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1

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

PubMed Central

Vaginal cuff dehiscence is a rare, but potentially serious complication after total hysterectomy. We report a case of vaginal cuff dehiscence after vaginal cuff brachytherapy. A 62 year old female underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and was found to have International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB endometrioid adenocarcinoma of the uterus. The patient was referred for adjuvant vaginal cuff brachytherapy. During the radiation treatment simulation, a computerized tomography (CT) of the pelvis showed abnormal position of the vaginal cylinder. She was found to have vaginal cuff dehiscence that required immediate surgical repair. Vaginal cuff dehiscence triggered by vaginal cuff brachytherapy is very rare with only one case report in the literature. PMID:24143152

Cattaneo, Richard; Bellon, Maria

2013-01-01

2

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

PubMed Central

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

Hassouna, Ashraf; Constantinescu, Camelia

2014-01-01

3

Adjuvant vaginal cuff brachytherapy for high-risk, early stage endometrial cancer  

PubMed Central

Purpose To report outcomes following adjuvant high-dose-rate vaginal brachytherapy (VBT) with or without chemotherapy for high-intermediate risk (HIR) and high-risk, early stage endometrial cancer as defined in Gynecologic Oncology Group trial 0249. Material and methods From May 2000 to January 2014, 68 women with HIR and high-risk endometrial cancer underwent surgical staging followed by VBT. Median VBT dose was 21 Gy delivered in three fractions prescribed to 0.5 cm depth. Paclitaxel 175 mg/m2 and carboplatin area under the curve 6 was administered every 21 days in sequence with VBT. Actuarial survival estimates were calculated using the Kaplan-Meier method. Results Patient demographics included a median age of 66 years (range: 36-91) and stages IA (49%), IB (38%), and II (13%), respectively. Thirty-one (46%) patients had HIR disease with endometrioid histology, and 33 (48%) patients had serous or clear cell histology. Thirty-seven (54%) patients received a median 3 cycles (range: 3-6) of chemotherapy in addition to VBT, and 65 patients (96%) completed all prescribed therapy. During a median follow up of 33.1 months (range: 4.0-161.7), four patients have recurred, including one vaginal recurrence. The 3-year estimates of vaginal, pelvic, and distant recurrences were 1.9%, 2.4%, and 9.1%, respectively. The 3-year rates of disease-free and overall survival were 87.7% and 93.9%, respectively. Conclusions Early outcomes with adjuvant VBT with or without chemotherapy demonstrate high rates of vaginal and pelvic control for women with HIR disease. Early vaginal and pelvic relapses in high-risk patients suggest that pelvic external beam radiotherapy is warranted in this subgroup, but additional data from large phase III trials is warranted. PMID:25337127

Eastwick, Gary; Anne, Pramila Rani; Rosenblum, Norman G.; Schilder, Russell J.; Chalian, Raffi; Zibelli, Allison M.; Kim, Christine H.; Den, Robert

2014-01-01

4

A Prospective Clinical Trial of Bladder Filling and 3D-Dosimetry in High-Dose-Rate Vaginal-Cuff Brachytherapy  

PubMed Central

Purpose To investigate the impact of bladder filling state on dosimetry and determine the best bladder dosimetric parameter in vaginal-cuff brachytherapy. Materials and Methods Twenty women received vaginal cylinder high-dose-rate (HDR) brachytherapy with each fraction followed by a planning CT scan on a prospective clinical trial. The bladder was full for fraction 2 and empty for fraction 3. Dose volume histogram (DVH) and dose surface histogram (DSH) values were generated for the bladder, rectum, and urethra. The midline maximum bladder point (MBP) and the midline maximum rectal point (MRP) were recorded. Paired t-tests, Pearson correlations, and regression analyses were performed. Results The volume and surface area of bladder irradiated were significantly smaller when the bladder was empty than when full. Of several DVH and DSH parameters evaluated, the bladder D2cc, V50, V70 and SA50 significantly predicted the difference in empty versus full filling states. The V70 and D2cc were significantly correlated with the MBP. Bladder filling did not alter the volume or surface area of 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 In order to minimize radiation dose to the bladder, patients receiving vaginal-cuff HDR brachytherapy should be treated with an empty bladder if feasible. The MBP correlates well with the volumetric assessments of bladder dose and provides a non-invasive method for reporting maximum bladder point dose using 3D imaging. The MBP can therefore be used as a surrogate for complex dosimetry in the clinic. PMID:18395360

Stewart, Alexandra J.; Cormack, Robert A.; Lee, Hang; Xiong, Li; Hansen, Jorgen L.; O’Farrell, Desmond A.; Viswanathan, Akila N.

2010-01-01

5

Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation  

SciTech Connect

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

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

2012-03-15

6

Oxidized Regenerated Cellulose Resembling Vaginal Cuff Abscess  

PubMed Central

Introduction: Application of oxidized regenerated cellulose is commonly performed in laparoscopy to achieve hemostasis during surgery. The appearance of an abscess resembles oxidized regenerated cellulose, causing imaging studies to be difficult to interpret. Case Description: We describe the cases of 3 patients who underwent oxidized regenerated cellulose placement during laparoscopic gynecologic surgery. They subsequently presented with signs and symptoms resembling an abscess. Computed tomographic imaging can be challenging to interpret in such cases; radiologic findings can be used to differentiate between the characteristics of oxidized regenerated cellulose and those of abscess formation on the vaginal cuff. Discussion: Oxidized regenerated cellulose has an appearance that often mimics postsurgical abscess formation. There are distinct characteristics that distinguish both findings. It is essential that patients' records accurately describe the presence and location of regenerated oxidized cellulose when placed intraoperatively, and this information must be relayed to the interpreting radiologist to facilitate medical diagnosis and guide clinical management. PMID:24960506

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

2014-01-01

7

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

SciTech Connect

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

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

2012-05-01

8

Vaginal vault dehiscence and increased use of vaginal vault brachytherapy: what are the implications?  

PubMed

Literature reports describe the potential for increased incidence of vaginal vault dehiscence after minimally invasive surgery, and incidental reports of vaginal vault dehiscence with vaginal vault brachytherapy. This review explores the risk of increased vaginal complications in a setting of greater use of both minimally invasive surgical techniques and adjuvant vaginal vault brachytherapy in early endometrial cancer. The impact of associated patient-related and tumor-related risk factors on clinical decision making is evaluated in selecting therapy that provides optimal tumor control while minimizing treatment adverse effects. PMID:23095777

Wiebe, Ericka; Covens, Allan; Thomas, Gillian

2012-11-01

9

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

Microsoft Academic Search

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

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

2000-01-01

10

Bladder and rectum dose estimations on digitized radiographs for vaginal brachytherapy after hysterectomy.  

PubMed

The purpose of this study was to evaluate the feasibility of assessing bladder and rectal point doses, using orthogonal radiographs without treatment planning, for vaginal cylinder applicator (VC), high-dose-rate (HDR) vaginal cuff brachytherapy (BT) after hysterectomy. Thirty-three VC HDR BT treatment plans from 31 postop- erative endometrial cancer patients were retrospectively analyzed. Single-channel VC with four differing diameters - 2.0 cm, 2.3 cm, 2.6 cm, and 3.0 cm - were analyzed. Dose-distance modeling was performed to estimate bladder and rectal point doses by measuring distances on each orthogonal radiograph without treat- ment planning. The estimated doses were then compared with doses calculated on treatment planning system (TPS). Their percent (%) dose differences were recorded. Analysis was performed for each VC size, ICRU bladder and rectal points, and the closest rectal point. The estimated doses obtained from dose-distance modeling displayed on average less than 2.5% difference when compared with TPS doses at ICRU bladder and rectal points for each VC size. Dose percent differences between estimated values and TPS values were on average 1.9% and 2.5% for ICRU blad- der and rectal point, respectively, regardless of VC sizes. Dose-distance modeling for closest rectal point presented on average 5.4% dose difference when compared with TPS values of all VC sizes. It was feasible to estimate rectal and bladder point doses by measuring distances on orthogonal radiographs without treatment plan- ning. Percent dose differences were 2.5% less for both ICRU bladder and rectal points, regardless of VC sizes. The use of closest rectal point is not recommended for estimating rectal dose.  PMID:25493529

Zhang, Winson; Bhatia, Sundershan K; Sun, Wenqing; Modrick, Joseph M; Kim, Yusung

2014-01-01

11

Vaginal Recurrence More than 17 Years after Hysterectomy and Adjuvant Treatment for Uterine Carcinoma with Successful Salvage Brachytherapy: A Case Report  

PubMed Central

Purpose Although the majority of recurrences occur within the first 3 years of hysterectomy for endometrioid carcinoma, we report herein a successful salvage vaginal brachytherapy in a patient with endometrioid uterine carcinoma which recurred more than 17 years after initial treatment. Materials and Methods A 61-year-old female was diagnosed with endometrioid adenocarcinoma of the uterus and treated with TAH-BSO, followed by adjuvant external beam radiation therapy (EBRT) to the whole pelvis. After remaining free of any recurrent or metastatic disease for more than 17 years, she was diagnosed with isolated vaginal cuff recurrence and successfully treated with a salvage high-dose-rate intracavitary vaginal brachytherapy. Results The patient remained disease free until her death from unrelated causes 7 years later. Conclusion To the best of our knowledge, this case represents the longest time to recurrence of endometrial cancer in someone who had been treated with TAH-BSO and adjuvant pelvic EBRT. This case highlights that even with adjuvant therapy, late recurrences may occur, and successful salvage brachytherapy is very effective. PMID:21589885

Yechieli, Raphael; Robbins, Jared R.; Schultz, Daniel; Munkarah, Adnan; Elshaikh, Mohamed A.

2011-01-01

12

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

SciTech Connect

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

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

2011-07-01

13

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

SciTech Connect

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

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

2005-08-01

14

Vaginal vault brachytherapy: the effect of varying bladder volumes on normal tissue dosimetry.  

PubMed

This study was designed to assess the impact of bladder volume on dosimetry to critical normal structures in vaginal vault brachytherapy using a single line source vaginal applicator. 30 consecutive patients undergoing vaginal vault brachytherapy were studied by CT scanning with the applicator in situ and the bladder empty and then with the bladder containing either 35 ml of water (10 patients), 70 ml of water (10 patients) or 100 ml of water (10 patients). The scans were then analysed with isodose distributions overlayed to determine changes in dosimetry. No effect on bladder dose was seen with increasing volume compared with the empty bladder; however, there was a reduction in amount of small bowel within the high dose treatment region as bladder volume increased. With 100 ml bladder volume, the reduction reached 57.5% compared with the empty bladder. We conclude that vaginal vault brachytherapy should be undertaken with a bladder volume of at least 100 ml, which will considerably reduce the amount of small bowel in the irradiation volume with no increase in bladder dose. PMID:11026862

Hoskin, P J; Vidler, K

2000-08-01

15

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

PubMed Central

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years. PMID:23378855

Wojcieszek, Piotr; Bia?as, Brygida

2012-01-01

16

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

PubMed

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years. PMID:23378855

Kellas-?l?czka, Sylwia; Wojcieszek, Piotr; Bia?as, Brygida

2012-12-01

17

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

PubMed Central

Purpose To evaluate local control, survival and toxicity in patients with early-stage endometrioid adenocarcinoma of the uterus treated with adjuvant high-dose-rate (HDR) vaginal brachytherapy (VB) alone using a novel low dose regimen Methods We reviewed records of 414 patients with stage IA to stage II endometrial adenocarcinoma treated with VB alone from 2005 to 2011. Of these, 157 patients with endometrioid histology received 24 Gy in 6 fractions of HDR vaginal cylinder brachytherapy and constitute the study population. Dose was prescribed at the cylinder surface and delivered twice weekly in the post-operative setting. Local control and survival rates were calculated by the Kaplan-Meier method. Results All 157 patients completed the prescribed course of VB. Median follow-up time was 22.8 months (range, 1.5–76.5). Two patients developed vaginal recurrence, one in the periurethral region below the field and one in the fornix after treatment with a 2.5-cm cylinder. Three patients developed regional recurrence in the para-aortic region. Two patients developed distant metastasis (lung and carcinomatosis). The 2-year rate of vaginal control was 98.6%, locoregional control was 97.9% and disease-free survival was 96.8%. The 2-year overall survival rate was 98.7%. No Grade 2 or higher vaginal, gastrointestinal, genitourinary or skin long-term toxicity was reported for any patient. Conclusion Vaginal brachytherapy alone in early-stage endometrial cancer provides excellent results in terms of locoregional control and disease-free survival. The fractionation scheme of 24 Gy in 6 fractions prescribed to the cylinder surface was well-tolerated with minimal late toxicity. PMID:22850411

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

2012-01-01

18

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

PubMed Central

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

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

19

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

PubMed

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. Pediatr Blood Cancer 2015;62:531-532. © 2014 Wiley Periodicals, Inc. PMID:25284601

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

2015-03-01

20

The influence of applicator angle on dosimetry in vaginal vault brachytherapy.  

PubMed

In vaginal vault brachytherapy, the critical normal tissues are bladder and rectum; doses to these tissues may be affected by the position of a single line applicator placed in the vagina. Dosimetry with the applicator lying at its "natural" angle in the vagina with the patient in the lithotomy position has been compared with the applicator held horizontal as defined by a spirit level in 30 consecutive patients. A mean change in angle of 19.7 degrees was found. This resulted in a mean decrease in ICRU (International Commission of Radiation Units and Measurements) rectal point dose when the applicator is horizontal of 12.9%, equivalent to a mean absolute dose reduction of 1.3 Gy for a prescription dose of 5.5 Gy at 5 mm depth. An increase in mean dose to the ICRU bladder point when the applicator is horizontal of 13.3%, equivalent to an absolute mean dose increase of 0.5 Gy per fraction for the same prescription dose, was also found. On the basis of these findings, it is recommended that vaginal vault brachytherapy is performed with a single line source held in the "corrected" horizontal position to reduce bowel dose as this is the most sensitive critical normal tissue. PMID:11932216

Hoskin, P J; Bownes, P; Summers, A

2002-03-01

21

Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement  

PubMed Central

Objective: This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies. Methods: The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series. Results: Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps >2?mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson ?2 test=46.19; p<0.0001). Conclusion: The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps >2?mm. Advances in knowledge: For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre. PMID:23407428

Cornes, P; Al-Booz, H

2013-01-01

22

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

SciTech Connect

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

Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan)], E-mail: tomokaz31@cancer-c.pref.saitama.jp; Kato, Shingo [Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Tabushi, Katsuyoshi; Kutsutani-Nakamura, Yuzuru [Department of Radiation Oncology, Saitama Medical School, Saitama (Japan); Mizuno, Hideyuki [Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Takahashi, Michiko [Department of Gynecology, Saitama Cancer Center, Saitama (Japan); Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Shiromizu, Kenji [Department of Gynecology and Obstetrics, Saitama Medical School, Saitama (Japan); Saito, Yoshihiro [Department of Radiology, Saitama Cancer Center, Saitama (Japan)

2007-11-15

23

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

Microsoft Academic Search

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

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

1999-01-01

24

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

PubMed Central

The purpose of this study is to develop a procedure for eradicative brachytherapy that can deliver a curative boost dose to bulky (>4 cm) vaginal stump recurrence of uterine cancer without risk of damaging surrounding organs. We separated risk organs (the rectum and sigmoid) from the target during brachytherapy, with a hyaluronate gel injection into the pararectal space via the percutaneous paraperineal approach under local anesthesia. The rectum anchored to the sacrum by native ligament was expected to shift posteriorly. We encountered a patient with bulky stump recurrence of uterine cancer, approximately 8 cm in maximum diameter. She was complaining of abdominal pain and constipation due to bowel encasement. Following 50 Gy of external beam radiotherapy, we applied a single fraction of brachytherapy under gel separation and delivered 14.5 Gy (50.8 GyE: equivalent dose in 2-Gy fraction calculated with linear quadratic model at ?/? = 3) to the target. The gel injection procedure was completed in 30 min without complications. A total irradiation dose of 100.8 GyE was delivered to the target and the cumulative minimum dose to the most irradiated rectosigmoidal volume of 2 cc (cumulative D2cc) was calculated as 58.5 GyE with gel injection, and was estimated to be 96 GyE without. Over three years, the local stump tumor has completely disappeared, with no complications. Brachytherapy with a pararectal gel injection can be a safe and effective eradicative option for bulky vaginal stump recurrence. PMID:22843626

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

2012-01-01

25

Cost-effectiveness analysis of the treatment for intermediate risk endometrial cancer: postoperative brachytherapy vs. observation  

Microsoft Academic Search

Objective. To compare the survival, morbidity, and cost of treating women with intermediate risk endometrial cancer with postoperative vaginal cuff brachytherapy versus observation followed by treatment for vaginal recurrence.Methods. A cost-effectiveness analysis was performed comparing two treatment strategies for intermediate risk endometrial cancer (Stage IC, IG3, II—tumors limited to the uterus with greater than 50% myometrial invasion or poor differentiation

James Fanning; Michael L Hoffman; Stephen J Andrews; Allen W Harrah; John J Feldmeier

2004-01-01

26

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

PubMed Central

Objective To describe the effects of intracavitary brachytherapy (IVB) on sexual function and quality of life of women with early-stage endometrial cancer. Methods Women with International Federation of Gynecology and Obstetrics stage I to stage II endometrial cancer treated surgically with or without IVB were identified and mailed questionnaires. Quality of life and sexual function were measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the cervical cancer disease-specific module. Pertinent data from prior surgery and radiation treatments were abstracted retrospectively. Linear transformation of the survey subscale scores was conducted per European Organization for Research and Treatment of Cancer guidelines. Results Sixteen women in the IVB arm and 53 in the surgery-alone group completed the survey. Of the sexually active patients, 33% of the IVB patients and 42% of the surgery-alone patients felt their vagina was dry during sexual activity (P = 0.804) and 17% versus 20% felt their vagina was short (P = 0.884). Seventeen percent of patients in the IVB group felt their vagina was tight compared to 29% in the surgery-alone group (P = 0.891) and 0% versus 14% of patients reported pain during intercourse (P = 0.808). There was no statistically significant difference in sexual/vaginal functioning, sexual worry, or sexual enjoyment between the 2 groups. Conclusions Although both groups report vaginal changes that may affect sexual function, the patients treated with IVB reported similar outcomes on a sexual function questionnaire compared to patients treated with surgery alone. PMID:22398710

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

2013-01-01

27

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

PubMed Central

Background Purpose of this study was to identify predictors of vaginal ulcer after CT based three-dimensional image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for gynecologic malignancies. Methods Records were reviewed for 44 female (14 with primary disease and 30 with recurrence) with gynecological malignancies treated with HDR-ISBT with or without external beam radiation therapy. The HDR-ISBT applicator insertion was performed with image guidance by trans-rectal ultrasound and CT. Results The median clinical target volume was 35.5 ml (2.4-142.1 ml) and the median delivered dose in equivalent dose in 2 Gy fractions (EQD2) for target volume D90 was 67.7 Gy (48.8-94.2 Gy, doses of external-beam radiation therapy and brachytherapy were combined). For re-irradiation patients, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 91.1 Gy, 100.9 Gy, 260.3 Gy, 212.3 Gy, 170.1 Gy, 117.1 Gy, 105.2 Gy, and 94.7 Gy, respectively. For those without prior radiation therapy, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 56.3 Gy, 54.3 Gy, 147.4 Gy, 126.2 Gy, 108.0 Gy, 103.5 Gy, 94.7 Gy, and 80.7 Gy, respectively. Among five patients with vaginal ulcer, three had prior pelvic radiation therapy in their initial treatment and three consequently suffered from fistula formation. On univariate analysis, re-irradiation and vaginal wall D2cc in EQD2 was the clinical predictors of vaginal ulcer (p?=?0.035 and p?=?0.025, respectively). The ROC analysis revealed that vaginal wall D2cc is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D2cc in EQD2 equal to or less than 145 Gy and over 145 Gy were 3.7% and 23.5%, respectively, with a statistically significant difference (p?=?0.026). Conclusions Re-irradiation and vaginal D2cc is a significant predictor of vaginal ulcer after HDR-ISBT for gynecologic malignancies. Three-dimensional image-guided treatment planning should be performed to ensure adequate target coverage while minimizing vaginal D2cc in order to avoid vagina ulcer. PMID:24456669

2014-01-01

28

Tolerance of the vaginal vault to high-dose rate brachytherapy and concomitant chemo-pelvic irradiation: Long-term perspective?  

PubMed Central

Aim/background We sought to determine the tolerance level and complication rates of the vaginal vault to combined high-dose-rate intra-cavitary brachytherapy with concomitant chemo-radiotherapy. Patients and methods A retrospective review of medical records of all the patients who received definitive chemo-radiotherapy for cervical cancer between 1998 and 2002 was undertaken. The records were reviewed for doses and for radiation-associated early and late sequelae of the vagina, rectum and bladder. Cumulative biological effective dose was calculated for two reference vaginal surface points. Results Fifty patients were included. Average age at diagnosis was 54 years. Median follow-up was 59 months. There were no recorded instances of acute grade IV toxicity. Maximal high-dose-rate vaginal surface dose (upper central point) was 103 Gy, and maximal brachytherapy lateral surface dose was 70 Gy. Maximal cumulative biological effective dose for the lateral surface reference point was 465.5 Gy3, and the maximal cumulative biological effective dose for the superior reference point was 878.6 Gy3. There were no cases of vaginal necrosis or fistulas, and no cases of grade IV late vaginal, rectal or bladder toxicity. No correlation was found between the maximal vaginal surface dose and vaginal, rectal or bladder toxicity. Conclusions The maximal surface HDR brachytherapy dose of 103 Gy and the maximal cBED of 878.6 Gy3 were not associated with fistula or necrosis or other grade 3–4 vaginal complications. Concomitant chemo-radiotherapy, including pelvic radiotherapy and high-dose-rate intracavitary brachytherapy, is relatively safe for cervical cancer patients. PMID:24936320

Kaidar-Person, Orit; Abdah-Bortnyak, Roxolyana; Amit, Amnon; Nevelsky, Alexander; Berniger, Alison; Bar-Deroma, Raquel; Ben-Yosef, Rahamim; Kuten, Abraham

2013-01-01

29

Vaginitis.  

PubMed

Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur. PMID:21524046

Hainer, Barry L; Gibson, Maria V

2011-04-01

30

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

SciTech Connect

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.

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

31

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

PubMed Central

Purpose We perform a clinical retrospective study to determine whether a vaginal balloon-packing system provides a dosimetric reduction to organs at risk (OARs) versus traditional gauze packing for gynecological high-dose-rate brachytherapy (HDR-BT). We also test various balloon filling materials for optimizing imaging quality. Material and methods Filling materials for balloon-packing were evaluated based on imaging quality with X-ray, computerized tomography, and magnetic resonance imaging modalities. We then retrospectively reviewed 45 HDR-BT plans of 18 patients performed with gauze packing and 39 plans of 16 patients performed with balloon-packing. Twelve patients received both gauze and balloon-packing. HDR-BT was delivered with an iridium-192 afterloader and a Fletcher-Suit-Declos-style T&O applicator. At each fraction, 3D imaging was obtained. The D2cc values of OARs were calculated, as well as ICRU-defined point doses. Results In the 84 HDR fractions reviewed, vaginal balloon-packing provides statistically equivalent doses to rectum, bladder, and sigmoid compared to gauze packing. On average balloon-packing produced average reductions of 3.3% and 6.9% in the rectal and sigmoid D2cc doses and an increase of 3.2% to the bladder D2cc dose (normalized to prescription dose), although none of these values were statistically significant for the twelve patients who received both gauze and balloon-packing (32 and 40 total fractions, respectively). Conclusions In the 84 HDR fractions analyzed, vaginal balloon-packing is as effective as gauze packing for dose sparing to the rectum, bladder, and sigmoid. A 1: 1 solution of saline and contrast for filling material enables easy contouring for image-guided HDR with minimal artefacts. PMID:23634151

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

2013-01-01

32

Adjuvant intravaginal brachytherapy for uterus didelphys with synchronous endometrial adenocarcinomas and unfavourable vaginal topography.  

PubMed

? We describe a case of uterus didelphys with synchronous endometrial cancers. ? Unfavorable post-operative disturbance of the vaginal vault topography was present. ? Hence the Institut Gustave-Roussy "moulage" IVBT technique was utilised. ? This customised technique achieved excellent mould-to-mucosa conformance. PMID:24371641

Morris, Lucinda; Stevens, Mark John; Valmadre, Susan; Martland, Judith; Lee, Tony

2012-01-01

33

[Adenocarcinoma of the endometrium. The role of vaginal brachytherapy in the therapeutic sequence].  

PubMed

Surgery is the traditional treatment for endometrial carcinoma stage I and II. Radiotherapy is given to improve local control rate. Vaginal vault curietherapy can reduce vaginal recurrences rate. Chronology of curietherapy (pre or post operative) is under discussion. We have retrospectively analyzed treatment results of patients treated either with pre operative curietherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (group 1), or with RH-BSO and then vaginal curietherapy (60 Gy) (group 2). Patients with bad prognostic factors (grade 3 and deep tumor invasion into the myometrium) received pelvic external irradiation and were excluded. 121 patients were in group 1, 63 patients were in group 2. All patients received curietherapy using Cesium 137 sources (one uterine and two vaginal sources in group 1, three vaginal sources in group 2). Total dose delivered to the reference volume was 60 Gy. Doses delivered to some reference points (vagina, rectum, bladder, pelvic wall) were calculated according to the ICRU recommendations. Surgery was at least RH-BSO performed either before or after curietherapy. 82 patients in group 1 and 44 in group 2 had a pelvic lymphadenectomy. Curietherapy data were comparable in the two groups according to the dose distribution to the vagina, rectum and bladder. Reference volume was smaller in the group 2. Local failure rate was 13% in group 1 and 10% in group 2. Distant metastases rate was 12% in group 1 and 9% in group 2. Five year actuarial survival rate was not statistically different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2019710

Calais, G; Vitu, L; Descamps, P; Fignon, A; Reynaud-Bougnoux, A; Body, G; Lansac, J; Le Floch, O

1991-01-01

34

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

SciTech Connect

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

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

2012-02-01

35

Vaginal repair of vaginal vault dehiscence after postpartum hysterectomy  

PubMed Central

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

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

2014-01-01

36

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

SciTech Connect

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

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

2004-11-01

37

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

SciTech Connect

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

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

2012-05-01

38

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.  

PubMed

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(2cc), d(1cc), and d(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. PMID:22382087

Pedicini, Piernicola; Caivano, Rocchina; Fiorentino, Alba; Strigari, Lidia; Califano, Giorgia; Barbieri, Viviana; Sanpaolo, Piero; Castaldo, Giovanni; Benassi, Marcello; Fusco, Vincenzo

2012-01-01

39

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

SciTech Connect

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

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

2012-01-01

40

Local tumor control probability to evaluate an applicator-guided volumetric-modulated arc therapy solution as alternative of 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecological cancer.  

PubMed

The purpose of this study was to evaluate the applicator-guided volumetric-modulated arc therapy (AGVMAT) solution as an alternative to high-dose-rate brachytherapy (HDR-BRT) treatment of the vaginal vault in patients with gynecological cancer (GC). AGVMAT plans for 51 women were developed. The volumetric scans used for plans were obtained with an implanted CT-compatible vaginal cylinder which provides spatial registration and immobilization of the gynecologic organs. Dosimetric and radiobiological comparisons for planning target volume (PTV) and organs at risk (OARs) were performed by means of a dose-volume histogram (DVH), equivalent uniform dose (EUD), and local tumor control probability (LTCP). In addition, the integral dose and the overall delivery time, were evaluated. The HDR-BRT averages of EUD and minimum LTCP were significantly higher than those of AGVMAT. Doses for the OARs were comparable for the bladder and sigmoid, while, although HDR-BRT was able to better spare the bowel, AGVMAT provided a significant reduction of d2cc, d1cc, and dmax (p < 0.01) for the rectum. AGVMAT integral doses were higher than HDR-BRT with low values in both cases. Delivery times were about two or three times higher for HDR-BRT with respect to the single arc technique (AGVMAT1) and dual arc technique (AGVMAT2), respectively. The applicator-guided volumetric-modulated arc therapy seems to have the potential of improving rectum avoidance. However, brachytherapy improves performance in terms of PTV coverage, as demonstrated by a greater EUD and better LTCP curves. PMID:23470938

Pedicini, Piernicola; Strigari, Lidia; Caivano, Rocchina; Fiorentino, Alba; Califano, Giorgia; Nappi, Antonio; Improta, Giuseppina; Storto, Giovanni; Cozzolino, Mariella; Chiumento, Costanza; Fusco, Vincenzo; Vavassori, Andrea; Benassi, Marcello; Orecchia, Roberto; Salvatore, Marco

2013-01-01

41

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

NASA Astrophysics Data System (ADS)

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

Sloboda, Ron S.; Wang, Ruqing

1998-12-01

42

Vaginal Pessary  

MedlinePLUS

... normal. Your vaginal discharge may also develop an odor. Certain vaginal gels can help with these side ... more often may also help with foul-smelling odor. Vaginal irritation is another possible side effect. Women ...

43

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 ...

44

Rotator cuff exercises  

MedlinePLUS

... tendinitis, which is irritation and swelling of these tendons A rotator cuff tear, which occurs when one of the tendons is ... Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio ...

45

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 ...

46

Rotator Cuff Repair Rehabilitation  

PubMed Central

Background There is no consensus for the optimal postoperative rehabilitation protocol after rotator cuff repairs. Objective To determine if there is sufficient level I or II evidence available in the literature for establishment of a uniform, optimal rotator cuff rehabilitation protocol. Data Sources A systematic review of level I and II English-language, prospective, randomized controlled trials published between 1966 and 2008 was performed. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies that met the inclusion criteria. Search terms included rotator cuff, supraspinatus, infraspinatus, subscapularis, teres minor, rehab, rehabilitation, physical therapy, and physiotherapy. Study Selection Inclusion criteria were English-language level I or level II studies, including randomized clinical trials involving the rehabilitation of rotator cuff repairs. Exclusion criteria were non-English language, level IV or V studies, or studies involving shoulder rehabilitation of diagnoses other than rotator cuff repairs. Three independent reviewers arrived at a consensus for including 4 studies in this review out of 12 studies identified by the literature search. Data Extraction Included studies underwent worksheet quality appraisal independently by each of the 3 authors identifying strengths, weaknesses, and biases. The quality appraisal was then discussed among the authors and consensus reached regarding the strengths, weaknesses, and value of the included studies. Results Two studies examined the use of continuous passive motion for rotator cuff rehabilitation, and 2 studies compared an unsupervised, standardized rehabilitation program to a supervised, individualized rehabilitation program. These studies did not support the use of continuous passive motion in rotator cuff rehabilitation, and no advantage was shown with a supervised, individualized rehabilitation protocol compared to an unsupervised, standardized home program. Each investigation had weaknesses in study design that decreased the validity of its findings. Conclusion There is not enough high-level evidence to develop an evidence-based medicine approach to rotator cuff rehabilitation. There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol. PMID:23015863

Baumgarten, Keith M.; Vidal, Armando F.; Wright, Rick W.

2009-01-01

47

Vulvar and vaginal cancer.  

PubMed

Vulvar cancer is becoming more common as the population ages and is primarily a disease of the elderly. Most vulvar cancers are diagnosed at a localized stage and can be cured with surgery and adjuvant radiotherapy. More conservative therapy has been the mainstay in vulvar cancer treatment, which has lessened short-term and long-term morbidity without sacrificing efficacy. Recent national and international studies continue to prove the value of sentinel lymph node technology, which is moving toward a new standard of care for women with early stage vulvar cancer. Vaginal cancer is a rare cancer that also affects elderly women. Prognosis is poor; however, adequate treatment can be delivered with a combination of external beam radiotherapy and brachytherapy, and with surgical resection for a select group of patients. PMID:22640712

Carter, Jori S; Downs, Levi S

2012-06-01

48

Estrogen Vaginal  

MedlinePLUS

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

49

COMMUNITY CUFF: MANUALLYPOWERED BLOOD PRESSURE CUFF FOR SUBSAHARAN AFRICA  

E-print Network

clinics Community health workers CriBcal need High blood pressure (BP) is a major contributorCOMMUNITY CUFF: MANUALLYPOWERED BLOOD PRESSURE CUFF FOR SUBSAHARAN AFRICA Stepbystep instruc a manuallypowered, inexpensive, and easytouse blood pressure monitoring device for use by a minimally trained

McGaughey, Alan

50

Rolling cuff flexible bellows  

DOEpatents

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

Lambert, Donald R. (Livermore, CA)

1985-01-01

51

Modern brachytherapy.  

PubMed

Brachytherapy consists of placing radioactive sources within, or directly adjacent to a tumor, and is a means of delivering highly targeted and conformal radiation. While its history dates back to the origins of the field, in recent years brachytherapy treatment paradigms have been evolving considerably. This has been driven primarily by advancements in imaging, which allow for precise placement of sources and applicators under image guidance, and volume-based optimization to ensure adequate tumor coverage while sparing adjacent normal tissue. There has been a shift towards high-dose-rate (HDR) brachytherapy for many of the disease sites treated with brachytherapy. Simultaneously, with increasingly conformal treatment, there has been a shift towards utilization of higher doses per fraction, over fewer fractions, for specific disease sites where hypofractionation is believed to confer a radiobiological benefit. Here we review recent data and trends for those disease sites and conditions that are commonly treated with brachytherapy, including prostate, gynecologic, breast, head and neck, and skin cancers and salvage of recurrent disease. PMID:25499641

Nicholas Lukens, J; Gamez, Mauricio; Hu, Kenneth; Harrison, Louis B

2014-12-01

52

Hysterectomy - vaginal - discharge  

MedlinePLUS

Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... you are unable to urinate. You have a discharge from your vagina that has a bad odor. ...

53

Rotator cuff - self-care  

MedlinePLUS

... the bursa (a normally smooth layer) lining these tendons A tear, which occurs when one of the tendons is ... Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio ...

54

[Rupture of the rotator cuff].  

PubMed

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

Wurmig, C

2006-01-01

55

Vaginitis: diagnosis and management.  

PubMed

Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin. PMID:21084788

Quan, Martin

2010-11-01

56

21 CFR 870.1120 - Blood pressure cuff.  

Code of Federal Regulations, 2013 CFR

... 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...

2013-04-01

57

21 CFR 870.1120 - Blood pressure cuff.  

Code of Federal Regulations, 2014 CFR

... 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...

2014-04-01

58

21 CFR 870.1120 - Blood pressure cuff.  

Code of Federal Regulations, 2010 CFR

... 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...

2010-04-01

59

National Trends in Rotator Cuff Repair  

PubMed Central

Background: Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair. Methods: The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities. Results: The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001). Conclusions: The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair. PMID:22298054

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

2012-01-01

60

Biomechanical evaluation of rotator cuff fixation methods  

Microsoft Academic Search

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

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

1989-01-01

61

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

Microsoft Academic Search

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

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

1984-01-01

62

Ruptures of the rotator cuff.  

PubMed Central

Through the use of improved diagnostic techniques, including arthrography and arthroscopy, ruptures of the rotator cuff that previously might not have been recognized are now being identified more frequently. In most cases the symptoms are relatively mild and respond satisfactorily to rest and therapy. Occasionally, however, there is severe, persistent disability despite treatment. These ruptures require surgical repair. In such cases the data obtained from special investigations help the surgeon select the appropriate surgical approach and repair technique. An imaginative program of physiotherapy before and after the operation contributes greatly to a satisfactory result. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:7437980

Ha'eri, G B

1980-01-01

63

Rolling-cuff flexible bellows  

DOEpatents

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

Lambert, D.R.

1982-09-27

64

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, ...

65

Current Biomechanical Concepts for Rotator Cuff Repair  

PubMed Central

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

2013-01-01

66

Recurrent vaginal candidiasis.  

PubMed

Recurrent vaginal candidiasis is one of the most common reasons for patients visiting their primary care doctors. Majority of the cases are caused by Candida albicans. Controlling of risk factors such as diabetes mellitus, used of broad spectrum antibiotics, contraceptive pills and steroid therapy helps in managing recurrent vaginal candidiasis. Initial 14-day course of oral azoles and followed by 6 months maintenance are effective in treating majority of the cases. Failure to treat recurrent vaginal candidiasis can lead to various bio-psycho-social complications. PMID:15190674

Loh, K Y; Sivalingam, N

2003-12-01

67

Vaginal dryness alternative treatments  

MedlinePLUS

... it would seem that a diet rich in soy foods would improve symptoms of vaginal dryness. There continues ... the ideal sources or dose is still unknown. Soy foods include tofu, soy milk, and whole soybeans (also ...

68

Review of Vaginitis  

PubMed Central

Adisruption of the dynamic equilibrium of the healthy vagina may have significant sequelae, leading to chronic or serious conditions. Therefore, all cases of vaginitis should be accurately diagnosed and appropriately treated. PMID:18475337

1993-01-01

69

Management of vaginal prolapse.  

PubMed

Vaginal prolapse is a common health problem, and although severe morbidity is rare, it can have marked effects on quality of life. The treatment of vaginal vault prolapse can be a difficult and challenging problem. A detailed history and clinical evaluation is required in order to plan the appropriate choice of procedure. There are numerous surgical procedures that have been described using either abdominal or vaginal approaches. The choice of procedure is often dependent on the individual surgeon's choice and experience, and should be tailored to the individual patient. The ideal procedure should have a low risk of morbidity and mortality, but should also have long-term durability. There is a need for large, randomized trials to evaluate surgical techniques to correct vaginal prolapse and related urinary, bowel and sexual dysfunction. PMID:19803899

Chaliha, Charlotte; Khullar, Vik

2006-03-01

70

Continuous Measurement of Endotracheal Tube Cuff Pressure  

PubMed Central

Continuous monitoring and download of endotracheal tube cuff pressure for a 12-hour period were required to collect data for an ongoing program of research related to airway management of the critically ill patient. On the basis of reports from the anesthesia literature, continuous monitoring of cuff pressure via a traditional pressure transducer and monitor was identified as the best method to collect data. Although continuous pressure monitoring of many physiologic variables is routine in critical care settings, application of the technology to measurement of endotracheal tube cuff pressure has not been reported outside the operating room. The research team conducted bench testing and pilot testing in human subjects to establish feasibility, accuracy, and safety of continuous cuff pressure monitoring. Monitoring was feasible with stringent procedures applied to ensure safety. A bias of 0.5 cm H2O between continuous and intermittent measures was obtained in both in vitro and in vivo testing. PMID:18560292

Sole, Mary Lou; Aragon, Daleen; Bennett, Melody; Johnson, Randall L.

2012-01-01

71

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

SciTech Connect

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.

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

72

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

PubMed

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

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

2013-01-01

73

Clinical Examination of the Rotator Cuff  

PubMed Central

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

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

2013-01-01

74

Can Vaginal Cancer Be Prevented?  

MedlinePLUS

... kidneys, and several other organs. Find and treat pre-cancerous conditions Most vaginal squamous cell cancers are believed to start out as pre-cancerous changes, called vaginal intraepithelial neoplasia or VAIN . ...

75

JAMA Patient Page: Vaginal Symptoms  

MedlinePLUS

... 20% of vaginal symptoms are caused by trichomoniasis. • Vaginal candidiasis —Also known as a yeast infection , this condition is caused by an overgrowth of fungus that occurs naturally in the vagina and accounts for about 20% to 25% of ...

76

Prehospital endotracheal intubation; need for routine cuff pressure measurement?  

PubMed

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

Peters, Joost H; Hoogerwerf, Nico

2013-10-01

77

Preoperative or postoperative brachytherapy for patients with endometrial carcinoma stage I and II.  

PubMed

In endometrial carcinoma, vaginal vault brachytherapy is performed to improve the local control rate and to decrease vaginal recurrences. To assess the best chronology of this brachytherapy compared to surgery, we have retrospectively analyzed results of treatment of patients treated either with preoperative brachytherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (Group 1), or with RH-BSO and then postoperative brachytherapy (60 Gy) (Group 2). There were one hundred twenty-one patients in Group 1 and 63 in Group 2. The mean age was 61.8 years in Group 1 and 64.3 in Group 2. In Group 1, 73% of the patients were Stage I, and 77.6% were in Group 2. The two groups were comparable for histological grading and depth of tumoral invasion into the myometrium. Brachytherapy was delivered with one uterine and two vaginal sources in Group 1 and with three vaginal sources in Group 2. Doses to the reference volume and to reference points were calculated according to ICRU recommendations. Brachytherapy data were similar in the two groups except reference volume, which was smaller in Group 2. Local control rate was 87% in Group 1 and 91% in Group 2. Distant metastasis occurred in 12% of patients in Group 1 and 9% in Group 2. The 5-year actuarial survival rate was 84% in Group 1 and 89% in Group 2. Regarding stage, histological grading, and depth of tumoral invasion, no differences were observed between the two therapeutic groups. The only prognostic factor in the entire population was Stage. The 5-year actuarial survival rate was 91% for Stage I patients and 69% for Stage II (p value less than 0.03). The late severe complication rate was 14% in Group 1 and 7.9% in Group 2, a difference which was not statistically significant. We concluded that since no differences were observed between the two techniques, vaginal brachytherapy should be performed postoperatively when surgery is the first treatment (Stage I or II, grade 1 or 2, and no deep tumoral invasion into the myometrium). PMID:2211199

Calais, G; Vitu, L; Descamps, P; Body, G; Reynaud-Bougnoux, A; Lansac, J; Bougnoux, P; Le Floch, O

1990-09-01

78

[Brachytherapy of breast cancer].  

PubMed

For breast cancer, interstitial brachytherapy remains an accurate irradiation technique for delivering a high dose (increasing the local control) in a small volume (decreasing the toxicity). In this article, we present the technical data related to the breast brachytherapy proceeding, from the implantation of the vectors to the treatment itself, including the planning. The different indications of breast brachytherapy include all the breast irradiations focusing on the initial tumour bed (partial irradiation of the breast), such as boost, accelerated and partial breast irradiation (APBI) and second conservative radiosurgical treatment in case of ipsilateral in-breast recurrence. The results in terms of efficacy and toxicity are presented for each indication. Interstitial breast brachytherapy, performed according with the standard rules, remains a major technique for breast cancer treatment. PMID:23453755

Chand, M-È; Rivera, S; Hennequin, C; Hannoun-Lévi, J-M; Quero, L

2013-04-01

79

Fatty infiltration and rotator cuff atrophy.  

PubMed

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

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

2013-10-01

80

Delivery systems for brachytherapy.  

PubMed

Brachytherapy is described as the short distance treatment of cancer with a radioactive isotope placed on, in, or near the lesions or tumor to be treated. The main advantage of brachytherapy compared with external beam radiation (EBR) is the improved localized delivery of dose to the target volume of interest, thus normal tissue irradiation is reduced. The precise and targeted nature of brachytherapy provides a number of key benefits for the effective treatment of cancer such as efficacy, minimized risk of side effects, short treatment times, and cost-effectiveness. Brachytherapy devices have yielded promising results in preclinical and clinical studies. However, brachytherapy can only be used in localized and relatively small tumors. Although the introduction of new delivery devices allows the treatment of more complex tumor sites, with wider range of dose rate for improving treatment efficacy and reduction of side effects, a better understanding about the safety, efficacy, and accuracy of these systems is required, and further development of new techniques is warranted. Therefore, this review focuses on the delivery devices for brachytherapy and their application in prostate, breast, brain, and other tumor sites. PMID:25008970

de la Puente, Pilar; Azab, Abdel Kareem

2014-10-28

81

[Arthroscopic reconstruction of the rotor cuff].  

PubMed

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

Bauer, G J; Kniesel, B

2006-08-01

82

Vaginitis in adolescents.  

PubMed

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

Syed, Tahniat S; Braverman, Paula K

2004-06-01

83

Clinical and biological aspects of rotator cuff tears  

PubMed Central

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

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

2013-01-01

84

Full thickness tears: retaining the cuff.  

PubMed

Repair of rotator cuff tears is technically challenging. Full thickness rotator cuff tears have no potential for spontaneous healing, no reliable tendons substitutes are available, and their management is only partially understood. Many factors seem to contribute to the final outcome, and considerable variations in the decision-making process exist. For these reasons, decisions are often taken on the basis of surgeon's clinical experience. Accurate and prompt diagnosis is fundamental to guide correct management, and the tear pattern should be carefully evaluated to planning the most appropriate repair. PMID:22089291

Osti, Leonardo; Rizzello, Giacomo; Panascì, Manlio; Denaro, Vincenzo; Maffulli, Nicola

2011-12-01

85

Vaginal dilator therapy for women receiving pelvic radiotherapy  

PubMed Central

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

Miles, Tracie; Johnson, Nick

2014-01-01

86

Dosimetric audit in brachytherapy.  

PubMed

Dosimetric audit is required for the improvement of patient safety in radiotherapy and to aid optimization of treatment. The reassurance that treatment is being delivered in line with accepted standards, that delivered doses are as prescribed and that quality improvement is enabled is as essential for brachytherapy as it is for the more commonly audited external beam radiotherapy. Dose measurement in brachytherapy is challenging owing to steep dose gradients and small scales, especially in the context of an audit. Several different approaches have been taken for audit measurement to date: thimble and well-type ionization chambers, thermoluminescent detectors, optically stimulated luminescence detectors, radiochromic film and alanine. In this work, we review all of the dosimetric brachytherapy audits that have been conducted in recent years, look at current audits in progress and propose required directions for brachytherapy dosimetric audit in the future. The concern over accurate source strength measurement may be essentially resolved with modern equipment and calibration methods, but brachytherapy is a rapidly developing field and dosimetric audit must keep pace. PMID:24807068

Palmer, A L; Bradley, D A; Nisbet, A

2014-09-01

87

First two cases of primary carcinoma of the vagina successfully treated with concurrent weekly carboplatin plus paclitaxel, external beam radiotherapy and high-dose-rate interstitial brachytherapy: A case report and published work review.  

PubMed

Vaginal carcinoma is rare, accounting for only 2% of all gynecological malignancies. Due to a lack of prospective randomized studies, the role of concurrent chemoradiotherapy in the treatment of primary vaginal carcinoma remains unclear. We report the first two cases of primary vaginal carcinoma successfully treated with a regimen involving concurrent weekly carboplatin plus paclitaxel, external beam radiotherapy and high-dose-rate interstitial brachytherapy. These cases strongly indicate that definitive chemoradiation involving carboplatin plus paclitaxel may be a reasonable treatment for primary vaginal carcinoma. PMID:25227150

Mabuchi, Seiji; Kawano, Mahiru; Isohashi, Fumiaki; Kuroda, Hiromasa; Sasano, Tomoyuki; Kimura, Tadashi

2015-01-01

88

Regenerative Medicine in Rotator Cuff Injuries  

PubMed Central

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

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

2014-01-01

89

Vulvar and vaginal disorders.  

PubMed

Vulvovaginitis is the most common reason for a woman to see her gynecologist. The most common causes are bacterial vaginosis, Candida species, and Trichomonas vaginals, respectively. Human papillomavirus has become a major diagnostic and therapeutic problem. Human papillomavirus DNA testing suggests that exposure to human papillomavirus occurs frequently at birth and intermittently throughout a woman's life after the onset of sexual activity. Interferon has been shown to be effective in treating some forms of human papillomavirus. PMID:1333291

Hatch, K D

1992-12-01

90

[Vaginal injuries during coitus].  

PubMed

Based on a prospective study on a continuous series of women admitted on emergency for post-coitus hemorrhage. The authors present an epidemiology and prognosis of vaginal injuries in to coitus in the Dakar University Teaching Hospital. Over a period of 33 months (October 1991 to December 1994), 106 cases were recorded, giving an incidence rate of 32 cases per year. The average profile is that of young women (26 years), usually during the post-partum period (41.5%) or in the second phase of menstrual cycle (32%). The main influencing factors found included: chronic vaginal infection (74%), position during coitus (especially that dorsal decubitus with hyperflexion and abduction of the lower members (56%), sexual abstinence of 3 months on average (21 days to 2 years), and use of aggressive product "aphrodisiac" for vaginal mucus. The damage was most often located at the bottom of dead end of Douglas and could be estimated at 5 cm long and 5 mm deep. The immediate prognosis was favourable, after stitching with absorbable thread, healing was obtained within 8 to 15 days. Given a retrospective view about 2 to 5 years, morbidity was represented by 3 recurrent cases and 13% after effects of the deep dyspareunia type. PMID:10797947

Cisse, C T; Dionne, P; Cathy, A; Mendes, V; Diadhiou, F; Ndiaye, P D

1998-01-01

91

COMPARISONS OF NEEDLE INSERTION IN BRACHYTHERAPY  

E-print Network

aims at comparing the results of different prostate brachytherapy protocols concerning needle insertion order and its influence on tissue deformations. Prostate brachytherapy of other parameters was also demonstrated through the different simulations. PROSTATE BRACHYTHERAPY

Promayon, Emmanuel

92

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

PubMed Central

Background A modified form of high dose rate (HDR) brachytherapy has been developed called Axxent Electronic Brachytherapy (EBT). EBT uses a kilovolt X-ray source and does not require treatment in a shielded vault or a HDR afterloader unit. A multi-center clinical study was carried out to evaluate the success of treatment delivery, safety and toxicity of EBT in patients with endometrial cancer. Methods A total of 15 patients with stage I or II endometrial cancer were enrolled at 5 sites. Patients were treated with vaginal EBT alone or in combination with external beam radiation. Results The prescribed doses of EBT were successfully delivered in all 15 patients. From the first fraction through 3 months follow-up, there were 4 CTC Grade 1 adverse events and 2 CTC Grade II adverse events reported that were EBT related. The mild events reported were dysuria, vaginal dryness, mucosal atrophy, and rectal bleeding. The moderate treatment related adverse events included dysuria, and vaginal pain. No Grade III or IV adverse events were reported. The EBT system performed well and was associated with limited acute toxicities. Conclusions EBT shows acute results similar to HDR brachytherapy. Additional research is needed to further assess the clinical efficacy and safety of EBT in the treatment of endometrial cancer. PMID:20646289

2010-01-01

93

Levator Trauma After Vaginal Delivery  

Microsoft Academic Search

RESULTS: Fifty women (82%) were seen postpartum. Of the 39 women delivered vaginally, levator avulsion was diagnosed in 14 (36%, 95% confidence interval 21-51%). Among those delivered vaginally, there were associations with higher maternal age (P.10), vaginal operative delivery (P.07), and worsened stress incontinence postpartum (P.02). CONCLUSIONS: Avulsion of the inferomedial aspects of the levator ani from the pelvic sidewall

Hans Peter Dietz; Valeria Lanzarone

94

Robotic brachytherapy of the prostate.  

PubMed

Recent applications of robotics in the field of prostate brachytherapy are seeding the future and could potentially lead to a fully automated prostate brachytherapy surgery. Currently, a typical prostate brachytherapy surgery involves the implantation of upwards of 100 radioactive I-125 seeds by a surgeon. This review supplies background information on prostate biology, brachytherapy of the prostate, robotic brachytherapy, and transrectal ultrasound. Subsequently, it examines the physics involved in ultrasound, radiation from an I-125 source, dosimetry, and robotics. A current semi-automated robotic brachytherapy system is examined in detail and a discussion on future improvements is outlined. Finally, future work to improve prostate brachytherapy is postulated, most notably, phantom optimization using polyvinyl alcohol cryogel. The future of robotic brachytherapy lies in the advent of more sophisticated robotics. This review will give the reader a superior understanding of brachytherapy and its recent robotic advancements. Hopefully, this review will generate new ideas needed to advance prostate brachytherapy procedures leading to more accurate dosimetry, faster procedure time, less ionizing radiation received by surgery staff, more rapid patient recovery, and an overall safer procedure. PMID:20201771

Wilson, Kyle J

2009-01-01

95

Red herring vaginal discharge.  

PubMed

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

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

2013-01-01

96

Predictors of the vaginal microflora  

Microsoft Academic Search

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

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

2001-01-01

97

Anomalous biceps origin from the rotator cuff  

PubMed Central

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

Banerjee, Samik; Patel, Vipul R

2015-01-01

98

Biological Augmentation of Rotator Cuff Tendon Repair  

PubMed Central

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery. PMID:18264850

Kovacevic, David

2008-01-01

99

Baby cuff as a reason for laryngeal mask airway cuff malfunction during airway management for anesthesia  

PubMed Central

Placement of laryngeal mask airway (LMA) is a blind procedure without requiring laryngoscopy. The reported success rate for LMA insertion at the first attempt is almost 95%; however, many functioning LMAs may not be in an ideal anatomic place. It seems that disposable LMAs have more stable cuff pressure compared to reusable LMAs; therefore, Anesthesiologists should bear in mind this fact when using reusable LMAs to achieve a proper sealing and safe airway management. In this report, we introduced a case with malfunction of LMA cuff during the airway management. PMID:25191199

Panahi, Jafar Rahimi; Mahmoodpoor, Ata; Golzari, Samad E. J.; Soleimanpour, Hassan

2014-01-01

100

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

PubMed Central

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

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

2015-01-01

101

A new iridium applicator for vaginal vault irradiation.  

PubMed

A new disposable gynecologic applicator designed for postoperative vaginal vault brachytherapy is presented. The applicator is afterloading manually with iridium 192 wire. We have used this new applicator in more than thirty patients and recorded the following advantages: 1) There is no need to install expensive and complicated equipment; 2) Single use applicators are in sterile packages and are ready to use; 3) Applicator is easily and comfortably carried by patient; 4) There is no need for specific training to use the system; 5) There is no need for general anesthesia during application; 6) There is no need for patient immobilization during treatment; 7) There is no need for urinary catheterization during treatment; 8) Dose distribution is homogeneous; 9) Bladder and rectum doses are at acceptable levels; 10) Radioprotective measures needed to be taken are inexpensive. We believe that this new system could easily be used in every radiation oncology unit. PMID:7957330

Töre, G; Aslay, I; Dinçer, M; Kemikler, G

1994-01-01

102

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

PubMed Central

Purpose To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma. Material and methods The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy. Results The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV. Conclusions Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances. PMID:24790625

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

2014-01-01

103

Localized prostate cancer: brachytherapy  

Microsoft Academic Search

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

Anthony L. Zietman

2002-01-01

104

Arthroscopic rotator cuff repair: 4- to 10-year results  

Microsoft Academic Search

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

Eugene M Wolf; William T Pennington; Vivek Agrawal

2004-01-01

105

Arthroscopic Rotator Cuff Repair: 4- to 10Year Results  

Microsoft Academic Search

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

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

2004-01-01

106

Vaginal bleeding in early pregnancy  

MedlinePLUS

... can happen any time from conception (when the egg is fertilized) to the end of pregnancy. About 2 or 3 out of every 10 pregnant women have vaginal bleeding during their first 20 weeks of pregnancy.

107

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 ...

108

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.

109

Management of Rotator Cuff and Impingement Injuries in the Athlete  

PubMed Central

Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13. PMID:16558644

Williams, Gerald R.; Kelley, Martin

2000-01-01

110

Clinical Characteristics of Aerobic Vaginitis and Its Association to Vaginal Candidiasis, Trichomonas Vaginitis and Bacterial Vaginosis  

PubMed Central

ABSTRACT Aim of the work: Examine clinical characteristics of aerobic vaginitis and mixed infection for the purpose of better diagnostic accuracy and treatment efficiency. Materials and methods: Prospective research has been conducted at Clinic for Gynecology and Obstetrics, Department for Microbiology and Pathology at Polyclinic for laboratory diagnostic and Gynecology and Obstetrics Department at Health Center Sapna. Examination included 100 examinees with the signs of vaginitis. Examination consisted of: anamnesis, clinical, gynecological and microbiological examination of vaginal smear. Results: The average age of the examinees was 32,62±2,6. Examining vaginal smears of the examinees with signs of vaginitis in 96% (N-96) different microorganisms have been isolated, while in 4% (N-4) findings were normal. AV has been found in 51% (N-51) of the examinees, Candida albicans in 17% (N-17), BV in 15% (N-15), Trichomonas vaginalis in 13% (N-13). In 21% (N-21) AV was diagnosed alone while associated with other agents in 30% (N-30). Most common causes of AV are E. coli (N-55) and E. faecalis (N-52). AV and Candida albicanis have been found in (13/30, 43%), Trichomonas vaginalis in (9/30, 30%) and BV (8/30, 26%). Vaginal secretion is in 70,05% (N-36) yellow coloured, red vagina wall is recorded in 31,13% (N-16) and pruritus in 72,54% (N-37). Increased pH value of vagina found in 94,10% (N-48). The average pH value of vaginal environment was 5,15±0,54 and in associated presence of AV and VVC, TV and BV was 5,29±0,56 which is higher value considering presence of AV alone but that is not statistically significant difference (p>0,05). Amino-odor test was positive in 29,94% (N-15) of associated infections. Lactobacilli are absent, while leukocytes are increased in 100% (N-51) of the examinees with AV. Conclusion: AV is vaginal infection similar to other vaginal infections. It is important to be careful while diagnosing because the treatment of AV differentiates from treatment of other vaginitis.

Jahic, Mahira; Mulavdic, Mirsada; Nurkic, Jasmina; Jahic, Elmir; Nurkic, Midhat

2013-01-01

111

Vaginal itching and discharge - Adult and adolescent  

MedlinePLUS

Vaginal discharge refers to secretions from the vagina . The discharge may be: Thick, pasty, or thin Clear, cloudy, bloody, ... area (vulva) may be present along with vaginal discharge. It can also occur on its own.

112

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

MedlinePLUS

... Disorders Relaxation Exercises The Flu Vaccine 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 ...

113

Successful hemostasis by embolization in a case of uncontrollable arterial bleeding following posterior tension-free vaginal mesh procedure puncture.  

PubMed

An 82-year-old woman presented to our hospital in April 2009 complaining of sensations of a descending bladder and residual urine, and frequent urination. She had given birth to two children. She had undergone simple total hysterectomy for uterine myoma at another hospital in 1974 and anterior colporrhaphy for anterior vaginal wall prolapse, also at another hospital, in 2008. On presentation, examination with the pelvic organ prolapse quantitative system revealed a stage-III cuff scar prolapse and cystocele. A cystogram revealed a cystocele. We report here a tension-free vaginal mesh (TVM) procedure and the development of arterial bleeding following the third puncture for posterior TVM, which could not be controlled through the operative field but was successfully stopped by embolization. PMID:22436007

Hongoh, Sachiko; Miyakita, Hideshi; Terachi, Toshiro; Iwata, Yoshirou

2012-05-01

114

Optimization of brachytherapy dose distributions by simulated annealing.  

PubMed

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

Sloboda, R S

1992-01-01

115

Rotator Cuff Tendinitis and Tear (Beyond the Basics)  

MedlinePLUS

... article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for ... a weight in your hand. Graphic 50148 Version 3.0 Wand exercises for rotator cuff Wand exercises such ...

116

Dual-Camera Technique for Arthroscopic Rotator Cuff Repair  

PubMed Central

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.

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

2014-01-01

117

21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...

2011-04-01

118

21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2012 CFR

...2012-04-01 2012-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...

2012-04-01

119

21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...

2010-04-01

120

21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...

2013-04-01

121

21 CFR 884.3900 - Vaginal stent.  

Code of Federal Regulations, 2014 CFR

...2014-04-01 2014-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and...Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina...

2014-04-01

122

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

PubMed

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

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

2014-07-01

123

Advances in biology and mechanics of rotator cuff repair.  

PubMed

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

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

2015-02-01

124

Intraoral angiosarcoma: Treatment with a brachytherapy prosthesis.  

PubMed

Angiosarcomas are rare, malignant neoplasms of vascular origin that account for less than 1% of all soft tissue tumors. Angiosarcomas of the oral cavity are especially rare, and brachytherapy may be prescribed as a localized treatment to manage these malignancies. Intraoral brachytherapy requires collaboration between the radiation oncologist and a dental professional for the fabrication of the brachytherapy delivery prosthesis. The present clinical report describes an intraoral angiosarcoma and the fabrication of an intraoral brachytherapy prosthesis to manage this malignancy. PMID:25449613

Rosen, Evan B; Ko, Eugene; Wolden, Suzanne; Huryn, Joseph M; Estilo, Cherry L

2014-11-20

125

Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound  

SciTech Connect

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

Van Dyk, Sylvia [Radiation Therapy Services, Peter MacCallum Cancer Center, East Melbourne (Australia)], E-mail: 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

126

Improved apparatus for predictive diagnosis of rotator cuff disease  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

127

Suprascapular nerve: is it important in cuff pathology?  

PubMed

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

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

2012-01-01

128

Suprascapular Nerve: Is It Important in Cuff Pathology?  

PubMed Central

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

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

2012-01-01

129

Pharmacokinetic fundamentals of vaginal treatment with clotrimazole.  

PubMed

Absorption of clotrimazole after vaginal application was estimated to be between 3 and 10%. In order to investigate the fate of clotrimazole reaching systemic circulation, pharmacokinetic studies following oral and intravenous administration were carried out. The concentrations of clotrimazole in vaginal fluid and in blood plasma after vaginal application of 200 and 500 mg were determined using a specific assay by quantitative thin-layer chromatography. Fungicidal concentrations of clotrimazole in vaginal fluid up to 3 days after application of one vaginal tablet containing 500 mg were found. In contrast, clotrimazole plasma levels were lower than 0.01 micrograms/ml, demonstrating that clotrimazole is rapidly metabolized. PMID:7160239

Ritter, W; Patzschke, K; Krause, U; Stettendorf, S

1982-01-01

130

Dermatologic causes of vaginitis: a clinical review.  

PubMed

The concept of vaginitis is widely accepted. Most physicians assume that vaginitis represents an infection, with nearly all vaginal complaints diagnosed as Candidiasis, bacterial vaginosis, or trichomonas. However, like the mouth, the vagina is covered with squamous epithelium, and therefore affected by various dermatoses. Some dermatoses prominently affect mucous membranes, such as lichen planus, pemphigus vulgaris, cicatricial pemphigoid, and blistering forms of erythema multiforme. In addition, some dermatoses affect only the vagina, including desquamative inflammatory vaginitis and atrophic vaginitis. The diagnosis and management of these diseases are hampered by the difficulty of visualizing the vagina, and the lack of medications other than antimicrobials available for use in the vagina. PMID:20883916

Edwards, Libby

2010-10-01

131

The Societal and Economic Value of Rotator Cuff Repair  

PubMed Central

Background: Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective. Methods: A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs). Results: The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient’s lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion. Conclusions: Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease. PMID:24257656

Mather, Richard C.; Koenig, Lane; Acevedo, Daniel; Dall, Timothy M.; Gallo, Paul; Romeo, Anthony; Tongue, John; Williams, Gerald

2013-01-01

132

Concurrent Chemoradiation for Vaginal Cancer  

PubMed Central

Background It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT). Methods Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS) and disease-free survival (DFS) rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. Results The median age at diagnosis was 61 years (range, 18–92 years) and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS?=?56% vs. 79%, log-rank p?=?0.037; 3-yr DFS?=?43% vs. 73%, log-rank p?=?0.011). Twenty-three patients (45%) in the RT group had a relapse at any site compared to 3 (15%) in the CRT group (p?=?0.027). With regard to the sites of first relapse, 10 patients (14%) had local only, 4 (6%) had local and regional, 9 (13%) had regional only, 1 (1%) had regional and distant, and 2 (3%) had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10–0.97; p?=?0.04)). Conclusions Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients. PMID:23762284

Miyamoto, David T.; Viswanathan, Akila N.

2013-01-01

133

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

SciTech Connect

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.

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

134

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

PubMed Central

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

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

2013-01-01

135

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

E-print Network

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 ...

Gill, Harmeet (Harmeet Kaur)

2007-01-01

136

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

Microsoft Academic Search

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or\\u000a an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff\\u000a repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair,\\u000a and 32 patients

Leonardo Osti; Rocco Papalia; Massimo Paganelli; Enzo Denaro; Nicola Maffulli

2010-01-01

137

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

PubMed Central

Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and/or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems. PMID:25076828

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

2014-01-01

138

Leakage of fluid around endotracheal tube cuffs: a cadaver study  

PubMed Central

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

Lucius, Ralph; Ewald, Kristian

2013-01-01

139

Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

PubMed Central

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup. We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three cohorts of patients had repair of a symptomatic rotator cuff tear using (1) an open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, and 2 years postoperatively. Ultrasound studies were performed with a validated protocol at 6 months and 2 years postsurgery. Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better American Shoulder and Elbow Surgeons scores than the open group at 6 months and 2 years. Retear correlated with tear size and operation time and occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. An intact cuff on ultrasound corresponded to better results for supraspinatus strength, patient outcomes, and rotator cuff functional ability. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19184264

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

2009-01-01

140

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial  

PubMed Central

Background: The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ? 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ? 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ? 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001). Conclusions: The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications. PMID:25191181

Almarakbi, Waleed A.; Kaki, Abdullah M.

2014-01-01

141

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

PubMed Central

Background: Detachment of a tendon from its osseous insertion, as can be the case with severe rotator cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a rotator cuff injury model in the rabbit and to test the hypothesis that tenotomy of a rotator cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle. Methods: New Zealand white rabbits were divided into three groups: (1) partial rotator cuff tear without retraction of the muscle, (2) complete rotator cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury. Results: At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury. Conclusions: This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with rotator cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic rotator cuff tears may induce a neurologic injury. Clinical Relevance: Chronic rotator cuff injuries are associated with neuronal injury of the affected muscle. As such, neuronal injury may explain the histopathologic changes that have been observed following chronic rotator cuff tears. PMID:20926720

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

2010-01-01

142

Vaginal microbiome: rethinking health and disease.  

PubMed

Vaginal microbiota form a mutually beneficial relationship with their host and have a 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 are composed of a diverse array of anaerobic microorganisms. Bacterial vaginosis is the most common vaginal condition and is vaguely characterized as the disruption of the equilibrium of the normal vaginal microbiota. A better understanding of normal and healthy vaginal ecosystems that is based on their true function and not simply on their 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

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

2012-01-01

143

Primary Vaginal Cancer Treated With Concurrent Chemoradiation Using Cis-Platinum  

SciTech Connect

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

Samant, Rajiv [Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, Ottawa, ON (Canada); Faculty of Medicine, University of Ottawa Hospital, Ottawa, ON (Canada)], E-mail: 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

144

Subacromial Spacer Placement for Protection of Rotator Cuff Repair  

PubMed Central

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

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

2014-01-01

145

Multicatheter Device for Brachytherapy Treatment  

NASA Astrophysics Data System (ADS)

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

Velasco, Carlos; Gueye, Paul; Keppel, Cynthia

2007-03-01

146

Prostate brachytherapy under local anesthesia  

Microsoft Academic Search

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

Kent Wallner

2002-01-01

147

Vaginal stenosis after toxic epidermal necrolysis.  

PubMed

A 17-year-old adolescent girl developed severe toxic epidermal necrolysis after inhalation of methamphetamine. Recovery was complicated by vaginal synechiae and occlusion necessitating surgery. PMID:20885170

Rowan, Darion M; Jones, Ronald W; Oakley, Amanda; de Silva, Hiromel

2010-10-01

148

Clinicomicrobiological profile of women with vaginal discharge.  

PubMed

One hundred and ten patients presenting with vaginal discharge were investigated for microbiological spectrum of vaginitis and outcome of treatment. Laboratory-documented disorder could be ascertained in 86 patients (78%). Bacterial vaginosis was the commonest aetiology (43.6%), followed by candidiasis (10%), trichomoniasis (9.1%), senile vaginitis (5.4%) and vaginitis of unknown origin (5.4%). Endocervicitis was seen in 13.6% patients and urinary tract infection in 1.8%. Complete relief of symptoms was seen in 77 patients (70%). PMID:19810384

Gupta, Vineeta; Gupta, Pratima; Chatterjee, Biswaroop; Bansal, Rani

2009-03-01

149

HPV-Associated Vaginal Cancer Rates by Race and Ethnicity  

MedlinePLUS

... Cancer Home HPV-Associated Vaginal Cancer Rates by Race and Ethnicity Vaginal cancers are rare. It is ... women get vaginal cancer than women of other races and ethnicities, similar to cervical cancer. * Note: This ...

150

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 ...

151

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 ...

152

Decision-making in massive rotator cuff tear.  

PubMed

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

Thès, André; Hardy, Philippe; Bak, Klaus

2015-02-01

153

Shoulder labral pathomechanics with rotator cuff tears.  

PubMed

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

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

2014-05-01

154

Image-based brachytherapy for cervical cancer  

PubMed Central

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

Vargo, John A; Beriwal, Sushil

2014-01-01

155

CT-Based Interstitial HDR Brachytherapy  

Microsoft Academic Search

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

Christos Kolotas; Dimos Baltas; Nikolaos Zamboglou

1999-01-01

156

Image-based brachytherapy for cervical cancer.  

PubMed

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

Vargo, John A; Beriwal, Sushil

2014-12-10

157

Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study  

Microsoft Academic Search

Purpose  Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause\\u000a of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials\\u000a (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing\\u000a fluid leakage across the cuff.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We compared fluid

Alberto Zanella; Vittorio Scaravilli; Stefano Isgrò; Manuela Milan; Massimo Cressoni; Nicolò Patroniti; Roberto Fumagalli; Antonio Pesenti

2011-01-01

158

Suitability of point kernel dose calculation techniques in brachytherapy treatment planning  

PubMed Central

Brachytherapy treatment planning system (TPS) is necessary to estimate the dose to target volume and organ at risk (OAR). TPS is always recommended to account for the effect of tissue, applicator and shielding material heterogeneities exist in applicators. However, most brachytherapy TPS software packages estimate the absorbed dose at a point, taking care of only the contributions of individual sources and the source distribution, neglecting the dose perturbations arising from the applicator design and construction. There are some degrees of uncertainties in dose rate estimations under realistic clinical conditions. In this regard, an attempt is made to explore the suitability of point kernels for brachytherapy dose rate calculations and develop new interactive brachytherapy package, named as BrachyTPS, to suit the clinical conditions. BrachyTPS is an interactive point kernel code package developed to perform independent dose rate calculations by taking into account the effect of these heterogeneities, using two regions build up factors, proposed by Kalos. The primary aim of this study is to validate the developed point kernel code package integrated with treatment planning computational systems against the Monte Carlo (MC) results. In the present work, three brachytherapy applicators commonly used in the treatment of uterine cervical carcinoma, namely (i) Board of Radiation Isotope and Technology (BRIT) low dose rate (LDR) applicator and (ii) Fletcher Green type LDR applicator (iii) Fletcher Williamson high dose rate (HDR) applicator, are studied to test the accuracy of the software. Dose rates computed using the developed code are compared with the relevant results of the MC simulations. Further, attempts are also made to study the dose rate distribution around the commercially available shielded vaginal applicator set (Nucletron). The percentage deviations of BrachyTPS computed dose rate values from the MC results are observed to be within plus/minus 5.5% for BRIT LDR applicator, found to vary from 2.6 to 5.1% for Fletcher green type LDR applicator and are up to ?4.7% for Fletcher-Williamson HDR applicator. The isodose distribution plots also show good agreements with the results of previous literatures. The isodose distributions around the shielded vaginal cylinder computed using BrachyTPS code show better agreement (less than two per cent deviation) with MC results in the unshielded region compared to shielded region, where the deviations are observed up to five per cent. The present study implies that the accurate and fast validation of complicated treatment planning calculations is possible with the point kernel code package. PMID:20589118

Lakshminarayanan, Thilagam; Subbaiah, K. V.; Thayalan, K.; Kannan, S. E.

2010-01-01

159

Vaginitis: Its Diagnosis and Treatment  

PubMed Central

Ninety-nine patients with a variety of specific and non-specific vaginitis were treated initially with a broad spectrum anti-microbial agent (AVC cream) in an effort to alleviate the acute symptoms of these problems even before specific organisms could be isolated. Diagnostic methods are discussed for Candida albicans and trichomonas vaginalis which could be employed in routine office practice. This agents advantage in being effective against almost all known pathogens, is offset by its some-what limited effectiveness against trichomoniasis. It has been shown in this study to be well tolerated, and it offers an overall cure rate of 66 percent against the more common pathogens. PMID:20468509

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

1970-01-01

160

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

PubMed Central

Background: This retrospective, multicenter study evaluated the feasibility and safety of high-dose rate electronic brachytherapy (EBT) as a postsurgical adjuvant radiation therapy for endometrial cancer. Methods: Medical records were reviewed from 41 patients (age 40–89 years) with endometrial cancer (Federation of International Gynecology and Obstetrics stages IA–IIIC) treated at nine centers between April 2008 and October 2009. Treatment included intracavitary vaginal EBT alone (n = l6) at doses of 18.0–24.0 Gy in 3–4 fractions and EBT in combination with external beam radiation therapy (EBRT, n = 25) at a total radiation dose range of 40.0–80.4 Gy. Doses were prescribed to a depth of 5 mm from the applicator surface and to the upper third (n = 15) and the upper half (n = 26) of the vagina. Results: Median follow-up was 3.8 (range 0.5–12.0) months. All 41 patients received the intended dose of radiation as prescribed. Adverse events occurred in 13 of 41 patients and were mild to moderate (Grade 1–2), consisting primarily of vaginal mucositis, rectal mucosal irritation and discomfort, and temporary dysuria and diarrhea. There were no Grade 3 adverse events in the EBT-only treatment group. One patient, who was being treated with the combination of EBT and EBRT for recurrent endometrial cancer, had a Grade 3 adverse event. No recurrences have been reported to date. Conclusion: Electronic brachytherapy provides a feasible treatment option for postoperative adjuvant vaginal brachytherapy as sole radiation therapy and in combination with EBRT for primary endometrial cancer. Early and late toxicities were mild to moderate. PMID:21049086

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

2010-01-01

161

Laparoscopically assisted vaginal resection of rectovaginal endometriosis  

Microsoft Academic Search

Background: We wanted to establish a technique of laparoscopically assisted radical vaginal surgery for deep endometriosis of the rectovaginal septum with extensive rectal involvement.Technique: The procedure is started by vaginally excising the involved area which is left on the rectum, followed by bilateral dissection of the pararectal and retrorectal spaces. Para- and retrosigmoido-rectal spaces are developed laparoscopically along the coccygeosacral

Marc Possover; Herbert Diebolder; Karin Plaul; Achim Schneider

2000-01-01

162

[Brachytherapy with pulsed dosage. General considerations. Radiobiological considerations. First clinical experience in Mestre (Venice)].  

PubMed

The pulsed dose rate (PDR) brachytherapy technique is analyzed and compared with the low and high dose rate (LDR and HDR, respectively) techniques relative to therapy and management, considering the advantages and pitfalls of each technique. From a radiobiological viewpoint, PDR optimization is aimed at obtaining the same therapeutic results as with LDR and HDR relative to both tumor cell killing and possible late damage. PDR permits to administer the same nominal dose rates as with LDR and HDR, but with very different pulse intervals and length. March, 1995, through March, 1996, forty-two patients were treated with microSelectron PDR at the radiotherapy Department of Umberto I Hospital in Mestre (Venice). Twenty-two patients were irradiated on the vaginal vault, 14 on the anal canal, 4 on the breast, one on the endometrium and one on the urethra (the latter patient was a man). Dose rates were 250-300 cGy/h in the vaginal vault and 90 cGy/h in the other sites. Source-dwell interval in the applicators was 2.5 mm, dwelling time for each position ranged 6.8-122 s, 3-73 pulses were applied lasting 167-1958 s. The unit was reliable and the only problem was the need to recalibrate it every 5-6 applications because of computer memory saturation. Because of the short minimum follow-up (3 months), only the early reactions to treatment have been assessed: no toxicity was found in the vaginal vault, endometrium and breast. Low-grade proctitis was observed in 11 of 14 treated anal canals and another patient complained of more severe symptoms for two weeks; the disease progressed in two anal canal patients, as in the urethra patient. In conclusion, PDR brachytherapy appears a reliable technique whose early clinical results are encouraging. PMID:9221420

Pizzi, G B; Marchetti, C

1997-03-01

163

Platelet-rich plasma for rotator cuff repair.  

PubMed

Rotator cuff tears are a common cause of shoulder pain and disability. Because they combine both traumatic and degenerative elements, the surgical repair can be challenging. Even after surgical intervention, tendon residual defects or "retears" often develop. Risk factors for tendon "retears" include patient age, number of tendons involved, tear size, and smoking. Platelet-rich plasma (PRP) is a supraphysiological concentration of platelets, which may be able to positively augment rotator cuff tendon healing. Not all PRPs are the same and those containing higher leukocyte levels may be detrimental to tendon healing. Thrombin activation triggers an immediate release of growth factors from the PRP and may actually inhibit some parts of the healing response. As yet, the clinical data does not conclusively prove a benefit from PRP, but discernment is required in evaluating the published results. As different PRPs may act differently and the results may be dose dependent requiring more PRP to achieve a beneficial threshold. How success is measured (clinical outcomes vs. intact cuff tendons) and how long the patients are followed are also critical items. Currently, the PRP fibrin matrix version holds the greatest promise for improving clinical success after rotator cuff tendon repair. PMID:24212367

Barber, F Alan

2013-12-01

164

The evolution of artificial sphincter cuff in growing animals.  

PubMed

An animal model was developed to simulate the effect of implantation of artificial sphincter cuff on the urethra in children. The study was conducted on 28 pigs, 15 castrated males, four uncastrated males and nine females, divided into four groups: control unoperated, and three operated groups. Group I contained young piglets (castrated males, uncastrated males and females), group II contained adult animals and group III contained sham operated animals. An AS 800 belt occlusion cuff was implanted in the deflated state distal to the bladder neck around the urethra in the young and adult groups, while no sphincter was implanted in the sham group. Neither primary nor secondary activation was done. The pigs were followed for a period of six to eight weeks and then sacrificed. The morphological and histological observations on the effects of the artificial sphincter cuff on the underlying urethral tissue showed significant transmural atrophy of the urethral and prostatic segment underlying the cuff in the young growing castrated and uncastrated male group with mild changes in the young female group. Bladder rupture occurred in three uncastrated males. There were no changes encountered in the adult or sham operated groups. Variable degrees of upper tract changes and renal deterioration were seen in the young group. These changes occurred mainly in the male piglets while a lesser degree occurred in the female piglets. No changes were demonstrated in the adult and sham groups. This study suggests the possibility of similar changes occurring in young male children who have undergone artificial sphincter implantation. PMID:3411693

Mokhless, I; Hassouna, M M; Kiruluta, G H; Seemeyer, T A; Homsy, Y L; Coolsaet, B L; Elhilali, M M

1988-09-01

165

Understanding and preventing complications in repairing rotator cuff tears.  

PubMed

Repair of rotator cuff tears is a common procedure. Prior to approaching this surgery, it should be realized that each surgical step can lead to complications, including those related to positioning and anaesthesia. Stiffness, infection and failure of repair are the more frequent complications reported. PMID:21986055

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2012-01-01

166

Anatomical Considerations of the Suprascapular Nerve in Rotator Cuff Repairs  

PubMed Central

Introduction. When using the double interval slide technique for arthroscopic repair of chronic large or massive rotator cuff tears, the posterior interval release is directed toward the scapular spine until the fat pad that protects the suprascapular nerve is reached. Injury to the suprascapular nerve can occur due to the nerve's proximity to the operative field. This study aimed to identify safe margins for avoiding injury to the suprascapular nerve. Materials and Methods. For 20 shoulders in ten cadavers, the distance was measured from the suprascapular notch to the glenoid rim, the articular margin of the rotator cuff footprint, and the lateral border of the acromion. Results. From the suprascapular notch, the suprascapular nerve coursed an average of 3.42?cm to the glenoid rim, 5.34?cm to the articular margin of the rotator cuff footprint, and 6.09?cm to the lateral border of the acromion. Conclusions. The results of this study define a safe zone, using anatomic landmarks, to help surgeons avoid iatrogenic injury to the suprascapular nerve when employing the double interval slide technique in arthroscopic repair of the rotator cuff. PMID:24724030

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

2014-01-01

167

Pharmacokinetic fundamentals of vaginal treatment with clotrimazole.  

PubMed

Pharmacokinetic studies with clotrimazole in rats and in humans, following oral and intravenous administration, have shown that clotrimazole is rapidly metabolized. After vaginal treatment with clotrimazole, the small fraction absorbed into the systemic circulation--between 3% and 10% of the dose--is subjected to metabolism and excretion as after oral or intravenous administration. The vaginal availability of clotrimazole is largely dependent on the formulation applied. In contrast, up to 3 days after single application of a vaginal tablet containing 500 mg clotrimazole together with lactic acid, fungicidal amounts of clotrimazole were measured in vaginal fluid, i.e., the single dose serves as a depot in the vagina for at least 3 days. Thus the single-dose treatment of vaginal mycosis with clotrimazole offers the advantage of combining a high availability in the vagina with a low availability of systemic circulation and is a means of solving the problem of the patient's noncompliance. PMID:4025444

Ritter, W

1985-08-01

168

Dose-Response Evaluation of Braslet-M Occlusion Cuffs  

NASA Technical Reports Server (NTRS)

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.

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

2010-01-01

169

Isolated subscapularis repair for massive rotator cuff tear.  

PubMed

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

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

2014-11-01

170

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

PubMed Central

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

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

171

[Which modality for prostate brachytherapy?].  

PubMed

Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20 years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. For both techniques, several topics still need to be clarified dealing with a recent enlargement of indications (HDR alone for low-risk, iodine-125 seeds boost for intermediate-high-risk cancers), or with technical aspects (loose seeds versus linked ones, number of fractions and dose for HDR protocols), while dosimetric issues have only recently been addressed by cooperatives groups. Last but not least, there is a real need to address and clearly characterize the correct definition of biochemical disease control both for iodine permanent implant and for HDR implant. New challenges are facing the prostate-brachytherapy community in the near future: local relapse after external beam radiotherapy are currently managed by several salvage treatments (prostatectomy, cryo, high intensity focused ultrasounds [HIFU]) but the role of reirradiation by brachytherapy is also actively investigated. Focal therapy has gained considerable interest in the last 5 years aiming at treating only the area of cancer foci inside the prostate and preserving nearby healthy tissues. Encouraging results have been obtained with the so-called "minimally invasive" approaches and both permanent seed implantation and HDR brachytherapy techniques may be worthwhile testing in this setting because of their capability of exactly sculpting the dose inside the prostatic gland. PMID:20724190

Bossi, A

2010-10-01

172

Brachytherapy Techniques: The Arizona Approach  

Microsoft Academic Search

This chapter reviews the Arizona approach to APBI. Six brachytherapy techniques for the delivery of APBI are discussed. Each\\u000a has its advantages and disadvantages, and a strong recommendation is for the radiation oncology\\/surgical team to have many,\\u000a if not all, techniques of delivering partial breast irradiation in their armamentarium. If a patient who is otherwise a candidate\\u000a for partial breast

Robert R. Kuske

173

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

PubMed Central

Background The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. Methods Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. Results One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. Conclusions One-year postoperative findings for patients in this series indicate that patients with stage II–III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique. PMID:24973955

2014-01-01

174

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

SciTech Connect

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

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

2012-03-01

175

Vaginitis  

MedlinePLUS

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176

Vaginitis  

MedlinePLUS

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177

Exposure of Treating Physician to Radiation during Pro-state Brachytherapy using Iodine-125 Seeds  

E-print Network

. Key Words: Prostate cancer, brachytherapy, Iodine-125 seeds, radiation expos- ure, TLD Short Title: Exposure to Radiation during Prostate Brachytherapy Kurztitel: Strahlenexposition bei der Brachytherapie1 Exposure of Treating Physician to Radiation during Pro- state Brachytherapy using Iodine-125

Krusche, Bernd

178

Dynamic rotating-shield brachytherapy  

SciTech Connect

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

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

2013-12-15

179

Dynamic rotating-shield brachytherapy  

PubMed Central

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

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

2013-01-01

180

Women's interest in vaginal microbicides.  

PubMed

Research is underway to develop safe, effective microbicides that women can use vaginally to prevent sexually transmitted disease (STD) transmission. To estimate potential interest in microbicide use, interviews were conducted in 1998 with a nationally representative sample of 1000 sexually active US women 18-44 years of age. 20% of these women had either had an STD in the past or thought they might be infected. 93% of respondents indicated they would be interested in using a vaginal microbicide if they found themselves in a situation where they were at risk of STD transmission and 40% expressed current interest in such a product. Women who were not in a union were almost 3 times as likely as cohabiting women and 12 times as likely as married women to be both worried about contracting an STD and very interested in using a vaginal microbicide. Women who were 25-34 years of age, had a family income under US$20,000, did not have a college education, and were Black or Hispanic also were significantly more likely to express worry about their STD risk and interest in the product. The strongest independent predictor of whether a woman was worried about STDs and very interested in using a microbicide was whether she and her partner were already using condoms for STD prevention (odds ratio, 8.8). Two-thirds of respondents preferred a product that could be applied several hours before intercourse and was available without a prescription. 84% said they would use microbicide along with condoms rather than as a substitute for them. The findings of this survey suggest an estimated 12.6 million US women 15-44 years of age would be interested in current use of a microbicide. More than 7 million of these women would remain interested even if the product protected only against HIV, was just 70-80% effective, and cost $2 per application. Given this level of interest, the development, testing, and marketing of such products should be expedited. PMID:10029928

Darroch, J E; Frost, J J

1999-01-01

181

High dose rate brachytherapy for oral cancer  

PubMed Central

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

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

2013-01-01

182

Vaginal Community Diversity p.1 of 34 11/12/03 Characterization of vaginal microbial communities in adult healthy women  

E-print Network

Vaginal Community Diversity p.1 of 34 11/12/03 Characterization of vaginal microbial communities;Vaginal Community Diversity p.2 of 34 11/12/03 Summary20 The normal microbial flora of the vagina plays to phylogenetic analyses. The diversity and kinds of organisms that comprise the vaginal microbial community

Forney, Larry J.

183

Angiomyofibroblastoma of the Vaginal Portion  

PubMed Central

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

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

2014-01-01

184

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

PubMed

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

Schuerwegh, W

1978-02-01

185

Persistence of miconazole in vaginal secretions after single applications. Implications for the treatment of vaginal candidosis.  

PubMed Central

In vaginal secretions from 16 healthy women aged between 20 and 27 years miconazole persisted in biodetectable concentrations for at least 48 hours after insertion of a single miconazole vaginal pessary. This finding casts doubt on cure rates in vaginal candidosis determined soon after the end of treatment and suggests that current treatment courses with imidazole antifungal agents may be longer than their nominal three or five days. PMID:7326555

Odds, F C; MacDonald, F

1981-01-01

186

Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements  

Microsoft Academic Search

To determine the effect of snugness of cuff wrap on the accuracy of blood pressure (BP) measurements, we performed two studies\\u000a on 6 healthy volunteers. In both studies, control values were obtained from the right upper arm with cuffs of appropriate\\u000a size and snug fit. Study 1 had two phases. In the first, cuffs of appropriate size were wrapped snugly

Tina E. Banner; J. S. Gravenstein

1991-01-01

187

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

Microsoft Academic Search

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

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

2006-01-01

188

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

PubMed Central

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

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

2013-01-01

189

Airway obstruction caused by endotracheal tube cuff herniation during creation of tracheal stoma.  

PubMed

We report an unusual case of airway obstruction caused by herniation of endotracheal tube (ETT) cuff in a 62-year-old male who underwent surgery for hypopharyngeal carcinoma. During the procedure of creating a tracheal stoma, a new oral ETT was inserted by the surgical team to the lower portion of the trachea through the cut opening to replace the old for ventilation and prevention of soiling of the airway. Upon resumption of surgical manipulation, right endobronchial intubation was disclosed. The ETT cuff was therefore repositioned and reinflated, but airway obstruction persisted in spite of tube obstruction being ruled out by successfully passing a suction catheter through the ETT. After deflating the cuff the obstruction was resolved, and ventilation was eased. Thus the ETT was replaced with another new one and careful scrutiny made after the event revealed a herniating cuff due to manufacturing defect. It was conceivable that endobronchial intubation with over-inflation of the tube cuff may cause cuff herniation, particularly when surgical manipulation was active at the adjacency, in spite of the use of a modern tube with low-pressure high-volume cuff. Performing the "cuff deflation test" is the simple way to diagnose cuff herniation. Awareness of this condition, especially when anesthesiologists lose direct control of the airway during such procedures is important because undesirable complications can be prevented through quick decision and action. PMID:15869007

Kao, Ming-Chang; Yu, Ya-Sheng; Liu, Hsu-Tang; Tsai, Shen-Kou; Lin, Su-Man; Huang, Ying-Che

2005-03-01

190

Calcific Tendinitis of the Rotator Cuff: Management Options.  

PubMed

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. PMID:25344596

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

191

Ultrasonic blood flow measurements: transcutaneous compared with implanted cuff.  

PubMed

Experiments were undertaken in our laboratory to establish relationships between flow parameters calculated from implanted ultrasonic cuff signals and those obtained with a transcutaneous probe. Analog signals were received from crystals surgically implanted on the right carotid, right femoral, and abdominal aorta of a mature male beagle dog. Near these locations, transcutaneous measurements were made using a prescribed technique. From these ultrasonic signals, the following time dependent flow parameters were calculated: spatial velocities, velocity profiles, diameters, flows, and velocity frequency distributions. Using these measurements, a comparison between the implanted cuff and transcutaneous probe was made. In addition to high reproductibility, results confirm a strong correlation between the two techniques; consequently, the validity of the less traumatic transcutaneous method is substantiated. PMID:950285

Greene, E R; Histand, M B; Miller, C W

1976-01-01

192

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

Microsoft Academic Search

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

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

1999-01-01

193

Rotator cuff strength weakness in recurrent anterior shoulder instability physiopathology  

Microsoft Academic Search

BackgroundAlthough rotator cuff contractions play an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in physiopathological recurrent anterior instability.ObjectiveTo analyze the association between isokinetic internal rotator (IR) and external rotator (ER) muscle strength and glenohumeral joint instability in patients with nonoperated recurrent anterior instability.DesignCase-control study.SettingDepartment of Physical Medicine and Rehabilitation, Laboratory setting.Participants48

P Edouard; L Beguin; F Farizon; P Calmels

2011-01-01

194

Vaginal disease. Venereal and nonvenereal types.  

PubMed

Vaginal diseases are, in many cases, sexually transmitted. However, most can also be non-venereal and can occur in any age-group. Special care should be taken in examining and treating young females with vaginal disease, and the possibility of sexual abuse should be considered in this age-group. Finally, special attention should be paid to girls and women exposed to diethylstilbestrol in utero, as these patients have an increased risk of anatomic and reproductive anomalies. PMID:6601795

Novotny, T

1983-05-01

195

Definition and classification of abnormal vaginal flora.  

PubMed

Studying the vaginal microflora is not only fascinating, with many discoveries to be made, it is also a very practical way to help women get rid of bothersome and sometimes dangerous infections. Gram-stained vaginal preparations, Pap smears, specific cultures, and nucleic acid detection techniques can be used to diagnose the constituents of the vaginal flora, but in trained hands office-based microscopy of a fresh vaginal smear, preferably using a x400 magnification phase-contrast microscope, allows almost every diagnosis and combination of diagnoses imaginable. In this chapter I will address the pros and cons of the tools that are in use to study vaginal flora, and discuss the different types of bacterial flora and the difficulties encountered in reaching the correct diagnosis of pathological conditions. The 'intermediate flora' is addressed separately, and a new entity--'aerobic vaginitis'--is discussed. Future research should focus on the interaction between infecting microorganisms and host defence mechanisms, as both together generate the pathogenicity of these conditions. PMID:17434799

Donders, Gilbert G G

2007-06-01

196

Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios  

PubMed Central

Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

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

2014-01-01

197

Evaluation of an Intervention to Maintain Endotracheal Tube Cuff Pressure Within Therapeutic Range  

PubMed Central

Background Endotracheal tube cuff pressure must be kept within an optimal range that ensures ventilation and prevents aspiration while maintaining tracheal perfusion. Objectives To test the effect of an intervention (adding or removing air) on the proportion of time that cuff pressure was between 20 and 30 cm H2O and to evaluate changes in cuff pressure over time. Methods A repeated-measure crossover design was used to study 32 orally intubated patients receiving mechanical ventilation for two 12-hour shifts (randomized control and intervention conditions). Continuous cuff pressure monitoring was initiated, and the pressure was adjusted to a minimum of 22 cm H2O. Caregivers were blinded to cuff pressure data, and usual care was provided during the control condition. During the intervention condition, cuff pressure alarm or clinical triggers guided the intervention. Results Most patients were men (mean age, 61.6 years). During the control condition, 51.7% of cuff pressure values were out of range compared with 11.1% during the intervention condition (P < .001). During the intervention, a mean of 8 adjustments were required, mostly to add air to the endotracheal tube cuff (mean 0.28 [SD, 0.13] mL). During the control condition, cuff pressure decreased over time (P < .001). Conclusions The intervention was effective in maintaining cuff pressure within an optimal range, and cuff pressure decreased over time without intervention. The effect of the intervention on outcomes such as ventilator-associated pneumonia and tracheal damage requires further study. PMID:21362715

Sole, Mary Lou; Su, Xiaogang; Talbert, Steve; Penoyer, Daleen Aragon; Kalita, Samar; Jimenez, Edgar; Ludy, Jeffery E.; Bennett, Melody

2012-01-01

198

Refining Treatment for High-risk Early Stage Endometrial Cancer  

Cancer.gov

In this clinical trial, women with high-risk early stage endometrial cancer will be randomly assigned following surgery to receive one of two types of adjuvant therapy: brachytherapy targeted to the vaginal cuff in combination with chemotherapy or standard pelvic external-beam radiotherapy.

199

Vaginal repair of neobladder-vaginal fistula: a case report and review of the literature.  

PubMed

Neobladder substitution after radical cystectomy for invasive cancer has become commonplace as it preserves normal volitional voiding through the native urethra and avoids urinary diversion. Neobladder-vaginal fistula (NVF) is a rare postoperative complication of this procedure that results in decreased quality of life. We describe a case of vaginal repair of a NVF and present a review of the literature. PMID:22237787

Gelber, Katherine; Bohrer, Justin; Kim, Charles O; Minaglia, Steven

2013-01-01

200

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

PubMed

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

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

201

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

PubMed Central

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

ITO, TAKUJI; BAI, TAO; TANAKA, TETSUJI; YOSHIDA, KENJI; UEYAMA, TAKASHI; MIYAJIMA, MASAYASU; NEGISHI, TAKAYUKI; KAWASAKI, TAKAHIKO; TAKAMATSU, HYOTA; KIKUTANI, HITOSHI; KUMANOGOH, ATSUSHI; YUKAWA, KAZUNORI

2015-01-01

202

QUANTIFICATION OF THE DYNAMIC GLENOHUMERAL STABILITY PROVIDED BY THE ROTATOR CUFF MUSCLES IN THE LATE COCKING PHASE OF THROWING  

Microsoft Academic Search

The purpose of this study was to investigate quantitatively the dynamic glenohumeral stability provided by the rotator cuff muscles in the late-cocking phase of throwing. Using ten cadaveric shoulders, a new biomechanical parameter (dynamic stability index) was calculated considering compressive and shear forces to the glenoid provided by each cuff muscle. The rotator cuff muscles provided the joint with significant

Seok-Beom Lee; Shawn W. O'Driscoll; Bernard F. Morrey; Kai-Nan An

203

Brachytherapy in India – a long road ahead  

PubMed Central

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

Mahantshetty, Umesh; Shrivastava, Shyamkishore

2014-01-01

204

Post implant dosimetric analysis for prostate brachytherapy.  

E-print Network

??[Truncated abstract] Purpose: Permanent prostate brachytherapy (PPB) as a treatment option for prostate cancer requires implantation of 80-150 radioactive iodine-125 (I-125) "seeds" into the prostate.… (more)

Haworth, Annette

2005-01-01

205

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

PubMed Central

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

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

2012-01-01

206

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review  

Microsoft Academic Search

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as

Dorcas Beaton

2004-01-01

207

[Radionuclides, technologies and quality control in brachytherapy].  

PubMed

Brachytherapy consists in placing radioactive sources directly in contact with the tumoral bed. The type of source, its characteristics and its use will be adapted regarding the kind of treatment foreseen. Modern brachytherapy techniques employ remote afterloading technologies allowing better quality and security in the delivery of treatment. This development of technology goes with an increase need of quality control of equipments, including radionuclides, and procedures. PMID:23474213

Marchesi, V; Gautier, M; Villani, N; Feuillade, J; Dejean, C

2013-04-01

208

Brachytherapy for advanced prostate cancer bleeding  

Microsoft Academic Search

Advanced prostate cancer patients frequently deal with intractable prostatic bleeding which is a difficult problem to manage. Intraurethral high-dose rate (HDR) brachytherapy may palliate this condition. Advanced prostate cancer patients with intractable prostatic bleeding were offered brachytherapy with Iridium-192 using a Micro-selectron HDR machine. During a 5-year period, analysis was performed in 23 patients with a median age and Gleason

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

2008-01-01

209

Comparison of vaginal flora after treatment with a clotrimazole 500 mg vaginal pessary or a fluconazole 150 mg capsule for vaginal candidosis.  

PubMed Central

The effect of antifungal therapy on the vaginal microbial flora was studied in 23 patients suffering from culture-positive, symptomatic vaginal candidosis. They were randomly allocated to receive either a 500 mg clotrimazole vaginal pessary or a 150 mg fluconazole capsule. Quantitative microbiological examination was carried out on samples of vaginal secretions obtained prior, and at intervals up to 10 days after, treatment. No significant difference was found in the vaginal flora before or after therapy in individual patients or between the treatment groups. In patients with C glabrata or C krusei, the yeasts persisted longer in the vagina with poorer response to either of the medications. PMID:2071126

Boag, F C; Houang, E T; Westrom, R; McCormack, S M; Lawrence, A G

1991-01-01

210

Optimization of intravascular brachytherapy treatment planning in peripheral arteries  

E-print Network

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

Paris-Sud XI, Université de

211

A comprehensive review of vaginitis phytotherapy.  

PubMed

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

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

2011-11-01

212

Effect of Vaginal Lubricants on Natural Fertility  

PubMed Central

Objective Over-the-counter vaginal lubricants have been shown to negatively affect in vitro sperm motility. The objective of this study was to estimate the effect of vaginal lubricant use during procreative intercourse on natural fertility. Methods Women aged 30–44 years with no history of infertility who had been trying to conceive for less than 3 months completed a baseline questionnaire on vaginal lubricant use. Subsequently, women kept a diary to record menstrual bleeding, intercourse, and vaginal lubricant use and conducted standardized pregnancy testing for up to 6 months. Diary data were used to determine the fertile window and delineate lubricant use during the fertile window. A proportional hazards model was used to estimate fecundability ratios with any lubricant use in the fertile window considered as a time-varying exposure. Results Of the 296 participants, 75 (25%) stated in their baseline questionnaire that they use vaginal lubricants while attempting to conceive. Based on daily diary data, 57% of women never used a lubricant, 29% occasionally used a lubricant, and 14% used a lubricant frequently. Women who used lubricants during the fertile window had similar fecundability to those women who did not use lubricants (fecundability ratio 1.05, 95% CI: 0.59, 1.85) after adjusting for age, partner race, and intercourse frequency in the fertile window. Conclusion Lubricants are commonly used by couples during procreative intercourse. Lubricant use during procreative intercourse does not appear to reduce the probability of conceiving. PMID:22914390

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

2012-01-01

213

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

PubMed

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

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

2015-02-01

214

Vaginal pH: Home-Use Tests  

MedlinePLUS

... Vitro Diagnostics Home Use Tests Cholesterol Hepatitis C Human Immunodeficiency Virus (HIV) Menopause Fecal Occult Blood Ovulation (Saliva Test) Ovulation (Urine Test) Pregnancy Prothrombin Vaginal pH Vaginal pH What does this test do? This ...

215

Necrotizing ruptured vaginal leiomyoma mimicking a malignant neoplasm  

PubMed Central

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

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

2014-01-01

216

Vaginal bleeding and early pregnancy outcome in an infertile population  

Microsoft Academic Search

Objective: Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding.

Zoetania N. Dantas; Anita P. Singh; Panagiotis Karachalios; Ricardo H. Asch; Jose P. Balmaceda; Sergio C. Stone

1996-01-01

217

Evaluation of tracheal cuff pressure variation in spontaneously breathing patients  

PubMed Central

Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently. PMID:24459624

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

2013-01-01

218

Classification of rotator cuff tendinopathy using high definition ultrasound  

PubMed Central

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

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

2014-01-01

219

Human dermal allograft for massive rotator cuff tears.  

PubMed

Previously published studies reported variable results using various suture techniques and reconstruction options for massive rotator cuff tears. Therefore, the current authors retrospectively studied 21 consecutive patients/shoulders with massive rotator cuff tears treated from January 2005 to October 2011 with a human dermal allograft through a mini-open approach. Mean patient age was 58 years (range, 33-72 years). Mean follow-up was 29 months (range, 18-52 months). Ten patients underwent revision repair for a failed rotator cuff repair. The authors measured the tendon gap (mean, 1.7 cm) and acromiohumeral interval (mean, 6.5 mm). They evaluated pain, shoulder range of motion (ROM) and function, patient satisfaction with the operation and outcome, and complications. At last follow-up, all patients experienced significant pain relief (P=.001) and improved ROM (P=.001) and American Shoulder and Elbow Surgeons (ASES) score (P=.001). Eighteen patients reported that they were satisfied or very satisfied and 3 reported that they were not satisfied with the operation and outcome. Comparison of outcomes between patients who underwent primary repair and those who underwent revision repair and between patients who had muscle atrophy and fatty infiltration grades 0 to II and those who had grades III to IV showed no statistically significant differences. A statistically significant correlation was observed between the size of the tendon gap and postoperative pain, ROM (except external rotation), and ASES score (P<.050). No significant correlation was observed between postoperative pain, ROM, and ASES score and the acromiohumeral interval (P>.050). Complications related to the dermal human allograft were not observed. PMID:25437086

Kokkalis, Zinon T; Mavrogenis, Andreas F; Scarlat, Marius; Christodoulou, Michael; Vottis, Christos; Papagelopoulos, Panayiotis J; Sotereanos, Dean G

2014-12-01

220

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

PubMed

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

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

2014-10-01

221

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

NASA Astrophysics Data System (ADS)

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.

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

2014-10-01

222

Retained uterine fundus after vaginal hysterectomy.  

PubMed

We report a case of retained uterine fundus after vaginal hysterectomy that was subsequently removed at laparoscopy. The patient had undergone vaginal hysterectomy 8 years previously and came to our hospital with abdominal pain. Examination revealed a supravesical mass. Laparoscopy was performed and showed the uterine fundus with its cornual attachments. The mass was excised and sent for histopathologic analysis, which confirmed that it was uterine tissue. Retained uterine tissue or myoma tissue has been reported, usually after morcellation. However, to our knowledge, our case is only the second reported case of retained fundus after complete vaginal hysterectomy. Because of adhesions, it is possible that the uterus was not completely removed. In such cases, laparoscopic assistance is extremely useful. PMID:20129338

Sinha, Rakesh; Lakhotia, Smita; Sundaram, Meenakshi; Manaktala, Gayatri; Shah, Parul; Mahajan, Chaitali

2010-01-01

223

Intermittent local prophylaxis against recurrent vaginal candidosis.  

PubMed Central

Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised. PMID:3060424

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

1988-01-01

224

Intermittent local prophylaxis against recurrent vaginal candidosis.  

PubMed

Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised. PMID:3060424

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

1988-10-01

225

High dose rate endobronchial brachytherapy using a new applicator  

Microsoft Academic Search

Background and purpose: To obtain adequate spatial dose distribution for endobronchial brachytherapy, we applied reference dose points according to the bronchial diameter. For this purpose, we devised a new applicator of which the source transfer tube is contained in the center of the lumen for high dose rate (HDR) brachytherapy.Materials and methods: Thirty-nine patients with endobronchial cancer underwent endobronchial brachytherapy

Yoshihito Nomoto; Kazufusa Shouji; Shun Toyota; Masahiro Sasaoka; Shuuichi Murashima; Maki Ooi; Kan Takeda; Tsuyoshi Nakagawa

1997-01-01

226

In vivo dosimetry in brachytherapy  

SciTech Connect

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

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

2013-07-15

227

Group A streptococcal vaginitis: an unrecognized cause of vaginal symptoms in adult women  

Microsoft Academic Search

Purpose  Vaginal infection with group A streptococci (GAS) is an established cause of vaginitis amongst prepubescent girls, but largely\\u000a unrecognized in adult women and therefore often misdiagnosed as vulvovaginal candidosis. We sought to give an overview of\\u000a the epidemiology, risk factors, symptoms, signs, and treatment of GAS vaginitis in adult women.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Systematic literature search.\\u000a \\u000a \\u000a \\u000a Results  We identified nine case reports covering 12

Hans Verstraelen; Rita Verhelst; Mario Vaneechoutte; Marleen Temmerman

2011-01-01

228

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

PubMed Central

Background A familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls. Methods Ninety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P<0.05 was considered significant). Results The average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005). Conclusion Individuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies. PMID:24966704

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

2014-01-01

229

Brachytherapy in the Treatment of Cholangiocarcinoma  

SciTech Connect

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

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

2010-11-01

230

{sup 106}Ruthenium Brachytherapy for Retinoblastoma  

SciTech Connect

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

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

2008-07-01

231

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

PubMed

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

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

2014-08-01

232

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

PubMed Central

The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease. PMID:23316375

Shi, Lewis L.; Edwards, T. Bradley

2012-01-01

233

The Global Percutaneous Shuttling Technique Tip for Arthroscopic Rotator Cuff Repair  

PubMed Central

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

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

2014-01-01

234

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

PubMed Central

The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month follow up. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup. PMID:25098365

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

2012-01-01

235

Posterosuperior rotator cuff tears: classification, pattern recognition, and treatment.  

PubMed

The posterosuperior rotator cuff, composed of the supraspinatus and infraspinatus tendons, is the most common site for full-thickness rotator cuff tears and represents a significant source of shoulder disability worldwide. Recognition of and classification of full-thickness tear patterns are essential in order to optimize surgical treatment and to improve prognosis. Until recently, tear patterns have been described using one- or two-dimensional classification systems. Three-dimensional pattern recognition is critical to achieving the most successful outcome possible. For more complex patterns, a combination of side-to-side stitching, margin convergence, and interval slide techniques may be needed to achieve a tension-free tendon-bone repair. Biomechanical and anatomic evidence supports the use of linked double-row repairs for most full-thickness tears. Although double-row repairs seem to result in improved structural outcomes, clinical evidence has not shown differences in outcomes scores between single-row and double-row repairs. Single-row repair may be performed in partial-thickness, small full-thickness, or very massive, immobile tears, whereas double-row repair may be performed in most other cases. PMID:25063750

Millett, Peter J; Warth, Ryan J

2014-08-01

236

Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears  

PubMed Central

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.

Dilisio, Matthew F.; Neyton, Lionel

2014-01-01

237

Calcific Tendinitis of the Rotator Cuff: A Review  

PubMed Central

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

Kachewar, Sushil G; Kulkarni, Devidas S

2013-01-01

238

Complications associated with arthroscopic rotator cuff repair: a literature review.  

PubMed

The aim of this literature review was to report complications associated with arthroscopic rotator cuff repair (RCR). A computerized search of articles published between 200 and 2009 was performed using MEDLINE and PubMed. We included clinical studies (Level 1-4): (a) investigating patients with rotator cuff tears, managed by a completely arthroscopic RCR technique; (b) reported data about complications. Data about arthroscopic-assisted techniques were excluded. Articles that meet criteria inclusion were analytically examined. Complications were classified into general complications and specific complications related to arthroscopic RCR. We found 414 complications in 2,890 patients; most of them were specific complications related to arthroscopic RCR. Re-rupture was the most frequently encountered complication: re-tear rate ranged between 11.4 and 94%. Stiffness and hardware-related complications were observed in 74 and 12 patients, respectively. Eleven less common complications were also reported: 5 neurovascular, 3 septic, 2 thromboembolic events, and 1 anesthesiological complication. This review stated that arthroscopic RCR is a low-risk surgical procedure. Anatomical failure of the repair is the most common complication encountered in the literature. PMID:22205384

Randelli, P; Spennacchio, P; Ragone, V; Arrigoni, P; Casella, A; Cabitza, P

2012-06-01

239

Comparison of miconazole-coated tampons with clotrimazole vaginal tablets in the treatment of vaginal candidosis.  

PubMed Central

The effectiveness and acceptability of miconazole-coated tampons were compared with those clotrimazole vaginal tablets in the treatment of vaginal candidosis in 100 women. Both treatments were highly effective in reducing the signs and symptoms of infection; 95% of the group treated with miconazole had negative culture results for Candida species immediately after treatment compared with 86% of those treated with clotrimazole. A 17.6% recurrence rate of positive culture results was found four weeks later in the miconazole-treated group compared with that of 30% in the clotrimazole-treated group. The miconazole tampons were highly acceptable to patients. Vaginal pH values did not differ significantly between those patients with candidosis and those treated and cured. Corynebacterium vaginale (Gardnerella vaginalis) vaginitis and nonspecific genital infection were common complicating factors during follow up. PMID:7272707

Balsdon, M J

1981-01-01

240

Comparison of miconazole-coated tampons with clotrimazole vaginal tablets in the treatment of vaginal candidosis.  

PubMed

The effectiveness and acceptability of miconazole-coated tampons were compared with those clotrimazole vaginal tablets in the treatment of vaginal candidosis in 100 women. Both treatments were highly effective in reducing the signs and symptoms of infection; 95% of the group treated with miconazole had negative culture results for Candida species immediately after treatment compared with 86% of those treated with clotrimazole. A 17.6% recurrence rate of positive culture results was found four weeks later in the miconazole-treated group compared with that of 30% in the clotrimazole-treated group. The miconazole tampons were highly acceptable to patients. Vaginal pH values did not differ significantly between those patients with candidosis and those treated and cured. Corynebacterium vaginale (Gardnerella vaginalis) vaginitis and nonspecific genital infection were common complicating factors during follow up. PMID:7272707

Balsdon, M J

1981-08-01

241

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

PubMed

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

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

2008-12-01

242

Cervix cancer brachytherapy: high dose rate.  

PubMed

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

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

2014-10-01

243

[Damage to condoms caused by vaginally administered drug].  

PubMed

A 28-year-old woman who was treated for vaginal candidiasis with Gyno-Daktarin vaginal capsules (miconazole nitrate) became pregnant because a condom used during intercourse had ruptured. Incubation in vitro with 400 and 1200 mg miconazole nitrate vaginal capsules (Gyno-Daktarin 3 and Gyno-Daktarin I), but not miconazole nitrate vaginal cream (20 mg/g), was shown to damage rubber condoms. Patients using vaginal medicines should be aware of a possible adverse effect on rubber condoms or contraceptive diaphragms and a subsequent increased risk of pregnancy or contagious diseases such as AIDS. Fatty excipients such as glycerin, paraffin, petrolatum or Witepsol may be involved. PMID:7675146

Meyboom, R H; Havinga, J S; Lastdrager, C J; de Koning, G H

1995-08-01

244

Vaginal perforation due to jet ski accident.  

PubMed

A case of full thickness vaginal perforation into the peritoneal cavity resulting from a jet-skiing accident is presented. Attention is drawn to the previously reported cases of similar injuries due to high speed water sports, and the need for adequate protective clothing in all people undertaking such sports. PMID:2082899

Wein, P; Thompson, D J

1990-11-01

245

Vaginal mesh erosion after abdominal sacral colpopexy  

Microsoft Academic Search

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

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

2001-01-01

246

Vaginal Lacerations from Consensual Intercourse in Adolescents  

ERIC Educational Resources Information Center

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

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

2011-01-01

247

Brachytherapy  

MedlinePLUS

... called seed implantation, involves placing radioactive seeds or pellets (about the size of a grain of rice) ... material (which is enclosed within small seeds or pellets) is placed directly in the site of the ...

248

Acromio-clavicular joint cyst associated with a complete rotator cuff tear - a case report.  

PubMed

This case report describes a patient with an acromio-clavicular joint (ACJ) cyst, associated with a complete tear of the supraspinatus tendon, and the related arthropathy. Ultrasound was a suitable imaging modality to make the diagnosis, and rule out other pathologies. Full assessment of the rotator cuff must be carried out in the presence of ACJ cysts due to their common co-existence with large cuff tears. Cyst aspiration is not a suitable treatment, due to the high likelihood of recurrence. Optimal treatment requires management of the underlying rotator cuff tear. PMID:24331701

McCreesh, Karen M; Riley, Sara J; Crotty, James M

2014-10-01

249

Condensation of humidified air in the inflation line of a polyurethane cuff precludes correct continuous pressure monitoring during mechanical ventilation.  

PubMed

Within continuously controlled limits of cuff pressure, an endotracheal tube cuff made of polyurethane (PU) prevents secretion inflow better than a conventional polyvinylchloride cuff. However, the temperature difference between ventilator gas and the air inside a PU cuff produces condensation droplets that accumulate in the cuff inflation canal. We investigated whether condensation influenced continuous cuff pressure monitoring. A PU-cuffed tube was placed into an artificial trachea and connected to a ventilator and test lung. An additional line was inserted at the distal cuff end to directly measure pressure inside the cuff. Methylene blue instillation via the inflation line mimicked condensation. Inspiratory (Pinsp) and expiratory (Pexp) pressures were continuously recorded. Six consecutive experiments were performed comparing pressures at baseline (T0) and at 24 h (T24). Shortly after dye instillation, pressures recorded at the inflation canal became permanently fixed at 25 cmH2O. In contrast, pressures measured directly in the cuff progressively decreased (mean Pinsp 30 ± 3 vs. 20 ± 2 cmH2O and mean Pexp 25 ± 0 vs. 12 ± 2 cmH2O, T0 vs. T24, both P < 0.05). Thus, condensation in the inflation line of a PU-cuffed tube renders continuous cuff pressure monitoring unreliable, thereby increasing the risk for microaspiration. PMID:24854520

Spapen, Herbert; Moeyersons, Walter; Stiers, Wim; Desmet, Geert; Suys, Emiel

2014-12-01

250

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

PubMed

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

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

251

10 CFR 35.400 - Use of sources for manual brachytherapy.  

Code of Federal Regulations, 2010 CFR

... false Use of sources for manual brachytherapy. 35.400 Section 35.400 Energy...MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.400 Use of sources for manual brachytherapy. A licensee shall use only...

2010-01-01

252

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

PubMed Central

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

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

2014-01-01

253

Reusing cadaveric humeri for fracture testing after testing simulated rotator cuff tendon repairs.  

PubMed

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

Skedros, John G; Pitts, Todd C; Knight, Alex N; Burkhead, Wayne Z

2014-10-01

254

Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?  

Microsoft Academic Search

Background: Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality.Purpose: To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: One hundred

Yang-Soo Kim; Seok Won Chung; Joon Yub Kim; Ji-Hoon Ok; Joo Han Oh

2012-01-01

255

Rotator Cuff Tears in Middle-Aged Tennis Players: Results of Surgical Treatment  

Microsoft Academic Search

Background: Tennis players, like participants in other overhead sports, are vulnerable to rotator cuff tears. In players who continue to play into their middle-age years, the incidence of such injury increases.Hypothesis: Surgical treatment of rotator cuff tears in middle-aged tennis players is largely successful in allowing return to tennis.Study Design: Retrospective review.Methods: We evaluated the results of surgical treatment of

Bertrand Sonnery-Cottet; T. Bradley Edwards; Eric Noel; Gilles Walch

2002-01-01

256

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

PubMed Central

Objective Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear. PMID:23091289

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

2012-01-01

257

US demographic trends in mid-arm circumference and recommended blood pressure cuffs: 1988–2002  

Microsoft Academic Search

Mid-arm circumference (AC) measurement is a prerequisite for the selection of properly sized blood pressure (BP) cuffs and accurate BP readings. This study examined trends in the frequency distribution of mid-AC and corresponding recommended BP cuff sizes using National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 1999–2002 data. Both surveys used a complex sample design to obtain

Y Ostchega; C Dillon; M Carroll; R J Prineas; M McDowell

2005-01-01

258

Vaginal hyperalgesia in a rat model of endometriosis Karen J. Berkley*, Angie Cason, Heather Jacobs,  

E-print Network

Vaginal hyperalgesia in a rat model of endometriosis Karen J. Berkley*, Angie Cason, Heather Jacobs-induced endometriosis that reduces fertility also evokes vaginal hyperalgesia along with changes in vaginal compliance of vaginal distention were measured for 2.5 months before and after endometriosis or sham surgery. Vaginal

Berkley, Karen J.

259

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

PubMed Central

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013 PMID:23401583

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

2013-01-01

260

Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement.  

PubMed

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. PMID:23401583

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

2013-05-01

261

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study.  

PubMed

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P < 0.05). No statistically significant difference in the total UCLA scores was found when comparing the two repair techniques (P > 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo; Maffulli, Nicola

2010-03-01

262

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

PubMed Central

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P?>?0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P? 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo

2009-01-01

263

Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?  

PubMed Central

Background Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. Methods We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. Results The mean occupation ratio was significantly increased postoperatively from 0.44 ± 0.17 to 0.52 ± 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). Conclusions The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair. PMID:23467404

Chung, Seok Won; Kim, Sae Hoon; Tae, Suk-Kee; Yoon, Jong Pil; Choi, Jung-Ah

2013-01-01

264

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

PubMed

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

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

2014-10-10

265

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

PubMed

An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4), which is an attribute of a healthy vagina. The effervescent mixture (citric acid and sodium bicarbonate) along with a superdisintegrant (Ac-Di-sol) was used to enhance the swellability of the bioadhesive tablet. The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as an antibacterial) were used in the formulation along with Lactobacillus acidophilus spores to treat mixed vaginal infections. From the ex vivo retention study it was found that the bioadhesive polymers hold the tablet for more than 24 hours inside the vaginal tube. The hardness of the acid-buffering bioadhesive vaginal tablet was optimized, at 4 to 5 kg hardness the swelling was found to be good and the cumulative release profile of the developed tablet was matched with a marketed conventional tablet (Infa-V). The in vitro spreadability of the swelled tablet was comparable to the marketed gel. In the in vitro antimicrobial study it was found that the acid-buffering bioadhesive tablet produces better antimicrobial action than marketed intravaginal drug delivery systems (Infa-V, Candid-V and Canesten 1). PMID:18181530

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

2007-01-01

266

Murine models of vaginal trichomonad infections.  

PubMed

Trichomonas vaginalis and Tritrichomonas foetus cause common sexually transmitted infections in humans and cattle, respectively. Mouse models of trichomoniasis are important for pathogenic and therapeutic studies. Here, we compared murine genital infections with T. vaginalis and T. foetus. Persistent vaginal infection with T. foetus was established with 100 parasites but T. vaginalis infection required doses of 10(6), perhaps because of greater susceptibility to killing by mouse vaginal polymorphonuclear leukocytes. Infection with T. vaginalis persisted longest after combined treatment of mice with estrogen and dexamethasone, whereas infection was only short-lived when mice were given estrogen or dexamethasone alone, co-infected with Lactobacillus acidophilus, and/or pretreated with antibiotics. Infection rates were similar with metronidazole-resistant (MR) and metronidazole-sensitive (MS) T. vaginalis. High dose but not low dose metronidazole treatment controlled infection with MS better than MR T. vaginalis. These murine models will be valuable for investigating the pathogenesis and treatment of trichomoniasis. PMID:21976570

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

2011-10-01

267

Transperineal Permanent Brachytherapy of Localised Prostate Cancer  

Microsoft Academic Search

Context: In absence of prospective randomized trials determining the optimal management of localized prostate cancer remains undefined. Objective: To develop and disseminate an update on outcome of different treatment modalities, recommendations and guidelines of transperineal prostate brachytherapy. Evidence acquisition: In the past decade, the average number of bra- chytherapy patients per centre has increased by at least 10%. Bra- chytherapy

Nader Naderi; Jelmer van Beek

268

Radiation safety requirements for cardiovascular brachytherapy  

Microsoft Academic Search

Cardiovascular brachytherapy, the use of high intensity radiation to inhibit the growth of neointimal tissue after coronary revascularization by either balloon angioplasty or other methods is being tested in a number of clinical trials to assess the efficacy of the treatment. This new use of radiation to aleviate the suffering of individuals with coronary artery disease has excited many interventionalists

Billy G Bass

1999-01-01

269

REVIEW ARTICLE Radiation Biology in Brachytherapy  

E-print Network

REVIEW ARTICLE Radiation Biology in Brachytherapy DAVID J. BRENNER, DSc Center for Radiological INTRODUCTION The first suggestion to treat cancer by direct implan- tation of radioactive sources in different countries adopted different names for this technique, using either the prefix brachy from

Brenner, David Jonathan

270

Vaginal vault prolapse: choice of operation.  

PubMed

The surgeon who faces a patient with vaginal vault prolapse is dealing with a complex and intriguing challenge. Part of the complexity is due to the lack of standardization and routine application of tools to assess pre- and postoperative anatomical and functional outcomes. Patient satisfaction is a major endpoint for surgical success; thus all aspects of the prolapse pathology and the patient's lifestyle should be considered. The surgeon needs to be well versed and flexible in order to choose the most appropriate operative approach to achieve optimal results for an individual patient. In this chapter we present the vaginal and abdominal approaches for the correction of vaginal vault prolapse, with discussion of the surgical outcomes and complications for each technique. A comprehensive comparison of the various techniques is offered on the basis of current published literature. In addition, we focus on various controversies, including the prevention of vault prolapse at the time of hysterectomy, issues regarding uterine preservation, the management of overt or occult concomitant stress incontinence, and the place-if any-for combined anti-incontinence procedures at the time of prolapse surgery. New minimally invasive techniques for vault prolapse are also reviewed. We emphasize areas that call for further research and for standardized outcome criteria. PMID:16221573

Arbel, Revital; Lavy, Yuval

2005-12-01

271

Vaginal retention of locally administered clindamycin.  

PubMed

Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 × 10(-3) to 8.4 × 10(-3) g/g vaginal fluid (median 2.87 × 10(-3)) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment. PMID:21569095

Eriksson, Katarina; Larsson, Per-Göran; Nilsson, Maud; Forsum, Urban

2011-06-01

272

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

PubMed Central

Background. The FDA approved over-the-counter (OTC) use of vaginal antifungals in 1990. Subsequently, a plethora of OTC products have become available to women on drugstore shelves. Objectives. The purpose of this study was to determine the availability of OTC products marketed for the treatment of vaginitis and to determine if their efficacy had been confirmed by published prospective randomized control trials (RCTs). Materials and methods. The authors chose four retail locations frequented by women seeking vaginitis treatment. All products deemed a viable treatment option were purchased. Results. All intravaginal imidazoles purchased, regardless of treatment duration or active ingredient, were found to be of proven efficacy. We were unable to find an RCT confirming the effectiveness of vaginal anti-itch creams and homeopathic treatments for vaginitis. Conclusion. 45% of products available to women in the feminine hygiene section of the stores surveyed could not be confirmed to be effective for treating infectious vaginitis. PMID:18253469

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

2007-01-01

273

Automated intraoperative calibration for prostate cancer brachytherapy  

SciTech Connect

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

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

2011-11-15

274

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

NASA Astrophysics Data System (ADS)

Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output, (2) the decrease of the vascular tone in the deep (mesenteric and splanchnic) and peripheral (Lower limbs) vascular areas. The use of thigh cuffs maintains the volemia and the cardiac output at the preflight level (without heart rate increase) and prevents the loss of vascular tone in the deep and peripheral areas. Moreover the adaptative process changes since the cuffs are removed and even the volemia seems to be unaffected at this stage the vascular tone decreases to a comparable extend as during the flight without cuffs. Nevertheless during the flight without cuffs or 3 days after removing the cuffs hemodynamic signs of decreased orthostatic tolerance are present during the inflight and the 3 days post flight LBNP. Presently the possible contribution of the thigh cuffs to the reduction of the vascular deconditioning has not been tested yet.

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

275

THE EFFECT OF TEAR SIZE AND NERVE INJURY ON ROTATOR CUFF MUSCLE FATTY DEGENERATION IN A RODENT ANIMAL MODEL  

PubMed Central

Background Irreversible muscle changes following rotator cuff tears is a well-known negative prognostic factor after shoulder surgery. Currently, little is known about the pathomechanism of fatty degeneration of the rotator cuff muscles after chronic cuff tears. Hypothesis/Purpose The purposes of this study were: 1) to develop a rodent animal model of chronic rotator cuff tears that can reproduce fatty degeneration of the cuff muscles seen clinically, 2) to describe the effects of tear size and concomitant nerve injury on muscle degeneration, and 3) to evaluate the changes in gene expression of relevant myogenic and adipogenic factors following rotator cuff tears using the animal model. Methods Rotator cuff tears were created in rodents with and without transection of the suprascapular nerve. The supraspinatus and infraspinatus muscles were examined 2, 8, and 16 weeks after injury for histological evidence of fatty degeneration and expression of myogenic and adipogenic genes. Results Histological analysis revealed adipocytes, intramuscular fat globules, and intramyocellular fat droplets in the tenotomized and neurotomized supraspinatus and infraspinatus muscles. Changes increased with time and were most severe in the muscles with combined tenotomy and neurotomy. Adipogenic and myogenic transcription factors and markers were upregulated in muscles treated with tenotomy or tenotomy combined with neurotomy compared to normal muscles. Conclusions The present study describes a rodent animal model that produces fatty degeneration of the rotator cuff muscles similar to human muscles after chronic cuff tears. The severity of changes was associated with tear size and concomitant nerve injury. PMID:21831663

Kim, H. Mike; Galatz, Leesa M.; Lim, Chanteak; Havlioglu, Necat; Thomopoulos, Stavros

2011-01-01

276

Relationship between lactobacilli and opportunistic bacterial pathogens associated with vaginitis  

PubMed Central

Background: Vaginitis, is an infectious inflammation of the vaginal mucosa, which sometimes involves the vulva. The balance of the vaginal flora is maintained by the Lactobacilli and its protective and probiotic role in treating and preventing vaginal infection by producing antagonizing compounds which are regarded as safe for humans. Aim: The aim of this study was to evaluate the protective role of Lactobacilli against common bacterial opportunistic pathogens in vaginitis and study the effects of some antibiotics on Lactobacilli isolates. Materials and Methods: In this study (110) vaginal swabs were obtained from women suffering from vaginitis who admitted to Babylon Hospital of Maternity and Paediatrics in Babylon province, Iraq. The study involved the role of intrauterine device among married women with vaginitis and also involved isolation of opportunistic bacterial isolates among pregnant and non pregnant women. This study also involved studying probiotic role of Lactobacilli by production of some defense factors like hydrogen peroxide, bacteriocin, and lactic acid. Results: Results revealed that a total of 130 bacterial isolates were obtained. Intrauterine device was a predisposing factor for vaginitis. The most common opportunistic bacterial isolates were Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumoniae. All Lactobacilli were hydrogen peroxide producers while some isolates were bacteriocin producers that inhibited some of opportunistic pathogens (S. aureus, E. coli). Lactobacilli were sensitive to erythromycin while 93.3% of them were resistant to ciprofloxacin and (40%, 53.3%) of them were resistant to amoxicillin and gentamycin respectively. Results revealed that there was an inverse relationship between Lactobacilli presence and organisms causing vaginitis. This may be attributed to the production of defense factors by Lactobacilli. Conclusion: The types of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria (Lactobacilli) that help in preservation of vaginal health and ecosystem as being one of the probiotic bacteria. PMID:22540089

Razzak, Mohammad Sabri A.; Al-Charrakh, Alaa H.; AL-Greitty, Bara Hamid

2011-01-01

277

Rotator Cuff Repair: Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome.  

PubMed

BACKGROUND:Rotator cuff tears are common, and rotator cuff repair represents a major health care expense. While patients often benefit from rotator cuff repair, anatomic failure of the repair is not unusual. PURPOSE:To identify the published evidence on the factors associated with retears and with suboptimal clinical outcomes of rotator cuff repairs. STUDY DESIGN:Systematic review and meta-analysis of articles with evidence levels 1-4. METHODS:A total of 2383 articles on rotator cuff repairs published between 1980 and 2012 were identified. Only 108 of these articles, reporting on over 8011 shoulders, met the inclusion criteria of reporting quantitative data on both imaging and clinical outcomes after rotator cuff repair. Factors related to the patients, their shoulders, the procedures, and the results were systematically categorized and submitted for meta-analysis. RESULTS:While the number of relevant articles published per year increased dramatically over the period of the study, the clinical and anatomic results did not show improvement over this period. The weighted mean retear rate was 26.6% at a mean of 23.7 months after surgery. Retears were associated with more fatty infiltration, larger tear size, advanced age, and double-row repairs. Clinical improvement averaged 72% of the maximum possible improvement. Patient-reported outcomes were generally improved whether or not the repair restored the integrity of the rotator cuff. The inconsistent and incomplete data in the published articles limited the meta-analysis of factors affecting the outcome of rotator cuff repair. CONCLUSION:In spite of a dramatic increase in the number of publications per year, there is little evidence that the results of rotator cuff repair are improving. The information needed to guide the management of this commonly treated and costly condition is seriously deficient. To accumulate the evidence necessary to inform practice, future clinical studies on the outcome of rotator cuff repair must report important data relating to each patient's condition, the surgical technique, the outcome in terms of integrity, and the change in patient self-assessed comfort and function. PMID:24753240

McElvany, Matthew D; McGoldrick, Erik; Gee, Albert O; Neradilek, Moni Blazej; Matsen, Frederick A

2014-04-21

278

The propeller flap concept used in vaginal wall reconstruction.  

PubMed

Most posterior vaginal wall defects are due to abdominoperineal resection for colorectal carcinoma involving the posterior vaginal wall or resection of local malignancies. The rectus abdominis myocutaneous flap, the modified Singapore flap and the gracilis myocutaneous flap remain workhorse solutions for this type of vaginal reconstruction. The introduction of the perforator concept has introduced new therapeutic options using the gluteal donor site region. Recently, perforator-based gluteal flaps have been described as a reliable solution for reconstruction of posterior vaginal wall defects, with low donor site morbidity. Here, we present a new technique to optimise results and minimise morbidity to the patient. PMID:22133384

Smeets, L; Hendrickx, B; Teo, T C

2012-05-01

279

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

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Powered vaginal muscle stimulator for therapeutic...Therapeutic Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic...use. (a) Identification. A powered vaginal muscle stimulator is an...

2013-04-01

280

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

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Powered vaginal muscle stimulator for therapeutic...Therapeutic Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic...use. (a) Identification. A powered vaginal muscle stimulator is an...

2010-04-01

281

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

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Powered vaginal muscle stimulator for therapeutic...Therapeutic Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic...use. (a) Identification. A powered vaginal muscle stimulator is an...

2011-04-01

282

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

Code of Federal Regulations, 2012 CFR

...2012-04-01 2012-04-01 false Powered vaginal muscle stimulator for therapeutic...Therapeutic Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic...use. (a) Identification. A powered vaginal muscle stimulator is an...

2012-04-01

283

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...Therapeutic Devices § 884.5940 Powered vaginal muscle stimulator for therapeutic...use. (a) Identification. A powered vaginal muscle stimulator is an...

2014-04-01

284

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

Federal Register 2010, 2011, 2012, 2013, 2014

...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...

2010-01-22

285

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

NASA Astrophysics Data System (ADS)

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

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

2001-08-01

286

Ineffectiveness of using the pressure relief valve technique during cuff inflation  

PubMed Central

Objective To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes. Methods In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range). Results There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer. Conclusion The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit. PMID:25607265

Annoni, Raquel; Pires-Neto, Ruy Camargo

2014-01-01

287

Single dose therapy of vaginal candidiasis: a comparative trial of fenticonazole vaginal ovules versus clotrimazole vaginal tablets.  

PubMed

An open, randomized comparative clinical trial was performed in 153 patients suffering from symptomatic vaginal candidiasis confirmed by mycological tests. Patients were allocated at random into two groups: the first group (consisting of 75 subjects) was treated with a single vaginal ovule of fenticonazole (600 mg) and the second group (consisting of 78 subjects) was treated with a single vaginal tablet of clotrimazole (500 mg). Therapeutic efficacy was assessed by microbiological and clinical criteria 7 days and 1 month (when possible) after the single dose treatment. At the first follow-up visit, complete disappearance of the signs and symptoms or a highly significant reduction of their intensity was observed in both treatment groups. No significant difference was evident between the two drugs. At 7 days, the mycological tests gave negative results in 92% of the patients in the fenticonazole group and in 88.5% of the patients in the clotrimazole group. The difference between the two treatment groups was again not statistically significant. The second follow-up visit was performed in 55 (73.3%) patients of the fenticonazole group and in 52 (66.7%) patients of the clotrimazole group. The results indicate that 83.6% of patients in the fenticonazole group and 69.2% of patients in the clotrimazole group were still disease free at the time of this visit. Both drugs were well tolerated. Mild, local and short lasting side-effects were reported in only 5 cases of the group treated with fenticonazole.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2202548

Lawrence, A G; Houang, E T; Hiscock, E; Wells, M B; Colli, E; Scatigna, M

1990-01-01

288

Endometrial carcinoma: high dose-rate brachytherapy in combination with external irradiation; a multivariate analysis of relapses.  

PubMed

From June 1974 to June 1984, 347 women with endometrial carcinoma were referred to the radiotherapy department of the Catharina Hospital, Eindhoven, The Netherlands. Of this total number, 327 patients were considered eligible for analysis; 36 being referred for recurrences of previous surgically treated endometrial carcinoma, and 291 being referred for radiotherapy as part of the initial treatment. The 28% 5-year relapse-free survival (RFS) of the group of 36 patients demonstrated that endometrial carcinoma may behave as a radiosensitive tumour. The remaining 291 had all undergone surgery, except 10. Radiotherapy consisted of high dose-rate brachytherapy applied to the vaginal vault for pathological stage I tumours, well differentiated, and with superficial myometrial invasion. All other patients received external beam irradiation to a pelvic dose of 40 Gy in 4 weeks, followed by brachytherapy (4 fractions of 5 Gy each). The 5-year RFS for pathologically staged patients was: stage I (232 patients) 88%, stage II (27 patients) 68%, stage III and IV (22 patients) 50%. Treatment-related complications were minimal. In-field recurrences were rare: 5% locoregional, 2.2% both loco-regional and distant, versus 9.3% distant failures. Multivariate RFS analysis demonstrated age, stage and tumour differentiation as independent prognostic factors, tumour differentiation being the most important factor. PMID:2616811

Lybeert, M L; van Putten, W L; Ribot, J G; Crommelin, M A

1989-12-01

289

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

PubMed Central

Purpose To investigate the dosimetric difference due to the different point A definitions in cervical cancer low-dose-rate (LDR) intracavitary brachytherapy. Material and methods Twenty CT-based LDR brachytherapy plans of 11 cervical patients were retrospectively reviewed. Two plans with point As following the modified Manchester system which defines point A being 2 cm superior to the cervical os along the tandem and 2 cm lateral (Aos), and the American Brachytherapy Society (ABS) guideline definition in which the point A is 2 cm superior to the vaginal fornices instead of os (Aovoid) were generated. Using the same source strength, two plans prescribed the same dose to Aos and Aovoid. Dosimetric differences between plans including point A dose rate, treatment volume encompassed by the prescription isodose line (TV), and dose rate of 2 cc of the rectum and bladder to the prescription dose were measured. Results On average Aovoid was 8.9 mm superior to Aos along the tandem direction with a standard deviation of 5.4 mm. With the same source strength and arrangement, Aos dose rate was 19% higher than Aovoid dose rate. The average TV(Aovoid) was 118.0 cc, which was 30% more than the average TV(Aos) of 93.0 cc. D2cc/D(Aprescribe) increased from 51% to 60% for rectum, and increased from 89% and 106% for bladder, if the prescription point changed from Aos to Aovoid. Conclusions Different point A definitions lead to significant dose differences. Careful consideration should be given when changing practice from one point A definition to another, to ensure dosimetric and clinical equivalency from the previous clinical experiences. PMID:24474971

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

2013-01-01

290

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

SciTech Connect

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

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

2010-06-01

291

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

SciTech Connect

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

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

2013-04-01

292

Vaginal microbiome of reproductive-age women  

PubMed Central

The means by which vaginal microbiomes help prevent urogenital diseases in women and maintain health are poorly understood. To gain insight into this, the vaginal bacterial communities of 396 asymptomatic North American women who represented four ethnic groups (white, black, Hispanic, and Asian) were sampled and the species composition characterized by pyrosequencing of barcoded 16S rRNA genes. The communities clustered into five groups: four were dominated by Lactobacillus iners, L. crispatus, L. gasseri, or L. jensenii, whereas the fifth had lower proportions of lactic acid bacteria and higher proportions of strictly anaerobic organisms, indicating that a potential key ecological function, the production of lactic acid, seems to be conserved in all communities. The proportions of each community group varied among the four ethnic groups, and these differences were statistically significant [?2(10) = 36.8, P < 0.0001]. Moreover, the vaginal pH of women in different ethnic groups also differed and was higher in Hispanic (pH 5.0 ± 0.59) and black (pH 4.7 ± 1.04) women as compared with Asian (pH 4.4 ± 0.59) and white (pH 4.2 ± 0.3) women. Phylotypes with correlated relative abundances were found in all communities, and these patterns were associated with either high or low Nugent scores, which are used as a factor for the diagnosis of bacterial vaginosis. The inherent differences within and between women in different ethnic groups strongly argues for a more refined definition of the kinds of bacterial communities normally found in healthy women and the need to appreciate differences between individuals so they can be taken into account in risk assessment and disease diagnosis. PMID:20534435

Ravel, Jacques; Gajer, Pawel; Abdo, Zaid; Schneider, G. Maria; Koenig, Sara S. K.; McCulle, Stacey L.; Karlebach, Shara; Gorle, Reshma; Russell, Jennifer; Tacket, Carol O.; Brotman, Rebecca M.; Davis, Catherine C.; Ault, Kevin; Peralta, Ligia; Forney, Larry J.

2011-01-01

293

Vaginal microbiome of reproductive-age women.  

PubMed

The means by which vaginal microbiomes help prevent urogenital diseases in women and maintain health are poorly understood. To gain insight into this, the vaginal bacterial communities of 396 asymptomatic North American women who represented four ethnic groups (white, black, Hispanic, and Asian) were sampled and the species composition characterized by pyrosequencing of barcoded 16S rRNA genes. The communities clustered into five groups: four were dominated by Lactobacillus iners, L. crispatus, L. gasseri, or L. jensenii, whereas the fifth had lower proportions of lactic acid bacteria and higher proportions of strictly anaerobic organisms, indicating that a potential key ecological function, the production of lactic acid, seems to be conserved in all communities. The proportions of each community group varied among the four ethnic groups, and these differences were statistically significant [?(2)(10) = 36.8, P < 0.0001]. Moreover, the vaginal pH of women in different ethnic groups also differed and was higher in Hispanic (pH 5.0 ± 0.59) and black (pH 4.7 ± 1.04) women as compared with Asian (pH 4.4 ± 0.59) and white (pH 4.2 ± 0.3) women. Phylotypes with correlated relative abundances were found in all communities, and these patterns were associated with either high or low Nugent scores, which are used as a factor for the diagnosis of bacterial vaginosis. The inherent differences within and between women in different ethnic groups strongly argues for a more refined definition of the kinds of bacterial communities normally found in healthy women and the need to appreciate differences between individuals so they can be taken into account in risk assessment and disease diagnosis. PMID:20534435

Ravel, Jacques; Gajer, Pawel; Abdo, Zaid; Schneider, G Maria; Koenig, Sara S K; McCulle, Stacey L; Karlebach, Shara; Gorle, Reshma; Russell, Jennifer; Tacket, Carol O; Brotman, Rebecca M; Davis, Catherine C; Ault, Kevin; Peralta, Ligia; Forney, Larry J

2011-03-15

294

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

PubMed

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

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

2014-11-18

295

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

PubMed Central

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

Oliva, Francesco; Osti, Leonardo; Padulo, Johnny; Maffulli, Nicola

2014-01-01

296

Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years  

PubMed Central

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

Silva, Sandra Regina Ramos; Arcuri, Edna Apparecida Moura; Isabella, Adriana Paula Jordão; Arcuri, Silvia Maria; Santos, Jair Lício Ferreira

2014-01-01

297

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

PubMed Central

Summary Rotator cuff repairs are commonly performed to reduce pain and restore function. Tears are also treated successfully without surgical intervention; however, the effect that a torn tendon has on the glenohumeral cartilage remains unknown. Clinically, a correlation between massive rotator cuff tears and glenohumeral arthritis has often been observed. This may be due to a disruption in the balance of forces at the shoulder, resulting in migration of the humeral head and subsequently, abnormal loading of the glenoid. Our lab previously demonstrated changes in ambulation and intact tendon mechanical properties following supraspinatus and infraspinatus rotator cuff tendon tears in a rat model. Therefore, the purpose of this study was to investigate the effects of supraspinatus and infraspinatus rotator cuff tears on the glenoid cartilage. Nine rats underwent unilateral detachment of the supraspinatus and infraspinatus tendons and were sacrificed after four weeks. Cartilage thickness significantly decreased in the antero-inferior region of injured shoulders. In addition, equilibrium elastic modulus significantly decreased in the center, antero-superior, antero-inferior, and superior regions. These results suggest that altered loading after rotator cuff injury may lead to damage to the joint with significant pain and dysfunction. Clinically, understanding the mechanical processes involved with joint damage will allow physicians to better advise patients. PMID:22407524

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

2012-01-01

298

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

PubMed Central

Background Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair. Purposes To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera. Results During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05). Conclusion RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides. PMID:21323485

2011-01-01

299

How to increase the proportion of hysterectomies performed vaginally  

Microsoft Academic Search

Objectives: The main purpose of our study was to identify the patient characteristics of women undergoing hysterectomy and to estimate the proportion of hysterectomies that could be done vaginally by recognized surgical techniques. Study Design: The records of 500 women who underwent hysterectomy were reviewed. The characteristics of patients without an absolute contraindication to vaginal hysterectomy were analyzed. Results: Overall,

Anthony Davies; Enrico Vizza; Nikolaos Bournas; Hugh O’Connor; Adam Magos

1998-01-01

300

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

ERIC Educational Resources Information Center

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…

Padawer, Jill A.; And Others

1988-01-01

301

Electromyographic assessment of muscle fatigue in massive rotator cuff tear.  

PubMed

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

Hawkes, D H; Alizadehkhaiyat, O; Kemp, G J; Fisher, A C; Roebuck, M M; Frostick, S P

2015-02-01

302

Assessment and characterization of in situ rotator cuff biomechanics  

NASA Astrophysics Data System (ADS)

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.

Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

2013-03-01

303

Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report  

Microsoft Academic Search

INTRODUCTION: Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. CASE PRESENTATION: A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was

Rohit Rambani; Roger G Hackney

2009-01-01

304

Design and optimization of a brachytherapy robot  

NASA Astrophysics Data System (ADS)

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

Meltsner, Michael A.

305

Brachytherapy radiation doses to the neurovascular bundles  

Microsoft Academic Search

Purpose: To investigate the role of radiation dose to the neurovascular bundles (NVB) in brachytherapy-related impotence.Methods and Materials: Fourteen Pd-103 or I-125 implant patients were studied. For patients treated with implant alone, the prostate and margin (clinical target volume [CTV]) received a prescription dose of 144 Gy for I-125 or 115 Gy for Pd-103. Two patients received Pd-103 (90 Gy)

Steven J DiBiase; Kent Wallner; Kevin Tralins; Steven Sutlief

2000-01-01

306

Rotating-shield brachytherapy for cervical cancer  

NASA Astrophysics Data System (ADS)

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.

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

2013-06-01

307

Progesterone implants enhance SIV vaginal transmission and early virus load.  

PubMed

Simian immunodeficiency virus (SIV) can cross the intact vaginal epithelium to establish a systemic infection in macaques (mac). Using this SIVmac model, we found that subcutaneous progesterone implants, which could mimic hormonally based contraceptives, thinned the vaginal epithelium and enhanced SIV vaginal transmission 7.7-fold over that observed in macaques treated with placebo implants and exposed to SIV in the follicular phase of the menstrual cycle. Progesterone treatment also increased the number of SIV DNA-positive cells in the vaginal lamina propria as detected by in situ polymerase chain reaction analysis. Moreover, plasma viral RNA was elevated for the first three months in macaques with progesterone implants, and three of the progesterone-treated macaques developed relatively rapid disease courses. This study shows that SIV genital infection and disease course are enhanced by subcutaneous implants containing progesterone when compared with the rate of vaginal transmission in the follicular phase. PMID:8837605

Marx, P A; Spira, A I; Gettie, A; Dailey, P J; Veazey, R S; Lackner, A A; Mahoney, C J; Miller, C J; Claypool, L E; Ho, D D; Alexander, N J

1996-10-01

308

An investigation of a PRESAGE® in vivo dosimeter for brachytherapy  

NASA Astrophysics Data System (ADS)

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.

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

2014-07-01

309

MIP Models and BB Strategies in Brachytherapy Treatment Optimization  

E-print Network

: brachytherapy, prostate cancer, branch­and­bound, optimization, inte­ ger programming, treatment planning­Madison Abstract. Brachytherapy (brachy being derived from a Greek word meaning short) is the treatment of cancer of therapy is becoming com­ mon in the treatment of early stage prostate cancer, the most common cancer

Meyer, Robert R.

310

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results.  

E-print Network

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results. Christophe Reynier, Jocelyne 217, F-38043 Grenoble cedex 09, France (Received Prostate brachytherapy involves implanting radioactive seeds (I125 for instance) permanently in the gland for the treatment of localized prostate cancers

Paris-Sud XI, Université de

311

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

PubMed Central

Background Bacterial vaginosis (BV) – a syndrome characterised by a shift in vaginal flora – appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa. Methods We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire. Results BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 – 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 – 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 – 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only Bacteroides spp. and Prevotella spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting). Conclusion In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics. PMID:15757510

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

2005-01-01

312

Rotator cuff biology and biomechanics: a review of normal and pathological conditions.  

PubMed

The glenohumeral joint is a complex anatomic structure commonly affected by injury such as tendinopathy and rotator cuff tears. This review presents an up-to-date overview of research on tendon biology and structure, shoulder joint motion and stability, tendon healing, and current and potential future repair strategies. Recent studies have provided information demonstrating the serious impact on uninjured tissues after a rotator cuff tear or other cause of altered shoulder joint mechanics. Another major focus of recent research is biological augmentation of rotator cuff repair with the goal of successfully reinstating normal tendon-to-bone structure. To effectively treat shoulder pathologies, clinicians need to understand normal tendon biology, the healing process and environment, and whole shoulder stability and function. PMID:25475598

Huegel, Julianne; Williams, Alexis A; Soslowsky, Louis J

2015-01-01

313

Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.  

PubMed

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

Vad, Vijay B; Southern, Daniel; Warren, Russell F; Altchek, David W; Dines, David

2003-01-01

314

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

PubMed Central

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears. PMID:19409148

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

2009-01-01

315

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

PubMed Central

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report. PMID:24976930

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

2014-01-01

316

Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland.  

PubMed

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

Talekar, C R; Udy, A A; Boots, R J; Lipman, J; Cook, D

2014-11-01

317

T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear  

PubMed Central

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

Gumucio, J.; Flood, M.; Harning, J.; Phan, A.; Roche, S.; Lynch, E.; Bedi, A.; Mendias, C.

2014-01-01

318

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

PubMed Central

Objectives: Aortic (central) blood pressure (BP) differs from brachial BP and may be a superior predictor of cardiovascular events. However, its measurement is currently restricted to research settings, owing to a moderate level of operator dependency. We tested a new noninvasive device in a large UK cohort. The device estimates central BP using measurements obtained with an upper arm cuff inflated to suprasystolic pressure. We compared these estimates with those obtained using radial tonometry as well as with invasively acquired measurements of aortic BP in a limited number of individuals. Methods: Consecutive cuff-based and tonometry-based estimates of the pressure waveform and the central BP were obtained from 1107 individuals (70?±?6 years). Short-term and long-term reproducibility studies were performed on 28 individuals. Simultaneous cuff-based and invasively measured pressure traces were acquired and compared in an additional six individuals (65?±?20 years). Results: Central systolic BP, as estimated by the cuff-based device, was found to be highly reproducible (coefficient of variation 4 and 8% for short and long-term reproducibility, respectively) and was comparable to that estimated by tonometry (average difference 3?±?6?mmHg, intraclass correlation coefficient?=?0.91). The cuff-based pressure waveforms were similar to those acquired invasively (cross-correlation coefficient 0.93), and the difference in the estimated central systolic BP was ?5?±?8?mmHg (P?=?0.2). Conclusion: Cuff-based devices show promise to simplify the measurement of central BP, whilst maintaining a similar fidelity to tonometry. This could lead to improved adoption of estimates of central BP in clinical practice. PMID:24379000

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

2014-01-01

319

Are Vaginal Symptoms Ever Normal? A Review of the Literature  

PubMed Central

Purpose Vaginal symptoms such as discharge, odor, and itch are among the most common presenting complaints in primary care. We undertook to determine if the symptoms associated with vaginitis (discharge, odor, irritation) occur in normal women. Methods To answer this question, we performed a literature review. We conducted a Medline search using the following terms: "vagina," "vaginal discharge," "secretion," "odors," discharge," "pruritus," "normal," "irritation," "itch," "physical examination," "healthy," "asymptomatic," "quantity," and "physiology." To find additional references we reviewed textbooks in gynecology, primary care, and physical diagnosis and contacted authors. Results There are few primary studies, and most are not of high quality. Existing data show that the quantity and quality of vaginal discharge in healthy women vary considerably both across individuals and in the same individual during the menstrual cycle. Most studies indicate that discharge is greatest at midcycle. Vaginal fluid contains malodorants, and one study of intact vaginal fluid found it to be malodorous. Two studies found that normal women reported irritative symptoms in the course of their menstrual cycle. Conclusions The primary literature indicates that there is a wide variation in the normal vagina and that some of the symptoms associated with vaginal abnormality are found in well women. Both clinicians and their patients would benefit from a better understanding of the range of normal as well as what constitutes a meaningful departure from that range. PMID:15775876

Anderson, Matthew; Karasz, Alison; Friedland, Sarah

2004-01-01

320

Double-blind evaluation of miconazole tampons, compared with clotrimazole vaginal tablets, in vaginal candidiasis.  

PubMed

Fifty-one patients with vaginal candidiasis and positive cultures in Nickerson medium were treated either with two miconazole tampons daily for five days (26 patients, median age 28 years) or with one clotrimazole vaginal tablet daily for six days (25 patients, median age 36 years) in a randomized double-blind trial. Seven days after the end of the treatment, 24 (92%) patients in the miconazole group and 19 (76%) in the clotrimazole group had negative cultures. One month after the end of the treatment, the relapse rate was significantly (P less than 0.05) higher in the clotrimazole group. Symptoms subsided rapidly in both groups. No unwanted effects were reported. PMID:7307036

Lolis, D; Kanellopoulos, N; Liappas, I; Xyngakis, A; Zissis, N P

1981-01-01

321

Effects of estroprogestins containing natural estrogen on vaginal flora.  

PubMed

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

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

2014-11-01

322

Formulation of mucoadhesive vaginal hydrogels insensitive to dilution with vaginal fluids.  

PubMed

The main objective of this work was to design thermosensitive and mucoadhesive vaginal hydrogels able to keep their rheological and mucoadhesive properties after dilution with vaginal fluids. Formulations were composed of pluronic F127 or a mix of two pluronics F127 and F68. Both formulations contained hydroxypropylmethyl cellulose (HPMC) as a mucoadhesive polymer. The determination of gelling temperature (T(gel)) after dilution with simulated vaginal fluid (SVF) demonstrated that hydrogels were resistant to dilution and T(gel) values were close to 30°C. Ex vivo mucoadhesion experiments conducted on porcine vaginal mucosa founded on the technique of traction of the adhesive/adherent joint allowed the characterization of mucoadhesive properties of hydrogels by measuring work of adhesion (W) and maximum force of detachment (F(max)). In the case of F127-based hydrogels, W and F(max) were lowered after dilution with SVF. However, in the case of F127/F68-based hydrogels, W, F(max) and mucoadhesion profiles were weakly affected by dilution. These differences could be attributed to the higher elasticity of F127/F68/HPMC (22.5/2.5/1% w/w) hydrogel in comparison with F127/HPMC one (20/1% w/w). Indeed, rheological analyses of the formulations showed that both elastic (G') and viscous moduli (G'') were higher for F127/F68/HPMC (22.5/2.5/1% w/w) than for F127/HPMC hydrogel (20/1% w/w). However, we demonstrated that the higher elasticity of the hydrogel was due to the higher total pluronic concentration and not due to the presence of F68 in the formulation. PMID:20656027

Aka-Any-Grah, Armelle; Bouchemal, Kawthar; Koffi, Armand; Agnely, Florence; Zhang, Min; Djabourov, Madeleine; Ponchel, Gilles

2010-10-01

323

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

SciTech Connect

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.

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

324

Results of single-dose treatment of vaginal mycoses with 500 mg Canesten vaginal tablets.  

PubMed

212 patients with cultural evidence of yeast-induced vaginal mycosis were treated with a single vaginal tablet of 500 mg clotrimazole. A diagnosis of infection due to a Candida species had been established before therapy in 95% of the patients studied. From the total group of 212 patients a further group was formed who had appeared at the check-ups as scheduled in the trial protocol and whose data were complete. This group included 83 cases. There was no therapeutic difference between the two patient groups. 89% of the patients of the total patient group evaluable were found to be mycologically cured at both check-ups. In the reduced patient group the rates of mycological cure at the times of examination were 87 and 89%, respectively. The clinical results obtained in the total patient group indicated a therapeutic success of 90% at both check-ups. In the reduced patient group the rate of therapeutic success was 93% at the first and 88% at the second check-up. The local tolerability of the Canesten vaginal tablet was good. The side effects observed were rare and mild. PMID:7160245

Krause, U

1982-01-01

325

Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy  

PubMed Central

Vulvovaginal atrophy (VVA) and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms. PMID:21072280

Kingsberg, SA; Kellogg, S; Krychman, M

2010-01-01

326

[Clinical experiences with clotrimazole in treating vaginal candidiasis].  

PubMed

The results of a clinical trial using Clotrimazole (Canesten) vaginal pessaries in the treatment of mycologically confirmed cases of vaginal candidiasis are presented. Treatment schedule consisted in the application of vaginal pessaries each containing 100 mg Clotramizole at bedtime on 6 successive days. In 68 patients who adhered to the treatment schedule and completed the observation and follow-up periods an overall cure-rate of 78.4% was recorded. There were no adverse reactions. Treatment schedules would vary from case to case and in instances of reinfection a repeated course of treatment is recommended. PMID:392965

Emokpare, N A

1979-08-15

327

Imperforate hymen and vaginal atresia and their associated anomalies.  

PubMed Central

The presenting features and associated abnormalities of imperforate hymen and vaginal atresia were studied in 24 girls under the age of 16 years. Hydrocolpos or hydrometrocolpos occurred in 8 infants, 13 older girls developed haematocolpos, but 3 of the girls had no distension of the genital tract. Seven of the older girls were diagnosed as having appendicitis. Anorectal anomalies were present in 9 of the children. Intravenous pyelography was performed on 16 girls and was normal in only one. Urinary tract investigations are indicated in all girls with vaginal outlet obstruction, and the vaginal orifice should be inspected in all girls with anorectal abnormalities. PMID:6876046

Shaw, L M; Jones, W A; Brereton, R J

1983-01-01

328

Duration of colposcopic changes associated with trichomonas vaginitis.  

PubMed

The possibility that an abnormal Papanicolaou smear of the uterine cervix may be associated with vaginitis due to trichomonas vaginalis has been known for some time. Since colposcopy is being used with increased frequency to evaluate patients with cytologic abnormalities noted on the cervical smear and the colposcopic changes produced by trichomonal vaginitis are quite typical, a study was designed to evaluate the duration of these changes after effective eradication of the parasite. Among 12 patients in whom the infection was successfully treated, none showed evidence of colposcopically detected abnormalities due to the trichomonal vaginitis at 2 weeks and again at 4 weeks after initiation of therapy. PMID:619328

Borten, M; Friedman, E A

1978-01-01

329

Policy for Prevention of a Retained Sponge after Vaginal Delivery  

PubMed Central

Background. Policies for sponge count are not routine practice in most labor and delivery rooms. Ignored or hidden retained vaginal foreign bodies has potentially significant health care morbidity. Case. This was a case of a retained vaginal sponge following an uncomplicated spontaneous vaginal delivery. Delivery room policy resulted in the discovery of the sponge on X-ray when an incorrect sponge count occurred and physical exam did not find the sponge. Conclusion. This emphasizes the use of protocols to enhance patient safety and prevent medical error. PMID:22312370

Garry, David J.; Asanjarani, Sandra; Geiss, Donna M.

2012-01-01

330

Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective  

PubMed Central

Vaginal bacterial communities are thought to help prevent sexually transmitted infections. Bacterial vaginosis (BV) is a common clinical syndrome in which the protective lactic acid–producing bacteria (mainly species of the Lactobacillus genus) are supplanted by a diverse array of anaerobic bacteria. Epidemiologically, BV has been shown to be an independent risk factor for adverse outcomes including preterm birth, development of pelvic inflammatory disease, and acquisition of sexually transmitted infections. Longitudinal studies of the vaginal microbiome using molecular techniques such as 16S ribosomal DNA analysis may lead to interventions that shift the vaginal microbiota toward more protective states. PMID:22133886

Brotman, Rebecca M.

2011-01-01

331

Vaginal Septoplasty in Septate Uterus with Double Cervix  

PubMed Central

Fusion defects of the Müllerian ducts occur frequently and they have been described by the American Fertility Society. However, septate uterus with cervical duplication and longitudinal vaginal septum is not described by this classification and has suggested a change in the classical theory of fusion of the Müllerian ducts. This paper describes a rare case report of a patient with complete septate uterus with double cervix and longitudinal vaginal septum, submitted to the vaginal septoplasty for dyspareunia, progressing to clinical improvement. The description of this case is to contribute with all uncommon cases of Müllerian anomalies reports and clinical treatment protocols, which is not yet established. PMID:25136464

Chiamulera, Nara; Botelho, Beatriz

2014-01-01

332

Temporal dynamics of the human vaginal microbiota.  

PubMed

Elucidating the factors that impinge on the stability of bacterial communities in the vagina may help in predicting the risk of diseases that affect women's health. Here, we describe the temporal dynamics of the composition of vaginal bacterial communities in 32 reproductive-age women over a 16-week period. The analysis revealed the dynamics of five major classes of bacterial communities and showed that some communities change markedly over short time periods, whereas others are relatively stable. Modeling community stability using new quantitative measures indicates that deviation from stability correlates with time in the menstrual cycle, bacterial community composition, and sexual activity. The women studied are healthy; thus, it appears that neither variation in community composition per se nor higher levels of observed diversity (co-dominance) are necessarily indicative of dysbiosis. PMID:22553250

Gajer, Pawel; Brotman, Rebecca M; Bai, Guoyun; Sakamoto, Joyce; Schütte, Ursel M E; Zhong, Xue; Koenig, Sara S K; Fu, Li; Ma, Zhanshan Sam; Zhou, Xia; Abdo, Zaid; Forney, Larry J; Ravel, Jacques

2012-05-01

333

Characterization of Human Vaginal Mucosa Cells for Autologous In Vitro Cultured Vaginal Tissue Transplantation in Patients with MRKH Syndrome  

PubMed Central

Mayer-Rokitansky-Küster-Hauser (MRKH) is a rare syndrome characterized by congenital aplasia of the uterus and vagina. The most common procedure used for surgical reconstruction of the neovagina is the McIndoe vaginoplasty, which consists in creation of a vaginal canal covered with a full-thickness skin graft. Here we characterized the autologous in vitro cultured vaginal tissue proposed as alternative material in our developed modified McIndoe vaginoplasty in order to underlie its importance in autologous total vaginal replacement. To this aim human vaginal mucosa cells (HVMs) were isolated from vaginal mucosa of patients affected by MRKH syndrome and characterized with respect to growth kinetics, morphology, PAS staining, and expression of specific epithelial markers by immunofluorescence, Western blot, and qRT-PCR analyses. The presence of specific epithelial markers along with the morphology and the presence of mucified cells demonstrated the epithelial nature of HMVs, important for an efficient epithelialization of the neovagina walls and for creating a functional vaginal cavity. Moreover, these cells presented characteristics of effective proliferation as demonstrated by growth kinetics assay. Therefore, the autologous in vitro cultured vaginal tissue might represent a highly promising and valid material for McIndoe vaginoplasty. PMID:25162002

Nodale, Cristina; D'Amici, Sirio; Maffucci, Diana; Ceccarelli, Simona; Monti, Marco; Benedetti Panici, Pierluigi; Romano, Ferdinando; Angeloni, Antonio; Marchese, Cinzia

2014-01-01

334

Characterization of human vaginal mucosa cells for autologous in vitro cultured vaginal tissue transplantation in patients with MRKH syndrome.  

PubMed

Mayer-Rokitansky-Küster-Hauser (MRKH) is a rare syndrome characterized by congenital aplasia of the uterus and vagina. The most common procedure used for surgical reconstruction of the neovagina is the McIndoe vaginoplasty, which consists in creation of a vaginal canal covered with a full-thickness skin graft. Here we characterized the autologous in vitro cultured vaginal tissue proposed as alternative material in our developed modified McIndoe vaginoplasty in order to underlie its importance in autologous total vaginal replacement. To this aim human vaginal mucosa cells (HVMs) were isolated from vaginal mucosa of patients affected by MRKH syndrome and characterized with respect to growth kinetics, morphology, PAS staining, and expression of specific epithelial markers by immunofluorescence, Western blot, and qRT-PCR analyses. The presence of specific epithelial markers along with the morphology and the presence of mucified cells demonstrated the epithelial nature of HMVs, important for an efficient epithelialization of the neovagina walls and for creating a functional vaginal cavity. Moreover, these cells presented characteristics of effective proliferation as demonstrated by growth kinetics assay. Therefore, the autologous in vitro cultured vaginal tissue might represent a highly promising and valid material for McIndoe vaginoplasty. PMID:25162002

Nodale, Cristina; Vescarelli, Enrica; D'Amici, Sirio; Maffucci, Diana; Ceccarelli, Simona; Monti, Marco; Benedetti Panici, Pierluigi; Romano, Ferdinando; Angeloni, Antonio; Marchese, Cinzia

2014-01-01

335

Recent developments and best practice in brachytherapy treatment planning.  

PubMed

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

Lee, C D

2014-09-01

336

The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study.  

PubMed

Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness. The aim of the study was to examine the effects of endotracheal tube cuff pressure changes during gynecological laparoscopic surgery on postoperative sore throat rates. Thirty patients who underwent gynecological laparoscopic surgery and 30 patients who underwent laparotomy under general anesthesia with endotracheal intubation were included. After induction of general anesthesia and endotracheal intubation, the cuff was inflated to 25 mmHg. At 5, 15, 30, 45 and 60 min after endotracheal intubation, cuff pressure and peak airway pressure were recorded. At 2 and 24 h after surgery, the patients were assessed for complaints of a sore throat. In patients who underwent laparotomy, cuff pressure and peak airway pressure did not change significantly at different time points after intubation. In patients who received laparoscopic surgery, cuff pressure and peak airway pressure were significantly increased compared to initial pressure at all examined time points. In both groups, the endotracheal tube cuff pressure and peak airway pressure were significantly correlated (R = 0.9431, P < 0.01; R = 0.8468, P < 0.01). Compared to patients who had undergone laparotomy, patients who had undergone laparoscopic surgery showed significantly higher sore throat scores at both 2 and 24 h after surgery (P < 0.01). Pneumoperitoneum and Trendelenburg position may increase airway pressure and cuff pressure, resulting in increased incidence of postoperative sore throat. PMID:24748551

Geng, Guiqi; Hu, Jingyi; Huang, Shaoqiang

2015-02-01

337

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

PubMed

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

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

2014-04-01

338

A Novel MRI Marker for Prostate Brachytherapy  

SciTech Connect

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

Frank, Steven J. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)], E-mail: 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

339

Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience  

Microsoft Academic Search

OBJECTIVE: Ultrasound of the rotator cuff is considered to be operator-dependent with its accuracy being related to the operator's level of experience. This study was conducted to test the hypothesis that ultrasound performed by operators with different levels of experience will give nonreproducible results. SUBJECTS AND METHODS: Two radiologists, one general radiologist with no experience in musculoskeletal ultrasound and one

M. J. Rutten; G. J. Jager; L. A. L. M. Kiemeney

2010-01-01

340

[Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff].  

PubMed

Shoulder sonography was performed prospectively in 4172 patients with 4588 shoulders affected with pathology of the subacromial space, among them 1227 operated cases with 425 rotator cuff tears (292 total tears and 133 partial tears). A two-criterion model with formal as well as echogenic and dynamic criteria was used for the diagnosis of cuff tears. The overall sensitivity in diagnosing rotator cuff tears was 95.3% (97.3% in total tears and 91.0% in partial tears). False-negative results were found overall in 1.6% of cases. Overall accuracy for all defects was 94.9%. Involvement of the supraspinatus tendon was found in 95.8%, of the infraspinatus in 39.3% and of the subscapularis in 10.1%. In 33.6% of cases, involvement of the long head of biceps was found. It was clearly correlated with the size of the tears: 25.9% in isolated supraspinatus tears and 68.8% in three-tendon tears of subscapularis, supraspinatus and infraspinatus. Differentiation between fresh, traumatic tears and degenerative tears is possible by means of measuring retraction, determining the length of the distal cuff stump and by formal criteria of the stump configuration as well as by bursal criteria. Differentiation of old tears of suspected traumatic origin from those with degenerative causes is impossible. PMID:8532336

Hedtmann, A; Fett, H

1995-11-01

341

A new technique for patch augmentation of rotator cuff repairs.  

PubMed

Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small- to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. PMID:25126505

Mihara, Shuzou; Ono, Teruyasu; Inoue, Hirofumi; Kisimoto, Tetsurou

2014-06-01

342

Finite element study of composite cuff connections for pultruded box sections  

Microsoft Academic Search

Detailed finite element models were developed to represent beam and column test frames comprising box sections connected together with innovative monolithic glass fiber reinforced plastic (GFRP) cuff connections. Model mechanical properties (both stiffness and strength) for the member and connection composite materials were determined from tests on the composite constituent materials and on composite lamina coupons. Damage was investigated in

Juan E. Carrion; Keith D. Hjelmstad; James M. LaFave

2005-01-01

343

Tissue Fixation Security in Transosseous Rotator Cuff Repairs: A Mechanical Comparison of Simple Versus Mattress Sutures  

Microsoft Academic Search

Summary: The primary purpose of this investigation was to compare tissue fixa- tion security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair

Stephen S. Burkhart; Scott P. Fischer; Wesley M. Nottage; James C. Esch; F. Alan Barber; James Ferrier

1996-01-01

344

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives.  

PubMed

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-11-18

345

RC-QOL score for rotator cuff pathology: adaptation to Italian.  

PubMed

We translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The RC-QOL questionnaire was then administered to 22 subjects (range 45-74 years) with a diagnosis of rotator cuff tears. For test-retest evaluation, the 22 patients were asked to complete the questionnaire at first examination, and 30 min following the end of this examination. The intraclass correlation coefficient for the 22 patients was 0.94 (95% CI = 0.85-0.98), indicating a high reliability. There were no significant differences between the scores immediately after the consultation and 30 min later. The Italian and the English versions of the RC-QOL questionnaire evaluate the same aspects of clinical severity in patients with rotator cuff tears. PMID:19838675

Papalia, Rocco; Osti, Leonardo; Leonardi, Francesco; Denaro, Vincenzo; Maffulli, Nicola

2010-10-01

346

Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age.  

PubMed

We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group: median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years). The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but different in age. After careful arthroscopic evaluation of the full-thickness rotator cuff tear, rotator cuff repair and biceps tenotomy were performed in all patients. Pre- and post-operatively, each patient was evaluated for range of motion, shoulder score (UCLA), and SF-36 self-administered questionnaire. Comparing pre- versus post-operative status at a minimum 24 months follow-up, forward elevation, internal and external rotation, modified UCLA rating system scores, and SF-36 scores improved significantly in both groups, with no significant difference between the groups. At the last follow-up, strength improved significantly in both groups, with non-significant intergroup difference. The Popeye sign was detected in 13/28 (46%) of the patients in the over 65 group and in 11/28 (39%) in the under 65 group (? = 0.29) with non-significant difference between the two groups. In selected active patients older than 65, arthroscopic rotator cuff repair associated with biceps tenotomy (when necessary) can yield clinical and related quality of life outcomes similar to those of patients younger than 65 years. PMID:20182868

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2010-12-01

347

Differential ubiquitin-proteasome and autophagy signaling following rotator cuff tears and suprascapular nerve injury  

PubMed Central

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

Joshi, Sunil K.; Kim, Hubert T.; Feeley, Brian T.; Liu, Xuhui

2013-01-01

348

The Single Needle Lockstitch Machine. [Making and Setting Cuffs.] Module 6.  

ERIC Educational Resources Information Center

This module on making and setting cuffs, one in a series on the single needle lockstitch sewing machine for student self-study, contains three sections. Each section includes the following parts: an introduction, directions, an objective, learning activities, student information, student self-check, check-out activities, and an instructor's final…

South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

349

Distribution and expression of type VI collagen and elastic fibers in human rotator cuff tendon tears.  

PubMed

There is increasing evidence for a progressive extracellular matrix change in rotator cuff disease progression. Directly surrounding the cell is the pericellular matrix, where assembly of matrix aggregates typically occurs making it critical in the response of tendon cells to pathological conditions. Studies in animal models have identified type VI collagen, fibrillin-1 and elastin to be located in the pericellular matrix of tendon and contribute in maintaining the structural and biomechanical integrity of tendon. However, there have been no reports on the localization of these proteins in human tendon biopsies. This study aimed to characterize the distribution of these ECM components in human rotator cuffs and gain greater insight into the relationship of pathology to tear size by analyzing the distribution and expression profiles of these ECM components. Confocal microscopy confirmed the localization of these structural molecules in the pericellular matrix of the human rotator cuff. Tendon degeneration led to an increased visibility of these components with a significant disorganization in the distribution of type VI collagen. At the genetic level, an increase in tear size was linked to an increased transcription of type VI collagen and fibrillin-1 with no significant alteration in the elastin levels. This is the first study to confirm the localization of type VI collagen, elastin and fibrillin-1 in the pericellular region of human supraspinatus tendon and assesses the effect of tendon degeneration on these structures, thus providing a useful insight into the composition of human rotator cuff tears which can be instrumental in predicting disease prognosis. PMID:25166893

Thakkar, Dipti; Grant, Tyler M; Hakimi, Osnat; Carr, Andrew J

2014-01-01

350

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives  

PubMed Central

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-01-01

351

Phacoemulsification of irradiation cataract after brachytherapy.  

PubMed

A 24-year old man presented to the Policlinic with severe visual impairment in his left eye. The patient had been treated earlier with Iodine-125 brachytherapy due to iris melanoma. Clinical examination revealed low visual acuity, filtration device, iris atrophy, posterior synachiae and completely white cataract. Ultrasonography revealed scleral thinning with no signs of retinal detachment. The patient underwent synechiolysis, trypan blue capsule staining, phacoemulsification and implantation of 23D intraocular lens Alcon AcrySof (MA60BM). Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,2 and fundus examination revealed radiation retinopathy with diffuse retinal scaring. PMID:23348192

?abri?, Emir; Zvor?anin, Jasmin; Jusufovi?, Vahid

2013-02-01

352

Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?  

PubMed Central

Background Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers’ professional background. Methods Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an emergency department to a higher facility. Results This study included 101 patients scheduled for aeromedical transport. Median cuff pressure measured at handover was 45 (25.0/80.0) cmH2O; range, 8-120 cmH2O. There was no difference between patient characteristics and tracheal tube-size or whether anaesthesia personnel or non-anaesthesia personnel inflated the cuff (30 (24.8/70.0) cmH2O vs. 50 (28.0/90.0) cmH2O); p?=?0.113. With regard to mission type (63 patients underwent an emergency transfer, 38 patients an ICU transport), median cuff pressure was different: 58 (30.0/100.0) cmH2O in emergency transfers vs. 30 (20.0/45.8) cmH2O in inter-ICU transports; p?cuff pressure assessment by the intubating team, a manometer had been applied in 2 of 59 emergency transfers and in 20 of 34 inter-ICU transports (method was unknown for 4 cases each). If a manometer was used, median cuff pressure was 27 (20.0/30.0) cmH2O, if not 70 (47.3/102.8) cmH2O; p?Cuff pressures in the pre-hospital setting and in intensive care units are often too high. Interestingly, there is no significant difference between non-anaesthesia and anaesthesia personnel. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. This method seems to be the only feasible one and is recommended for general use. PMID:24304522

2013-01-01

353

Recurrent anterior shoulder dislocation with glenoid bone loss and concurrent irreparable rotator cuff tear in a young patient: case report  

PubMed Central

Full-thickness rotator cuff tear associated with gleno-humeral anterior dislocation is a rare injury in patients younger than 40 years of age. We here report a case of recurrent anterior shoulder dislocation with glenoid bone loss and concurrent irreparable rotator cuff tear in a young patient. This is, to the best of our knowledge, the first such case reported in the literature. We also discuss the type of surgical treatment adopted and the measures that can be undertaken to address both instability and massive rotator cuff tear.

PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

2013-01-01

354

Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy  

PubMed Central

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

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

2014-01-01

355

Diversity of the Vaginal Microbiome Correlates With Preterm Birth  

PubMed Central

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

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

356

Trichomoniasis as Seen in a Chronic Vaginitis Clinic  

PubMed Central

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

Dan, Michael

1996-01-01

357

Vaginal Estrogen Therapy for Patients with Breast Cancer  

PubMed Central

On account of the good prognosis for patients with breast cancer, improving or maintaining the quality of life in the aftercare period is becoming more and more important. In particular, the increasing usage of aromatase inhibitors in the past few years has led to an increased incidence of vaginal atrophy with symptoms such as vaginal dryness, petechial bleeding, dyspareunia and recurrent cystitis. And just these symptoms have a detrimental impact on the quality of life of breast cancer patients. Application of a topical estrogen therapy represents the most effective means to treat vaginal atrophy. The use of a systemic or, respectively, topical hormone therapy is, however, contraindicated for breast cancer patients. Further clinical trials are needed in order to assess the safety of vaginal estrogen therapy. PMID:24771890

Moegele, M.; Buchholz, S.; Seitz, S.; Lattrich, C.; Ortmann, O.

2013-01-01

358

Management of Vaginal Atrophy: Implications from the REVIVE Survey  

PubMed Central

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

Wysocki, Susan; Kingsberg, Sheryl; Krychman, Michael

2014-01-01

359

Mucus-penetrating nanoparticles for vaginal and gastrointestinal drug delivery  

NASA Astrophysics Data System (ADS)

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

Ensign-Hodges, Laura

360

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

SciTech Connect

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.

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

361

Management of Vaginal Erosion of Polypropylene Mesh Slings  

Microsoft Academic Search

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

KATHLEEN C. KOBASHI; FRED E. GOVIER

2003-01-01

362

A classification system and reconstructive algorithm for acquired vaginal defects.  

PubMed

Although multiple flaps have been used for vaginal reconstruction, a logical approach to reconstruction of these often complex defects has not been described. The objective of this study was to establish a classification system for acquired vaginal defects and to develop a reconstructive algorithm derived from this system. This study is a retrospective review of a 7-year experience with 51 flaps in 37 consecutive vaginal reconstructions. Twenty-two partial defects and 15 circumferential defects were reconstructed in 35 patients. Average patient age was 48 years (range, 19 to 69 years). Of the 22 patients with partial vaginal defects, six involved primarily the anterior and lateral wall and 16 the posterior vaginal wall. Among the 15 patients with circumferential defects, four included only the upper two-thirds of the vagina and 11 encompassed the entire vagina. On the basis of these defects, a classification system was developed. Partial defects involving the anterior or lateral vaginal wall were classified as type IA defects and were reconstructed primarily with pedicled Singapore fasciocutaneous flaps. Partial defects involving the posterior wall were classified as type IB and were reconstructed with pedicled rectus abdominis myocutaneous flaps. Circumferential defects involving the upper two-thirds of the vagina were classified as type IIA defects and were reconstructed with a rolled rectus flap or, less commonly, sigmoid colon (one patient). Total circumferential defects, type IIB, were reconstructed largely with bilateral gracilis flaps. Six patients had major complications, including one perioperative death, one complete flap loss, one partial flap loss, and three pelvic abscesses. Three patients had minor complications that included delayed wound healing and donor-site infection. Vaginal defects can be categorized into one of four types on the basis of the location and extent of resection. Flap selection is determined on the basis of the type of defect. Using this algorithm, immediate vaginal reconstruction with pedicled regional flaps can be performed with minimal patient morbidity and few surgical complications. PMID:12198418

Cordeiro, Peter G; Pusic, Andrea L; Disa, Joseph J

2002-09-15

363

Rotator cuff muscle function and its relation to scapular morphology in apes.  

PubMed

It is widely held that many differences among primate species in scapular morphology can be functionally related to differing demands on the shoulder associated with particular locomotor habits. This perspective is largely based on broad scale studies, while more narrow comparisons of scapular form often fail to follow predictions based on inferred differences in shoulder function. For example, the ratio of supraspinous fossa/infraspinous fossa size in apes is commonly viewed as an indicator of the importance of overhead use of the forelimb, yet paradoxically, the African apes, the most terrestrial of the great apes, have higher scapular fossa ratios than the more suspensory orangutan. The recent discovery of several nearly complete early hominin scapular specimens, and their apparent morphological affinities to scapulae of orangutans and gorillas rather than chimpanzees, has led to renewed interest in the comparative analysis of human and extant ape scapular form. To facilitate the functional interpretation of differences in ape scapulae, particularly in regard to relative scapular fossa size, we used electromyography (EMG) to document the activity patterns in all four rotator cuff muscles in orangutans and gibbons, comparing the results with previously published data for chimpanzees. The EMG results indicate that the distinctive contributions of each cuff muscle to locomotion are the same in the three ape species, failing to support inferences of differences in rotator cuff function based on relative scapular fossa size comparisons. It is also shown that relative scapular fossa size is not in fact a good predictor of either the relative masses or cross-sectional areas of the rotator cuff muscles in apes, and relative fossa size gives a false impression of the importance of individual cuff muscles to locomotor differences among apes. A possible explanation for the disparity between fossa and muscle size relates to the underappreciated role of the scapular spine in structural reinforcement of the blade. PMID:23968682

Larson, Susan G; Stern, Jack T

2013-10-01

364

[Vaginal candidiasis--treatment protocols using miconazole and fluconazole].  

PubMed

The incidence of fungal infections is growing in the last 20 years. The epidemiological studies show that 45% of all vaginal infections are caused by Candida albicans or other Candida species. 7 out of 10 women suffer from yeast infection at least once in a lifetime and 4 out of 10 have multiple recurrences. 20-55% of women have asyptomatic vaginal colonization with Candida species. It is strongly believed that fungal infection is not sexually transmitted disease. The route of transmission is oral and it is estrogene dependant. The diagnosis is based on macroscopic, microscopic examination (KOH preparation), culture and rarely Pap test. Treatment of vaginal candidiosis is based on two principles: elimination of predisposing factors antifungal treatment Local treatment is the first line of choice in cases of acute vaginal yeast infection with 84-90% success rate. There are a variety of local preparations on our market including Nizoral, Clotrimazole, Canesten, Gyno-Daktarine, Gyno-Pevaryl, Miconazole. Different groups of broad spectrum oral antimycotics are also used including Nystatine, Ketoconazole (Nizoral), Fluconazole (Diflucan, Fungolon, Mycosyst), itraconazole (Orungal). The treatment of chronic, recurrent and resistant forms of vaginal candidosis is carried out with prolonged local and/or systemic therapy for a period of at least 6 months. Different regimes of therapy are proposed. Fluconazole is an oral drug of choice for continuous treatment of vaginal yeast infection with the least toxicity. PMID:14619753

Mazne?kova, V

2003-01-01

365

Assessment of Bony Pelvis and Vaginally Assisted Deliveries  

PubMed Central

Objective. To evaluate whether pelvic measurements have any association with operative vaginal deliveries and the duration of the second stage of the delivery. Study design. A retrospective study of pregnant women at an increased risk of fetal-pelvic disproportion during 2000–2008 in North-Carelian Central Hospital. The mode of the vaginal delivery was chosen to represent the reference standard. The target condition was spontaneous vaginal delivery. Patients were divided into subgroups according to the size of the fetus and also by the parity to evaluate the variability reflecting differences in patient groups. Receiver operating characteristic (ROC) curves were established. Results. A total of 226 participants with fetal cephalic presentation delivered vaginally; of these, 184 women delivered spontaneously, and 42 women required operative vaginal delivery with vacuum extraction. There were no clinically or statistically significant differences between the size of the maternal pelvic outlet and the different modes of delivery types within these subgroups. With respect to the pelvic inlet and outlet, the areas under the curve in ROC were 0.566 with the P value of 0.18 and 95% confidence interval (CI) of 0.465–0.667 and 0.573 (95% CI: 0.484–0.622; P = 0.14). Conclusions. The maternal bony pelvic dimensions exhibited virtually no correlation with the need for operative vaginal deliveries. PMID:23691343

Taipale, Pekka

2013-01-01

366

Bioadhesive mini-tablets for vaginal drug delivery.  

PubMed

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

Hiorth, Marianne; Nilsen, Susanne; Tho, Ingunn

2014-01-01

367

Liposomes containing drugs for treatment of vaginal infections.  

PubMed

To develop a novel vaginal delivery system, able to effectively deliver entrapped drugs during an extended period of time at the site of action, liposomes made of phosphatidylcholine were prepared by two different methods, namely the polyol dilution method and the proliposome method. Liposomes containing three commonly applied drugs in the treatment of vaginal infections: clotrimazole, metronidazole and chloramphenicol were tested for in vitro stability (in buffers at pH 4.5 and 5.9 representing pre- and postmenopausal vaginal pH). In situ stability (in the presence of cow vaginal mucosa) showed that after 6 h incubation (at 37 degrees C), liposomes retained more than 40% of originally entrapped clotrimazole, 28% of entrapped metronidazole or 37% of entrapped chloramphenicol. In vitro and in situ stability studies confirmed the applicability of liposomes as a carrier system for vaginal delivery. Even after 24 h of incubation in the presence of vaginal mucosa liposomes retained sufficient amounts of entrapped drugs. PMID:10425385

Paveli?, Z; Skalko-Basnet, N; Jalsenjak, I

1999-08-01

368

Improving photoacoustic imaging contrast of brachytherapy seeds  

NASA Astrophysics Data System (ADS)

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

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

2013-03-01

369

Coregistered photoacoustic-ultrasound imaging applied to brachytherapy  

NASA Astrophysics Data System (ADS)

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

Harrison, Tyler; Zemp, Roger J.

2011-08-01

370

21 CFR 892.5730 - Radionuclide brachytherapy source.  

Code of Federal Regulations, 2012 CFR

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

2012-04-01

371

21 CFR 892.5730 - Radionuclide brachytherapy source.  

Code of Federal Regulations, 2013 CFR

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

2013-04-01

372

21 CFR 892.5730 - Radionuclide brachytherapy source.  

Code of Federal Regulations, 2014 CFR

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

2014-04-01

373

21 CFR 892.5730 - Radionuclide brachytherapy source.  

Code of Federal Regulations, 2010 CFR

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

2010-04-01

374

Preparation and Characterisation of Fluconazole Vaginal Films for the Treatment of Vaginal Candidiasis  

PubMed Central

Objective of the present study was to develop and evaluate vaginal films with essential in vitro studies. Films were developed using hydroxypropyl methylcellulose as a polymer and formulations were coded. The developed films were evaluated with Fourier transform infrared spectroscopy, drug content, viscosity, surface pH, thickness, mechanical characterisation and in vitro drug release study. Fourier transform infrared spectroscopy results confirmed that there is no chemical interaction between drug and stabilisers/excipients. The batch variation was not more than 5% for average thickness and weight of the films. The drug content for the prepared formulation was in the range of 72.32±0.18% to 94.48±0.54%. Viscosity of the formulations increased with the increase in concentration of polymer. Mechanical characterisation revealed that tensile strength and percentage elongation of the films improved as there is increase in degree of substitution of the polymer, but the values of modulus decreased which confirmed that all the prepared films are soft in nature. The in vitro study indicated that 1 and 2% concentrations of polymer are the least concentrations to control the release of drug whereas the 4% concentration of polymer is a good and more effective concentration to control the release. Only one prepared formulation released the drug by following anomalous transport whereas other film formulations released the fluconazole by following Fickian diffusion mechanism. Prepared vaginal films may be an important alternative for the treatment of vaginal candidiasis, because these prepared films suggest the benefits of controlled release of fluconazole at the site of absorption. PMID:24403660

Kumar, L.; Reddy, M. S.; Shirodkar, R. K.; Pai, G. K.; Krishna, V. T.; Verma, R.

2013-01-01

375

Parameterization of brachytherapy source phase space file for Monte Carlo-based clinical brachytherapy dose calculation.  

PubMed

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

Zhang, M; Zou, W; Chen, T; Kim, L; Khan, A; Haffty, B; Yue, N J

2014-01-20

376

Parameterization of brachytherapy source phase space file for Monte Carlo-based clinical brachytherapy dose calculation  

NASA Astrophysics Data System (ADS)

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.

Zhang, M.; Zou, W.; Chen, T.; Kim, L.; Khan, A.; Haffty, B.; Yue, N. J.

2014-01-01

377

Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review  

PubMed Central

Purpose: To review the evidence for the effectiveness of therapeutic exercise for the treatment of full thickness (including massive and inoperable) tears of the rotator cuff. Relevance: There is little consensus as to the most effective treatment of full thickness and massive tears of the rotator cuff. There is consensus that the outcome of rotator cuff tendon surgery in the elderly is generally very poor. As such, exercise therapy is usually recommended for this patient group. Although commonly prescribed, the evidence to support this approach is equivocal. The aim of this study was to conduct a systematic review of the literature to determine the efficacy of exercise therapy for the management of full thickness rotator cuff tears. Methods: A systematic review was conducted to synthesise the available research literature on the effectiveness of exercise therapy for full thickness tears of the rotator cuff. Data source: Reports up to and including September 2006 were located from MEDLINE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane Database of Systematic Reviews and the Physiotherapy Evidence Database (PEDro) using the terms “rotator cuff” and “tear/s” and “exercise” or “physiotherapy” or “physical therapy” or “rehabilitation”. Study selection: Studies were included if they related to full thickness rotator cuff tears and exercise. Data extraction: Two independent reviewers assessed the methodological quality of the studies. Differences were resolved by consensus. Analysis/Data synthesis: Ten studies met the inclusion criteria: eight were observational case series and two were single case studies. There were no randomised clinical trials. Results: Four studies were specific to massive rotator cuff tears. One study had a sub?group with massive cuff tears and five studies were not specific as to the size of the full thickness tear. Due to the heterogeneity of outcome measures used, it was not possible to combine results. In all studies an improvement in outcome scores was reported. Exercise programmes were well documented in five studies. Conclusions: No randomised controlled trials met the inclusion criteria and the evaluation has been based on observational studies of lower scientific merit. The findings suggest that some evidence exists to support the use of exercise in the management of full thickness rotator cuff tears. There is a definite need for well?planned randomised controlled trials investigating the efficacy of exercise in the management of full thickness and massive rotator cuff tears. PMID:17264144

Ainsworth, Roberta; Lewis, Jeremy S

2007-01-01

378

Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial  

Microsoft Academic Search

Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease.Design Randomised, participant and single assessor blinded, placebo controlled trial.Setting Metropolitan region of Melbourne, Victoria, Australia.Participants 120 participants with chronic (>3 months) rotator cuff disease recruited through medical practitioners and from the community.Interventions

Kim Bennell; Elin Wee; Sally Coburn; Sally Green; Anthony Harris; Margaret Staples; Andrew Forbes; Rachelle Buchbinder

2010-01-01

379

Intratendinous strain fields of the supraspinatus tendon: Effect of a surgically created articular-surface rotator cuff tear  

Microsoft Academic Search

Articular-surface partial-thickness rotator cuff tears play a significant role in shoulder pathology, but the role of the articular-surface tissue is poorly understood. This investigation assessed the effect of an articular-surface partial-thickness rotator cuff tear on intratendinous strain fields. A magnetic resonance imaging–based technique quantified intratendinous strains in healthy cadaveric shoulders at 15°, 30°, 45°, and 60° of glenohumeral abduction. A

Michael J Bey; Matthew L Ramsey; Louis J Soslowsky

2002-01-01

380

Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position  

PubMed Central

Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n?=?38) and laparoscopic cholecystecomy (head-up position, n?=?32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26?±?3 to 32?±?6 and 27?±?3 to 33?±?5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p?cuff pressure from 33?±?5 to 35?±?5 cmH2O (p?cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. Conclusions An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position. PMID:25210501

2014-01-01

381

Vaginal suppositories containing Lactobacillus acidophilus: development and characterization.  

PubMed

Abstract Objective: The aim of this study was to develop and characterize suppositories for vaginal delivery of Lactobacillus acidophilus. Methods: Formulations were performed in order to select suitable excipients based on suppository formation feasibility and cytotoxicity. Solid body and hollow-type suppositories were prepared by melting and molding using poly(ethylene glycol) (PEG) 400 and 4000 or Witepsol (WIT) H12 as excipients. L. acidophilus was incorporated in the molten mass before molding solid body suppositories or added as suspension into the cavity of hollow-type suppositories and sealed molten excipients. Cytotoxicity of the selected excipients was evaluated by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium and lactate dehydrogenase assays against VK2/E6E7, HEC-1-A and HeLa cells. Suppositories were characterized regarding organoleptic characteristics, mass uniformity, disintegration, breaking strength and L. acidophilus in vitro release. Results: PEG 400, PEG 4000 and WIT H12 showed the absence of toxicity when tested using three different vaginal cell lines. Obtained vaginal suppositories presented uniform and mild texture, a content of about 1?×?10(8) colony-forming units, completely disintegrated in simulated vaginal environment in less than 60?min and provided sustained in vitro release of L. acidophilus. Release studies further demonstrated that incorporation of freeze-dried bacteria did not result in significant loss of viable bacteria, thus supporting that vaginal suppositories may possess good properties to promote the replacement of the vaginal flora in situations of urinary tract infection. Conclusion: Hollow-type suppositories showed to be promising delivery vehicles for vaginal delivery of probiotics. PMID:25265366

Rodrigues, Francisca; Maia, Maria João; das Neves, José; Sarmento, Bruno; Amaral, Maria Helena; P P Oliveira, Maria Beatriz

2014-09-29

382

Vaginal pH: A marker for menopause  

PubMed Central

Introduction: Menopause is suspected with age, cessation of menstruation for more than a year and presence of symptoms. The diagnosis of menopause is confirmed by follicle stimulating hormone (FSH) levels >40 IU/L. Few studies have focused on vaginal pH for menopausal diagnosis. It is a simple, non-invasive and inexpensive method for this purpose. Aim of the Study: The following study is to correlate the serum follicle stimulating hormone (FSH) level with vaginal pH estimation in menopause. Materials and Methods: This is a cross-sectional descriptive study conducted in 173 women aged 31-60 years with menopausal symptoms who attended the Menopausal Clinic of our hospital from January 2012 to January 2013. Vaginal pH was measured using pH micro-meter strips and serum FSH levels were measured using immunoassay methods. The data obtained was then analyzed using Statistical Package for the Social Sciences software (version 17) and results were evaluated statistically by the Chi-square and Kappa tests. P ? 0.05 was considered to be statistically significant. Results: According to our study of the 173 women studied, mean FSH level was 46.5 IU/L and mean vaginal pH was 5.3. If the menopausal hallmark is considered to be vaginal pH >4.5 and serum FSH ?40 IU/L, the sensitivity of vaginal pH for menopausal diagnosis was 84.9% and of serum FSH is 77.4%, respectively. Conclusion: Vaginal pH is a simple, accurate and cost-effective tool that can be suggested as a suitable and better alternative to serum FSH estimation for the diagnosis of menopause. PMID:24672204

Panda, Subrat; Das, Ananya; Singh, Ahanthem Santa; Pala, Star

2014-01-01

383

Arthroscopic management of recalcitrant stiffness following rotator cuff repair: A retrospective analysis  

PubMed Central

Background: Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair. Materials and Methods: Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24?70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2?36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1?43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test. Results: Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110?180° SD 22.3°), and ERS improved to 58.9°, (range 15?90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion. Conclusion: Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair. PMID:23682175

Bhatia, Sanjeev; Mather, Richard C; Hsu, Andrew R; Ferry, Amon T; Romeo, Anthony A; Nicholson, Gregory P; Cole, Brian J; Verma, Nikhil N

2013-01-01

384

Acid Production by Vaginal Flora In Vitro Is Consistent with the Rate and Extent of Vaginal Acidification  

PubMed Central

Perinatally, and between menarche and menopause, increased levels of estrogen cause large amounts of glycogen to be deposited in the vaginal epithelium. During these times, the anaerobic metabolism of the glycogen, by the epithelial cells themselves and/or by vaginal flora, causes the vagina to become acidic (pH ?4). This study was designed to test whether the characteristics of acid production by vaginal flora in vitro can account for vaginal acidity. Eight vaginal Lactobacillus isolates from four species—L. gasseri, L. vaginalis, L. crispatus, and L. jensenii—acidified their growth medium to an asymptotic pH (3.2 to 4.8) that matches the range seen in the Lactobacillus-dominated human vagina (pH 3.6 to 4.5 in most women) (B. Andersch, L. Forssman, K. Lincoln, and P. Torstensson, Gynecol. Obstet. Investig. 21:19–25, 1986; L. Cohen, Br. J. Vener. Dis. 45:241–246, 1969; J. Paavonen, Scand. J. Infect. Dis. Suppl. 40:31–35, 1983; C. Tevi-Bénissan, L. Bélec, M. Lévy, V. Schneider-Fauveau, A. Si Mohamed, M.-C. Hallouin, M. Matta, and G. Grésenguet, Clin. Diagn. Lab. Immunol. 4:367–374, 1997). During exponential growth, all of these Lactobacillus species acidified their growth medium at rates on the order of 106 protons/bacterium/s. Such rates, combined with an estimate of the total number of lactobacilli in the vagina, suggest that vaginal lactobacilli could reacidify the vagina at the rate observed postcoitally following neutralization by the male ejaculate (W. H. Masters and V. E. Johnson, Human sexual response, p. 93, 1966). During bacterial vaginosis (BV), there is a loss of vaginal acidity, and the vaginal pH rises to >4.5. This correlates with a loss of lactobacilli and an overgrowth of diverse bacteria. Three BV-associated bacteria, Gardnerella vaginalis, Prevotella bivia, and Peptostreptococcus anaerobius, acidified their growth medium to an asymptotic pH (4.7 to 6.0) consistent with the characteristic elevated vaginal pH associated with BV. Together, these observations are consistent with vaginal flora, rather than epithelial cells, playing a primary role in creating the acidity of the vagina. PMID:10496892

Boskey, E. R.; Telsch, K. M.; Whaley, K. J.; Moench, T. R.; Cone, R. A.

1999-01-01

385

Clinical evaluation of three-day treatment of vaginal mycosis with clotrimazole vaginal tablets.  

PubMed

A double-blind study was conducted comparing a 3-day (200 mg once a day for 3 consecutive days) treatment with a 6-day (100 mg once a day for 6 consecutive days) treatment of clotrimazole in patients with vaginal mycoses. Two days after therapy, fungal eradication was achieved in 87.7% of the patients who received 3-day therapy and 89.1% of patients who received 6-day therapy. With regard to the clinical assessment, 2 days after therapy the symptoms had disappeared in 54.4%, improvement in 42.1%, were unchanged in 1.8%, and aggravated in 1.8% of the 3-day therapy group. The corresponding values in the 6-day group were 63.6%, 34.5%, 1.8% and 0%. Reappearance of fungi was found 2 weeks after therapy in 15.6% of the 3-day treatment group and 8.7% of the 6-day treatment group. No adverse reactions were seen in either group which necessitated the discontinuation of therapy. There were no statistical differences between any of the above results and it is therefore concluded that 3-day clotrimazole therapy is an effective treatment for primary vaginal mycosis. PMID:6347750

Mizuno, S; Cho, N

1983-01-01

386

Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy  

PubMed Central

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

Shetty, Jyothi; Shanbhag, Asha

2014-01-01

387

Haptic System Design for MRI-Guided Needle Based Prostate Brachytherapy  

E-print Network

Feedback, Needle Driver, Prostate Needle Brachytherapy. 1 INTRODUCTION Prostate cancer is the most common biopsies are performed, yielding about 220,000 new prostate cancer cases [14]. Over 40,000 brachytherapiesHaptic System Design for MRI-Guided Needle Based Prostate Brachytherapy Hao Su Weijian Shang

Camesano, Terri

388

Brachytherapy 3 (2004) 147152 Comparison of inverse planning simulated annealing and geometrical  

E-print Network

optimization for prostate high-dose-rate brachytherapy I-Chow J. Hsu1,*, Etienne Lessard1 , Vivian Weinberg2. In this study, IPSA is compared with geometrical optimization (GO) for prostate brachytherapy. METHODS: Optimization; Inverse planning; Simulated annealing; Geometric optimization; HDR prostate brachytherapy

Pouliot, Jean

389

Iodine seed prostate brachytherapy: an alternative first-line choice for early prostate cancer  

Microsoft Academic Search

This article on permanent iodine-125 seed prostate brachytherapy reviews the techniques, results, and patient selection issues for early prostate cancer. The long-term 10 y results of brachytherapy from Seattle, and their reproducibility in other centres both in the USA and UK are reported. The use of hormone therapy in brachytherapy and the value of combining external beam radiotherapy with a

S E M Langley; R W Laing; SEM Langley

2004-01-01

390

An overview of interstitial brachytherapy and hyperthermia  

SciTech Connect

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.

Brandt, B.B.; Harney, J.

1989-11-01

391

A dynamic dosimetry system for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

The lack of dynamic dosimetry tools for permanent prostate brachytherapy causes otherwise avoidable problems in prostate cancer patient care. The goal of this work is to satisfy this need in a readily adoptable manner. Using the ubiquitous ultrasound scanner and mobile non-isocentric C-arm, we show that dynamic dosimetry is now possible with only the addition of an arbitrarily configured marker-based fiducial. Not only is the system easily configured from accessible hardware, but it is also simple and convenient, requiring little training from technicians. Furthermore, the proposed system is built upon robust algorithms of seed segmentation, fiducial detection, seed reconstruction, and image registration. All individual steps of the pipeline have been thoroughly tested, and the system as a whole has been validated on a study of 25 patients. The system has shown excellent results of accurately computing dose, and does so with minimal manual intervention, therefore showing promise for widespread adoption of dynamic dosimetry.

Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Song, Danny Y.; Prince, Jerry L.; Lee, Junghoon

2013-03-01

392

Automatic Brachytherapy Seed Placement Under MRI Guidance  

PubMed Central

The paper presents a robotic method of performing low dose rate prostate brachytherapy under magnetic resonance imaging (MRI) guidance. The design and operation of a fully automated MR compatible seed injector is presented. This is used with the MrBot robot for transperineal percutaneous prostate access. A new image-registration marker and algorithms are also presented. The system is integrated and tested with a 3T MRI scanner. Tests compare three different registration methods, assess the precision of performing automated seed deployment, and use the seeds to assess the accuracy of needle targeting under image guidance. Under the ideal conditions of the in vitro experiments, results show outstanding image-guided needle and seed placement accuracy. PMID:17694871

Patriciu, Alexandru; Petrisor, Doru; Muntener, Michael; Mazilu, Dumitru; Schär, Michael; Stoianovici, Dan

2011-01-01

393

Vaginal yeasts in the era of "over the counter" antifungals  

PubMed Central

Objective: To establish whether there has been any rise in the prevalence of non-albicans Candida species isolated from vaginal swabs since the introduction of "over the counter" antifungal treatments. Method: A retrospective review looking at all positive vaginal yeast isolates collected from women attending one genitourinary medicine clinic during the 6 year period from 1993 to 1998 inclusive. All positive vaginal yeast isolates were included, regardless of whether or not the patients were symptomatic. Isolates from HIV positive women were excluded from the analysis. Result: No increase in non-albicans vaginal yeast isolates was shown during the period studied. The proportion of non-albicans yeasts remained constant at approximately 5% of the total yeasts isolated. The most common non-albicans yeast isolated was C glabrata. Conclusion: There is no evidence from this study to suggest that the increasing use of "over the counter" antifungal treatment has selected for atypical, possibly inherently azole resistant, strains of vaginal yeasts in HIV seronegative women. Key Words: vulvovaginal candidiasis; non-albicans species; antifungal drug resistance PMID:11221124

Walker, P; Reynolds, M; Ashbee, H; Brown, C; Evans, E

2000-01-01

394

Vaginal microbiota of women with frequent vulvovaginal candidiasis.  

PubMed

Vulvovaginal candidiasis (VVC) is an insidious infection that afflicts a large proportion of women of all ages, and 5 to 8% of affected women experience recurrent VVC (RVVC). The aim of this study was to explore the possible importance of vaginal bacterial communities in reducing the risk of RVVC. The species composition and diversity of microbial communities were evaluated for 42 women with and without frequent VVC based on profiles of terminal restriction fragment polymorphisms of 16S rRNA genes and phylogenetic analysis of cloned 16S rRNA gene sequences from the numerically dominant microbial populations. The data showed that there were no significant differences between the vaginal microbial communities of women in the two groups (likelihood score, 5.948; bootstrap P value, 0.26). Moreover, no novel bacteria were found in the communities of women with frequent VVC. The vaginal communities of most women in both groups (38/42; 90%) were dominated by species of Lactobacillus. The results of this study failed to provide evidence for the existence of altered or unusual vaginal bacterial communities in women who have frequent VVC compared to women who do not have frequent VVC. The findings suggest that commensal vaginal bacterial species may not be able to prevent VVC. PMID:19528218

Zhou, Xia; Westman, Rachel; Hickey, Roxana; Hansmann, Melanie A; Kennedy, Colleen; Osborn, Thomas W; Forney, Larry J

2009-09-01

395

Air-kerma strength determination of a miniature x-ray source for brachytherapy applications  

NASA Astrophysics Data System (ADS)

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.

Davis, Stephen D.

396

The relative strengths of the rotator cuff muscles. A cadaver study.  

PubMed

We studied five cadaver shoulders to determine the strength relationship of the four rotator cuff muscles. The mean fibre length and volume of each muscle were measured, from which the physiological cross-sectional area was calculated. This value was used to estimate the force which each muscle was capable of generating. The lever arm of each muscle about the humeral head was then measured and the moment exerted was calculated. The strength ratios between the muscles were more or less constant in the five specimens. Subscapularis was the most powerful muscle and contributed 53% of the cuff moment; supraspinatus contributed 14%, infraspinatus 22% and teres minor 10%. The force-generating capacity of the subscapularis was equal to that of the other three muscles combined. PMID:8421011

Keating, J F; Waterworth, P; Shaw-Dunn, J; Crossan, J

1993-01-01

397

Current status of contraceptive vaginal rings.  

PubMed

Contraceptive vaginal rings (CVR) offer a new, effective contraceptive option, expanding the available choices of hormonal contraception. Various ring prototypes have been evaluated: progestin-only rings and combined progestin-estrogen rings, as well as different combination of progestins and estrogens. The progestin-only ring is intended for continuous use, whereas the combined ring has been designed for cyclic 3-week in/1-week out use, although several studies have explored alternative schemes of extended use. However, only two ring designs have reached the market: NuvaRing, a 1-month combined ring that releases etonogestrel and ethinylestradiol, and Progering, a 3-month progesterone-releasing ring for use in lactating women. A one year Nestorone/ethinyl estradiol CVR is approaching the final stages of development, as the Population Council is preparing to submit a new drug application to the Food and Drug Administration. The main advantages of CVRs are their effectiveness (similar or slightly better than the pill), ease of use without the need of remembering a daily routine, user ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring, in comparison with oral contraceptives. Current prototypes in development include rings releasing progesterone receptor modulators, which would provide estrogen-free contraception, as well as combined rings releasing estradiol, instead of ethinyl-estradiol, providing a safer profile. Furthermore, intensive efforts towards developing dual protection rings, providing both contraception and protection against reproductive tract infections, offer hope that this greatly needed technology will soon undergo clinical testing and will be in the hands of women worldwide in the near future. PMID:23040125

Brache, Vivian; Payán, Luis José; Faundes, Aníbal

2013-03-01

398

77 FR 8900 - Certain Vaginal Ring Birth Control Devices; Termination of the Investigation Based on Withdrawal...  

Federal Register 2010, 2011, 2012, 2013, 2014

...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...

2012-02-15

399

[Salvage 125I brachytherapy of locally recurrent prostate cancer].  

PubMed

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

Gesztesi, László; Agoston, Péter; Major, Tibor; Gõdény, Mária; Andi, Judit; Lengyel, Zsolt; Polgár, Csaba

2014-09-01

400

Long Head of the Biceps Pathology Combined with Rotator Cuff Tears  

PubMed Central

The long head of the biceps tendon (LHBT) is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT) tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies. PMID:23209915

Ditsios, Konstantinos; Agathangelidis, Filon; Boutsiadis, Achilleas; Karataglis, Dimitrios; Papadopoulos, Pericles

2012-01-01

401

Comparison of rotator cuff muscle architecture between humans and other selected vertebrate species  

PubMed Central

In this study, we compare rotator cuff muscle architecture of typically used animal models with that of humans and quantify the scaling relationships of these muscles across mammals. The four muscles that correspond to the human rotator cuff – supraspinatus, infraspinatus, subscapularis and teres minor – of 10 commonly studied animals were excised and subjected to a series of comparative measurements. When body mass among animals was regressed against physiological cross-sectional area, muscle mass and normalized fiber length, the confidence intervals suggested geometric scaling but did not exclude other scaling relationships. Based on the architectural difference index (ADI), a combined measure of fiber length-to-moment arm ratio, fiber length-to-muscle length ratio and the fraction of the total rotator cuff physiological cross-sectional area contributed by each muscle, chimpanzees were found to be the most similar to humans (ADI=2.15), followed closely by capuchins (ADI=2.16). Interestingly, of the eight non-primates studied, smaller mammals such as mice, rats and dogs were more similar to humans in architectural parameters compared with larger mammals such as sheep, pigs or cows. The force production versus velocity trade-off (indicated by fiber length-to-moment arm ratio) and the excursion ability (indicated by fiber length-to-muscle length ratio) of humans were also most similar to those of primates, followed by the small mammals. Overall, primates provide the best architectural representation of human muscle architecture. However, based on the muscle architectural parameters of non-primates, smaller rather than larger mammals may be better models for studying muscles related to the human rotator cuff. PMID:24072803

Mathewson, Margie A.; Kwan, Alan; Eng, Carolyn M.; Lieber, Richard L.; Ward, Samuel R.

2014-01-01

402

Cerebral autoregulation index at high altitude assessed by leg cuff and transfer function analysis techniques.  

PubMed

The occurrence and implications of changes in cerebral autoregulation (CA) at high altitude are controversial and confounded by differences in methods used to assess CA. To compare two of the most common methods of dynamic CA assessment, we studied 11 young, healthy sea-level residents (6 female, 5 male; 20.5 ± 2.3 years) as they ascended and acclimatized to 3424 m over 13 days. A common autoregulation index (ARI) was calculated from 1) transfer function analysis (TFA ARI) of resting oscillations in arterial blood pressure (ABP; finger plethysmography) and middle cerebral artery blood velocity (MCAv; transcranial Doppler), and 2) MCAv responses following large, abrupt drops in ABP using the classic leg cuff technique (Cuff ARI). Symptoms of acute mountain sickness (AMS) were monitored using the Lake Louise AMS Questionnaire. Cuff ARI scores decreased (P = 0.021) as subjects ascended from low (4.7± 1.5) to high altitude (3.2 ± 1.6) and did not change after 13 days of acclimatization (2.9 ± 1.3). TFA ARI scores were not affected by ascent or acclimatization to 3424 m. Neither Cuff nor TFA ARI scores were correlated with AMS symptoms. These findings suggest that the cerebral vasculature of healthy individuals may become less able to buffer large step changes in ABP, while still maintaining the ability to regulate slow rhythmical oscillations, during periods of moderate hypoxemia. Given the inherent differences in the autoregulatory stimulus between methods, multiple assessment techniques may be needed to clarify the implications of changes in cerebrovascular regulation at high altitude. This article is protected by copyright. All rights reserved. PMID:25480158

Subudhi, Andrew W; Grajzel, Katalin; Langolf, Robert J; Roach, Robert C; Panerai, Ronney B; Davis, John E

2014-12-01

403

The Biomechanical and Histologic Effects of Platelet-Rich Plasma on Rat Rotator Cuff Repairs  

PubMed Central

Background Rotator cuff tears are common injuries that are often treated with surgical repair. Because of the high concentration of growth factors within platelets, platelet-rich plasma (PRP) has the potential to enhance healing in rotator cuff repairs. Hypothesis Platelet-rich plasma would alter the biomechanical and histologic properties of rotator cuff repair during an acute injury response. Study Design Controlled laboratory study. Methods Platelet-rich plasma was produced from inbred donor rats. A tendon-from-bone supraspinatus tear was created surgically and an immediate transosseous repair performed. The control group underwent repair only. The PRP group underwent a repair with PRP augmentation. Rats in each group were sacrificed at 7, 14, and 21 days. The surgically repaired tendons underwent biomechanical testing, including failure load, stiffness, failure strain, and stress relaxation characteristics. Histological analysis evaluated the cellular characteristics of the repair tissue. Results At 7- and 21-day periods, augmentation with PRP showed statistically significant effects on the biomechanical properties of the repaired rat supraspinatus tear, but failure load was not increased at the 7-, 14-, or 21-day periods (P = .688, .209, and .477, respectively). The control group had significantly higher stiffness at 21 days (P = .006). The control group had higher failure strain at 7 days (P = .02), whereas the PRP group had higher failure strain at 21 days (P = .008). Histologically, the PRP group showed increased fibroblastic response and vascular proliferation at each time point. At 21 days, the collagen fibers in the PRP group were oriented in a more linear fashion toward the tendon footprint. Conclusion In this controlled, rat model study, PRP altered the tissue properties of the supraspinatus tendon without affecting the construct’s failure load. Clinical Relevance The decreased tendon tissue stiffness acutely and failure to enhance tendon-to-bone healing of repairs should be considered before augmenting rotator cuff repairs with PRP. Further studies will be necessary to determine the role of PRP in clinical practice. PMID:22822177

Beck, Jennifer; Evans, Douglas; Tonino, Pietro M.; Yong, Sherri; Callaci, John J.

2013-01-01

404

Extracorporeal Shock Wave Therapy in the Treatment of Calcific Tendinitis of the Rotator Cuff  

Microsoft Academic Search

Background: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff.Hypothesis: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback.Study Design: Randomized controlled clinical trial; Level of evidence, 1.Methods: A prospective, randomized, single-blind study was carried

Manuel Sabeti-Aschraf; Ronald Dorotka; Alexandra Goll; Klemens Trieb

2005-01-01

405

Three-day therapy of vaginal candidiasis with clotrimazole vaginal tablets and econazole ovules: a multicenter comparative study.  

PubMed

The activity and tolerance of 200 mg clotrimazole vaginal tablets and 150 mg econazole vaginal ovules were compared in the treatment of vaginal candidiasis in a controlled multicenter (3 centers) study. Treatment was allocated according to a randomized list and each investigator treated 20 patients per group. Duration of therapy was 3 days. Follow-up investigations were carried out approximately 1 and 4 weeks after commencement of treatment. The results were analyzed for 54 patients treated with clotrimazole and 57 with econazole; 9 patients were excluded from the analysis because of insufficient data. At the first follow-up examination, 1 week after starting therapy, 93.7% of patients on clotrimazole and 83.7% of patients on econazole had negative cultures. The success of therapy, as judged by the clinicians, was 95.8% for clotrimazole and 88.0% for econazole. For the first and fourth week combined reviews, 86.0% of clotrimazole patients and 77.8% of econazole patients had negative cultures and the success of therapy was 88.4% for clotrimazole and 80.0% for econazole. These differences were not statistically significant but there was a clear numerical superiority for clotrimazole. Tolerance was good in all the patients and no side-effects were observed. One can conclude that the treatment of vaginal candidiasis with a 200-mg vaginal tablet of clotrimazole over 3 days is highly effective and comparable with other established treatment regimes. PMID:6761088

Stettendorf, S; Benijts, G; Vignali, M; Kreysing, W

1982-01-01

406

The treatment of postmenopausal vaginal atrophy with Ovestin vaginal cream or suppositories: clinical, endocrinological and safety aspects.  

PubMed

Seventy-four postmenopausal women presenting with vaginal atrophy were treated with either Ovestin vaginal cream (Group A, 23 women: 1 mg/day E3; Group B, 30 women: 0.5 mg/day E3) or vaginal suppositories (Group C, 21 women: 0.5 mg/day E3), applied daily for 3 wk (A and B) or 2 wk (C) before retiring. Ten women from A and 10 from B applied a maintenance dose (1 application twice weekly) during wk 4-16. Effects on vaginal cytology, cervical mucus and clinical and colposcopic findings were studied. Endometrial biopsies were done in 16 patients (A) before and after 3 wk of treatment, and, in 8 of the cases, at 16 wk. A routine laboratory screening program was performed before and after 16 wk of treatment in 10 patients (A). Plasma samples for hormone level determinations were obtained in 32 patients. Clinical and colposcopic findings showed a beneficial effect of treatments, confirmed by vaginal smears, and persisting during maintenance therapy. Effect on cervical mucus was slight to moderate. No side effects occurred and tolerance was very good. Endometrium remained atrophic under treatment. Screening program revealed no abnormalities. Treatments induced a sharp rise in plasma E3, followed by a gradual decline. Gonadotropins were slightly suppressed. E1, E2, PRL and SHBG capacity remained unchanged. PMID:6785553

Kicovic, P M; Cortes-Prieto, J; Milojevi?, S; Haspels, A A; Aljinovic, A

1980-12-01

407

Laparoscopic Supracervical Hysterectomy Compared With Abdominal, Vaginal, and Laparoscopic Vaginal Hysterectomy in a Primary Care Hospital Setting  

PubMed Central

Objective: This study compares the operative parameters of laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, and total abdominal hysterectomy in patients in a small suburban medical center. Methods: This investigation is a Canadian Classification II-2. It was performed in a 238 bed not-for-profit community general hospital. Charts of 117 patients were reviewed. These patients had undergone the following procedures: laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, total abdominal hysterectomy; questionnaires completed by the patients were reviewed. All patients had hysterectomies performed by members of the Ob/Gyn department of Alamance Regional Medical Center. Comparisons of intraoperative and postoperative events were made in those patients who consented to the study and who returned their questionnaires. Parameters compared were patient age, weight, preoperative diagnosis, operative time, operative complications, blood loss, uterine weight, length of stay, postoperative complications, return to hospital, return to work, resumption of intercourse, dyspareunia, and bowel or bladder problems. Results: Patient demographics and outcomes are similar. Laparoscopic supracervical hysterectomy showed lower morbidity and quicker return to normal function, but most findings did not reach statistical significance. Conclusion: The results support the conclusion that the patients in each arm of the study are similar. The operative parameters show a longer operating time for the laparoscopic procedures than for total abdominal hysterectomy and total vaginal hysterectomy, respectively. The other indicators of morbidity show slight advantages of laparoscopic supracervical hysterectomy in blood loss, length of stay, and resumption of normal activities. PMID:16121874

2005-01-01

408

Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.  

PubMed

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions. PMID:25153817

Chavan, Prithviraj; Gothelf, Todd K; Nord, Keith M; Garrett, William H; Nord, Keith D

2014-01-01

409

COMPREHENSIVE STRENGTH TRAINING PROGRAM FOR A RECREATIONAL SENIOR GOLFER 11-MONTHS AFTER A ROTATOR CUFF REPAIR  

PubMed Central

Background and Purpose: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. Case Description: The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. Outcomes: The subject made improvements in power and muscular endurance of the core. She was able to resume