2011-01-01

    As any perinatal nurse knows, retained vaginal sponges are an obstetrical and postpartum patient safety problem. As surgical sponge counts are not routine in some obstetrical units for vaginal births, our healthcare system chose to institute a rigorous process to eliminate retained sponges in all vaginal births. This article describes this process, along with the lessons learned, when Catholic Healthcare West implemented the Sponge ACCOUNTing System in its 32 hospitals in California, Arizona, and Nevada. Implementation of this process involved the standardization of practice for obstetricians, certified nurse midwives, nurses, obstetric technicians, radiologists, and radiology technicians in the management and accounting of surgical sponges. PMID:21857202

  13. Vaginal intercourse frequency and heart rate variability.

    PubMed

    Brody, Stuart; Preut, Ragnar

    2003-01-01

    We examined the relationship between recalled and diary recorded frequency of penile-vaginal intercourse (FSI) and both resting heart rate variability (HRV; an index of cardiac autonomic control and parasympathetic tone associated with cardiovascular health outcomes) and resting diastolic blood pressure (DBP) in 120 healthy adults aged 19-38 (subjects scoring above the 87th percentile on the Lie scale of the Eysenck Personality Inventory were excluded from analyses). As in a previous smaller study, greater HRV was associated with greater FSI (but not masturbation or non-coital sex with a partner) and rated importance of intercourse. There were no sex differences in the HRV-FSI relationship, and the relationship was not explained by including measures of Extraversion, Neuroticism, Depression, Trait Anxiety, or partnership satisfaction. However, the previously obtained negative association of FSI with DBP was not replicated. PMID:14504008

  14. Improving Vaginal Examinations Performed by Midwives

    PubMed Central

    Muliira, Rhoda S.; Seshan, Vidya; Ramasubramaniam, Shanthi

    2013-01-01

    A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: “VEs in labour”, “midwives and use of VEs” and “women experiences of VEs in labour”. The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE. PMID:23984031

  15. [Vaginal sonography as a method of study in the evaluation of cervix insufficiency. A useful complement to vaginal palpation?].

    PubMed

    Böhmer, S; Degenhardt, F; Gerlach, C; Behrens, O; Mühlhaus, K

    1989-02-01

    In a clinical study a group of pregnant women with suspected cervical incompetence was examined by vaginal sonography. Aim of the investigation was to compare results of performed vaginal palpation with results of sonography. 53 pregnant women between 20th und 31st week of gestation were examined by a 5 MHz vaginal sector-scanner probe. After focussing sagittal projection of uterine cervix and lower uterine segment the cervical length and opening of the internal os were assessed prior to cerclage. Postoperative vaginal sonography was performed to ascertain lengthening and stabilization of the incompetent cervix. Comparing results of vaginal palpation and vaginal sonography showed, that the cervical length obtained by sonography was constantly higher in all patients than the results obtained by palpation. This difference became more distinct in the group of patients with extreme cervical incompetence. We are of the opinion that vaginal sonography is an objective method revealing the extent of cervical incompetence. Exact measurement of the cervical length and assessment of the internal os are efficient diagnostic criteria. They complete results of cervical palpation and offer precise information concerning an intended cerclage. PMID:2652287

  16. Three-Dimensional Imaging in Gynecologic Brachytherapy: A Survey of the American Brachytherapy Society

    SciTech Connect

    Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.ed [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Erickson, Beth A. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2010-01-15

    Purpose: To determine current practice patterns with regard to three-dimensional (3D) imaging for gynecologic brachytherapy among American Brachytherapy Society (ABS) members. Methods and Materials: Registered physician members of the ABS received a 19-item survey by e-mail in August 2007. This report excludes physicians not performing brachytherapy for cervical cancer. Results: Of the 256 surveys sent, we report results for 133 respondents who perform one or more implantations per year for locally advanced cervical cancer. Ultrasound aids 56% of physicians with applicator insertion. After insertion, 70% of physicians routinely obtain a computed tomography (CT) scan. The majority (55%) use CT rather than X-ray films (43%) or magnetic resonance imaging (MRI; 2%) for dose specification to the cervix. However, 76% prescribe to Point A alone instead of using a 3D-derived tumor volume (14%), both Point A and tumor volume (7%), or mg/h (3%). Those using 3D imaging routinely contour the bladder and rectum (94%), sigmoid (45%), small bowel (38%), and/or urethra (8%) and calculate normal tissue dose-volume histogram (DVH) analysis parameters including the D2cc (49%), D1cc (36%), D0.1cc (19%), and/or D5cc (19%). Respondents most commonly modify the treatment plan based on International Commission on Radiation Units bladder and/or rectal point dose values (53%) compared with DVH values (45%) or both (2%). Conclusions: More ABS physician members use CT postimplantation imaging than plain films for visualizing the gynecologic brachytherapy apparatus. However, the majority prescribe to Point A rather than using 3D image based dosimetry. Use of 3D image-based treatment planning for gynecologic brachytherapy has the potential for significant growth in the United States.

  17. Human epididymis protein 4 and secretory leukocyte protease inhibitor in vaginal fluid: relation to vaginal components and bacterial composition.

    PubMed

    Orfanelli, Theofano; Jayaram, Aswathi; Doulaveris, Georgios; Forney, Larry J; Ledger, William J; Witkin, Steven S

    2014-04-01

    Human epididymis protein 4 (HE4) is a protease inhibitor and a recently identified serum biomarker for ovarian cancer. Properties of HE4 in the genital tract of healthy women have not been evaluated. We evaluated associations between HE4 and a second vaginal protease inhibitor, secretory leukocyte protease inhibitor (SLPI), with vaginal concentrations of innate immune mediators or proteases and with the types of vaginal bacterial communities. Vaginal secretions were collected from 18 healthy reproductive age women and assayed by enzyme-linked immunosorbent assay for concentrations of HE4, SLPI, kallikrein 5, cathepsin B, interleukin 1? (IL-1), IL-1 receptor antagonist (IL-1 ra), mannose-binding lectin (MBL), the inducible 70-kDa heat shock protein, and matrix metalloproteinase (MMP)-8. The species composition of vaginal bacterial communities in 16 women was characterized by sequencing amplicons derived from 16S bacterial ribosomal RNA genes. Correlations between any 2 assays were analyzed by the Spearman rank correlation tests. Differences in the concentrations of HE4 and SLPI, and between soluble components and vaginal community types, were analyzed by the Mann-Whitney U tests. Vaginal HE4 concentrations, but not SLPI levels, were positively correlated with levels of IL-1? (P = .0152), IL-1ra (P = .0061), MBL (P = .0100), and MMP-8 (P = .0315). The median vaginal HE4 level, as well as concentrations of MBL, IL-1?, IL-1ra, and MMP-8, was highest when Gardnerella vaginalis dominated a vaginal community. The association between HE4, elevated levels of proteases, immune mediators and high proportions of G vaginalis strongly suggests that HE4 is a component of the proinflammatory immune response in the female genital tract. PMID:24023032

  18. Recent developments and best practice in brachytherapy treatment planning.

    PubMed

    Lee, C D

    2014-09-01

    Brachytherapy has evolved over many decades, but more recently, there have been significant changes in the way that brachytherapy is used for different treatment sites. This has been due to the development of new, technologically advanced computer planning systems and treatment delivery techniques. Modern, three-dimensional (3D) imaging modalities have been incorporated into treatment planning methods, allowing full 3D dose distributions to be computed. Treatment techniques involving online planning have emerged, allowing dose distributions to be calculated and updated in real time based on the actual clinical situation. In the case of early stage breast cancer treatment, for example, electronic brachytherapy treatment techniques are being used in which the radiation dose is delivered during the same procedure as the surgery. There have also been significant advances in treatment applicator design, which allow the use of modern 3D imaging techniques for planning, and manufacturers have begun to implement new dose calculation algorithms that will correct for applicator shielding and tissue inhomogeneities. This article aims to review the recent developments and best practice in brachytherapy techniques and treatments. It will look at how imaging developments have been incorporated into current brachytherapy treatment and how these developments have played an integral role in the modern brachytherapy era. The planning requirements for different treatments sites are reviewed as well as the future developments of brachytherapy in radiobiology and treatment planning dose calculation. PMID:24734939

  19. Evidence for an Inherited Predisposition Contributing to the Risk for Rotator Cuff Disease

    PubMed Central

    Tashjian, Robert Z.; Farnham, James M.; Albright, Frederick S.; Teerlink, Craig C.; Cannon-Albright, Lisa A.

    2009-01-01

    Background: A genetic predisposition has been suggested to contribute to the risk for development of rotator cuff disease on the basis of observed family clusters of close relatives. We used a population-based resource combining genealogical data for Utah with clinical diagnosis data from a large Utah hospital to test the hypothesis of excess familial clustering for rotator cuff disease. Methods: The Utah Population Database contains combined health and genealogical data on over two million Utah residents. Current Procedural Terminology, Fourth Revision, codes (29827, 23412, 23410, and 23420) and International Classification of Diseases, Ninth Revision, codes (726.1, 727.61, and 840.4) entered in patient records were used to identify patients with rotator cuff disease. We tested the hypothesis of excess familial clustering using two well-established methods (the Genealogical Index of Familiality test and the estimation of relative risks in relatives) in the overall study group (3091 patients) and a subgroup of the study group diagnosed before the age of forty years (652 patients). Results: The Genealogical Index of Familiality test in patients diagnosed before the age of forty years showed significant excess relatedness for individuals with rotator cuff disease in close and distant relationships (as distant as third cousins) (p = 0.001). The relative risk of rotator cuff disease in the relatives of patients diagnosed before the age of forty years was significantly elevated for second degree (relative risk = 3.66, p = 0.0076) and third degree (relative risk = 1.81, p = 0.0479) relatives. Conclusions: We analyzed a set of patients with diagnosed rotator cuff disease and a known genealogy to describe the familial clustering of affected individuals. The observations of significant excess relatedness of patients and the significantly elevated risks to both close and distant relatives of patients strongly support a heritable predisposition to rotator cuff disease. Clinical Relevance: A better understanding of the familial risk of rotator cuff disease could lead to the identification of candidate genes predisposing individuals to rotator cuff disease. Gene identification will possibly allow the development of improved treatments, including biologic augmentations of rotator cuff repairs, which may improve tendon healing and repair outcomes. Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence. PMID:19411462

  20. [The meshes in the cure of cystocele by vaginal way].

    PubMed

    Delmas, V; Haab, F; Costa, P

    2009-12-01

    The advantages of vaginal way in the treatment of cystocele are simplicity, rapidity, peritoneal security. Raphy is subject to recidive. The meshes replace the weak fascia in its role of hammock (Delancey) for the bladder. The mesh covers the central and lateral fascial defects. The procedure consists in a short vertical colpotomy, vesicovaginal dissection, uterine preservation (if uterus is not pathologic), no vaginal excision. The mesh can be spread without fixation, fixed or anchored by arms in the obturator foramen. The results show a significative improvement in the risk of redux cystocele. Complications become less frequent with the expertise and quality of new meshes. Implants are a new vaginal evolving surgery: it must be evaluated by experts and practiced by experienced in vaginal approach surgeons. PMID:19969274

  1. Martius graft for management of exposed vaginal prolapse mesh.

    PubMed

    Al-Badr, Ahmed

    2013-01-01

    Although the use of vaginal mesh kits in treatment of pelvic organ prolapse (POP) has decreased the number of surgical failures, mesh exposure can occur. When conservative management fails, removing the exposed material is associated with the risk of recurrence of POP and could be challenging. We report a successful outcome of treatment of exposed mesh via use of a Martius bulbocavernosus fat pad. A 46-year-old woman had urinary incontinence and POP, which was treated using a vaginal mesh kit and tension-free vaginal tape. At 2 months after the procedure, the mesh was found to be exposed. After failed conservative management, use of a Martius graft was used, with preservation of the mesh. At 2-, 5-, and 10-month follow-up, the patient was completely asymptomatic and continent. This procedure may be a practical alternative in patients with synthetic mesh-induced vaginal erosion after failed conservative management. PMID:23295200

  2. Mucus-penetrating nanoparticles for vaginal and gastrointestinal drug delivery

    NASA Astrophysics Data System (ADS)

    Ensign-Hodges, Laura

    A method that could provide more uniform and longer-lasting drug delivery to mucosal surfaces holds the potential to greatly improve the effectiveness of prophylactic and therapeutic approaches for numerous diseases and conditions, including sexually transmitted infections and inflammatory bowel disease. However, the body's natural defenses, including adhesive, rapidly cleared mucus linings coating nearly all entry points to the body not covered by skin, has limited the effectiveness of drug and gene delivery by nanoscale delivery systems. Here, we investigate the use of muco-inert mucus-penetrating nanoparticles (MPP) for improving vaginal and gastrointestinal drug delivery. Conventional hydrophobic nanoparticles strongly adhere to mucus, facilitating rapid clearance from the body. Here, we demonstrate that mucoadhesive polystyrene nanoparticles (conventional nanoparticles, CP) become mucus-penetrating in human cervicovaginal mucus (CVM) after pretreatment with sufficient concentrations of Pluronic F127. Importantly, the diffusion rate of large MPP did not change in F127 pretreated CVM, implying there is no affect on the native pore structure of CVM. Additionally, there was no increase in inflammatory cytokine release in the vaginal tract of mice after daily application of 1% F127 for one week. Importantly, HSV virus remains adherent in F127-pretreated CVM. Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that hypotonically-induced fluid uptake could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We evaluated hypotonic formulations for delivering water-soluble drugs and for drug delivery with MPP. Hypotonic formulations markedly increased the rate at which drugs and MPP reached the epithelial surface. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that isotonic formulations failed to reach. However, hypotonic formulations caused free drugs to be drawn through the epithelium, reducing vaginal retention. In contrast, hypotonic formulations caused MPP to accumulate rapidly and uniformly on vaginal surfaces, ideally positioned for sustained drug delivery. Using a mouse model of vaginal genital herpes (HSV-2) infection, we found that hypotonic delivery of free drug led to improved immediate protection, but diminished longer-term protection. Minimally hypotonic formulations provided rapid and uniform delivery of MPP to the entire vaginal surface, thus enabling formulations with minimal risk of epithelial toxicity. We then describe an ex vivo method for characterizing particle transport on freshly excised mucosal tissues. By directly observing MPP transport on vaginal, gastrointestinal, and respiratory tissue, we were able to determine an innate difference in mucus mesh size at different anatomical locations. In addition, we were able to optimize particle size for gastrointestinal delivery in mice. As described here, there are numerous barriers to effective drug delivery in the gastrointestinal tract, including the mucus barrier. We go on to demonstrate that MPP can improve delivery in the gastrointestinal tract, both by rectal and oral administration. Finally, we describe the use of MPP for improving vaginal drug delivery. Incomplete drug coverage and short duration of action limit the effectiveness of vaginally administered drugs, including microbicides for preventing sexually transmitted infections. We show that MPP provide uniform distribution over the vaginal epithelium, whereas CP are aggregated by mouse vaginal mucus, leading to poor distribution. By penetrating into the deepest mucus layers in the rugae, more MPP were retained in the vaginal tract compared to CP. After 24 h, when delivered in a conventional vaginal gel, patches of a model drug remained on the vaginal epithelium, whereas the epithelium was coated with drug delivered by MPP. We then demonstrate that when administered 30 min prior to inoculum, anti-HSV-2 MPP protected

  3. Vaginal pH: Home-Use Tests

    MedlinePLUS

    ... provide a more thorough assessment of your vaginal status through your history, physical exam, and other laboratory tests than you can using a single pH test in your home. Useful Links MedlinePlus: ...

  4. Trichomoniasis as Seen in a Chronic Vaginitis Clinic

    PubMed Central

    Dan, Michael

    1996-01-01

    Objective: We sought to determine the clinical and laboratory features of trichomonas vaginitis (TV) in a chronic vaginitis clinic. Methods: We studied 45 women with symptomatic TV attending a specialty chronic vaginitis clinic. These patients were older than the usual symptomatic patients with TV. They frequently described unusual chronicity of symptoms, half being referred because of clinical resistance and the other half referred because of chronic vaginitis of unknown etiology. Results: In spite of the chronicity of infection, the signs and symptoms of florid inflammation were still evident and high numbers of polymorphonuclear leukocytes and parasitic load were present. Conclusions: A longstanding infection, especially if previously untreated, invariably responded to conventional nitroimidazole therapy. In addition, the majority of patients seen with clinical resistance to the conventional doses of metronidazole responded to high-dose oral metronidazole therapy. Unsuspected TV should always be considered in low-risk patients with chronic vulvovaginal symptoms. PMID:18476071

  5. HPV-Associated Vaginal Cancer Rates by Race and Ethnicity

    MedlinePLUS

    ... Is Doing Related Links Stay Informed Rates by Race and Ethnicity for Other Kinds of Cancer All ... Cancer Home HPV-Associated Vaginal Cancer Rates by Race and Ethnicity Language: English Español (Spanish) Recommend on ...

  6. Management of Vaginal Atrophy: Implications from the REVIVE Survey

    PubMed Central

    Wysocki, Susan; Kingsberg, Sheryl; Krychman, Michael

    2014-01-01

    Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA. PMID:24987271

  7. Diversity of the Vaginal Microbiome Correlates With Preterm Birth

    PubMed Central

    Hyman, Richard W.; Fukushima, Marilyn; Jiang, Hui; Fung, Eula; Rand, Larry; Johnson, Brittni; Vo, Kim Chi; Caughey, Aaron B.; Hilton, Joan F.; Davis, Ronald W.; Giudice, Linda C.

    2014-01-01

    Reproductive tract infection is a major initiator of preterm birth (PTB). The objective of this prospective cohort study of 88 participants was to determine whether PTB correlates with the vaginal microbiome during pregnancy. Total DNA was purified from posterior vaginal fornix swabs during gestation. The 16S ribosomal RNA gene was amplified using polymerase chain reaction primers, followed by chain-termination sequencing. Bacteria were identified by comparing contig consensus sequences with the Ribosomal Database Project. Dichotomous responses were summarized via proportions and continuous variables via means ± standard deviation. Mean Shannon Diversity index differed by Welch t test (P = .00016) between caucasians with PTB and term gestation. Species diversity was greatest among African Americans (P = .0045). Change in microbiome/Lactobacillus content and presence of putative novel/noxious bacteria did not correlate with PTB. We conclude that uncultured vaginal bacteria play an important role in PTB and race/ethnicity and sampling location are important determinants of the vaginal microbiome. PMID:23715799

  8. Massive Delayed Vaginal Hemorrhage after Laparoscopic Supracervical Hysterectomy

    PubMed Central

    Holloran-Schwartz, M. Brigid; Potter, Shannon J.; Kao, Ming-Shian

    2012-01-01

    Background. A known complication of supracervical hysterectomy is cyclical bleeding from the retained cervix when functioning endometrial tissue is not totally removed. We present a rare case of delayed postoperative vaginal hemorrhage after supracervical hysterectomy. Case. A 44-year-old woman presented on postoperative day 15 after laparoscopic supracervical hysterectomy with massive vaginal hemorrhage requiring emergent re-operation. Her bleeding was controlled with vaginally placed sutures. Ultrasound confirmed no intraperitoneal free fluid. The etiology was thought to be induced by postoperative tissue necrosis from cautery applied to the endocervical canal during the original surgery. Conclusion. Delayed vaginal hemorrhage from a retained cervix is a rare complication of laparoscopic supracervical hysterectomy. Caution should be exercised when cauterizing the endocervical canal as induced tissue necrosis may increase the risk of postoperative bleeding. PMID:22919525

  9. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

    PubMed Central

    Pieh-Holder, Kelly L.; DeVente, James E.

    2014-01-01

    Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function. PMID:25379314

  10. A Novel MRI Marker for Prostate Brachytherapy

    SciTech Connect

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

    2008-05-01

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

  11. An afterloading brachytherapy device utilizing thermoplastic material.

    PubMed

    Kim, T H; Gerbi, B J; Deibel, F C; Priest, J R; Khan, F M

    1989-08-01

    An afterloading brachytherapy device for treatment of residual cancer in an enucleated orbit with two cesium-137 sources was designed using a thermoplastic material, Aquaplast. The device consists of a face-mask support held in place with elastic bands around the head and an acrylic afterloading applicator. The device is very easy to make, holds the sources firmly in place, allows full mobility of the patient, and gives excellent dose distribution to the target area. It was easily tolerated by a 7-year-old child during the 50 h of treatment. PMID:2798937

  12. Brachytherapy in the treatment of cervical cancer: a review.

    PubMed

    Banerjee, Robyn; Kamrava, Mitchell

    2014-01-01

    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. PMID:24920937

  13. Brachytherapy in the treatment of cervical cancer: a review

    PubMed Central

    Banerjee, Robyn; Kamrava, Mitchell

    2014-01-01

    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. PMID:24920937

  14. Management of Vaginal Erosion of Polypropylene Mesh Slings

    Microsoft Academic Search

    KATHLEEN C. KOBASHI; FRED E. GOVIER

    2003-01-01

    PurposeThe SPARC (American Medical Systems, Minneapolis, Minnesota) polypropylene sling has recently been introduced as an alternative delivery system to TVT (Ethicon, New Brunswick, New Jersey) tension-free vaginal tape for placement of a tension-free mid urethral sling. Erosion must always be considered a risk of synthetic materials. We present 4 cases of vaginal erosion of polypropylene mesh placed with this system

  15. Robotic removal of eroded vaginal mesh into the bladder.

    PubMed

    Macedo, Francisco Igor B; O'Connor, Jeffrey; Mittal, Vijay K; Hurley, Patrick

    2013-11-01

    Vaginal mesh erosion into the bladder after midurethral sling procedure or cystocele repair is uncommon, with only a few cases having been reported in the literature. The ideal surgical management is still controversial. Current options for removal of eroded mesh include: endoscopic, transvaginal or abdominal (either open or laparoscopic) approaches. We, herein, present the first case of robotic removal of a large eroded vaginal mesh into the bladder and discuss potential benefits and limitations of the technique. PMID:23600850

  16. Ileal pouch vaginal fistulas: Incidence, etiology, and management

    Microsoft Academic Search

    Steven D. Wexner; David A. Rothenberger; Linda Jensen; Stanley M. Goldberg; Emmanuel G. Balcos; Paul Belliveau; Bradley H. Bennett; John G. Buls; Jeffrey M. Cohen; Harold L. Kennedy; Steven J. Medwell; Theodore M. Ross; David J. Schoetz; Lee E. Smith; Alan G. Thorson

    1989-01-01

    Some of the initial problems associated with the ileonal reservoir have been solved. In their place, other complications have\\u000a been recognized. Among these, the ileal pouch vaginal fistula stands out as a recently recognized difficult management problem.\\u000a This multicenter study was undertaken to gain insight into the causes for, and treatment of, pouch vaginal fistulas. Cases\\u000a were gathered from 11

  17. Urinary and vaginal criteria for detecting ovulation in the mare

    E-print Network

    Householder, D. Douglas

    1973-01-01

    , anger, anxiety, etc. cause an inczeased secretion of epinephrine which leads to glycogen mobilization and resultant nervous glyco- suria. Cunningham and Friend (1965) demonstrated this nervous glycosuzia in pigs. Normal blood glucose levels of 94 mg... the secretory phase of the human menstrual cycle. Sexual stimulation also increases the quantity of vaginal fluid, according to PLasters (1959). In 1934 Cruickshsnk postulated that glycogenolysis occurs in living vaginal cells and stated that a glycogen...

  18. Vaginal vault prolapse following cystectomy: transvaginal reconstruction by mesh interposition.

    PubMed

    Graefe, Flora; Beilecke, Kathrin; Tunn, Ralf

    2013-08-01

    The present study aims to introduce a transvaginal interposition of polypropylene mesh as a reproducible procedure for women with vaginal vault prolapse following cystectomy due to bladder carcinoma. No recurrent prolapse occurred in two cases 16 and 4 months after the operation. With apical fixation of the mesh, vaginal length can be maintained. No perioperative complications appeared. Performing the technique in a reproducible way seems feasible irrespective of differing anatomical conditions. PMID:22955251

  19. Sexual absorption of vaginal progesterone: a randomized control trial.

    PubMed

    Merriam, Kathryn S; Leake, Kristina A; Elliot, Mollie; Matthews, Michelle L; Usadi, Rebecca S; Hurst, Bradley S

    2015-01-01

    Objective. To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Prospective, randomized, cross over, controlled study of 20 reproductive-aged women and their male sexual partners randomized to receive vaginal progesterone gel (Crinone 8% gel, Actavis Inc., USA) or placebo cream. Serum progesterone for both male and female partners were measured 10 hours after intercourse. One week later, subjects were crossed over to receive the opposite formulation. In the third week, women used progesterone gel at night and abstained from intercourse. Results. Serum progesterone was significantly reduced with vaginal progesterone gel + intercourse compared with vaginal progesterone gel + abstinence (P = 0.0075). Men absorbed significant progesterone during intercourse with a female partner using vaginal progesterone gel compared to placebo (P = 0.0008). Conclusion(s). Vaginal progesterone gel is reduced in women after intercourse which may decrease drug efficacy during luteal phase support. Because men absorb low levels of progesterone during intercourse, exposure could cause adverse effects such as decreased libido. This study is registered under Clinical Trial number NCT01959464. PMID:25713585

  20. Bioadhesive Mini-Tablets for Vaginal Drug Delivery

    PubMed Central

    Hiorth, Marianne; Nilsen, Susanne; Tho, Ingunn

    2014-01-01

    Different non-ionic cellulose ethers (methyl cellulose, MC; hydroxyethyl cellulose, HEC; hydroxypropyl cellulose, HPC; hydroxypropylmethyl cellulose, HPMC) and microcrystalline cellulose (MCC) were investigated as matrix formers for preparation of mini-tablets targeting vaginal drug delivery. Hexyl aminolevulinat hydrochloridum (HAL) was used as a model drug. The mini-tablets were characterized with respect to their mechanical strength, bioadhesion towards cow vaginal tissue in two independent tests (rotating cylinder test, detachment test using texture analyzer), and dissolution rate in two media mimicking the pH levels of fertile, healthy and post-menopausal women (vaginal fluid simulant pH 4.5, phosphate buffer pH 6.8). Mini-tablets with a matrix of either HPMC or HPC were found to possess adequate mechanical strength, superior bioadhesive behavior towards vaginal tissue, and pH independent controlled release of the model drug, suggesting that both systems would be suited for the treatment of women regardless of age, i.e., respective of their vaginal pH levels. Bioadhesive mini-tablets offer a potential for improved residence time in the vaginal cavity targeting contact with mucosal tissue and prolonged release of the drug. PMID:25166286

  1. Sexual Absorption of Vaginal Progesterone: A Randomized Control Trial

    PubMed Central

    Merriam, Kathryn S.; Leake, Kristina A.; Elliot, Mollie; Matthews, Michelle L.; Usadi, Rebecca S.; Hurst, Bradley S.

    2015-01-01

    Objective. To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Prospective, randomized, cross over, controlled study of 20 reproductive-aged women and their male sexual partners randomized to receive vaginal progesterone gel (Crinone 8% gel, Actavis Inc., USA) or placebo cream. Serum progesterone for both male and female partners were measured 10 hours after intercourse. One week later, subjects were crossed over to receive the opposite formulation. In the third week, women used progesterone gel at night and abstained from intercourse. Results. Serum progesterone was significantly reduced with vaginal progesterone gel + intercourse compared with vaginal progesterone gel + abstinence (P = 0.0075). Men absorbed significant progesterone during intercourse with a female partner using vaginal progesterone gel compared to placebo (P = 0.0008). Conclusion(s). Vaginal progesterone gel is reduced in women after intercourse which may decrease drug efficacy during luteal phase support. Because men absorb low levels of progesterone during intercourse, exposure could cause adverse effects such as decreased libido. This study is registered under Clinical Trial number NCT01959464. PMID:25713585

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

    PubMed Central

    2012-01-01

    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. PMID:23043271

  3. A simple versatile method for measuring tail cuff systolic blood pressure in conscious rats.

    PubMed

    Widdop, R E; Li, X C

    1997-09-01

    1. The non-invasive measurement of tail cuff systolic blood pressure in conscious rats is routinely used in long-term cardiovascular studies. There are a number of commercially available tail cuff systems, however, these apparatus are generally expensive and are dedicated for single-task operations. In the present study, a simple method for measuring systolic blood pressure, which requires only minor modifications to the existing hardware found in most cardiovascular laboratories, is described. 2. Systolic blood pressure measurements were made in the conventional manner by determining the systolic blood pressure which coincided with the restoration of the caudal artery pulse. This was achieved by using an inexpensive piezo-electric pulse transducer to detect the pulse, and this was coupled to a standard data-acquisition system (MacLab, ADInstruments) normally set up to record blood pressure. This method was compared with another established tail cuff method, as well as with direct intra-arterial recordings. 3. It was found that the results obtained using both tail cuff systems were in good agreement when systolic blood pressure was measured in Wistar-Kyoto rats and spontaneously hypertensive rats. In addition, systolic blood pressure was measured over 4 weeks in 2K1C rats and sham-operated rats, with both tail cuff methods producing similar results, which were not significantly different from direct intra-arterial recordings in the same animals. 4. Thus, in the present study, with only minor modifications, the same equipment was used for both direct and indirect determinations of systolic blood pressure. This situation differs from other conventional tail cuff systems since these items are designed for a single purpose. Therefore, the current method using piezo-electric sensor/MacLab-technology should be viewed as a relatively simple, flexible and cheap alternative method to measure tail cuff systolic blood pressure in conscious rats. PMID:9337632

  4. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part I. Electronic brachytherapy source

    PubMed Central

    Fulkerson, Regina K.; Micka, John A.; DeWerd, Larry A.

    2014-01-01

    Purpose: Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate (HDR) 192Ir sources, as well as electronic brachytherapy sources. Part I of this paper will discuss the applicators used with electronic brachytherapy sources; Part II will discuss those used with HDR 192Ir sources. Although the use of these applicators has gained in popularity, the dosimetric characteristics including depth dose and surface dose distributions have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Existing dosimetry protocols available from the AAPM bookend the cross-over characteristics of a traditional brachytherapy source (as described by Task Group 43) being implemented as a low-energy superficial x-ray beam (as described by Task Group 61) as observed with the surface applicators of interest. Methods: This work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with HDR electronic brachytherapy sources (Part I) and 192Ir sources (Part II). Air-kerma rate measurements for the electronic brachytherapy sources were completed with an Attix Free-Air Chamber, as well as several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally, relative dose measurements of the surface dose distributions and characteristic depth dose curves were completed in-phantom. Results: Theoretical dose distributions and depth dose curves were generated for each applicator and agreed well with the measured values. A method of output verification was created that allows users to determine the applicator-specific dose to water at the treatment surface based on a measured air-kerma rate. Conclusions: The novel output verification methods described in this work will reduce uncertainties in dose delivery for treatments with these kinds of surface applicators, ultimately improving patient care. PMID:24506635

  5. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part I. Electronic brachytherapy source

    SciTech Connect

    Fulkerson, Regina K., E-mail: rmkenned@gmail.com; Micka, John A.; DeWerd, Larry A. [Department of Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin 53705 (United States)] [Department of Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin 53705 (United States)

    2014-02-15

    Purpose: Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate (HDR){sup 192}Ir sources, as well as electronic brachytherapy sources. Part I of this paper will discuss the applicators used with electronic brachytherapy sources; Part II will discuss those used with HDR {sup 192}Ir sources. Although the use of these applicators has gained in popularity, the dosimetric characteristics including depth dose and surface dose distributions have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Existing dosimetry protocols available from the AAPM bookend the cross-over characteristics of a traditional brachytherapy source (as described by Task Group 43) being implemented as a low-energy superficial x-ray beam (as described by Task Group 61) as observed with the surface applicators of interest. Methods: This work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with HDR electronic brachytherapy sources (Part I) and{sup 192}Ir sources (Part II). Air-kerma rate measurements for the electronic brachytherapy sources were completed with an Attix Free-Air Chamber, as well as several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally, relative dose measurements of the surface dose distributions and characteristic depth dose curves were completed in-phantom. Results: Theoretical dose distributions and depth dose curves were generated for each applicator and agreed well with the measured values. A method of output verification was created that allows users to determine the applicator-specific dose to water at the treatment surface based on a measured air-kerma rate. Conclusions: The novel output verification methods described in this work will reduce uncertainties in dose delivery for treatments with these kinds of surface applicators, ultimately improving patient care.

  6. Homogeneity of the vaginal microbiome at the cervix, posterior fornix, and vaginal canal in pregnant Chinese women.

    PubMed

    Huang, Yi-E; Wang, Yan; He, Yan; Ji, Yong; Wang, Li-Ping; Sheng, Hua-Fang; Zhang, Min; Huang, Qi-Tao; Zhang, Dong-Jing; Wu, Jing-Jing; Zhong, Mei; Zhou, Hong-Wei

    2015-02-01

    The vaginal microbiome is an emerging concern in prenatal health. Because the sampling process of vaginal microbiota may pose potential risks for pregnant women, the choice of sampling site should be carefully considered. However, whether the microbial diversity is different across various sampling sites has been controversial. In the present study, three repeated swabs were collected at the cervix (C), posterior fornix (P), and vaginal canal (V) from 34 Chinese women during different pregnancy stages, and vaginal species were determined using the Illumina sequencing of 16S rRNA tag sequences. The identified microbiomes were classified into four community state types (CSTs): CST I (dominated by L. crispatus), CST II (dominated by L. gasseri), CST III (dominated by L. iners), and CST IV-A (characterized by a low abundance of Lactobacillus, but with proportions of various species previously shown to be associated with bacterial vaginosis). All individuals had consistent CST at the three sampling sites regardless of pregnancy stage and CST group. In addition, there was little heterogeneity across community structures within each individual, as determined by LEfSe, indicating high vaginal microbiome homogeneity at the three sampling sites. The present study also revealed different beta diversity during pregnancy stages. The vaginal microbiome variation among women during trimester T1 (9?±?2.6 weeks) is larger than that of non-pregnant women and women from other trimesters, as demonstrated by the UniFrac distance (P?vaginal microbiome of postpartum women compare to women in gestation. These results will be useful for future studies of the vaginal microbiota during pregnancy. PMID:25230887

  7. Innovations in brachytherapy in gynecologic oncology.

    PubMed

    Brady, L W; Micaily, B; Miyamoto, C T; Heilmann, H P; Montemaggi, P

    1995-11-15

    With the discovery of radium by Curie in 1898, researchers recognized that this unique radionuclide had specific biologic properties that were applicable to treating patients with cancer. In the beginning, the radium sources were placed within cavities as independent sources and, when needles were available, implanted into tissues. The first combination of brachytherapy, technologies with external-beam radiation therapy was reported by Wright at the Memorial Sloan-Kettering Cancer Center in New York in 1914 in the treatment of a patient with cervical cancer. Next, there was a rapid implementation of brachytherapy in the treatment of cancer by intracavitary placement of radionuclides, interstitial implantation technologies, and systemic administrations. With the development of new radionuclides, including cesium-137, cobalt-60, iridium-192, iodine-125, palladium-103, ruthenium-109, strontium-90, iodine-131, and californium-225, which had varying types of radiation emissions appropriate when properly selected in treatment of cancer, there was a rapid development of innovative technologies to treat all malignancies, especially gynecologic cancer. The evolution of events brought forth new applicators and techniques that allowed for better distribution of the radiation dosage within the tumor being treated, safer use of radionuclides, and the development of computer programs allowing for varying source applications and dose distributions within the volume implanted. PMID:8635014

  8. Perioperative neutron brachytherapy with californium-252.

    PubMed

    Vtyurin, B M; Medvedev, V S; Ivanov, V N; Anikin, V A; Ivanova, L F

    1992-01-01

    Between 1973 and 1988, 495 patients were treated with Cf-252 neutron brachytherapy. Cf-252 neutron therapy sources developed in the USSR has been used in the trial. A numerical reconstruction method for localization of Cf-252 cell coordinates by projections on orthogonal radiographs has been designed and used for treatment planning. Eight (1.6%) patients with recurrent and persistent head and neck tumors and ages from 32 to 48 years (mean age 43 years) were treated with Cf-252 perioperative neutron brachytherapy. There were three patients with oral cavity, one with oropharynx, three with parotid gland cancers, and one with a skin tumor. The dose rate ranged fro 3.2 cGy/h to 11.1 cG/h, the minimal peripheral dose ranged from 3 Gy to 8 Gy. Initial local control was achieved in all patients. Local recurrence developed in two cases. Three patients died in first year after therapy. Three patients died during the second year. Two patients are long term cures, one patient more than nine years and one eight years, that is 25% of the treated patients. PMID:1535620

  9. Adjuvant brachytherapy in the treatment of soft-tissue sarcomas.

    PubMed

    Crownover, R L; Marks, K E

    1999-06-01

    For many patients with STS, administering adjuvant radiation treatments in the form of interstitial brachytherapy provides an excellent alternative to a protracted course of EBRT. Ideal patients are those with intermediate- or high-grade tumors amenable to en bloc resection. Attractive features of this approach include an untainted pathologic specimen, expeditious completion of treatment, reduction in wound complications, and improved functional outcome. Brachytherapy can permit definitive reirradiation by tightly localizing the high dose radiation exposure. It is also useful in patients who are known to have or be at high risk of metastatic disease, for whom the rapid completion of local treatment allows systemic therapy to begin quickly. Introduction of HDR techniques has shifted the delivery of brachytherapy from inpatient solitary confinement to an outpatient setting. Early reports using HDR brachytherapy for treatment of adult and pediatric STS are quite encouraging. The clinical equivalence between hyperfractionated HDR schedules and traditional LDR techniques is gaining acceptance. PMID:10432432

  10. Patient release criteria for low dose rate brachytherapy implants.

    PubMed

    Boyce, Dale E; Sheetz, Michael A

    2013-04-01

    A lack of consensus regarding a model governing the release of patients following sealed source brachytherapy has led to a set of patient release policies that vary from institution to institution. The U.S. Nuclear Regulatory Commission has issued regulatory guidance on patient release in NUREG 1556, Volume 9, Rev. 2, Appendix U, which allows calculation of release limits following implant brachytherapy. While the formalism presented in NUREG is meaningful for the calculation of release limits in the context of relatively high energy gamma emitters, it does not estimate accurately the effective dose equivalent for the common low dose rate brachytherapy sources Cs, I, and Pd. NUREG 1556 states that patient release may be based on patient-specific calculations as long as the calculation is documented. This work is intended to provide a format for patient-specific calculations to be used for the consideration of patients' release following the implantation of certain low dose rate brachytherapy isotopes. PMID:23439145

  11. [Valorisation of brachytherapy and medico-economic considerations].

    PubMed

    Pommier, P; Morelle, M; Millet-Lagarde, F; Peiffert, D; Gomez, F; Perrier, L

    2013-04-01

    Economic data in the literature for brachytherapy are still sparse and heterogeneous, with few controlled prospective studies and a perspective most often limited to those of the provider (health insurances). Moreover, these observation and conclusions are difficult to generalize in France. The prospective health economic studies performed in France in the framework of a national program to sustain innovative and costly therapies (STIC program) launched by the French cancer national institute are therefore of most importance. With the exception of prostate brachytherapy with permanent seeds, the valorisation of the brachytherapy activity by the French national health insurance does not take into account the degree of complexity and the real costs supported by health institutions (i.e. no specific valorisation for 3D image-based treatment planning and dose optimization and for the use of pulsed dose rate brachytherapy). PMID:23601252

  12. MCNP modeling of prostate brachytherapy and organ dosimetry

    E-print Network

    Usgaonker, Susrut Rajanikant

    2004-09-30

    Using the computer code Monte Carlo N-Particle (MCNP), doses were calculated for organs of interest such as the large intestine, urinary bladder, testes, and kidneys while patients were undergoing prostate brachytherapy. This research is important...

  13. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  14. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  15. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  16. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  17. Vaginal ultrasonography in patients with postmenopausal bleeding.

    PubMed

    Auslender, R; Bornstein, J; Dirnfeld, M; Kogan, O; Atad, J; Abramovici, H

    1993-11-01

    Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol. PMID:12797245

  18. Vaginal intraepithelial neoplasia: a therapeutical dilemma.

    PubMed

    Frega, Antonio; Sopracordevole, Francesco; Assorgi, Chiara; Lombardi, Danila; DE Sanctis, Vitaliana; Catalano, Angelica; Matteucci, Eleonora; Milazzo, Giusi Natalia; Ricciardi, Enzo; Moscarini, Massimo

    2013-01-01

    Vaginal intraepithelial neoplasia (VaIN) represents a rare and asymptomatic pre-neoplastic lesion. Its natural history and potential evolution into invasive cancer are uncertain. VaIN can occur alone or as a synchronous or metachronous lesion with cervical and vulvar HPV-related intra epithelial or invasive neoplasia. Its association with cervical intraepithelial neoplasia is found in 65% of cases, with vulvar intraepithelial neoplasia in 10% of cases, while for others, the association with concomitant cervical or vulvar intraepithelial neoplasias is found in 30-80% of cases. VaIN is often asymptomatic and its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically-guided biopsy of suspicious areas. In the past, high-grade VaIN and multifocal VaIN have been treated by radical surgery, such as total or partial upper vaginectomy associated with hysterectomy and radiotherapy. The need to maintain the integrity of reproductive capacity has determined the transition from radical therapies to conservative ones, according to the different patients' characteristics. PMID:23267125

  19. Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

    PubMed Central

    Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

    2014-01-01

    The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

  20. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease

    PubMed Central

    Oliva, Francesco; Osti, Leonardo; Padulo, Johnny; Maffulli, Nicola

    2014-01-01

    Summary Background: in the last years the incidence of rotator cuff tears increased and one main cause still waiting to be clarified. Receptors for thyroid hormones in rotator cuff tendons suggest possible effects on tendons metabolism and status. We undertook a retrospective, observational cohort study of 441 patients who underwent arthroscopic and mini-open repair for non traumatic degenerative rotator cuff tears. Methods: all the patients, predominantly females (63%), were interview to assess the relationship (frequency for class age “20 yrs” and factor analysis) between lesions of the rotator cuff with the following variables: gender, thyroid disease, smoker, taking medications for diabetes, hypertension or high cholesterol; presence of associated conditions (diabetes, hypertension, hypercholesterolemia). Results: thyroid disease is highly frequently (until 63% for 60<80 yrs) in females group independent to the age. Conversely, males showed a high frequency for smoker 37<62% until 80 yrs and 50% hypercholesterolemia over 80 yrs for the clinical variable studied. Conclusions: this is the first clinical report that shown a relationship between thyroid pathologies and non-traumatic rotator cuff tear as increased risk factors. PMID:25489548

  1. Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years

    PubMed Central

    Silva, Sandra Regina Ramos; Arcuri, Edna Apparecida Moura; Isabella, Adriana Paula Jordão; Arcuri, Silvia Maria; Santos, Jair Lício Ferreira

    2014-01-01

    Objective to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40. Methods high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group). They were compared to 20 subjects from the original sample with lower blood pressure values (Control group). Results the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02) in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided. Conclusions data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes. PMID:24553697

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

    PubMed

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

    2014-06-01

    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

  3. Possibilities offered by implantable miniaturized cuff-electrodes for insect neurophysiology.

    PubMed

    Hartbauer, Manfred; Krüger, Thilo B; Stieglitz, Thomas

    2012-05-01

    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. PMID:23576843

  4. Delayed vaginal reconstruction in the fibrotic pelvis following radiation or previous reconstruction

    SciTech Connect

    Berek, J.S.; Hacker, N.F.; Lagasse, L.D.; Smith, M.L.

    1983-06-01

    Vaginal reconstruction was performed in 14 patients who had developed vaginal stenosis secondary to extensive pelvic fibrosis after pelvic radiation therapy (12 patients) or prior vaginal reconstruction (2 patients). Sixteen procedures were performed using a split-thickness skin graft. All patients had satisfactory vaginal restoration, and 12 patients reported good vaginal function. No fistula developed as a result of the operative procedure, but one patient later developed a rectovaginal fistula resulting from tumor recurrence. Successful vaginal reconstruction can be achieved even years after initial therapy in patients who develop an obliterated vagina from previous radiation or surgery.

  5. Arthroscopic repair of massive rotator cuff tears: A prospective cohort with 2- to 4-year follow-up

    Microsoft Academic Search

    William F. Bennett

    2003-01-01

    Purpose: The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. Type of Study: Prospective cohort study. Methods: Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow

  6. Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age or younger

    Microsoft Academic Search

    Richard J Hcwkins; William D Morin; Peter M Bonutti

    1999-01-01

    Full-thickness tears of the rotator cuff are uncommon in the first 4 decades of life. A retrospective analysis was conducted of 19 consecutive patients who were 40 years of age or younger and had been treated surgically for a full-thickness tear of the rotator cuff. Sixteen patients (84%) recalled an acute injury that heralded the onset of symptoms. Five of

  7. Arthroscopic Debridement and Acromioplasty Versus Mini-Open Repair in the Treatment of Significant Partial-Thickness Rotator Cuff Tears

    Microsoft Academic Search

    Stephen C. Weber

    1999-01-01

    Summary: Partial tears of the rotator cuff, especially of the articular side, have received attention only with the recent ability of magnetic resonance imaging (MRI) and arthroscopy to diagnose these lesions. Several early reports showed nearly 100% success in managing these lesions with arthroscopic debridement with or without acromioplasty. This series compares 32 patients with significant partial-thickness rotator cuff tears

  8. Matrix Metalloproteinase and Tissue Inhibitor of Matrix Metalloproteinase mRNA Levels are Specifically Altered in Torn Rotator Cuff Tendons

    Microsoft Academic Search

    Ian K. Y. Lo; Linda L. Marchuk; Robert Hollinshead; David A. Hart; Cyril B. Frank

    2004-01-01

    Background: Rotator cuff tears are a cause of pain and disability in the shoulder. The molecular changes associated with rotator cuff tearing are unclear. A subset of matrix metalloproteinases and tissue inhibitors of metalloproteinase, which are involved in extracellular matrix remodeling and degradation, were evaluated.Hypothesis: There would be an increase in the mRNA level of spcific matrix metalloproteinase and a

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

    Microsoft Academic Search

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

    2001-01-01

    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%

  10. Parameterization of brachytherapy source phase space file for Monte Carlo-based clinical brachytherapy dose calculation.

    PubMed

    Zhang, M; Zou, W; Chen, T; Kim, L; Khan, A; Haffty, B; Yue, N J

    2014-01-20

    A common approach to implementing the Monte Carlo method for the calculation of brachytherapy radiation dose deposition is to use a phase space file containing information on particles emitted from a brachytherapy source. However, the loading of the phase space file during the dose calculation consumes a large amount of computer random access memory, imposing a higher requirement for computer hardware. In this study, we propose a method to parameterize the information (e.g., particle location, direction and energy) stored in the phase space file by using several probability distributions. This method was implemented for dose calculations of a commercial Ir-192 high dose rate source. Dose calculation accuracy of the parameterized source was compared to the results observed using the full phase space file in a simple water phantom and in a clinical breast cancer case. The results showed the parameterized source at a size of 200 kB was as accurate as the phase space file represented source of 1.1 GB. By using the parameterized source representation, a compact Monte Carlo job can be designed, which allows an easy setup for parallel computing in brachytherapy planning. PMID:24374831

  11. The evolution of computerized treatment planning for brachytherapy: American contributions

    PubMed Central

    Rivard, Mark J.

    2014-01-01

    Purpose To outline the evolution of computerized brachytherapy treatment planning in the United States through a review of technological developments and clinical practice refinements. Material and methods A literature review was performed and interviews were conducted with six participants in the development of computerized treatment planning for brachytherapy. Results Computerized brachytherapy treatment planning software was initially developed in the Physics Departments of New York's Memorial Hospital (by Nelson, Meurk and Balter), and Houston's M. D. Anderson Hospital (by Stovall and Shalek). These public-domain programs could be used by institutions with adequate computational resources; other clinics had access to them via Memorial's and Anderson's teletype-based computational services. Commercial brachytherapy treatment planning programs designed to run on smaller computers (Prowess, ROCS, MMS), were developed in the late 1980s and early 1990s. These systems brought interactive dosimetry into the clinic and surgical theatre. Conclusions Brachytherapy treatment planning has evolved from systems of rigid implant rules to individualized pre- and intra-operative treatment plans, and post-operative dosimetric assessments. Brachytherapy dose distributions were initially calculated on public domain programs on large regionally located computers. With the progression of computer miniaturization and increase in processor speeds, proprietary software was commercially developed for microcomputers that offered increased functionality and integration with clinical practice. PMID:25097560

  12. Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy

    PubMed Central

    Shetty, Jyothi; Shanbhag, Asha

    2014-01-01

    Background. The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated morbidity and hastening recovery. We compared intraoperative and postoperative outcomes between LAVH and abdominal hysterectomy, to find out if LAVH achieves better clinical results compared with abdominal hysterectomy. Material and methods. A total of 48 women were enrolled in the study. Finally 17 patients underwent LAVH (cases) and 20 underwent abdominal hysterectomy (controls). All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise. Results.None of the patients in LAVH required conversion to laparotomy. Mean operating time was 30 minutes longer in LAVH group as compared to abdominal hysterectomy group (167.06 + 31.97?min versus 135.25 + 31.72 min; P < 0.05). However, the mean blood loss in LAVH was 100?mL lesser than that in abdominal hysterectomy and the difference was found to be statistically significant (248.24 + 117.79?mL versus 340.00 + 119.86?mL; P < 0.05). Another advantage of LAVH was significantly lower pain scores on second and third postoperative days. Overall complications and postoperative hospital stay were not significantly different between the two groups. PMID:24729873

  13. Assessment and characterization of in situ rotator cuff biomechanics

    NASA Astrophysics Data System (ADS)

    Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

    2013-03-01

    Rotator cuff disease is a degenerative disorder that is a common, costly, and often debilitating, ranging in severity from partial thickness tear, which may cause pain, to total rupture, leading to loss in function. Currently, clinical diagnosis and determination of disease extent relies primarily on subjective assessment of pain, range of motion, and possibly X-ray or ultrasound images. The final treatment plan however is at the discretion of the clinician, who often bases their decision on personal experiences, and not quantitative standards. The use of ultrasound for the assessment of tissue biomechanics is established, such as in ultrasound elastography, where soft tissue biomechanics are measured. Few studies have investigated the use of ultrasound elastography in the characterization of musculoskeletal biomechanics. To assess tissue biomechanics we have developed a device, which measures the force applied to the underlying musculotendentious tissue while simultaneously obtaining the related ultrasound images. In this work, the musculotendinous region of the infraspinatus of twenty asymptomatic male organized baseball players was examined to access the variability in tissue properties within a single patient and across a normal population. Elastic moduli at percent strains less than 15 were significantly different than those above 15 percent strain within the normal population. No significant difference in tissue properties was demonstrated within a single patient. This analysis demonstrated elastic moduli are variable across individuals and incidence. Therefore threshold elastic moduli will likely be a function of variation in local-tissue moduli as opposed to a specific global value.

  14. Electromyographic assessment of muscle fatigue in massive rotator cuff tear.

    PubMed

    Hawkes, D H; Alizadehkhaiyat, O; Kemp, G J; Fisher, A C; Roebuck, M M; Frostick, S P

    2015-02-01

    Shoulder muscle fatigue has not been assessed in massive rotator cuff tear (MRCT). This study used EMG to measure fatigability of 13 shoulder muscles in 14 healthy controls and 11 patients with MRCT. A hand grip protocol was applied to minimise artifacts due to pain experience during measurement. The fatigue index (median frequency slope) was significantly non-zero (negative) for anterior, middle, and posterior parts of deltoid, supraspinatus and subscapularis muscles in the controls, and for anterior, middle, and posterior parts of deltoid, and pectoralis major in patients (p?0.001). Fatigue was significantly greater in patients compared to the controls for anterior and middle parts of deltoid and pectoralis major (p?0.001). A submaximal grip task provided a feasible way to assess shoulder muscle fatigue in MRCT patients, however with some limitations. The results suggest increased activation of deltoid is required to compensate for lost supraspinatus abduction torque. Increased pectoralis major fatigue in patients (adduction torque) likely reflected strategy to stabilise the humeral head against superior subluxing force of the deltoid. Considering physiotherapy as a primary or adjunct intervention for the management of MRCT, the findings of this study generate a base for future clinical studies aiming at the development of evidence-based protocols. PMID:25301260

  15. Multivariate Analyses of Rotator Cuff Pathologies in Shoulder Disability

    PubMed Central

    Henseler, Jan F.; Raz, Yotam; Nagels, Jochem; van Zwet, Erik W.; Raz, Vered; Nelissen, Rob G. H. H.

    2015-01-01

    Background Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC) muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability. Methods Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA). We investigated patients with superior (supraspinatus, n = 39) and posterosuperior (supraspinatus and infraspinatus, n = 30) RC tears, and patients with an intact RC (n = 52) as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively. Results Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (p<0.001) and discriminated between superior and posterosuperior tears. In contrast neither tear size nor fatty infiltration of the supraspinatus or infraspinatus contributed to superior humeral translation. Conclusion Our study reveals that infraspinatus atrophy has the strongest contribution to RC tear pathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability. PMID:25710703

  16. Predictors of Metastatic Disease After Prostate Brachytherapy

    SciTech Connect

    Forsythe, Kevin [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan [Department of Radiation Oncology, New York-Presbyterian Hospital, New York, NY (United States); Stone, Nelson [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G., E-mail: richard.stock@moutsinai.org [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

    2012-06-01

    Purpose: To identify predictors of metastatic disease after brachytherapy treatment for prostate cancer. Methods and Materials: All patients who received either brachytherapy alone (implant) or brachytherapy in combination with external beam radiation therapy for treatment of localized prostate cancer at The Mount Sinai Hospital between June 1990 and March 2007 with a minimum follow-up of 2 years were included. Univariate and multivariable analyses were performed on the following variables: risk group, Gleason score (GS), clinical T stage, pretreatment prostate-specific antigen level, post-treatment prostate-specific antigen doubling time (PSA-DT), treatment type (implant vs. implant plus external beam radiation therapy), treatment era, total biological effective dose, use of androgen deprivation therapy, age at diagnosis, and race. PSA-DT was analyzed in the following ordinate groups: 0 to 90 days, 91 to 180 days, 180 to 360 days, and greater than 360 days. Results: We included 1,887 patients in this study. Metastases developed in 47 of these patients. The 10-year freedom from distant metastasis (FFDM) rate for the entire population was 95.1%. Median follow-up was 6 years (range, 2-15 years). The only two significant predictors of metastatic disease by multivariable analyses were GS and PSA-DT (p < 0.001 for both variables). Estimated 10-year FFDM rates for GS of 6 or less, GS of 7, and GS of 8 or greater were 97.9%, 94.3%, and 76.1%, respectively (p < 0.001). Estimated FFDM rates for PSA-DT of 0 to 90 days, 91 to 180 days, 181 to 360 days, and greater than 360 days were 17.5%, 67.9%, 74%, and 94.8%, respectively (p < 0.001). Estimated 10-year FFDM rates for the low-, intermediate-, and high-risk groups were 98.6%, 96.2%, and 86.7%, respectively. A demographic shift to patients presenting with higher-grade disease in more recent years was observed. Conclusions: GS and post-treatment PSA-DT are both statistically significant independent predictors of metastatic disease. Patients with a high GS and/or short PSA-DT have a higher likelihood of developing metastatic disease and should be considered for systemic therapy.

  17. Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland.

    PubMed

    Talekar, C R; Udy, A A; Boots, R J; Lipman, J; Cook, D

    2014-11-01

    The application of tracheal cuff pressure monitoring is likely to vary between institutions. The aim of this study was therefore to review current evidence concerning this intervention in the intensive care unit (ICU) and to appraise regional practice by performing a state-wide survey. Publications for review were identified through searches of PubMed, EMBASE and Cochrane (1977 to 2014). All studies in English relevant to critical care and with complete data were included. Survey questions were developed by small-group consensus. Public and private ICUs across Queensland were contacted, with responses obtained from a representative member of the medical or nursing staff. Existing literature suggests significant variability in tracheal cuff pressure monitoring in the ICU, particularly in the applied technique, frequency of assessment and optimal intra-cuff pressures. Twenty-nine respondents completed the survey, representing 80.5% (29/36) of ICUs in Queensland. Twenty-eight out of twenty-nine respondents reported routinely monitoring tracheal cuff function, primarily employing cuff pressure measurement (26/28). Target cuff pressures varied, with 3/26 respondents aiming for 10 to 20 cmH2O, 10/26 for 21 to 25 cmH2O, and 13/26 for 26 to 30 cmH2O. Fifteen out of twenty-nine reported they had no current guideline or protocol for tracheal cuff management and only 16/29 indicated there was a dedicated area in the clinical record for reporting cuff intervention. Our results indicate that many ICUs across Queensland routinely measure tracheal cuff function, with most utilising pressure monitoring devices. Consistent with existing literature, the optimum cuff pressure remains uncertain. Most, however, considered that this should be a routine part of ICU care. PMID:25342409

  18. Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

    PubMed Central

    Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe

    2014-01-01

    Summary Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient’s pain and disability, surgery should be considered. Methods: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation. Purpose: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears.

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

    PubMed Central

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

    2014-01-01

    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. PMID:24976930

  20. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.

    PubMed

    Vad, Vijay B; Southern, Daniel; Warren, Russell F; Altchek, David W; Dines, David

    2003-01-01

    The purpose of this study is to define the prevalence of peripheral nerve injury associated with full-thickness tears of the rotator cuff presenting with shoulder muscle atrophy. Twenty-five patients with the diagnosis of full-thickness rotator cuff tear were included. Electrodiagnostic testing, including nerve conduction studies and needle examination, was performed on all patients. There were 7 abnormal electromyographic examinations. The most common diagnosis was upper trunk brachial plexopathy severely affecting the axillary nerve (4/7), followed by suprascapular neuropathy (2/7) and cervical radiculopathy (1/7). The prevalence of associated peripheral neuropathy was found to be 28%. Greater degrees of atrophy were significantly associated with the presence of neuropathy in these patients. Careful neurologic screening in all patients and electromyographic examination in clinically suspicious groups are recommended in patients with full-thickness cuff tears before surgical repair. PMID:12934025

  1. Synovial Chondromatosis of the Subacromial Bursa Causing a Bursal-Sided Rotator Cuff Tear

    PubMed Central

    Neumann, Julie A.; Garrigues, Grant E.

    2015-01-01

    Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up.

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

    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.

  3. Some characteristics of vaginal prolapse in Nepali buffaloes.

    PubMed

    Sah, Shyam Kishore; Nakao, Toshihiko

    2003-11-01

    Prolapse of vagina is one of the important maternal abnormalities during pregnancy in cattle and buffaloes. A field investigation was carried out on 26 Murrah graded buffaloes to study clinical characteristics of vaginal prolapse in buffaloes in Nepal. Fifty-seven percent of the 26 buffaloes with vaginal prolapse were either heifers or in first lactation. Sixty-five percent of the cases were in seventh month of pregnancy or later. About three quarters of the cases occurred between June and October. Twelve cases (63%) of the 19 animals excluding 7 heifers had a history of vaginal prolapse in previous gestations. A half of the buffaloes were showing prolapse of the vagina even when they were in standing position and showing moderate or vigorous straining. After the conventional treatments, twenty-three buffaloes retained the replaced vagina and calved normally. One animal aborted although the vagina was retained. Two buffaloes had severest degree of vaginal prolapse complicated with edema, injury and cyanosis, and they did not respond to the treatment. The two buffaloes had frequently recurrent prolapse and subsequently died. Early detection and prompt treatment may be imperative to control the vaginal prolapse in buffaloes. PMID:14665751

  4. T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear

    PubMed Central

    Gumucio, J.; Flood, M.; Harning, J.; Phan, A.; Roche, S.; Lynch, E.; Bedi, A.; Mendias, C.

    2014-01-01

    Objectives Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as ‘fatty degeneration’. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified. Methods A full-thickness, massive supraspinatus and infraspinatus tear was induced in adult T-cell deficient rats. We hypothesised that, compared with controls, 28 days after inducing a tear we would observe a decrease in muscle force production, an accumulation of type IIB fibres, and an upregulation in the expression of genes involved with muscle atrophy, fibrosis and inflammation. Results Chronic cuff tears in nude rats resulted in a 30% to 40% decrease in muscle mass, a 23% reduction in production of muscle force, and an induction of genes that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. Marked large lipid droplet accumulation was also present. Conclusions The extent of degenerative changes in nude rats was similar to what was observed in T-cell competent rats. T cells may not play an important role in regulating muscle degeneration following chronic muscle unloading. The general similarities between nude and T-cell competent rats suggest the nude rat is likely an appropriate preclinical model for the study of xenografts that have the potential to enhance the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262–72. PMID:25185444

  5. NPIP: A skew line needle configuration optimization system for HDR brachytherapy

    E-print Network

    Goldberg, Ken

    NPIP: A skew line needle configuration optimization system for HDR brachytherapy Timmy Siauwa) Purpose: In this study, the authors introduce skew line needle configurations for high dose rate (HDR needles than the current HDR brachytherapy workflow. Combined with robot assisted brachytherapy

  6. A dynamic dosimetry system for prostate brachytherapy

    NASA Astrophysics Data System (ADS)

    Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Song, Danny Y.; Prince, Jerry L.; Lee, Junghoon

    2013-03-01

    The lack of dynamic dosimetry tools for permanent prostate brachytherapy causes otherwise avoidable problems in prostate cancer patient care. The goal of this work is to satisfy this need in a readily adoptable manner. Using the ubiquitous ultrasound scanner and mobile non-isocentric C-arm, we show that dynamic dosimetry is now possible with only the addition of an arbitrarily configured marker-based fiducial. Not only is the system easily configured from accessible hardware, but it is also simple and convenient, requiring little training from technicians. Furthermore, the proposed system is built upon robust algorithms of seed segmentation, fiducial detection, seed reconstruction, and image registration. All individual steps of the pipeline have been thoroughly tested, and the system as a whole has been validated on a study of 25 patients. The system has shown excellent results of accurately computing dose, and does so with minimal manual intervention, therefore showing promise for widespread adoption of dynamic dosimetry.

  7. A Dynamic Dosimetry System for Prostate Brachytherapy.

    PubMed

    Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Song, Danny Y; Prince, Jerry L; Lee, Junghoon

    2013-03-01

    The lack of dynamic dosimetry tools for permanent prostate brachytherapy causes otherwise avoidable problems in prostate cancer patient care. The goal of this work is to satisfy this need in a readily adoptable manner. Using the ubiquitous ultrasound scanner and mobile non-isocentric C-arm, we show that dynamic dosimetry is now possible with only the addition of an arbitrarily configured marker-based fiducial. Not only is the system easily configured from accessible hardware, but it is also simple and convenient, requiring little training from technicians. Furthermore, the proposed system is built upon robust algorithms of seed segmentation, fiducial detection, seed reconstruction, and image registration. All individual steps of the pipeline have been thoroughly tested, and the system as a whole has been validated on a study of 25 patients. The system has shown excellent results of accurately computing dose, and does so with minimal manual intervention, therefore showing promise for widespread adoption of dynamic dosimetry. PMID:24392207

  8. An overview of interstitial brachytherapy and hyperthermia

    SciTech Connect

    Brandt, B.B.; Harney, J.

    1989-11-01

    Interstitial thermoradiotherapy, an experimental cancer treatment that combines interstitial radiation implants (brachytherapy) and interstitial hyperthermia, is in the early stages of investigation. In accordance with the procedure used in a current national trial protocol, a 60-minute hyperthermia treatment is administered after catheters are placed into the tumor area while the patient is under general anesthesia. This is immediately followed by loading of radioactive Iridium-192 seeds into the catheters for a defined period of time. Once the prescribed radiation dose is delivered, the radioactive sources are removed and a second, 60-minute hyperthermia treatment is administered. Clinical trials with hyperthermia in combination with radiation have increased in recent years. Nurses caring for these patients need to become more knowledgeable about this investigational therapy. This paper provides an overview of the biologic rationale for this therapy, as well as a description of the delivery method and clinical application. Specific related nursing interventions are defined in a nursing protocol.23 references.

  9. 77 FR 8900 - Certain Vaginal Ring Birth Control Devices; Termination of the Investigation Based on Withdrawal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-15

    ...COMMISSION [Investigation No. 337-TA-768] Certain Vaginal Ring Birth Control Devices; Termination of the Investigation Based on...within the United States after importation of certain vaginal birth control devices by reason of infringement of certain...

  10. Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

    Microsoft Academic Search

    João L. Ellera Gomes; Ricardo Canquerini da Silva; Lúcia M. R. Silla; Marcelo R. Abreu; Roberto Pellanda

    Purpose  To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone\\u000a marrow mononuclear cells (BMMC).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Fourteen consecutive patients (9 women, 5 men, mean age of 59.2 years) with complete rotator cuff tears (mean preoperative\\u000a UCLA score of 12 ± 3.0) were fixed by transosseous stitches through mini-open incision, with subsequent injection of BMMC\\u000a into the

  11. Air-kerma strength determination of a miniature x-ray source for brachytherapy applications

    NASA Astrophysics Data System (ADS)

    Davis, Stephen D.

    A miniature x-ray source has been developed by Xoft Inc. for high dose-rate brachytherapy treatments. The source is contained in a 5.4 mm diameter water-cooling catheter. The source voltage can be adjusted from 40 kV to 50 kV and the beam current is adjustable up to 300 muA. Electrons are accelerated toward a tungsten-coated anode to produce a lightly-filtered bremsstrahlung photon spectrum. The sources were initially used for early-stage breast cancer treatment using a balloon applicator. More recently, Xoft Inc. has developed vaginal and surface applicators. The miniature x-ray sources have been characterized using a modification of the American Association of Physicists in Medicine Task Group No. 43 formalism normally used for radioactive brachytherapy sources. Primary measurements of air kerma were performed using free-air ionization chambers at the University of Wisconsin (UW) and the National Institute of Standards and Technology (NIST). The measurements at UW were used to calibrate a well-type ionization chamber for clinical verification of source strength. Accurate knowledge of the emitted photon spectrum was necessary to calculate the corrections required to determine air-kerma strength, defined in vacuo. Theoretical predictions of the photon spectrum were calculated using three separate Monte Carlo codes: MCNP5, EGSnrc, and PENELOPE. Each code used different implementations of the underlying radiological physics. Benchmark studies were performed to investigate these differences in detail. The most important variation among the codes was found to be the calculation of fluorescence photon production following electron-induced vacancies in the L shell of tungsten atoms. The low-energy tungsten L-shell fluorescence photons have little clinical significance at the treatment distance, but could have a large impact on air-kerma measurements. Calculated photon spectra were compared to spectra measured with high-purity germanium spectroscopy systems at both UW and NIST. The effects of escaped germanium fluorescence photons and Compton-scattered photons were taken into account for the UW measurements. The photon spectrum calculated using the PENELOPE Monte Carlo code had the best agreement with the spectrum measured at NIST. Corrections were applied to the free-air chamber measurements to arrive at an air-kerma strength determination for the miniature x-ray sources.

  12. Calibration of Photon Sources for Brachytherapy

    NASA Astrophysics Data System (ADS)

    Rijnders, Alex

    Source calibration has to be considered an essential part of the quality assurance program in a brachytherapy department. Not only it will ensure that the source strength value used for dose calculation agrees within some predetermined limits to the value stated on the source certificate, but also it will ensure traceability to international standards. At present calibration is most often still given in terms of reference air kerma rate, although calibration in terms of absorbed dose to water would be closer to the users interest. It can be expected that in a near future several standard laboratories will be able to offer this latter service, and dosimetry protocols will have to be adapted in this way. In-air measurement using ionization chambers (e.g. a Baldwin—Farmer ionization chamber for 192Ir high dose rate HDR or pulsed dose rate PDR sources) is still considered the method of choice for high energy source calibration, but because of their ease of use and reliability well type chambers are becoming more popular and are nowadays often recommended as the standard equipment. For low energy sources well type chambers are in practice the only equipment available for calibration. Care should be taken that the chamber is calibrated at the standard laboratory for the same source type and model as used in the clinic, and using the same measurement conditions and setup. Several standard laboratories have difficulties to provide these calibration facilities, especially for the low energy seed sources (125I and 103Pd). Should a user not be able to obtain properly calibrated equipment to verify the brachytherapy sources used in his department, then at least for sources that are replaced on a regular basis, a consistency check program should be set up to ensure a minimal level of quality control before these sources are used for patient treatment.

  13. BLT Humanized Mice as Model to Study HIV Vaginal Transmission

    PubMed Central

    Deruaz, Maud; Luster, Andrew D.

    2013-01-01

    The majority of human immunodeficiency virus type 1 (HIV-1) infections occur by sexual exposure, and vaginal transmission accounts for more than half of all newly acquired infections. Studies of vaginal transmission of simian immunodeficiency virus to nonhuman primates (NHPs) have suggested an important role for immune cell trafficking in the establishment of infection as well is in the process of viral dissemination. However, NHP models do not permit the study of HIV transmission and dissemination. The improvement of humanized mouse models with robust human immune cell reconstitution of the female genital tract renders these mice susceptible to intravaginal HIV infection. Thus humanized mouse models of HIV vaginal infection will allow the study of the mechanisms involved in HIV transmission and dissemination in vivo. PMID:24151319

  14. Sustained release of proteins from a modified vaginal ring device

    PubMed Central

    Morrow, Ryan J.; Woolfson, A. David; Donnelly, Louise; Curran, Rhonda; Andrews, Gavin; Katinger, Dietmar; Malcolm, R. Karl

    2013-01-01

    A new vaginal ring technology, the insert vaginal ring (InVR), is presented. The InVR overcomes the current shortfall of conventional vaginal rings (VRs) that are generally ineffectual for the delivery of hydrophilic and/or macromolecular actives, including peptides, proteins and antibodies, due to their poor permeation characteristics in the hydrophobic polymeric elastomers from which VRs are usually fabricated. Release of the model protein BSA from a variety of insert matrices for the InVR is demonstrated, including modified silicone rods, directly compressed tablets and lyophilised gels, which collectively provided controlled release profiles from several hours to beyond 4 weeks. Furthermore, the InVR was shown to deliver over 1 mg of the monoclonal antibody 2F5 from a single device, offering a potential means of protecting women against the transmission of HIV. PMID:21055465

  15. Vaginal antisepsis for hysterectomy: a review of the literature.

    PubMed

    Eason, E L

    1997-01-01

    Infectious complications of hysterectomy remain common despite the use of prophylactic antibiotics. Most are caused by contamination of the surgical site by vaginal bacteria which are not controlled by current methods of pre-operative antisepsis. The medical literature concerning antiseptic preparation of the vagina for surgery was reviewed to discover the evidence on which practice may be based. A search using Medline, Current Contents, the Cochrane Library and the reference lists of articles on the subject and of major gynaecology textbooks produced 13 comparative studies. No conclusive randomized controlled trials were found and most of the studies had severe methodological problems limiting interpretation of their results. The scant available data suggest that use of vaginal antiseptics before the patient arrives in the operating room is probably not useful, and that application of povidone-iodine vaginal gel at the beginning of abdominal hysterectomy is sufficiently promising to justify further investigation. PMID:9403256

  16. Magnetic resonance imaging in the evaluation of vaginal foreign bodies in a young girl.

    PubMed

    Kihara, M; Sato, N; Kimura, H; Kamiyama, M; Sekiya, S; Takano, H

    2001-11-01

    A 7-year-old girl with foul-smelling, bloody vaginal discharge for more than 2 years was initially suspected of suffering from vaginal foreign bodies. Although plain radiography revealed no abnormal findings in the pelvis, magnetic resonance imaging (MRI) showed multiple low intensity objects and an intact vaginal wall. Four plastic toys were removed with forceps under general anesthesia. MRI is supposed to be the best technique for evaluating vaginal foreign bodies in young girls. PMID:11789752

  17. Depomedroxyprogesterone-induced hypoestrogenism and changes in vaginal flora and epithelium

    Microsoft Academic Search

    Leslie Miller; Dorothy L Patton; Amalia Meier; Soe Soe Thwin; Thomas M Hooton; David A Eschenbach

    2000-01-01

    Objective: To identify the effects of depomedroxyprogesterone acetate (DMPA) on vaginal microbial flora and epithelium.Methods: Women who desired DMPA for contraception were evaluated before and at 3 and 6 months after initiation of 150-mg DMPA injections every 3 months. At each visit, we assessed genital symptoms, vaginal signs, vaginal microflora, and histopathology by vaginal biopsies.Results: Among 38 women observed for

  18. [Salvage 125I brachytherapy of locally recurrent prostate cancer].

    PubMed

    Gesztesi, László; Ágoston, Péter; Major, Tibor; G?dény, Mária; Andi, Judit; Lengyel, Zsolt; Polgár, Csaba

    2014-09-01

    The purpose of the study is to report a case of salvage low dose rate (LDR) prostate brachytherapy in a patient with locally recurrent prostate cancer, four years after his first treatment with combined external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. A 61-year-old man was treated with 1x10 Gy HDR brachytherapy and a total of 60 Gy EBRT for an organ confined intermediate risk carcinoma of the prostate in 2009. The patient's tumor had been in regression with the lowest PSA level of 0.09 ng/ml, till the end of 2013. After slow but continuous elevation, his PSA level had reached 1.46 ng/ml by February 2014. Pelvis MRI and whole body acetate PET/CT showed recurrent tumor in the dorsal-right region of the prostate. Bone scan was negative. After discussing the possible salvage treatment options with the patient, he chose LDR brachytherapy. In 2014, in spinal anesthesia 21 125I "seeds" were implanted with transrectal ultrasound guidance into the prostate. The prescribed dose to the whole prostate was 100 Gy, to the volume of the recurrent tumor was 140 Gy. The patient tolerated the salvage brachytherapy well. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. PSA level decreased from the pre-salvage value of 1.46 ng/ml to 0.42 ng/ml by one month and 0.18 ng/ml by two months after the brachytherapy. No gastrointestinal side effects appeared, the patient's urination became slightly more frequent. In selected patients, salvage LDR brachytherapy can be a good choice for curative treatment of locally recurrent prostate cancer, after primary radiation therapy. Multiparametric MRI is fundamental, acetate PET/CT can play an important role when defining the localization of the recurrent tumor. PMID:25260087

  19. Primate vaginal microbiomes exhibit species specificity without universal Lactobacillus dominance.

    PubMed

    Yildirim, Suleyman; Yeoman, Carl J; Janga, Sarath Chandra; Thomas, Susan M; Ho, Mengfei; Leigh, Steven R; Consortium, Primate Microbiome; White, Bryan A; Wilson, Brenda A; Stumpf, Rebecca M

    2014-12-01

    Bacterial communities colonizing the reproductive tracts of primates (including humans) impact the health, survival and fitness of the host, and thereby the evolution of the host species. Despite their importance, we currently have a poor understanding of primate microbiomes. The composition and structure of microbial communities vary considerably depending on the host and environmental factors. We conducted comparative analyses of the primate vaginal microbiome using pyrosequencing of the 16S rRNA genes of a phylogenetically broad range of primates to test for factors affecting the diversity of primate vaginal ecosystems. The nine primate species included: humans (Homo sapiens), yellow baboons (Papio cynocephalus), olive baboons (Papio anubis), lemurs (Propithecus diadema), howler monkeys (Alouatta pigra), red colobus (Piliocolobus rufomitratus), vervets (Chlorocebus aethiops), mangabeys (Cercocebus atys) and chimpanzees (Pan troglodytes). Our results indicated that all primates exhibited host-specific vaginal microbiota and that humans were distinct from other primates in both microbiome composition and diversity. In contrast to the gut microbiome, the vaginal microbiome showed limited congruence with host phylogeny, and neither captivity nor diet elicited substantial effects on the vaginal microbiomes of primates. Permutational multivariate analysis of variance and Wilcoxon tests revealed correlations among vaginal microbiota and host species-specific socioecological factors, particularly related to sexuality, including: female promiscuity, baculum length, gestation time, mating group size and neonatal birth weight. The proportion of unclassified taxa observed in nonhuman primate samples increased with phylogenetic distance from humans, indicative of the existence of previously unrecognized microbial taxa. These findings contribute to our understanding of host-microbe variation and coevolution, microbial biogeography, and disease risk, and have important implications for the use of animal models in studies of human sexual and reproductive diseases. PMID:25036926

  20. Effect of dehydroepiandrosterone on vaginal and uterine histomorphology in the rat

    Microsoft Academic Search

    Antigone Sourla; Michel Flamand; Alain Bélanger; Fernand Labrie

    1998-01-01

    Dehydroepiandrosterone (DHEA) applied on the dorsal skin of ovariectomized animals, at the twice daily dose of 30mg, resulted in a complete reversal of the vaginal atrophy seen 1, 3 and 6months after ovariectomy, and induced proliferation and mucification of the vaginal epithelium. A similar mucification of the vaginal epithelium related to androgenic action was observed in intact rats treated with

  1. Successful pregnancy outcome in an untreated case of concomitant transverse complete vaginal septum with unicornuate uterus.

    PubMed

    Kumar, Naina; Tayade, Surekha

    2014-01-01

    Transverse vaginal septum is a result of faulty canalization of embryonic vagina. Septum may be complete but usually has laterally placed tiny hole giving an impression of vaginal vault without cervix. We described a case of untreated transverse vaginal septum with small central aperture diagnosed during labor and unicornuate uterus diagnosed intraoperatively, with successful pregnancy outcome. PMID:25624665

  2. 76 FR 17444 - In the Matter of Certain Vaginal Ring Birth Control Devices; Notice of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-29

    ...In the Matter of Certain Vaginal Ring Birth Control Devices; Notice of Investigation...after importation of certain vaginal ring birth control devices by reason of infringement...after importation of certain vaginal ring birth control devices that infringe claim 1...

  3. Analysis of Bacterial Vaginosis-Related Amines in Vaginal Fluid by Gas Chromatography and Mass Spectrometry

    Microsoft Academic Search

    HELEN WOLRATH; URBAN FORSUM; P. G. LARSSON; HANS BOREN

    2001-01-01

    The presence of various amines in vaginal fluid from women with malodorous vaginal discharge has been reported before. The investigations have used several techniques to identify the amines. However, an optimized quantification, together with a sensitive analysis method in connection with a diagnostic procedure for vaginal discharge, including the syndrome of bacterial vaginosis, as defined by the accepted \\

  4. Free Glycogen in Vaginal Fluids Is Associated with Lactobacillus Colonization and Low Vaginal pH

    PubMed Central

    Mirmonsef, Paria; Hotton, Anna L.; Gilbert, Douglas; Burgad, Derick; Landay, Alan; Weber, Kathleen M.; Cohen, Mardge; Ravel, Jacques; Spear, Gregory T.

    2014-01-01

    Objective Lactobacillus dominates the lower genital tract microbiota of many women, producing a low vaginal pH, and is important for healthy pregnancy outcomes and protection against several sexually transmitted pathogens. Yet, factors that promote Lactobacillus remain poorly understood. We hypothesized that the amount of free glycogen in the lumen of the lower genital tract is an important determinant of Lactobacillus colonization and a low vaginal pH. Methods Free glycogen in lavage samples was quantified. Pyrosequencing of the 16S rRNA gene was used to identify microbiota from 21 African American women collected over 8–11 years. Results Free glycogen levels varied greatly between women and even in the same woman. Samples with the highest free glycogen had a corresponding median genital pH that was significantly lower (pH 4.4) than those with low glycogen (pH 5.8; p<0.001). The fraction of the microbiota consisting of Lactobacillus was highest in samples with high glycogen versus those with low glycogen (median?=?0.97 vs. 0.05, p<0.001). In multivariable analysis, having 1 vs. 0 male sexual partner in the past 6 months was negatively associated, while BMI ?30 was positively associated with glycogen. High concentrations of glycogen corresponded to higher levels of L. crispatus and L. jensenii, but not L. iners. Conclusion These findings show that free glycogen in genital fluid is associated with a genital microbiota dominated by Lactobacillus, suggesting glycogen is important for maintaining genital health. Treatments aimed at increasing genital free glycogen might impact Lactobacillus colonization. PMID:25033265

  5. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth.

    PubMed

    Witkin, S S

    2015-01-01

    Ascending bacterial infection is implicated in about 40-50% of preterm births. The human vaginal microbiota in most women is dominated by lactobacilli. In women whose vaginal microbiota is not lactobacilli-dominated anti-bacterial defence mechanisms are reduced. The enhanced proliferation of pathogenic bacteria plus degradation of the cervical barrier increase bacterial passage into the endometrium and amniotic cavity and trigger preterm myometrial contractions. Evaluation of protocols to detect the absence of lactobaciili dominance in pregnant women by self-measuring vaginal pH, coupled with measures to promote growth of lactobacilli are novel prevention strategies that may reduce the occurrence of preterm birth in low-resource areas. PMID:25316066

  6. Image-guided brachytherapy for cervix cancer: from Manchester to Melbourne.

    PubMed

    Narayan, Kailash; Barkati, Maroie; van Dyk, Sylvia; Bernshaw, David

    2010-01-01

    Brachytherapy for cervix cancer has evolved rapidly over the last few years through the introduction of image-guided brachytherapy. This has enabled the transition from Manchester-based orthogonal radiograph planning to more conformal treatments, incorporating the concepts of patients' anatomy, tumor characteristics and tumor response with time. The purpose of this article is to outline the evolution of cervix cancer brachytherapy, discuss guidelines and recommendations on image-guided brachytherapy and describe our single-institution conformal image-based brachytherapy experience. PMID:20014884

  7. Evaluation of the Effects of a New Intravaginal Gel, Containing Purified Bovine Colostrum, on Vaginal Blood Flow and Vaginal Atrophy in Ovariectomized Rat

    PubMed Central

    Vailati, Silvia; Melloni, Elsa; Riscassi, Ermanno; Behr Roussel, Delphine; Sardina, Marco

    2013-01-01

    Introduction Vaginal dryness due to vaginal atrophy is a common complaint of postmenopausal women, interfering with sexual function and quality of life. Hormone replacement therapy is the only effective therapy but with known risks that leave unmet medical needs. A new product, ZP-025 vaginal gel, containing purified (dialyzed lyophilized) bovine colostrum, has been developed for the treatment of vaginal dryness secondary to vaginal atrophy. Aim The study aims to investigate the effects of intravaginal application of ZP-025 on vaginal atrophy using an animal model. Methods Ovariectomized female Sprague-Dawley rats were used. Three weeks after surgery, rats were divided into four groups and treated for 4 weeks (twice a day) with placebo or ZP-025 at low (0.5%) or high (2.3%) concentrations of colostrum; in the control group, rats did not receive any treatment. Changes in vaginal blood flow due to pelvic nerve stimulation were assessed by laser Doppler flowmetry and vaginal tissue was collected for histological assay. Main Outcome Measures The main outcome measures were vaginal blood flow before and after pelvic nerve stimulation and histology of vaginal epithelium. Results Treatment with ZP-025 to ovariectomized rats induced an increase of vaginal blood flow parameters (vascular capacitance, amplitude and area under the curve of the response) in response to pelvic nerve stimulation compared with control group, statistically significant at 2.3%. Vaginal epithelium showed a physiological estrous cycle aspect in treated animals, with at least five cell layers vs. one or two cell layers in control rats. As expected from a topical formulation, systemic effects on body weights and uterine wet weights were not observed with application of ZP-025. Conclusions In this study, the new product ZP-025, containing purified colostrum, was shown to have beneficial effects on vaginal atrophy in ovariectomized rats, improving vaginal hemodynamics and thickness of vaginal epithelium. Vailati S, Melloni E, Riscassi E, Behr Roussel D, and Sardina M. Evaluation of the effects of a new intravaginal gel, containing purified bovine colostrum, on vaginal blood flow and vaginal atrophy in ovariectomized rat. Sex Med 2013;1:35–43. PMID:25356286

  8. Percutaneous interstitial brachytherapy for adrenal metastasis: technical report.

    PubMed

    Kishi, Kazushi; Tamura, Shinji; Mabuchi, Yasushi; Sonomura, Tetsuo; Noda, Yasutaka; Nakai, Motoki; Sato, Morio; Ino, Kazuhiko; Yamanaka, Noboru

    2012-09-01

    We developed and evaluated the feasibility of a brachytherapy technique as a safe and effective treatment for adrenal metastasis. Adapting a paravertebral insertion technique in radiofrequency ablation of adrenal tumors, we developed an interstitial brachytherapy for adrenal metastasis achievable on an outpatient basis. Under local anesthesia and under X-ray CT guidance, brachytherapy applicator needles were percutaneously inserted into the target. A treatment plan was created to eradicate the tumor while preserving normal organs including the spinal cord and kidney. We applied this interstitial brachytherapy technique to two patients: one who developed adrenal metastasis as the third recurrence of uterine cervical cancer after reirradiation, and one who developed metachronous multiple metastases from malignant melanoma. The whole procedure was completed in 2.5 hours. There were no procedure-related or radiation-related early/late complications. FDG PET-CT images at two and three months after treatment showed absence of FDG uptake, and no recurrence of the adrenal tumor was observed for over seven months until expiration, and for six months until the present, respectively. This interventional interstitial brachytherapy procedure may be useful as a safe and eradicative treatment for adrenal metastasis. PMID:22843376

  9. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency.

    PubMed

    Franklin, J L; Barrett, W P; Jackins, S E; Matsen, F A

    1988-01-01

    Seven cases of total shoulder arthroplasty exhibiting major glenoid radiolucent lines or actual translation of the glenoid component were evaluated to identify factors associated with glenoid loosening. The average time from arthroplasty was 30 months (range, 14-44 months). Six of the patients had severe, incompletely reconstructable rotator cuff tears present at the time of surgery, and one patient developed a cuff tear within 1 year of surgery. The amount of superior migration of the humeral component was closely correlated with the degree of glenoid loosening. With superior displacement of the humeral component, superior tipping of the glenoid component was observed: a "rocking horse" glenoid. For comparison, a contemporary group of 16 consecutive total shoulder arthroplasty patients with intact rotator cuffs were reviewed. The control group had no glenoid loosening an average of 5 years after operation. Upward riding of the prosthetic humeral head in patients with rotator cuff deficiency may contribute to loosening of the glenoid component in total shoulder arthroplasty. PMID:3361319

  10. Margin convergence: A method of reducing strain in massive rotator cuff tears

    Microsoft Academic Search

    Stephen S. Burkhart; K. A. Athanasiou; Michael A. Wirth

    1996-01-01

    Increased security of fixation in rotator cuff repair is usually achieved by increasing the strength of fixation. Paradoxically, the problem can be approached by techniques that decrease the strain at the margins of the tear so that weaker fixation will still be adequate. Such techniques provide greater safety tolerances for the strength characteristics of suture, tendon, and bone. The principle

  11. Arthroscopic “Interval Slide” in the Repair of Large Rotator Cuff Tears

    Microsoft Academic Search

    Joseph C. Tauro

    1999-01-01

    Summary: An arthroscopic technique for coracohumeral ligament release from a retracted supraspinatus tendon is presented. The procedure is technically simple and can greatly improve the mobility of retracted rotator cuff tears, thus expanding the application of arthroscopic repair to larger tears.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 5 (July-August), 1999: pp 527–530

  12. Transplantation of teres major muscle for infraspinatus muscle in irreparable rotator cuff tears

    Microsoft Academic Search

    Luigi Celli; Claudio Rovesta; Maria Carmen Marongiu; Stetano Manzieri

    1998-01-01

    The authors suggest transfer of teres major muscle for a detached and atrophic infraspinatus muscle in irreparable rotator cuff tears. Original studies were done on cadavers. In the period between November 1993 and June 1994, we used this technique on 6 patients. Those patients were evaluated with the Constant-Murley test and improved from an average of 40 points (minimum 27

  13. The 'dropping' and 'hornblower's' signs in evaluation of rotator-cuff tears

    Microsoft Academic Search

    Gilles Walch; Aziz Boulahia; Salvatore Calderone; Andrew H. N. Robinson

    1998-01-01

    e studied 54 patients operated on for combined supraspinatus and infraspinatus rotator-cuff tears. The presence or absence of the dropping and hornblower's clinical signs of impaired external rotation were correlated with Goutallier stage-3 or stage-4 fatty degeneration of infraspinatus and teres minor. These grades of fatty degeneration have previously been correlated with a poorer outcome from reconstructive surgery. We found

  14. Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing

    Microsoft Academic Search

    Anthony C. Nwakama; Robert H. Cofield; Brian F. Kavanagh; J. F. Loehr

    2000-01-01

    Each of 6 patients (7 shoulders) underwent semiconstrained total shoulder arthroplasty for glenohumeral arthritis, subluxation, and extensive rotator cuff tearing to obtain a more balanced joint and achieve consistent pain relief. A hooded glenoid component (Neer 600%) was used to contain the humeral head within the joint. Patients were followed for an average of 69 months (range, 26-125 months) or

  15. Natural history of asymptomatic rotator cuff tears: A longitudinal analysis of asymptomatic tears detected sonographically

    Microsoft Academic Search

    Ken Yamaguchi; A. Marc Tetro; Oren Blam; Bradley A. Evanoff; Sharlene A. Teefey; William D. Middleton

    2001-01-01

    The purpose of this study was to examine longitudinally the natural history of asymptomatic rotator cuff tears over a 5-year period and to assess the risk for development of symptoms and tear progression. Since 1985 through the present, bilateral sonograms were done on all patients. A review of consecutive sonograms done from 1989 to 1994 revealed 58 potential patients with

  16. A Multicenter Study of 210 Rotator Cuff Tears Treated by Arthroscopic Acromioplasty

    Microsoft Academic Search

    Jean-François Kempf; Pascal Gleyze; François Bonnomet; Gilles Walch; Daniel Mole; André Frank; Philippe Beaufils; Christophe Levigne; Bruno Rio; André Jaffe

    1999-01-01

    Summary: We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was

  17. Arthroscopic Treatment of Partial Rotator Cuff Tears in Young AthletesA Preliminary Report

    Microsoft Academic Search

    Loel Z. Payne; David W. Altchek; Edward V. Craig; Russell F. Warren

    1997-01-01

    Forty-three athletes under age 40, more than half of which were collegiate or professional, with partial rota tor cuff tears were treated arthroscopically and ob served for a minimum of 24 months. By history and mechanism of injury, two main groups were identified. Group A had 14 patients with acute, traumatic injuries. All 14 had inflamed subacromial bursas, but increased

  18. Arthroscopic repair of large rotator cuff tears using the interval slide technique

    Microsoft Academic Search

    Joseph C Tauro

    2004-01-01

    Purpose: In some cases of larger and chronic rotator cuff tears, the supraspinatus tendon may be held in a retracted position by the contracted tissue of the rotator interval and the attached coracohumeral ligament. This study was performed to evaluate the utility and clinical effectiveness of an arthroscopic release of the rotator interval from the supraspinatus tendon combined with repair

  19. Differential ubiquitin-proteasome and autophagy signaling following rotator cuff tears and suprascapular nerve injury

    PubMed Central

    Joshi, Sunil K.; Kim, Hubert T.; Feeley, Brian T.; Liu, Xuhui

    2013-01-01

    Previous studies have evaluated role of Akt/mTOR signaling in rotator cuff muscle atrophy and determined that there was differential in signaling following tendon transection (TT) and suprascapular nerve (SSN) denervation (DN), suggesting that atrophy following TT and DN was modulated by different protein degradation pathways. In this study, two muscle proteolytic systems that have been shown to be potent regulators of muscle atrophy in other injury models, the ubiquitin-proteasome pathway and autophagy, were evaluated following TT and DN. In addition to examining protein degradation, this study assessed protein synthesis rate following these two surgical models to understand how the balance between protein degradation and synthesis results in atrophy following rotator cuff injury. In contrast to the traditional theory that protein synthesis is decreased during muscle atrophy, this study suggests that protein synthesis is up-regulated in rotator cuff muscle atrophy following both surgical models. While the ubiquitin-proteasome pathway was a major contributor to the atrophy seen following DN, autophagy was a major contributor following TT. The findings of this study suggest that protein degradation is the primary factor contributing to atrophy following rotator cuff injury. However, different proteolytic pathways are activated if SSN injury is involved. PMID:24018537

  20. Incidence and Treatment of Postoperative Stiffness Following Arthroscopic Rotator Cuff Repair

    Microsoft Academic Search

    David P. Huberty; John D. Schoolfield; Paul C. Brady; Antonio P. Vadala; Paolo Arrigoni; Stephen S. Burkhart

    2009-01-01

    Purpose: The purpose of this study was to determine the incidence of clinically significant postoperative stiffness following arthroscopic rotator cuff repair. This study also sought to determine the clinical and surgical factors that were associated with higher rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic lysis of adhesions and capsular release for treatment of patients who developed