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1

Large vesico-vaginal fistula caused by a foreign body.  

PubMed

Foreign body is a rare cause of vesico-vaginal fistula most often reported in developed countries. In developing countries obstructed labor is the commonest cause of fistula. A nulliparous 19-year-old female presented with a 3-week history of a foreign body in the vagina causing urinary incontinence and offensive vaginal discharge. Her guardian allegedly inserted the foreign body after she refused a pre-arranged marriage. A plastic container was removed from the vagina under general anesthesia. A large vesico-vaginal fistula was discovered, which was successfully surgically repaired. We recommend urgent removal of the foreign body, preferably under general anesthesia. However, if the history or physical examination reveals prolonged exposure, repair of the fistula should be delayed to allow for adequate debridement in order to prevent any life-threatening complications. PMID:24116334

Massinde, An; Kihunrwa, A

2013-07-01

2

Vesico-vaginal fistula in a patient with Meyer-Rokitansky-Kuster-Hauser syndrome.  

PubMed

This was a case of Gishiri cut in a patient with Meyer-Rokitansky-Kuster-Hauser syndrome resulting in a vesico-vaginal fistula and urethral loss. This followed an attempt to enlarge and lengthen the vagina to enhance penile penetration. Few cases of MRKH syndrome presenting with complications after an attempt at treatment by traditional birth attendants have been reported. This report is particularly of essence as most urinary fistulae in Nigeria are obstetric fistulae following prolonged obstructed labour. PMID:20348986

Okusanya, B O; Garba, K K D

2010-03-01

3

Transvaginal repair of a vesico-vaginal fistula using a mobilised vaginal flap to form the bladder base: a case report  

Microsoft Academic Search

We describe a case of a vesico-vaginal fistula in a 32-year-old lady presenting with true urinary incontinence. There was\\u000a a 1.5×1.5 cm deficit in the bladder wall and the left ureteric orifice was very close to the edge of the defect. For a successful\\u000a transvaginal repair, we used a mobilized vaginal flap to bridge the defect in the bladder wall. This

J. B. Sharma; A. Seth; S. Mittal

2006-01-01

4

Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography.  

PubMed

Intravenous urographies carried out routinely on 216 cases of vesico-vaginal fistulae were reviewed. All the patients had suffered from urinary incontinence following obstructed labour for periods varying from immediate post-partum period to as long as 35 years with the majority (48%) presenting in the first year of the disease. One hundred and eleven patients (51-4%) showed no urinary tract abnormality. Calyceal abnormality was graded from 1-5 in ascending order of severity. The most frequent abnormality was Grade 1 (or minimal calyceal blunting) found in 75 (71%) of 105 cases showing lesions. Ten patients had non-functioning kidneys. There was no correlation of severity of calyceal grading with duration of the disease. Other notable changes were hydroureter in 75 (34%), medial deviation of the terminal ureters in 21 (9-7%) and bladder calculi in four. The study reveals a high risk of morbidity to the kidneys in patients with vesico-vaginal fistulae and the predominant role of fibrous itssue in tis genesis is postulated. PMID:1000897

Lagundoye, S B; Bell, D; Gill, G; Ogunbode, O

1976-10-01

5

Vesico-acetabular cutaneous fistula: a delayed complication of hip surgery.  

PubMed

Vesico-acetabular cutaneous fistula is an uncommon but important postoperative complication of prosthetic hip surgery. We present a case and images involving a 70-year-old woman who presented with a chronically discharging gluteal wound, 5 years after a complex composite hip replacement. PMID:20708222

Jones, Abeyna L C; Acher, Pete; Cynk, Mark

2011-08-01

6

Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: A case report and review of literature.  

PubMed

Association between Prune belly syndrome (PBS) and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction. PMID:24311916

Sarhan, Osama M; Al-Ghanbar, Mustafa S; Nakshabandi, Ziad M

2013-10-01

7

Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: A case report and review of literature  

PubMed Central

Association between Prune belly syndrome (PBS) and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction. PMID:24311916

Sarhan, Osama M.; Al-Ghanbar, Mustafa S.; Nakshabandi, Ziad M.

2013-01-01

8

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

9

Repair of urinary tract fistulas with bulbocavernosus myocutaneous flaps  

SciTech Connect

Urinary tract fistulas resulting from severe trauma or pelvic irradiation are often associated with extensive tissue loss, scar formation, and fibrosis. Two cases, one with a urethro-vaginal fistula secondary to trauma and one with a vesico-vaginal fistula secondary to irradiation, are presented. In neither case could the bladder, urethra, or vagina be repaired primarily. Using a bulbocavernosus myocutaneous ''island'' flap, the fistulas were successfully repaired. The anatomy of the graft and the operative procedure are described. This new procedure should be considered in urinary tract fistulas in which there is extensive tissue loss and scarring.

Hoskins, W.J.; Park, R.C.; Long, R.; Artman, L.E.; McMahon, E.B.

1984-04-01

10

Do unplanned cystotomies during vaginal operative procedures lead to vesicovaginal fistulae or other complications?  

Microsoft Academic Search

Urology has recently experienced a renewed interest in vaginal operative procedures such as bladderneck suspension, vesicovaginal fistula closure, fascial slings and artificial urinary sphincters. Because many vaginal operations are done on patients who have had previous bladder neck or urethral surgeries, considerable scar tissue may be encountered. With the absence of normal tissue planes unplanned cystotomy may occur. These patients

R. Hadley; R. C. Myers; H. C. Ruckle

1994-01-01

11

Vaginocutaneous fistula and inguinal abcess presented 6 years after tension-free vaginal tape sling.  

PubMed

Surgical treatment of female stress urinary incontinence (SUI) has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF) plus inguinal abcess after tension-free vaginal tape (TVT). A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT. PMID:23820661

?ahin, Ali Feyzullah; ?lbey, Yusuf Özlem; ?ahin, Nur

2013-06-01

12

A new method to repair recto-vaginal fistula: Use of human amniotic membrane in an animal model  

PubMed Central

Background: Recto-vaginal fistula is primarily one of the co-morbidities of vaginal delivery. These patients suffer from persistent malodor vaginal discharge. Various surgical techniques have been employed by surgeons in the course of time. This is the first trial of applying Human Amniotic Membrane (HAM) as a bio-prosthesis in repairing recto-vaginal fistula. Materials and Methods: In a prospective animal study, 8 mixed-breed female dogs weighing 23-27 kg with the age of 12-18 months were selected. They were randomly divided into two groups for standard recto-vaginal fistula repair and fistula repair with human amniotic membrane. The Kruskal-Wallis and Mann Whitney tests were performed to indicate statistical differences. Results: After 6 weeks, fistulas were evaluated both grossly and microscopically. In gross examination, there were no difference between the two groups and healing of fistula seemed to have been occurred in all dogs expect for one which had a persistent patent fistulous tract. Microscopic healing was scored according to epithelialization, collagenization inflammation, ulcer and necrosis of samples. Healing score was significantly higher in the HAM group than the standard group (P = 0.029). Conclusion: Our findings revealed that using HAM as a bio-prosthesis to repair recto-vaginal fistula would result in better surgical and histological outcomes comparing to simple repair. PMID:24804188

Roshanravan, Reza; Ghahramani, Leila; Hosseinzadeh, Massood; Mohammadipour, Mastoureh; Moslemi, Sam; Rezaianzadeh, Abbas; Safarpour, Ali Reza; Rahimikazerooni, Salar; Hosseini, Seyed Vahid

2014-01-01

13

Gluteo-vaginal fistula after posterior intravaginal slingplasty: a case report.  

PubMed

In patients with posthysterectomy prolapse of the vaginal vault, the posterior intravaginal slingplasty (posterior IVS, Tyco Healthcare, USA) has been suggested as an alternative to traditional vaginal vault suspensions. The goal of this technique is to recreate the uterosacral ligaments and to reinforce the rectovaginal fascia with the use of prosthetic material. We report the case of a 53-year-old woman with a history of 27 months of perineal suppurative discharge after she underwent a vaginal vault prolapse and rectocele repair using a posterior IVS (Tyco Healthcare, USA). The IVS tape was reinforced by interposing a rectovaginal monofilament polypropylene mesh (Parietex, Sofradim, France). Imaging studies and surgical exploration confirmed infection of the IVS mesh with the formation of a gluteo-vaginal fistula while the rectovaginal mesh was intact. PMID:19015799

Grynberg, Michael; Teyssedre, Jacques; Staerman, Frederic

2009-07-01

14

Fistulas  

MedlinePLUS

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between ... two arteries. Some people are born with a fistula. Other common causes of fistulas include Complications from ...

15

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

16

Placenta percreta with a vaginal fistula after successful management by uterine transverse fundal incision and subsequent cesarean hysterectomy.  

PubMed

Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature. PMID:25264531

Matsuzaki, Satoko; Matsuzaki, Shinya; Ueda, Yutaka; Egawa-Takata, Tomomi; Mimura, Kazuya; Kanagawa, Takeshi; Morii, Eiichi; Kimura, Tadashi

2014-09-01

17

Placenta percreta with a vaginal fistula after successful management by uterine transverse fundal incision and subsequent cesarean hysterectomy  

PubMed Central

Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature. PMID:25264531

Matsuzaki, Satoko; Ueda, Yutaka; Egawa-Takata, Tomomi; Mimura, Kazuya; Kanagawa, Takeshi; Morii, Eiichi; Kimura, Tadashi

2014-01-01

18

Case report: diagnosis and management of peritoneovaginal fistula.  

PubMed

Fallopian tube vaginal fistula, a form of peritoneovaginal fistula, is an uncommon cause of persistent vaginal leakage after hysterectomy. Fallopian tube vaginal fistula resulting in peritoneal leakage has been reported in conjunction with a prolapsed fimbria. Herein is presented a case of fallopian tube vaginal fistula without a visibly prolapsed tubal fimbria. The patient was a 43-year-old woman with a 6-year history of cyclic vaginal leakage with onset shortly after vaginal hysterectomy. Examination using a vaginal speculum revealed a clear vaginal fluid but no distinct lesion or mass in the vagina, and bimanual examination did not reveal a vesicovaginal or ureterovaginal fistula. Laparoscopic surgical exploration revealed a densely adherent fallopian tube attached to the vaginal cuff, forming a fallopian tube vaginal fistula. PMID:24910932

Quezada, Yarini; Karram, Mickey; Whiteside, James L

2015-01-01

19

Meckel's diverticulum: an exceptional cause of vesicoenteric fistula: case report and literature review  

PubMed Central

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can cause complications in the form of ulceration, hemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae as noted in six previously reported cases. 66-year-old woman was presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel?s diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike four of the six previously reported cases, our patient had no coexisting bowel or bladder disease occurring with her vesico-diverticular fistula. Conclusion: This is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel?s diverticulum that did not contain ectopic tissue. PMID:23847706

Bouassida, Mahdi; Mighri, Mohamed Mongi; Trigui, Khaled; Chtourou, Mohamed Fadhel; Sassi, Selim; Feidi, Bilel; Chebbi, Fathi; Bouzaidi, Khaled; Touinsi, Hassen; Sassi, Sadok

2013-01-01

20

Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations  

PubMed Central

Background Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. Description The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. Conclusions Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis. PMID:24266908

2013-01-01

21

Gastrointestinal fistula  

MedlinePLUS

Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... Most gastrointestinal fistulas occur after surgery. Other causes include: Blockage in the gastrointestinal tract Infection Inflammatory bowel disease (most often Crohn's ...

22

An uncommon case of inflammatory infiltration of the urinary bladder in the long-term process of the purulent inflammation of the cervix and vaginal fornix, complicated with vesicovaginal fistula of unknown etiology.  

PubMed

We shall discuss the case of a female patient, aged 64 years, who was suffering from long-term purulent inflammation of the vaginal fornix that later involved the vaginal stump. This inflammatory process spread to the bladder trigone and resulted in vesicovaginal fistula (VVF) formation together with a bilateral hydronephrosis that required the placement of a temporary percutaneous nephrostomy. A non-cicatrized inflammatory reaction occurred at the right-sided insertion of the nephrostomy, which has yet to be successfully treated despite intensive dermatological and surgical approaches that included skin grafting. In the course of five-year treatment we observed a gradual regression of the inflammatory infiltration of both the trigone of the bladder and the vagina as well as a gradual closing of the VVF. The extremely long-lasting and uncommon local inflammatory reactions in the vagina, bladder, and dermal layers mandated the application of conservative treatment. The possibility of difficulties and defective healing of tissues that could result from surgical correction of the VVF are discouraging for both the patient and medical staff. PMID:24579004

Starownik, Rados?aw; Michalak, Jerzy; Bar, Krzysztof; P?aza, Pawe?; Muc, Kamil; Rechberger, Tomasz

2013-01-01

23

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 ...

24

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 ...

25

Incontinence and trauma: Sexual violence, female genital cutting and proxy measures of gynecological fistula  

Microsoft Academic Search

Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically

Amber Peterman; Kiersten Johnson

2009-01-01

26

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 ...

27

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 ...

28

Aortopulmonary Fistula  

PubMed Central

In a patient with degenerative disease of the thoracic aorta, an aortopulmonary fistula with an aortic aneurysm after trauma is a rare occurrence. Few cases of successful surgical management have been reported. Aortopulmonary fistula should be suspected in a patient who has an aortic aneurysm and exhibits signs of congestive heart failure. Herein, we report the case of a 50-year-old man who underwent surgical repair of an ascending aortic aneurysm with fistula into the main pulmonary artery. Early diagnosis and prompt surgical intervention were crucial to the successful outcome. PMID:19876436

Dixit, Mahadev Damodar; Gan, Mohan; Narendra, Nishanimath Gurudev; Mohapatra, Raghunath L.; Halkatti, Prabhu C.; Bhaskar, Bhagyalakshmi V.

2009-01-01

29

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. ...

30

Colouterine fistula caused by diverticulitis of the sigmoid colon.  

PubMed

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula. PMID:23346512

Choi, Pyong Wha

2012-12-01

31

Voiding urosonography: Contrast-enhanced ultrasound cystography to diagnose vesico-ureteric reflux: A pilot study  

PubMed Central

We report two children with hydronephrosis, in whom we have utilized voiding urosonography (VUS) in the evaluation of vesico-ureteric reflux. With wider availability of ultrasound contrast agents and high-end ultrasound machines, VUS is likely to become a popular tool to diagnose or exclude VUR. PMID:25552831

Babu, Ramesh; Gopinath, Vinu; Sai, Venkata

2015-01-01

32

Aortoesophageal Fistula  

PubMed Central

Purpose: The purpose of this report is to describe our experience in management of aortoesophageal fistulas (AEF) with special emphasis on the value of in situ aortic allograft replacement. Patients: Nine patients presenting with AEF were observed between May 1988 and April 2002. There were 4 men and 5 women with a mean age of 54.3 years (range, 32–77 years). Six patients presented secondary AEF after aortic repair. Two patients presented primary AEF after rupture of an atherosclerotic aneurysm into the esophagus. In the remaining patient, AEF was caused by swallowing a fishbone. In 6 cases involving true AEF with a direct communication between the aorta and esophagus, massive exsanguinating hematemesis occurred. It was usually preceded by minor sentinel bleeding. Two patients presented esophagoparaprosthetic fistula (EPPF). One patient presented primary AEF that was contained by a large thrombus in the communication. The clinical picture in these 3 patients involved severe sepsis without hemorrhage. Results: Two patients died as a result of massive hemorrhage before assessment and surgical treatment could be undertaken. One 77-year-old woman presenting EPPF refused to undergo surgery and died because of infection. The remaining 6 patients underwent surgical treatment with various outcomes. One man died during thoracotomy caused by exsanguinating hemorrhage. One woman presenting EPPF was treated by exclusion followed by ascending aorta to abdominal aorta bypass grafting, removal of the prosthesis, esophageal exclusion, and directed esophageal fistula. She died of infection. The other 4 patients were treated by in situ aortic allograft replacement. The damaged esophagus was repaired by using the Thal technique in 1 patient. In the remaining 3 cases subtotal esophagectomy was performed in association with cervical esophagostomy, ligation of the abdominal esophagus, gastrostomy, and jejunostomy. One patient died of sepsis during the first 24 hours after the operation. The other 3 patients underwent secondary esophagoplasty and survived with no further sign of infection. Mean duration of follow-up in the survivor group was 53 months (range, 15-95 months). Overall 6 patients, including 3 that did not undergo surgical treatment, died and 3 patients survived. Conclusion: Our experience confirms that AEF is a rare but catastrophic disorder. In situ allograft replacement usually in association with subtotal esophagectomy appears to be an excellent salvage modality whenever emergency surgery is feasible. PMID:12894023

Kieffer, Edouard; Chiche, Laurent; Gomes, Dominique

2003-01-01

33

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

34

The Addis Ababa fistula hospital: an holistic approach to the management of patients with vesicovaginal fistulae.  

PubMed

Ethiopia is amongst the world's poorest countries. It is estimated that approximately 30,000 women have an untreated vesicovaginal fistula, the overwhelming proportion of which are complications of neglected, prolonged or obstructed labour. When unrelieved, the presenting foetal part is impacted against the soft tissues of the pelvis, resulting in a widespread ischaemic injury. This 'field injury' often results in multiple other injuries, in addition to a vesicovaginal fistula. Focusing simply on the 'hole' between the bladder and vagina will ignore many of the other injuries these women have sustained. These include both physical and social problems, stress and urge urinary incontinence, hydronephrosis, renal failure, rectovaginal fistulae, third degree tears, amenorrhea, secondary infertility, vaginal scarring and foot drop. Over 50% will be divorced by their husband and excluded from religious activities, their home, public transport and hospitals. The Fistula Hospital in Addis Ababa in Ethiopia, founded in 1975 and run entirely by charitable donation, is dedicated exclusively to the care of women with obstetric fistulae, and the treatment of other physical and social injuries they have sustained. PMID:17313130

Williams, G

2007-02-01

35

Congenital vesicovaginal fistula with or without menouria: a literature review.  

PubMed

Congenital vesicovaginal fistula (CVVF) is a rare, complex female genital malformation that is difficult to diagnose, classify and treat. Symptoms include menouria, cyclical haematuria and urinary incontinence from birth. The aim of this review was to highlight the importance of correct diagnosis and treatment of this congenital anomaly. A comprehensive literature review was conducted to identify articles on CVVF with and without menouria. Forty-one articles were found, of which 31 described 37 original cases of congenital fistula (30 CVVF, six uterovesical fistula and one urethrovaginal fistula): 14 in girls and 23 in adults. The cases were classified according to clinical, diagnostic and therapeutic parameters in order to unify concepts and terms. Menouria occurred in 21 of the 23 adults: 14 cases were CVVF, six cases were congenital uterovesical fistula, and one case was congenital urethrovaginal fistula in a young woman without congenital adrenal hyperplasia. Sixteen (53%) of the 30 patients with CVVF had urinary incontinence or hydrocolpometra, and 14 (47%) had menouria. There were associated anomalies in 91% of cases, 29 (48%) of which involved the urinary tract. Various diagnostic and therapeutic methods were used, and there was confusion surrounding the aetiopathogenesis in most cases. CVVF should be suspected in any girl with urinary incontinence, urinary tract infections from birth, vaginal swelling or hydrocolpometras, as well as in adults with menouria. Diagnosis should be based on physical examination and imaging (cystoscopy during menouria, ultrasound and magnetic resonance imaging). Surgical treatment should be based on correction of the vaginal defects (obstructive problem opening or vaginal reconstruction) and CVVF closure. The embryological origin of CVVF lies in the abnormal persistence of the urogenital sinus due to lack of formation and caudal growth of the urogenital wedge, combined with distinct degrees of agenesis or hypoplasia of the entire urogenital ridge or the mesonephric ducts (which affects development of the Müllerian ducts). PMID:24560718

Martínez Escoriza, J C; Palacios Marqués, A M; López Fernández, J A; Feliu Rey, E; Martín Medina, P; Herráiz Romero, I; Delgado García, S; Oliva García, A B; Oliver Sánchez, C

2014-04-01

36

Enterocutaneous fistulas: an overview  

Microsoft Academic Search

Enterocutaneous fistulas remain a difficult management problem. The basis of management centers on the prevention and treatment\\u000a of sepsis, control of fistula effluent, and fluid and nutritional support. Early surgery should be limited to abscess drainage\\u000a and proximal defunctioning stoma formation. Definitive procedures for a persistent fistula are indicated in the late postoperative\\u000a period, with resection of the fistula segment

J. F. Whelan Jr; R. R. Ivatury

2011-01-01

37

[Clinical experiences of five cases with ulcerative colitis and recto- or anovaginal fistula].  

PubMed

Clinical aspects, treatment and outcome of five patients with ulcerative colitis recto- or anovaginal fistula and were studied retrospectively. All patients had total colitis (relapse and remission type) and more than a 5 year history of ulcerative colitis. They all had anorectal complications, such as periproctal abscess, stenosis of fistula. Four patients had total colectomy with an ileal pouch anal canal anastomosis for intractability or dysplasia. One was treated conservatively. Complete closure of fistula was obtained in two patients;in one patient rectum was resected below the fistula and in one patient defect of the vaginal posterior wall was reconstructed by using a gluteal fold flap following colectomy. Recto- or anovaginal fistula complicating ulcerative colitis is rare but may occur in the patients with severe rectal inflammation and they can be managed by restorative proctocolectomy with an ileal pouch anal or anal canal anastomosis. PMID:17148923

Koganei, Kazutaka; Kimura, Hideaki; Sugita, Akira; Arai, Katsuhiko; Fukushima, Tsuneo; Shimada, Hiroshi

2006-12-01

38

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

39

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

40

Gastro-bronchial fistula  

PubMed Central

1. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess. 2. Other causes include trauma and necrosis within an infiltrating neoplasm. 3. The treatment of those fistulae which are secondary to a subphrenic abscess should be by drainage of the abscess, jejunal tube feeding and continuous gastric aspiration. ImagesFig. 1 PMID:4464513

Missen, Anthony J. B.; Pemberton, James; Boon, Andrew

1974-01-01

41

Odontogenic Cutaneous Fistula  

PubMed Central

Odontogenic cutaneous fistula or sinus is an uncommon, but well documented condition, which is often initially misdiagnosed as a sole cutaneous lesion and inappropriately treated. The misdiagnosis as a skin infection often results in inappropriate management. We here present two cases of odontogenic cutaneous fistula that were seen after being treated unnecessarily with antibiotics. PMID:21509218

Samir, Nafisa; Al-Mahrezi, Abdulaziz; Al-Sudairy, Salim

2011-01-01

42

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 ...

43

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

44

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

45

Spontaneous Healing of a Rectovaginal Fistula Developing after Laparoscopic Segmental Bowel Resection for Intestinal Deep Infiltrating Endometriosis  

PubMed Central

The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment. PMID:23710392

Trippia, Carlos Henrique; Zomer, Monica Tessmann

2013-01-01

46

Anal Fistula Plug  

MedlinePLUS

... actually close it, but it does prevent recurrent abscess formation. Obviously the patient is reassured that theyíre probably ... pain from constant draining fistula tracts and recurrent abscess formation. In this particular patient, there are at least ...

47

Secondary aortoesophageal fistula.  

PubMed

Secondary aortoesophageal fistula is the rarest type of aortopeptic fistula, characterized by communication between the reconstructed aorta and the esophagus. This condition has been reported to be uniformly fatal, even after prompt diagnosis and treatment. We report what may be the first case of a successfully managed secondary aortoesophageal fistula that occurred 14 months after repair of a Crawford type II thoracoabdominal aortic aneurysm. The entity was diagnosed with a combination of esophagogastroduodenoscopy and aortography. At exploration, a communication between the proximal anastomosis and the esophagus with otherwise minimal mediastinal contamination was encountered. The anastomosis was replaced with an interposition polytetrafluoroethylene graft, and the esophageal defect was debrided, primarily closed, and reinforced with adjacent old aneurysm wall. There were no postoperative complications, and the patient remains well 18 months after fistula repair. PMID:9240335

Pipinos, I I; Reddy, D J

1997-07-01

48

Management of enteroatmospheric fistulae.  

PubMed

A small-bowel enteroatmospheric fistula (EAF) is an especially challenging complication for patients with open abdomens (OAs) and their surgeons. Manipulation of the bowel during treatment (e.g. dressing changes) is one of the risk factors for developing these openings between the atmosphere and the gastrointestinal tract. Unlike enterocutaneous fistulae, EAFs have neither overlying soft tissue nor a real fistula tract, which reduces the likelihood of their spontaneous closure. Surgical closure is necessary but not always easy to do in the OA environment. Negative pressure wound therapy (NPWT) has been used successfully as an adjunct therapy to heal the wound around EAFs. This review discusses many aspects of managing EAFs in patients with OAs, and presents techniques that have been developed to isolate the fistula and divert effluent while applying NPWT to the surrounding wound bed. PMID:24851732

Terzi, Cem; Egeli, Tufan; Canda, Aras E; Arslan, Naciye C

2014-06-01

49

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 . ...

50

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 ...

51

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

52

Pancreaticopleural fistula: a review.  

PubMed

Pancreaticopleural fistula is a rare complication of chronic pancreatitis consequent to posterior disruption of the pancreatic duct. The fistulous track ascends into the pleural cavity and gives rise to large volumes of pleural fluid. Pancreaticopleural fistula thus poses a diagnostic problem since the source of pleural fluid is extrathoracic. To further complicate the matter, abdominal pain is seldom the presenting or significant feature. The pleural effusion is typically rapidly accumulating, recurrent and exudative in nature. Pleural fluid amylase in the correct clinical setting virtually clinches the diagnosis. Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography and computed tomography may delineate the fistula and thus aid in diagnosis. Endoscopic retrograde cholangiopancreatography has emerged both as a diagnostic as well as therapeutic modality in select patients of pancreaticopleural fistula while magnetic resonance cholangiopancreatography is the radiological investigation of choice. Besides delineating the ductal anatomy, magnetic resonance cholangiopancreatography can help stratify patients for appropriate management. A near normal or mildly dilated pancreatic duct responds well to chest drainage with octreotide while endoscopic stent placement benefits patients with duct disruption located in head or body of pancreas. Failure of medical or endoscopic therapy calls in for surgical intervention. Besides, a primary surgical management may be tried in patients with complete ductal obstruction, ductal disruption in tail or ductal obstruction proximal to fistula site. PMID:25640793

Aswani, Yashant; Hira, Priya

2015-01-01

53

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

54

[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

55

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

56

Anorectal Infection: Abscess–Fistula  

PubMed Central

Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in ~40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered. PMID:22379401

Abcarian, Herand

2011-01-01

57

Vesicovaginal fistula repair with genito-gluteal fold fat pad flap.  

PubMed

We report our experience of supratrigonal vesicovaginal fistula (VVF) repair cases developed after gynaecologic surgery. Two patients presented with urinary incontinence after hysterectomy and adjuvant radiation therapy for cervical carcinoma. Cystoscopy findings showed vesicovaginal fistula near the bladder neck area. In a transvaginal approach, we excised the fistulous tract and transferred the genito-gluteal fold fat pad flap for interpositioning. Postoperative cystography showed no evidence of leakage and no recurrence was found after a 1 year follow-up period. This flap technique is particularly useful for a vaginal cuff area fistula in terms of ease of dissection, lower donor site morbidity and large flap dimension. Also the fat pad provides neovascularity and lymphatic drainage, fills dead space, and enhances granulation tissue formation. PMID:18024252

Heo, Chanyeong; Eun, Seokchan; Baek, Rongmin; Minn, Kyungwon

2008-01-01

58

Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition  

PubMed Central

INTRODUCTION Rectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures. PRESENTATION OF CASE We report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures. DISCUSSION This technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum. CONCLUSION In our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair. PMID:25016079

Pata, Giacomo; Pasini, Mario; Roncali, Stefano; Tognali, Daniela; Ragni, Fulvio

2014-01-01

59

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

60

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

61

Transcatheter Embolization for the Treatment of Both Vaginal and Lower Intestinal Bleeding Due to Advanced Pelvic Malignancy  

PubMed Central

We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fistula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated first in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and effective treatment technique.

Karaman, Bulent; Oren, Nisa Cem; Andic, Cagatay; Ustunsoz, Bahri

2010-01-01

62

Malignant sigmoidoduodenal fistula  

PubMed Central

INTRODUCTION Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas. PRESENTATION OF CASE A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema. DISCUSSION Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies. CONCLUSION Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion. PMID:25460456

Shapey, I.M.; Mahmood, K.; Solkar, M.H.

2014-01-01

63

Modern management of anal fistula  

PubMed Central

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of new sphincter-preserving techniques. PMID:25574077

Limura, Elsa; Giordano, Pasquale

2015-01-01

64

A rare spontaneous enterocutaneous fistula  

PubMed Central

A 70-year-old woman presented with a short history of a spontaneous enterocutaneos fistula in the left inguinal region. A laparotomy revealed a fistulizing Richter's hernia. The fistulizing small bowel segment was resected and the femoral hernia repaired from below. Although rare, a complicating Richter's hernia should be considered in the differential diagnosis of a groin fistula. PMID:25391523

Weledji, Elroy P.; Puepi, Marlene A.; Chichom, Alain M.

2014-01-01

65

A case of aortoesophageal fistula.  

PubMed

Aneurysms of the thoracic aorta can have various manifestations, some of which may simulate esophageal diseases, clinically and radiographically. Aortoesophageal fistula is rare and usually fatal. We report a case of aortoesophageal fistula presenting with progressive dysphagia and intermittent episodes of upper gastrointestinal bleeding. PMID:22160414

Bakhshandeh, Ali Reza; Salehi, Mehrdad; Radmehr, Hasan; Riahi, Gholam Reza

2011-12-01

66

[Perianal fistula and anal fissure].  

PubMed

CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation. PMID:23179514

Heitland, W

2012-12-01

67

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

68

Genes in the Ureteric Budding Pathway: Association Study on Vesico-Ureteral Reflux Patients  

PubMed Central

Vesico-ureteral reflux (VUR) is the retrograde passage of urine from the bladder to the urinary tract and causes 8.5% of end-stage renal disease in children. It is a complex genetic developmental disorder, in which ectopic embryonal ureteric budding is implicated in the pathogenesis. VUR is part of the spectrum of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). We performed an extensive association study for primary VUR using a two-stage, case-control design, investigating 44 candidate genes in the ureteric budding pathway in 409 Dutch VUR patients. The 44 genes were selected from the literature and a set of 567 single nucleotide polymorphisms (SNPs) capturing their genetic variation was genotyped in 207 cases and 554 controls. The 14 SNPs with p<0.005 were included in a follow-up study in 202 cases and 892 controls. Of the total cohort, ?50% showed a clear-cut primary VUR phenotype and ?25% had both a duplex collecting system and VUR. We also looked for association in these two extreme phenotype groups. None of the SNPs reached a significant p-value. Common genetic variants in four genes (GREM1, EYA1, ROBO2 and UPK3A) show a trend towards association with the development of primary VUR (GREM1, EYA1, ROBO2) or duplex collecting system (EYA1 and UPK3A). SNPs in three genes (TGFB1, GNB3 and VEGFA) have been shown to be associated with VUR in other populations. Only the result of rs1800469 in TGFB1 hinted at association in our study. This is the first extensive study of common variants in the genes of the ureteric budding pathway and the genetic susceptibility to primary VUR. PMID:22558067

van Eerde, Albertien M.; de Kovel, Carolien G. F.; Koeleman, Bobby P. C.; Knoers, Nine V. A. M.; Renkema, Kirsten Y.; van der Horst, Henricus J. R.; Bökenkamp, Arend; van Hagen, Johanna M.; van den Berg, Leonard H.; Wolffenbuttel, Katja P.; van den Hoek, Joop; Feitz, Wouter F.; de Jong, Tom P. V. M.; Giltay, Jacques C.; Wijmenga, Cisca

2012-01-01

69

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.

70

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 ...

71

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.

72

Urinary fistula and incontinence.  

PubMed

It is estimated that as many as 3.5 million women worldwide suffer from obstetric urinary fistula. This public health tragedy is a result of obstructed labor and inadequate access to health care, and its eradication lies in prevention and treatment. Efforts at prevention should be made through targeted education and public intervention for improved nutrition, access to health care, and women's social status. Diagnosis and treatment in limited resource settings can occur, and there are specific recommendations regarding nonsurgical and surgical approaches to care. Treatment success may be complicated by social, psychological, and clinical factors, with reintegration a primary concern for this group of women. PMID:25565512

Hampton, Brittany Star; Kay, Allison; Pilzek, Anna

2015-01-01

73

Traumatic subarachnoid-pleural fistula  

SciTech Connect

Traumatic subarachnoid-pleural fistulas are rare. The authors found nine cases reported since 1959. Seven have been secondary to trauma and two following thoracotomy. One patient's death is thought to be directly related to the fistula. The diagnosis should be suspected in patients with a pleural effusion and associated vertebral trauma. The diagnosis can usually be confirmed with contrast or radioisotopic myelography. Successful closure of the fistula will usually occur spontaneously with closed tube drainage and antibiotics; occasionally, thoracotomy is necessary to close the rent in the dura.

Brown, W.H.; Stothert, J.C. Jr.

1985-11-01

74

Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world.  

PubMed

Prolonged obstructed labor may produce injuries to multiple organ systems. The best known, and most common, of these injuries is obstetric fistula formation. When obstructed labor is unrelieved, the presenting fetal part is impacted against the soft tissues of the pelvis and a widespread ischemic vascular injury develops that results in tissue necrosis and subsequent fistula formation. Unlike the postsurgical vesicovaginal fistula, however, which is usually the result of focal trauma to otherwise healthy tissues, the obstetric fistula is the result of a "field injury" to a broad area. The field injury that is produced by prolonged obstructed labor may result in multiple birth-related injuries in addition to (or instead of) a vesicovaginal fistula. Focusing simply on the "hole" between the bladder and the vagina ignores the multifaceted nature of the injury that many of these patients have sustained. These injuries may include total urethral loss, stress incontinence, hydroureteronephrosis, renal failure, rectovaginal fistula formation, rectal atresia, anal sphincter incompetence, cervical destruction, amenorrhea, pelvic inflammatory disease, secondary infertility, vaginal stenosis, osteitis pubis, and foot-drop. In addition to their physical injuries, women who have experienced prolonged obstructed labor often develop serious social problems, including divorce, exclusion from religious activities, separation from their families, worsening poverty, malnutrition, and almost unendurable suffering. Isolated almost exclusively to the developing world, particularly Africa, this problem has not received the international attention that it deserves, from either a medical or a social standpoint. PMID:8873157

Arrowsmith, S; Hamlin, E C; Wall, L L

1996-09-01

75

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

76

Colovesical fistula presenting with epididymitis.  

PubMed

This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Subsequent CT imaging revealed air in the bladder and a colovesical fistula. The patient went on to have Hartmann's procedure with repair of the bladder defect. This case highlights that: (1) Colovesical fistulae may rarely present with epididymitis. (2) Colovesical fistulae are the most common cause of pneumaturia. PMID:23616326

Arneill, Matthew; Hennessey, Derek Barry; McKay, Damian

2013-01-01

77

[Case of rectal migratin of mesh after TVM (tension-free vaginal mesh) operation].  

PubMed

A 64-year-old woman presented with recto-cutaneous fistula after tension-free vaginal mesh reconstruction using polypropylene mesh for pelvic organ prolapse. Eleven months after the operation, an ulcerative lesion with stools smell secretion developed in the left hip. Magnetic resonance imaging and colonoscopy revealed a migration of the left arm of the mesh and a recto-cutaneous fistula. The patient underwent excision of the infected mesh and rectal wall closure together with transient colostomy. After 8 months, colonoscopy revealed a new migration of the mesh in the rectum, which was also removed. The colostomy was closed one year later and rectal erosion has not reccurred since then. The possibility of developing a rare but severe mesh-related complication as presented here should always be kept in mind. PMID:22390087

Taoka, Rikiya; Mizuno, Kei; Matsuoka, Takashi; Kita, Yuki; Nakanishi, Shotaro; Asai, Seiji; Soda, Takeshi; Inoue, Koji; Terai, Akito

2011-11-01

78

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

79

Large rectovaginal fistula due to a cube pessary despite routine follow-up; but what is 'routine'?  

PubMed

Vaginal pessaries are generally considered a safe and effective form of management for pelvic organ prolapse. Serious complications such as rectovaginal fistula can develop with or without regular follow-up. This case report describes the rapid development over a 10-week period of a large rectovaginal fistula in a 75-year-old woman, despite routine follow-up and replacement of her cube pessary. Currently, there is a lack of evidence-based guidelines for pessary care and, in particular, the frequency of pessary replacement. Intervals for pessary replacements vary greatly and are often based on the manufacturer's recommendations. This case highlights the rapidity at which serious complications can develop and also represents the first reported case of a cube pessary-induced rectovaginal fistula. PMID:25164211

Torbey, Matthew J

2014-11-01

80

Endocaval suture of aortocaval fistula.  

PubMed

A case of aortocaval fistula complicating a ruptured infrarenal aortic aneurysm is reported. As the length of the defect and the thickness of the aortic wall made repair from within the aorta unsafe, the defect was repaired from within the vena cava. The details of the technique are reported. It can be a useful alternative to inferior vena cava ligation, when standard repair of aortocaval fistulae from within the aorta is risky or difficult to attempt. PMID:9128225

Illuminati, G; Calió, F G; Bertagni, A; Caratozzolo, M; Vietri, F

1997-05-01

81

[Surgical treatment of anal fistula].  

PubMed

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess. PMID:25529943

Zeng, Xiandong; Zhang, Yong

2014-12-25

82

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.

83

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 ...

84

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

85

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

86

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

87

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

88

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

89

Successful management of secondary aortoesophageal fistula.  

PubMed

Aortoesophageal fistula is a rare complication after thoracic aortic aneurysm repair. Six previously reported cases of aortoesophageal fistula management have been uniformly fatal. We present our successful management and review the literature of this topic. PMID:8957407

Luketich, J D; Sommers, K E; Griffith, B P; Boujoukos, A; Landreneau, R J; Ferson, P F; Keenan, R J

1996-12-01

90

Rectourethral fistula: a rare cause of infertility.  

PubMed

Rectourethral fistulas are rare, and infertility due to rectal ejaculation is extremely rare. We report a case of congenital rectourethral fistula presenting as infertility due to rectal ejaculation. PMID:3787902

Hershman, M; Kallmeyer, V; Wood, C B; Williams, G

1986-11-01

91

[Gluteal fistula that developed spontaneously from pyonephrosis].  

PubMed

A case is described in which pyonephrosis of 21 months standing has caused gluteal fistula by spontaneously breaking through the deep dorsal musculature. Though the patient has been hospitalized in the surgical ward and treated as out-patient in the specialized surgery for gluteal abscess, i.e. fistula, pyonephrosis maintaining of the fistula was detected and treated only after 18 months. After nephrectomy the fistula closed spontaneously and the patient was cured when leaving the hospital. PMID:755321

Kottász, S; Gálos, L; Kántor, M; Schalkovszky, E

1978-01-01

92

Urinary fistulas: What does the evidence say?  

Microsoft Academic Search

Urinary fistulas are well-recognized, iatrogenic complications in developed countries that require timely diagnosis and tailored\\u000a management. Vesicovaginal fistula (VVF) is the most common type of urinary fistula. Depending on the size, mechanism of injury,\\u000a time of discovery, evidence of active inflammation, and experience of the surgeon, a wide range of treatment options exist\\u000a for VVF. Most fistulas can be promptly

Ja-Hong Kim; Ariana L. Smith; Shlomo Raz

2008-01-01

93

Chronic extraoral fistulae of dental origin.  

PubMed

Infections of dental origin may cause serious problems such as osteomyelitis and cutaneous fistulae. This article reviews 59 cases of extraoral fistulae of dental origin on the face and neck. The fistulae resolved after treatment of the intraoral lesion. Possible sources of such fistulae may be an obviously carious tooth, innocent-looking retained roots, or residual chronic dental infection of the maxilla or mandible. PMID:2598206

Javid, B; Barkhordar, R A

1989-01-01

94

Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman  

PubMed Central

Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.

Grechukhina, Olga; Gressel, Gregory M.; Taylor, Graham; Schwartz, Jeremy I.; Welsh, Regan J.

2014-01-01

95

Aggressive treatment of early fistula failure  

Microsoft Academic Search

Aggressive treatment of early fistula failure.BackgroundFistula failure has been classified as early and late. Early failure refers to those cases in which the arteriovenous (AV) fistula never develops to the point that it can be used or fails within the first 3 months of usage. It has been common practice to abandon these early failures; however, aggressive evaluation and treatment

Gerald A. Beathard; Perry Arnold; Jerry Jackson; Terry Litchfield

2003-01-01

96

Congenital tracheobiliary fistula in an adolescent patient.  

PubMed

Congenital tracheobiliary fistula is a rare malformation that allows communication between the respiratory system and hepatobiliary tract. We describe a male adolescent patient who was admitted with a destroyed lung caused by repetitive bile pneumonitis with a congenital tracheobiliary fistula. Left pneumonectomy was performed, and the fistula tract was successfully divided. PMID:25555959

Kim, Ju Sang; Suh, Jong Hui; Park, Chan Beom; Yoon, Jeong Seob

2015-01-01

97

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

98

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

99

Optimizing management of pancreaticopleural fistulas  

PubMed Central

AIM: To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic duct. METHODS: Eight patients with a spontaneous pancreaticopleural fistula underwent endoscopic retrograde cholangiopancreatography (ERCP) with an intention to stent the site of a ductal disruption as the primary treatment. Imaging features and management were evaluated retrospectively and compared with outcome. RESULTS: In one case, the stent bridged the site of a ductal disruption. The fistula in this patient closed within 3 wk. The main pancreatic duct in this case appeared normal, except for a leak located in the body of the pancreas. In another patient, the papilla of Vater could not be found and cannulation of the pancreatic duct failed. This patient underwent surgical treatment. In the remaining 6 cases, it was impossible to insert a stent into the main pancreatic duct properly so as to cover the site of leakage or traverse a stenosis situated downstream to the fistula. The placement of the stent failed because intraductal stones (n = 2) and ductal strictures (n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas (n = 2). In 3 out of these 6 patients, the pancreaticopleural fistula closed on further medical treatment. In these cases, the main pancreatic duct was normal or only mildly dilated, and there was a leakage at the body/tail of the pancreas. In one of these 3 patients, additional percutaneous drainage of the peripancreatic fluid collections allowed better control of the leakage and facilitated resolution of the fistula. The remaining 3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not be inserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. After a failed therapeutic ERCP, 3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of 8 patients in our series required subsequent surgery due to a failed non-operative treatment. Distal pancreatectomy with splenectomy was performed in 3 cases. In one case, only external drainage of the pancreatic pseudocyst was done because of diffuse peripancreatic inflammatory infiltration precluding safe dissection. There were no perioperative mortalities. There was no recurrence of a pancreaticopleural fistula in any of the patients. CONCLUSION: Optimal management of pancreaticopleural fistulas requires appropriate patient selection that should be based on the underlying pancreatic duct abnormalities. PMID:22180712

Wronski, Marek; Slodkowski, Maciej; Cebulski, Wlodzimierz; Moronczyk, Daniel; Krasnodebski, Ireneusz W

2011-01-01

100

A simple novel technique for enteroatmospheric fistulae: silicone fistula plug.  

PubMed

Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an open abdomen, present serious problems for the surgeon. There are no fixed algorithms for treatment of EAF, and treatment options are determined based on the experience of the surgeon and status of the patient. We developed a 'suspended silicone fistula plug' for treating a patient who developed an EAF after undergoing multiple operations in a short period of time. Used in conjunction with negative pressure wound therapy, application of this novel therapy resulted in EAF closure and patient discharge. PMID:24851733

Ozer, M Tahir; Sinan, Hüseyin; Zeybek, Nazif; Peker, Yusuf

2014-06-01

101

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

102

The OTSC® Proctology clip system for anorectal fistula closure: the 'anal fistula claw': case report.  

PubMed

Abstract Surgical treatment of high or complex anal fistulas often renders unsatisfying results. This is the report of the first successful closure of such anal fistula using a special Nitinol clip and applicator, the OTSC® Proctology system (Ovesco AG, Tuebingen, Germany): A 54-year old female patient was suffering from a high transsphincteric anal fistula. After seton drainage of the fistula for ten weeks, the fistula track was debrided using a special fistula brush. After transanal clip release from the applicator, the internal fistula opening was adequately closed by the clip. Eight months after clip closure the fistula had healed and the clip was removed using the OTSC® Proctology Clip Cutter. Fistula closure using the OTSC® Proctology system represents a promising sphincter-preserving minimally invasive procedure. PMID:22657572

Prosst, Ruediger L; Ehni, Wolfgang

2012-07-01

103

First experience with the use of a collagen fistula plug to treat enterocutaneous fistulas.  

PubMed

This report describes the authors' first experiences with the use of the Biodesign Enterocutaneous Fistula Plug (EFP). Six patients presented with intraperitoneal abscess and associated chronic bowel fistulas. The fistulas were treated by delivering an EFP by using radiologic guidance. The EFP placement procedure was successfully performed in all patients. All fistulas were closed within 2 weeks. Fistula recurrence occurred in two patients (33%) at 9 and 12 months after the procedure. One recurrence was associated with an adverse reaction to chemotherapy. The other was associated with the silicone flange migrating out of the bowel lumen. The Biodesign EFP offers a promising new approach for the treatment of enterocutaneous fistulas. PMID:24070512

Lyon, James W; Hodde, Jason P; Hucks, David; Changkuon, Daniela I

2013-10-01

104

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

105

Gastropulmonary fistula after bariatric surgery  

PubMed Central

The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery. PMID:19319386

Doumit, Maya; Doumit, Gaby; Shamji, Farid M; Gregoire, Sylvie; Seppala, Richard E

2009-01-01

106

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

107

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

108

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

109

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 ...

110

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 ...

111

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 ...

112

Unusual 2-[18F]-fluoro-2-deoxy-D-glucose accumulation induced by postoperative intestinocutaneous fistula in the patient with uterine cervical cancer and SLE.  

PubMed

A 47-year-old woman with systemic lupus erythematosus presented with a history of radical hysterectomy and pelvic lymph node dissection for cervical cancer Ia and brachytherapy for vaginal recurrence. Four years later, abnormal hypermetabolic lesion at vaginal vault on FDG-PET/CT was found and confirmed as vaginal recurrence by punch biopsy. So, she underwent anterior pelvic exenteration with urostomy. She underwent colostomy because of colonic fistula 1 week after anterior pelvic exenteration. She had wound problem near the colostomy site. The wound waxed and waned, however, no definite discharge was identified from wound. Three months later after anterior pelvic exenteration, FDG-PET/CT revealed multiple hypermetabolic lesions along the incision line, colostomy site and abdominopelvic lymph nodes. Biopsies of the skin and lymph nodes with FDG accumulation revealed an inflammatory granulation tissue and reactive lymphadenopathy. Definite symptom such as leakage of stool was not identified. One year later, there was no interval change of multiple hypermetabolic lesions on follow-up FDG-PET/CT. There was still wound problem. So, revision of colostomy was done with impression of subtle fistula between skin and colostomy. Multiple hypermetabolic lesions on FDG-PET/CT disappeared after 3 months of repair of colostomy. We reported a case showing high FDG accumulation at wound and paraaortic lymph node on PET/CT because of intestinocutaneous fistula around colostomy. These malignant mimicking FDG accumulations were disappeared after colostomy reversion. PMID:19066925

Kim, Myungsin; Lim, Myong Cheol; Seo, Sang Soo; Kang, Sokbom; Kim, Seok-Ki; Park, Sang-Yoon

2009-07-01

113

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

114

German S3-Guideline: Rectovaginal fistula  

PubMed Central

Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease. Methods: A systematic review of the literature was undertaken. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient. Conclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature. PMID:23255878

Ommer, Andreas; Herold, Alexander; Berg, Eugen; Fürst, Alois; Schiedeck, Thomas; Sailer, Marco

2012-01-01

115

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

116

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

117

Spontaneous esophageal-pleural fistula.  

PubMed

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed. PMID:22084548

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-10-01

118

Spontaneous esophageal-pleural fistula  

PubMed Central

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed. PMID:22084548

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-01-01

119

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

120

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

121

Aortoesophageal fistula after thoracic stent grafting.  

PubMed

Aortoesophageal fistula after thoracic stent grafting is rare and usually fatal. A 66-year-old woman developed an aortoesophageal fistula 1 month after endovascular stent grafting of the thoracic aorta for a complicated type B dissection. She had a fatal episode of massive bleeding before she could be treated. The limited treatment options are discussed. PMID:22100932

Albors, José; Bahamonde, José Ángel; Sanchis, Juan Manuel; Boix, Ricardo; Palmero, Julio

2011-10-01

122

Clinical and roentgen manifestations of cholecystoduodenal fistula  

Microsoft Academic Search

A review of the clinical, pathologic, and radiographic features of cholecystoduodenal fistulas has been presented. A high percentage of patients will have abnormal air patterns in the right upper quadrant on plain radiographic examination, and virtually all patients can be diagnosed by upper-gastrointestinal examination. The characteristic pseudodiverticulum seen with cholecystoduodenal fistula is described, and differential considerations are reviewed.

Michael C. Beachley; Gary G. Ghahremani; Lawrence E. Southworth; Ernest P. Siconolfi

1976-01-01

123

Multiple spontaneous enterocutaneous fistulae in malakoplakia.  

PubMed

Malakoplakia is a rare chronic inflammatory disease, usually involving the urogenital tract. We report a patient who presented with a psoas abscess, and later developed colocutaneous fistula at the site of abscess drainage and multiple spontaneous fistulae away from the site of incision. Histology of the resected specimen showed Michaelis-Gutmann bodies, which are diagnostic of malakoplakia. PMID:15030043

Sinha, Saroj Kant; Sethy, Pradeepta Kumar; Kaman, Lileswar; Vaiphei, Kim; Nagi, Birinder; Dutta, Usha; Singh, Kartar

2003-01-01

124

Uteroenteric Fistula Resulting From Fibroid Expulsion After Uterine Fibroid Embolization: Case Report and Review of the Literature  

SciTech Connect

A 44-year-old woman underwent uncomplicated uterine fibroid embolization (UFE) for menstrual and bulk-related symptoms in an enlarged, myomatous uterus. After surgery, she spontaneously sloughed a large mass of fibroids that arrested in the cervical canal during passage. Four days after gynecological extraction, she developed copious vaginal discharge that contained enteric contents. Contrast-enhanced computed tomography (CT) demonstrated a fistula between the small bowel and the uterus. She subsequently underwent hysterectomy, left oophorectomy, and small-bowel resection. Her postoperative recovery was uneventful.

Gutierrez, Luis B., E-mail: lbgutier@stanford.edu [Stanford University, School of Medicine (United States); Bansal, Anshuman K., E-mail: abansal@mednet.ucla.edu [University of California at Los Angeles, Department of Radiology (United States); Hovsepian, David M., E-mail: hovsepian@stanford.edu [Stanford University, School of Medicine (United States)

2012-10-15

125

Vaginitis  

MedlinePLUS

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126

Vaginitis  

MedlinePLUS

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127

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

128

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.

129

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

130

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

131

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

132

Introducing the operation method for curing anal fistula by laser  

NASA Astrophysics Data System (ADS)

The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

Ji, Bingzhi

1993-03-01

133

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

134

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

135

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

136

Cholecystocutaneous Fistula after Percutaneous Gallbladder Drainage  

PubMed Central

Cases of cholecystocutaneous fistulas are now a rare occurrence as a result of rapid diagnosis and treatment. We present a case of cholecystocutaneous fistula developing after the removal of a percutaneous drain for the treatment of acute cholecystitis. Re-occurring infection and presence of gallstones led to fistulization of the gallbladder fundus and the development of a tract along the path created by the drain. The patient presented with re-occurring right upper quadrant abdominal pain, purulent discharge from the fistulous opening and expulsion of multiple gallstones. She underwent laparoscopic cholecystectomy and fistula excision. PMID:24847193

Pripotnev, Stahs; Petrakos, Andrew

2014-01-01

137

Cholecystocutaneous fistula after percutaneous gallbladder drainage.  

PubMed

Cases of cholecystocutaneous fistulas are now a rare occurrence as a result of rapid diagnosis and treatment. We present a case of cholecystocutaneous fistula developing after the removal of a percutaneous drain for the treatment of acute cholecystitis. Re-occurring infection and presence of gallstones led to fistulization of the gallbladder fundus and the development of a tract along the path created by the drain. The patient presented with re-occurring right upper quadrant abdominal pain, purulent discharge from the fistulous opening and expulsion of multiple gallstones. She underwent laparoscopic cholecystectomy and fistula excision. PMID:24847193

Pripotnev, Stahs; Petrakos, Andrew

2014-01-01

138

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

139

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

140

Limited indication of gastrocystoplasty.  

PubMed

A 28-year-old woman presented a huge vesico-vagino-rectal fistula after radiotherapy applied because of a gynaecological tumour. Reconstruction consisted of a colostomy, closure of the rectal hole with a pedicled perineal skin graft, a bivalve opening of the bladder and, with the two halves coverage of the vaginal suture line, and augmentation gastrocystoplasty. The fistulas healed but the patient suffered from an intolerable burning sensation. That is, why the stomach wall was removed and ureteroileocutaneostomy was created. The colostomy was closed, and now the patient has a well-functioning urine stoma. PMID:8659226

Pajor, L; Harsányi, L; Frang, D

141

Aortoesophageal fistula due to esophageal ulcer.  

PubMed

Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs. PMID:19440823

Takano, Shinji; Katsuhara, Kazuhiro; Nobuhara, Kenji; Ueda, Shigeharu; Imura, Masato; Hohjo, Yoshihisa

2009-05-01

142

Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture.  

PubMed

Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery. PMID:25623503

Soumer, K; Benomrane, S; Derbel, B; Laribi, J; Benmrad, M; Elleuch, N; Kalfat, T; Khayati, A

2015-02-01

143

Dural arteriovenous fistulae at the foramen magnum  

Microsoft Academic Search

s   Spinal dural arteriovenous fistulae (DAVF) affect predominantly levels of the lower thoracic and lumbar segments; only 13\\u000a cases have been reported of DAVF at the foramen magnum. We present three surgically treated patients with DAVF at the foramen\\u000a magnum. In none of our three patients could the site of the arteriovenous fistula be suspected from the clinical presentation.\\u000a The

Marcus H. T. Reinges; Armin Thron; Michael Mull; Beate C. Huffmann; Joachim M. Gilsbach

2001-01-01

144

Aortoesophageal fistula secondary to reflux esophagitis.  

PubMed

Aortoenteric fistula is a rare cause of massive upper gastrointestinal bleeding and is in the overwhelming majority of cases due to erosion of a suture line of a prosthetic vascular graft into the bowel. We report the case of a massive fatal gastrointestinal hemorrhage from an aortoenteric fistula secondary to erosion from reflux esophagitis. Proper management requires expedient radiographic and endoscopic evaluation, and even with appropriate management mortality remains extremely high. PMID:17369684

Podbielski, Francis J; Rodriguez, Heron E; Zhu, Richard Y; Worley, Todd A; Fontaine, Jacques Pierre; Connolly, Mark M

2007-01-01

145

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

146

Fistula eligibility: a work in progress.  

PubMed

Effective hemodialysis requires a reliable vascular access. Clinical practice guidelines strongly recommend the fistula as the preferred option followed by arteriovenous (AV) grafts, with central venous catheters being least preferred. Recently, there has been a growing awareness of the limitations of the fistula, its high rate of primary failure and that a fistula may not be appropriate for all patients initiating or on hemodialysis. However, determinates for fistula eligibility have not been clearly defined. The creation and use of a fistula requires the complex integration of patient, biological, and surgical factors, none of which can be easily predicted or planned. There have been several successful initiatives over the last decade addressing patient suitability for AV access, but none have validated defined criteria for fistula eligibility. We discuss these initiatives by addressing: 1) process of care, 2) radiological and nonradiological tests and procedures, and 3) alternative surgical approaches. Careful clinical judgment, appropriate vascular access assessment and placement, and an individualized approach to the risks and benefits will optimize patient health outcomes while minimizing prolonged catheter dependence among hemodialysis patients. PMID:24494627

Al-Jaishi, Ahmed A; Moist, Louise M

2014-03-01

147

Hemodynamic Simulations in Dialysis Access Fistulae  

NASA Astrophysics Data System (ADS)

Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with End-Stage Renal Disease. It has long been hypothesized that the hemodynamic and mechanical forces (such as wall shear stress, wall stretch, or flow- induced wall vibrations) constitute the primary external influence on the remodeling process. Given that nearly 50% of fistulae fail after one year, understanding fistulae hemodynamics is an important step toward improving patency in the clinic. We perform numerical simulations of the flow in patient-specific models of AV fistulae reconstructed from 3D ultrasound scans with physiologically-realistic boundary conditions also obtained from Doppler ultrasound. Comparison of the flow features in different geometries and configurations e.g. end-to-side vs. side-to-side, with the in vivo longitudinal outcomes will allow us to hypothesize which flow conditions are conducive to fistulae success or failure. The flow inertia and pulsatility in the simulations (mean Re 700, max Re 2000, Wo 4) give rise to complex secondary flows and coherent vortices, further complicating the spatio- temporal variability of the wall pressure and shear stresses. Even in mature fistulae, the anastomotic regions are subjected to non-physiological shear stresses (>10.12pcPa) which may potentially lead to complications.

McGah, Patrick; Leotta, Daniel; Beach, Kirk; Riley, James; Aliseda, Alberto

2010-11-01

148

Anorectal conditions: anal fissure and anorectal fistula.  

PubMed

Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening. PMID:24742084

Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

2014-04-01

149

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

150

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

151

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 ...

152

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

153

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

154

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

155

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

156

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

157

Vaginoperineal Fistula as a Complication of Perianal Surgery in a Patient with Sjögren's Syndrome: A Case Report  

PubMed Central

Forty-seven-year-old woman with Sjögren's syndrome had been operated on because of transsphincteric perianal fistula secondary to perianal abscess. Vaginal wall injury occurred during the course of the operation and injured tissue was repaired primarily. Three months later, patient suffered from the recurrence of perianal fistula symptoms and fistulectomy was performed once again under antibiotic suppression. Several months later, perineal discharge continued, and, therefore, patient was admitted to the hospital for the third time and a fistulotomy was performed. Two months after the third operation, patient was admitted with leukorrhea and a perineovaginal fistula was detected. This time, not only her surgical problem but also her immune system disorder was considered in the preoperative workup. Then, patient was hospitalized for the fourth time and “fistulectomy/perineoplasty” was performed successfully. We believe that patients with autoimmune disorders with or without medical treatment may have healing problems during the course of surgical processes and therefore such medical problems must be taken into consideration by the surgeons. PMID:25295212

Beksac, Kemal; Turgal, Mert; Aran, Omer; Beksac, M. Sinan

2014-01-01

158

Vaginoperineal Fistula as a Complication of Perianal Surgery in a Patient with Sjögren's Syndrome: A Case Report.  

PubMed

Forty-seven-year-old woman with Sjögren's syndrome had been operated on because of transsphincteric perianal fistula secondary to perianal abscess. Vaginal wall injury occurred during the course of the operation and injured tissue was repaired primarily. Three months later, patient suffered from the recurrence of perianal fistula symptoms and fistulectomy was performed once again under antibiotic suppression. Several months later, perineal discharge continued, and, therefore, patient was admitted to the hospital for the third time and a fistulotomy was performed. Two months after the third operation, patient was admitted with leukorrhea and a perineovaginal fistula was detected. This time, not only her surgical problem but also her immune system disorder was considered in the preoperative workup. Then, patient was hospitalized for the fourth time and "fistulectomy/perineoplasty" was performed successfully. We believe that patients with autoimmune disorders with or without medical treatment may have healing problems during the course of surgical processes and therefore such medical problems must be taken into consideration by the surgeons. PMID:25295212

Beksac, Kemal; Turgal, Mert; Basaran, Derman; Aran, Omer; Beksac, M Sinan

2014-01-01

159

Oesophageal moniliasis causing fistula formation and lung abscess.  

PubMed Central

Oesophageal moniliasis is reviewed and the incidence of fistula formation discussed. A case of oesophageal moniliasis without any predisposing factors, with fistula formation and lung abscess, is presented. Images PMID:941124

Sehhat, S; Hazeghi, K; Bajoghli, M; Touri, S

1976-01-01

160

Endovascular treatment of a tentorial dural arteriovenous fistula.  

PubMed

Tentorial dural arteriovenous fistulae are rare intracranial fistulae, in which the fistula pocket is present within the leaves of tentorium cerebelli. These tentorial fistulae can be rarely present near the galenic complex, where they can engorge the deep venous system and cause symptoms of venous hypertension. We present an interesting case of endovascular treatment of a galenic tentorial dural arteriovenous fistula in a patient with headaches and imbalance. The fistula was accessed through the artery of Davidoff and Schecter from the posterior cerebral artery supplying the fistula. The fistula was completely embolized using Onyx and with preservation of vein of Galen. The video can be found here: http://youtu.be/igX2X5tfvrg . PMID:24983732

Choudhri, Omar; Marks, Michael P

2014-07-01

161

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

162

Endovascular Management of Acute Bleeding Arterioenteric Fistulas  

SciTech Connect

The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage of low morbidity.

Leonhardt, Henrik [Sahlgrenska University Hospital S, Department of Radiology (Sweden)], E-mail: henrik.leonhardt@vgregion.se; Mellander, Stefan [Sahlgrenska University Hospital S, Department of Vascular Surgery (Sweden); Snygg, Johan [Sahlgrenska University Hospital S, Department of Anesthesiology (Sweden); Loenn, Lars [Sahlgrenska University Hospital S, Department of Radiology (Sweden)

2008-05-15

163

Effects of arteriovenous fistulas on cardiac oxygen supply and demand  

Microsoft Academic Search

Effects of arteriovenous fistulas on cardiac oxygen supply and demand.BackgroundArteriovenous (AV) fistulas used for hemodialysis access may affect cardiac load by increasing the preload while decreasing the afterload. In dogs, AV fistulas have also been shown to affect coronary perfusion negatively. We investigated the net effect of AV fistulas on cardiac oxygen supply and demand.MethodsAortic pressure waves were reconstructed from

Willem Jan W. Bos; Robert Zietse; Karel H. Wesseling; Nico Westerhof

1999-01-01

164

Evaluation of the Cost Effectiveness of Vesico-Amniotic Shunting in the Management of Congenital Lower Urinary Tract Obstruction (Based on Data from the PLUTO Trial)  

PubMed Central

Objective To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS) in the management of fetal lower urinary tract obstruction (LUTO) Design Model based economic analysis using data from the randomised controlled arm of the PLUTO (percutaneous vesico-amniotic shunting for lower urinary tract obstruction) trial. Setting Fetal medicine departments in United Kingdom, Ireland and Netherlands. Population or Sample Pregnant women with a male, singleton fetus with LUTO. Methods Costs and outcomes were prospectively collected in the trial; three separate base case analyses were performed using the intention to treat (ITT), per protocol and uniform prior methods. Deterministic and probabilistic sensitivity analyses were performed to explore data uncertainty. Main Outcome Measures Survival at 28 days, 1 year and disease free survival at 1 year. Results VAS was more expensive but appeared to result in higher rates of survival compared with conservative management in patients with LUTO. Using ITT analysis the incremental cost effectiveness ratios based on outcomes of survival at 28 days, 1 year, or 1 morbidity-free year on the VAS arm were £15,506, £15,545, and £43,932, respectively. Conclusions VAS is a more expensive option compared to the conservative approach in the management of individuals with LUTO. Data from the RCT suggest that VAS improves neonatal survival but does not result in significant improvements in morbidity. Our analysis concludes that VAS is not likely to be cost effective in the management of these patients given the NICE (National Institute of Health and Clinical Excellence) cost threshold of £20,000 per QALY. PMID:24376546

Diwakar, Lavanya; Morris, Rachel K.; Barton, Pelham; Middleton, Lee J.; Kilby, Mark D.; Roberts, Tracy E.

2013-01-01

165

The mouse aortocaval fistula recapitulates human arteriovenous fistula maturation  

PubMed Central

Several models of arteriovenous fistula (AVF) have excellent patency and help in understanding the mechanisms of venous adaptation to the arterial environment. However, these models fail to exhibit either maturation failure or fail to develop stenoses, both of which are critical modes of AVF failure in human patients. We used high-resolution Doppler ultrasound to serially follow mice with AVFs created by direct 25-gauge needle puncture. By day 21, 75% of AVFs dilate, thicken, and increase flow, i.e., mature, and 25% fail due to immediate thrombosis or maturation failure. Mature AVF thicken due to increased amounts of smooth muscle cells. By day 42, 67% of mature AVFs remain patent, but 33% of AVFs fail due to perianastomotic thickening. These results show that the mouse aortocaval model has an easily detectable maturation phase in the first 21 days followed by a potential failure phase in the subsequent 21 days. This model is the first animal model of AVF to show a course that recapitulates aspects of human AVF maturation. PMID:24097429

Yamamoto, Kota; Protack, Clinton D.; Tsuneki, Masayuki; Hall, Michael R.; Wong, Daniel J.; Lu, Daniel Y.; Assi, Roland; Williams, Willis T.; Sadaghianloo, Nirvana; Bai, Hualong; Miyata, Tetsuro; Madri, Joseph A.

2013-01-01

166

The mouse aortocaval fistula recapitulates human arteriovenous fistula maturation.  

PubMed

Several models of arteriovenous fistula (AVF) have excellent patency and help in understanding the mechanisms of venous adaptation to the arterial environment. However, these models fail to exhibit either maturation failure or fail to develop stenoses, both of which are critical modes of AVF failure in human patients. We used high-resolution Doppler ultrasound to serially follow mice with AVFs created by direct 25-gauge needle puncture. By day 21, 75% of AVFs dilate, thicken, and increase flow, i.e., mature, and 25% fail due to immediate thrombosis or maturation failure. Mature AVF thicken due to increased amounts of smooth muscle cells. By day 42, 67% of mature AVFs remain patent, but 33% of AVFs fail due to perianastomotic thickening. These results show that the mouse aortocaval model has an easily detectable maturation phase in the first 21 days followed by a potential failure phase in the subsequent 21 days. This model is the first animal model of AVF to show a course that recapitulates aspects of human AVF maturation. PMID:24097429

Yamamoto, Kota; Protack, Clinton D; Tsuneki, Masayuki; Hall, Michael R; Wong, Daniel J; Lu, Daniel Y; Assi, Roland; Williams, Willis T; Sadaghianloo, Nirvana; Bai, Hualong; Miyata, Tetsuro; Madri, Joseph A; Dardik, Alan

2013-12-01

167

ARTERIOVENOUS FISTULAE AFTER FREE FLAP SURGERY IN A REPLANTED HAND  

Microsoft Academic Search

AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand.This paper discusses the mechanisms responsible for the formation of AV fistulae.

M. NINKOVI?; D. SU?UR; B. STAROVI?; S. MARKOVI?

1992-01-01

168

Malignant Colojejunal Fistula First Discovered on CT: A Case Report  

PubMed Central

Benign coloenteric fistula is an uncommon condition. It may occur secondary to diverticular disease, peptic ulcer, inflammatory bowel disease and so on. Malignant coloenteric fistula is a rare occurrence. Here we present a rare case of malignant colojejunal fistula secondary to locally invading colonic malignancy.

Hiremath, Rudresh; K.C., Aishwarya; Tippani, Deepthi; C.R., Aruna

2014-01-01

169

Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement  

SciTech Connect

Stent-graft exclusion of an ischemic, hilar portobiliary fistula after liver transplantation has not been reported. Isolated reports have described peripheral or nonischemic fistulas, and alternative treatment options have ranged from balloon tamponade to surgical repair. We present a unique case of a hilar portobiliary fistula successfully treated to resolution by unilateral placement of a stent-graft.

Lorenz, Jonathan M.; Zangan, Steven M., E-mail: szangan@radiology.bsd.uchicago.edu; Leef, Jeffrey A.; Ha, Thuong G. Van [University of Chicago Medical Center, Department of Radiology (United States)

2010-04-15

170

Urinary fistulae after partial nephrectomy  

PubMed Central

Objective To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3–6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. Patients and Methods This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. Results Fifty-two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5–6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9–5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09–0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re-operative open surgery. Conclusion The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms. PMID:20230384

Kundu, Shilajit D.; Thompson, R. Houston; Kallingal, George J.; Cambareri, Gina; Russo, Paul

2015-01-01

171

Endoanal Ultrasound in Perianal Fistulae and Abscesses.  

PubMed

Endoanal ultrasound is a technique that provides imaging of the anal sphincters and its surrounding structures as well as the pelvic floor. However, endoanal magnetic resonance imaging (MRI) is preferred by most physicians, although costs are higher and demand easily outgrows availability. Endoanal ultrasound is an accurate imaging modality delineating anatomy of both cryptoglandular as well as Crohn perianal fistula and abscess. Endoanal ultrasound is comparable with examination under anesthesia and equally sensitive as endoanal MRI in fistula detection. When fistula tracts or abscesses are located above the puborectal muscle, an additional endoanal MRI should be performed. Preoperative imaging is advocated in recurrent cryptoglandular fistula because a more complex pattern can be expected. Endoanal ultrasound can help avoid missing tracts during surgery, lowering the chance for the fistula to persist or recur. It can easily be performed in an outpatient setting and endosonographic skills are quickly incremented. Costs are low and endoanal ultrasound has the potential to improve outcome of patients with both cryptoglandular and fistulizing Crohn disease; therefore, it values more attention. PMID:25364961

Visscher, Arjan Paul; Felt-Bersma, Richelle Jf

2014-10-31

172

An accountable fistula management treatment plan.  

PubMed

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort. PMID:18642685

Thompson, Mary Jo; Epanomeritakis, Emanuel

173

A Balance Test for Chronic Perilymph Fistula  

PubMed Central

Perilymph fistula is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semicircular canal from cholesteotoma and the superior canal dehiscence syndrome. First recognized as a complication of stapedectomy, it then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause. Descriptions of “spontanenous” perilymph fistulas with no trauma history followed. It is likely that most perilymph fistula patients have a congential potential weakness of the otic capsule at the round or oval window. The vestibular symptoms have been assumed to be due to endolymphatic hydrops, but there is poor evidence. Their unilateral disequilibrium, nausea, and subtle cognitive problems suggest they are due to otolith disfunction and that these patients have a specific balance abnormality, unlike subjects with unilateral vestibular hypofuction. In this series of twenty patients with a confirmed fistula a logical simplification of Singleton's “eyes-closed turning” test predicted a PLF in twelve with a trauma history. In four no cause was found. In three a prior traumatic event was later recalled, but one patient had concealed it. PMID:23028388

Hornibrook, Jeremy

2012-01-01

174

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

175

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

176

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

177

[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

178

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

179

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

180

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

181

Primary aortoenteric fistula due to septic aortitis.  

PubMed

Primary aortoenteric fistula is most commonly caused from erosion of the bowel wall by an abdominal aortic aneurysm. Septic aortitis with pseudoaneurysm formation and finally erosion into the duodenum represents a rare cause that has been described in very few patients in the literature. We present a rare clinical case of Salmonella aortitis and associated infrarenal aortic pseudoaneurysm that evolved into an aortoduodenal fistula. A 51-year-old man was admitted in our hospital with symptoms and signs of sepsis caused by Salmonella bacteremia. Imaging studies revealed an infrarenal aortic pseudoaneurysm. The patient presented hemodynamic instability, and during emergency laparotomy a fistula was found between the third portion of the duodenum and a false aneurysm arising from a nonaneurysmal grossly infected aorta. The affected aortic segment was excised and the intestinal defect was repaired. The aortic stumps were sutured and an axillobifemoral bypass was performed. The patient had an uncomplicated postoperative course. PMID:20472386

Skourtis, Georgios; Papacharalambous, Gerasimos; Gerasimos, Papacharalambous; Makris, Sotirios; Sotirios, Makris; Kasfikis, Fotios; Fotios, Kasfikis; Kastrisios, Georgios; Georgios, Kastrisios; Goulas, Sotirios; Sotirios, Goulas; Antoniou, Ioannis; Ioannis, Antoniou; Giannakakis, Sotirios; Sotirios, Giannakakis; Maltezos, Chrisostomos; Chrisostomos, Maltezos

2010-08-01

182

Diagnosis and management of pancreaticopleural fistula.  

PubMed

Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment. PMID:23624444

Tay, Clifton Ming; Chang, Stephen Kin Yong

2013-04-01

183

[A vertebral arteriovenous fistula diagnosed by auscultation].  

PubMed

Cervical artery fistulas are rare arteriovenous malformations. The etiology of the vertebral arteriovenous fistulas (AVF) can be traumatic or spontaneous. They tend to be asymptomatic or palpation or continuous vibration in the cervical region. An arteriography is necessary for a definitive diagnosis. The treatment is complete embolization of the fistula. We present the case of a two year-old male, where the mother described it «like a washing machine in his head». On palpation during the physical examination, there was a continuous vibration, and a continuous murmur in left cervical region. A vascular malformation in vertebral region was clinically suspected, and confirmed with angio-MRI and arteriography. AVF are rare in childhood. They should be suspected in the presence of noises, palpation or continuous vibration in the cervical region. Early diagnosis can prevent severe complications in asymptomatic children. PMID:24598790

Iglesias Escalera, G; Diaz-Delgado Peñas, R; Carrasco Marina, M Ll; Maraña Perez, A; Ialeggio, D

2015-01-01

184

[Mastitis with abscesses caused by esophageal fistula].  

PubMed

Mastitis originating from a fistula from intramediastinal esophago-jejunostomy following gastrectomy is an extremely rare event. We report on a 79-year old woman who had undergone repeated surgery due to recurrent breast abscesses for more than a year. The patient's history showed gastrectomy and esophago-jejunostomy two years earlier, with subsequent undetected insufficiency of the anastomosis and inflammation of the breast. The reason for the recurrent breast abscesses was found intraoperatively to be due to a fistula which could be followed to the anastomosis. Histologically, vegetable tissue (food particles) was detected in the fistula specimen. Detailed assessment of the patient's history could have helped detecting the circumstances when the first breast abscess appeared. Exact preoperative diagnosis and accurate wound débridement could have revealed the real cause of the recurrent abscess formation much earlier. PMID:18322774

Witzel, Kai; Riester, Ursula; Arps, Hartmut; Kronsbein, Hartmut; Benhidjeb, Tahar

2008-01-01

185

Colouterine fistula after polymyomectomy: a case report  

PubMed Central

Introduction Colouterine fistula is a very rare condition; most cases described in the literature are secondary to complications of diverticulitis in elderly patients. Case presentation We report the case of a 34-year-old African woman who presented with a colouterine fistula secondary to polymyomectomy, which was diagnosed in the setting of severe endometritis. She had a Hartmann procedure and abundant irrigation of her abdominal and uterine cavities followed by placement of a double drainage in order to preserve fertility. This is the first case of a conservative management of the uterus in such conditions. Conclusion Conservative surgery in colouterine fistula should be discussed as an alternative to hysterectomy in young infertile women. PMID:24942344

2014-01-01

186

Surgical management of primary aortoesophageal fistula secondary to thoracic aneurysm.  

PubMed

Aortoesophageal fistula, secondary to thoracic aortic aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. These may be primary fistulas, in cases of thoracic aortic aneurysm without previous repair, or secondary fistulas occurring after surgical repair of thoracic aortic aneurysm. Surgical treatment has been successful in a small number of cases of primary aortoesophageal fistula, secondary to thoracic aortic aneurysm, but techniques used have varied. We report a successful repair of primary aortoesophageal fistula, secondary to descending thoracic aortic aneurysm, and review the evolution of management since the three previously reported successful repairs at our institution. PMID:10750807

Reardon, M J; Brewer, R J; LeMaire, S A; Baldwin, J C; Safi, H J

2000-03-01

187

Magnetic resonance imaging of perianal fistulas.  

PubMed

Perianal fistulization is the result of a chronic inflammation of the perianal tissues. A wide spectrum of clinical manifestations, ranging from simple to complex fistulas, can be seen, the latter especially in patients with Crohn disease. Failure to detect secondary tracks and hidden abscesses may lead to therapeutic failure, such as insufficient response to medical treatment and relapse after surgery. Currently, magnetic resonance (MR) imaging is the preferred technique for evaluating perianal fistulas and associated complications. Initially used most often in the preoperative setting, MR imaging now also plays an important role in evaluating the response to medical therapy. PMID:24238135

Vanbeckevoort, Dirk; Bielen, Didier; Vanslembrouck, Ragna; Van Assche, Gert

2014-02-01

188

Conservative Management of a Delayed Neovesicocutaneous Fistula  

PubMed Central

A neovesicocutaneous fistula is a rare complication after orthotopic bladder reconstruction, particularly in the late postoperative period. We report the case of a 59-year-old man who had undergone ileal neobladder construction 17 months previously. He presented with urinary retention concomitant with urinary tract infection due to a neovesicourethral anastomotic stricture. After a combination of transurethral catheter drainage and broad-spectrum antibiotic therapy for 3 weeks, the fistulous tract completely closed. Therefore, conservative treatment may be regarded as a valid option for a delayed neovesicocutaneous fistula. PMID:25061533

Motoi, Isamu

2014-01-01

189

Developmental oronasal fistula of the incisive papilla.  

PubMed

Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used to describe the presence of a developmental fistulous tract that connects the oral and nasal cavities through an oral opening located at the incisive papilla. Reportedly, this condition is a rare developmental variant; approximately 40 cases have been reported in the literature. Because awareness of this entity is important to avoid misdiagnosis, this article presents the clinical and conebeam computed tomography findings of two cases. Based on a review of the development of the nasopalatine structures in man, the authors propose that this entity be classified as a developmental oronasal fistula of the incisive papilla. PMID:20129895

Edwards, Paul C; Kanjirath, Preetha P; Norton, Neil S; McVaney, Timothy; Scanlon, Charles; Saini, Tarnjit

2010-01-01

190

[Chronic cutaneous fistula secondary to mandibular osteomyelitis].  

PubMed

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation. PMID:16796969

Roche, Elena; García-Melgares, María L; Laguna, Cecilia; Martín-González, Blanca; Fortea, José M

2006-04-01

191

Colovesical fistula demonstrated on renal cortical scintigraphy.  

PubMed

A 70-year-old man with a history of weight loss, changes in bowel habits, and hematochezia had rectal adenocarcinoma. He was palliated with diverting colostomy, followed by radiochemotherapy. Bilateral hydronephrosis was found incidentally on lower abdominal CT scan. He underwent 99mTc dimercaptosuccinic acid scan prior to percutaneous nephrostomy tube placement. Apart from the renal cortex, scintigraphy showed activity in the ascending colon continuous to the activity of the bladder. This indicated urine extravasation on account of a colovesical fistula, complicating postoperative radiation treatment. Here we highlight the contribution of renal cortical scintigraphy in the detection of colovesical fistulas. PMID:23047758

Stathaki, Maria; Vamvakas, Lampros; Papadaki, Emmanouela; Papadimitraki, Elisavet; Tsaroucha, Angeliki; Karkavitsas, Nikolaos

2012-11-01

192

Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula  

PubMed Central

AIM: To compare healing rates between intersphincteric fistula tract (LIFT) and LIFT plus partial fistulectomy procedures. METHODS: A study of complex fistula-in-ano patients was carried out from 1st March 2010 to 31th January 2012. All operations were done by colorectal surgeons at a referral center in a Ministry of Public Health hospital. Data collected included patients’ demographic details, fistula type determined by endorectal-ultrasonography, preoperative and postoperative continence status, previous operations, time between diagnosis of fistula-in-ano and operation, type of surgery, healing rates, recurrence rates, and types of failure examined by endorectal-ultrasosnography, re-operation in recurrence or failure cases, and complications. RESULTS: The study involved 41 patients whose average age was 40.78 ± 11.84 years (range: 21-71 years). The major fistula type was high-transsphincteric type fistula. The median follow-up period was 24 wk. The overall success rate was 83%: in the LIFT (Ligation intersphincteric fistula tract) group the success rate was 81% and in the LIFT plus (LIFT with partial coreout fistulectomy) group it was 85% (P = 0.529). The median wound-healing time was 4 wk in both groups (P = 0.262). The median time to recurrence was 12 wk. Neither group had incontinence (Wexner incontinence score-0) and the difference in healing rates between the two groups was not statistically significant. CONCLUSION: There was no difference in results between LIFT and LIFT plus operations. The LIFT procedure is a good option for maintaining continence in management of fistula-in-ano. PMID:23671739

Sirikurnpiboon, Siripong; Awapittaya, Burin; Jivapaisarnpong, Paiboon

2013-01-01

193

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.

194

Coronary Arteriovenous Fistula Causing Hydrops Fetalis  

PubMed Central

Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy. PMID:25247099

Çetiner, Nilüfer

2014-01-01

195

Knee Lymphocutaneous Fistula Secondary to Knee Arthroplasty  

PubMed Central

Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published. PMID:25580333

Pérez-de la Fuente, T.; Sandoval, E.; Alonso-Burgos, A.; García-Pardo, L.; Cárcamo, C.; Caballero, O.

2014-01-01

196

[Broncholithiasis, lithoptysis and broncho-oesophageal fistula].  

PubMed

Broncho-oesophageal fistulas in broncholithiasis are extremely rare. Preceding lithoptysis is only seen infrequently. We report on a 68-year-old patient who complained of cough for more than 3 years. 5 months prior to admission he had hemoptysis and expectorated several greyish stones of up to 5?mm diameter. Endoscopy revealed a small excavation at the medial wall of the left main bronchus. Compared to a former CT, an actual CT scan of the thorax showed a small fistula between the oesophagus and the left main bronchus and revealed a missing calcification at this site. The patient underwent a left-sided thoracotomy with excision of the fistula, suture of the oesophagus and interponation of a flap of the M. latissimus dorsi. The demonstration of broncholith migration with CT scans before and after lithoptysis, the development of a left-sided fistula and its demonstration in the CT scan as well as endoscopically have not been reported in this combination before. PMID:22048872

Westhoff, M; Litterst, P; Al-Shahrabani, F

2012-02-01

197

Video-Assisted Anal Fistula Treatment  

PubMed Central

Background and Objectives: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. The latest addition to the list of treatment options is video-assisted anal fistula treatment (VAAFT). It is a minimally invasive, sphincter-saving procedure with low morbidity. The aim of our study was to compare the results with a premier study done previously. Methods: The procedure involves diagnostic fistuloscopy and visualization of the internal opening, followed by fulguration of the fistulous tract and closure of the internal opening with a stapling device or suture ligation. The video equipment (Karl Storz, Tuttlingen, Germany) was connected to an illuminating source. Results: The study was conducted from July 2010 to March 2014. Eighty-two patients with fistula in ano were operated on with VAAFT and were followed up according to the study protocol. The recurrence rate was 15.85%, with recurrences developing in 13 cases. Postoperative pain and discomfort were minimal. Conclusion: VAAFT is a minimally invasive procedure performed under direct visualization. It enables visualization of the internal opening and secondary branches or abscess cavities. It is a sphincter-saving procedure and offers many advantages to patients. Our initial results with the procedure are quite encouraging. PMID:25419106

Saha, Sudipta; Andley, Manoj; Kumar, Ashok; Saurabh, Gyan; Pusuluri, Rahul; Bhise, Vikas; Kumar, Ajay

2014-01-01

198

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

199

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

200

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

201

RECTOVAGINAL FISTULA REPAIR USING A DISPOSABLE BIOPSY PUNCH  

PubMed Central

Objectives To describe a novel surgical technique for complete excision of a rectovaginal fistula tract using a disposable biopsy punch during a transvaginal rectovaginal fistula repair and present our initial surgical experience. Methods Description of four cases of simple rectovaginal fistulas and an innovative surgical technique for the complete excision of the fistula tract using a disposable biopsy punch. Results Successful three, nine and twelve month follow up of four cases with simple rectovaginal fistulas after transvaginal rectovaginal fistula repair using a novel approach for complete fistula tract excision with a disposable biopsy punch and layered non overlapping suture closure. Demographic information reported included age, parity, medical and surgical history as well as fistula characteristics including size, location, presenting symptoms and duration of symptoms. We describe our operative technique with picture description. Conclusion This novel approach using a disposable punch biopsy device to complete excision of simple rectovaginal fistula tracts during a transvaginal rectovaginal fistula repair can help with achieving a successful surgical outcome. PMID:24368490

Adelowo, Amos; Ellerkmann, Richard; Rosenblatt, Peter

2013-01-01

202

Morphological characterisation of Crohn’s disease fistulae  

PubMed Central

Background: Fistulae are a common complication in up to 35% of all patients with Crohn’s disease. Their therapy is difficult and frequently unsatisfactory. To date, no histological comparison of Crohn’s disease fistulae with non-inflammatory bowel disease fistulae has been performed. In addition, Crohn’s disease fistulae have not been well characterised morphologically. Methods: Eighty four fistulae from Crohn’s disease patients were compared with 13 fistulae from controls. Haematoxylin-eosin staining, electron microscopy, and immunohistochemistry for panCytokeratin (epithelial cells), CD20 (B cells), CD45R0 (T cells), and CD68 (macrophages) were performed according to standard techniques. In addition, histopathological findings were compared with clinical and laboratory data. Results: In 31.0% of controls and 27.4% of Crohn’s disease specimens, fistulae had a lining of flattened intestinal epithelium without goblet cells or, in the case of cutaneous/perianal disease, narrow squamous epithelium. Non-epithelialised fistulae were covered by a thin layer of (myo)fibroblasts, focally forming a new basement membrane, as demonstrated by electron microscopy. All fistulae were surrounded by granulation tissue. Crohn’s disease fistulae presented with central infiltration by CD45R0+ T cells, followed by a small band of CD68+ macrophages and dense accumulation of CD20+ B cells. In contrast, in controls, there was dense infiltration by CD68+ macrophages with only few CD20+ B cells and CD45R0+ T lymphocytes. Conclusions: Fistulae in Crohn’s disease differ markedly from non-Crohn’s disease fistulae with regard to their cellular composition. The presence of an epithelial lining in a subgroup of fistulae may be important for the therapeutic approach and healing process. PMID:15306592

Bataille, F; Klebl, F; Rümmele, P; Schroeder, J; Farkas, S; Wild, P-J; Fürst, A; Hofstädter, F; Schölmerich, J; Herfarth, H; Rogler, G

2004-01-01

203

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

204

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

205

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

206

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

207

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

208

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

209

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

210

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

211

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

212

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

213

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

214

Evidence of calcium phosphate depositions in stenotic arteriovenous fistulas  

Microsoft Academic Search

This study investigates vascular samples from patients with and without end-stage renal disease (ESRD) to determine the occurrence of calcium depositions. Findings in stenotic arteriovenous (AV)-fistula veins were compared with those of nonstenotic AV-fistula veins, non[ndash ]AV-fistula veins, and atherosclerotic vessels. Calcium and phosphorus content was measured by means of scanning electron microscopy and its built-in method of energy-dispersive spectrometry

Lars-Fride Olsson; Rolf Odselius; Else Ribbe

2001-01-01

215

[Aortoesophageal fistulae as a cause of fatal hemorrhage].  

PubMed

Aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding, ranging from 0 to 2.3% in literature. The authors studied a group of 266 patients with upper gastrointestinal bleeding during the period of three years (1996-1998). According to two patient cases and the data from literature diagnostic methods, causes of aortoesophageal fistulas are analysed and the necessity of urgent closure of the fistulas is stressed. (Tab. 2, Fig. 2, Ref. 15.) PMID:10573651

Hutan, M; Bandzak, J; Balaz, P; Hostyn, L

1999-06-01

216

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia  

PubMed Central

A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the anterior spinal artery and vein. The lesion was occluded by embolization with immediate improvement. The potential mechanism is discussed. PMID:24653807

Argyrakis, Nikolaos; Matis, Georgios K.; Mpata-Tshibemba, Stephanie

2014-01-01

217

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

218

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae.  

PubMed

Stenosis of arteriovenous (A-V) fistulae secondary to neointimal hyperplasia (NIH) compromises dialysis delivery, which worsens patients' quality of life and increases medical costs associated with the maintenance of vascular accesses. In the present study, we evaluated the role of the receptor tyrosine kinase c-Kit in A-V fistula neointima formation. Initially, c-Kit was found in the neointima and adventitia of human brachiobasilic fistulae, whereas it was barely detectable in control veins harvested at the time of access creation. Using the rat A-V fistula model to study venous vascular remodeling, we analyzed the spatial and temporal pattern of c-Kit expression in the fistula wall. Interestingly, c-Kit immunoreactivity increased with time after anastomosis, which concurred with the accumulation of cells in the venous intima. In addition, c-Kit expression in A-V fistulae was positively altered by chronic kidney failure conditions. Both blockade of c-Kit with imatinib mesylate (Gleevec) and inhibition of stem cell factor production with a specific short hairpin RNA prevented NIH in the outflow vein of experimental fistulae. In agreement with these data, impaired c-Kit activity compromised the development of NIH in A-V fistulae created in c-KitW/Wv mutant mice. These results suggest that targeting of the c-Kit signaling pathway may be an effective approach to prevent postoperative NIH in A-V fistulae. PMID:25186298

Skartsis, Nikolaos; Martinez, Laisel; Duque, Juan Camilo; Tabbara, Marwan; Velazquez, Omaida C; Asif, Arif; Andreopoulos, Fotios; Salman, Loay H; Vazquez-Padron, Roberto I

2014-11-01

219

Successful management of esophagoparaprosthetic fistula after aortic surgery.  

PubMed

Aortoesophageal fistula is a relatively rare but highly fatal condition, especially in the case of secondary aortoesophageal fistulas after previous thoracic aortic surgery in which the aortic prosthetic graft itself may be involved in the infection, resulting in an esophagoparaprosthetic fistula. In this report, we describe a complicated case of esophagoparaprosthetic fistula arising after descending thoracic aortic replacement and endovascular pseudoaneurysm repair that was successfully treated by surgical resection and in situ aortic graft replacement using a homograft completely covered with an omental flap, combined with subtotal esophagectomy and staged reconstruction of the alimentary tract. The patient has been doing well for 24 months without signs of recurrent infection. PMID:18355554

Kawamoto, Shunsuke; Saiki, Yoshikatsu; Oda, Katsuhiko; Nitta, Yoshio; Akasaka, Jun-etsu; Miyazaki, Shukichi; Tabayashi, Koichi

2008-04-01

220

Our Experience with MR Imaging of Perianal Fistulas  

PubMed Central

Summary Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated abscess formation and its secondary extensions. Accurate information is necessary for surgical treatment and to obtain a decrease in the incidence of recurrence and complications. Radiologists should be familiar with anatomical and pathological findings of perianal fistulas and classify them using the MRI – based grading system. The purpose of this article was to provide an overview for evaluation of perianal fistulas, examples of various fistula types and their classification.

Baskan, Ozdil; Koplay, Mustafa; Sivri, Mesut; Erol, Cengiz

2014-01-01

221

Spontaneous ventral urethral fistula in a young healty man and a modified surgical technique of urethral fistula repair  

PubMed Central

Urethral fistula is rare and is usually a complication of penile and urethral surgery. A few congenital cases have been reported. Also, one acquired spontaneous case in a diabetic man has been reported. We present the first case in the literature of a healthy man with a spontaneous ventral urethral fistula, with unknown etiology. We performed a modified technique of urethral fistula repair (four-layer technique). PMID:23283105

Akkoc, Ali; Metin, Ahmet

2012-01-01

222

Spontaneous ventral urethral fistula in a young healty man and a modified surgical technique of urethral fistula repair.  

PubMed

Urethral fistula is rare and is usually a complication of penile and urethral surgery. A few congenital cases have been reported. Also, one acquired spontaneous case in a diabetic man has been reported. We present the first case in the literature of a healthy man with a spontaneous ventral urethral fistula, with unknown etiology. We performed a modified technique of urethral fistula repair (four-layer technique). PMID:23283105

Akkoc, Ali; Metin, Ahmet

2012-12-01

223

Endovascular treatment of intracranial dural arteriovenous fistulas.  

PubMed

Endovascular treatment options for dural arteriovenous fistulas (DAVFs) have vastly expanded and become progressively safer in the last several years. Angiographic imaging systems have improved, catheter technology has advanced, and liquid embolic and coil options have increased. As a likely result, an increasing proportion of DAVFs are treated via an endovascular approach. In addition to allowing physicians to appreciate and treat lesions better, varied approaches have been developed. The "plug and push" technique and the new availability of dimethyl sulfoxide--compatible dual lumen balloons have allowed safer and more thorough transarterial treatments. Transvenous treatment has proved to be a valuable technique for some lesions. Hybrid approaches with surgical assisted access to vascular structures have been successfully used to treat more challenging fistulas. PMID:24402491

Vanlandingham, Matthew; Fox, Benjamin; Hoit, Daniel; Elijovich, Lucas; Arthur, Adam S

2014-02-01

224

Spinal dural arteriovenous fistula with lipomyelodysplasia.  

PubMed

A 72-year-old man presented with a very rare case of spinal dural arteriovenous fistula (AVF) with lipomyelodysplasia manifesting as progressive paraparesis and bladder dysfunction. Magnetic resonance imaging revealed a spinal lipoma associated with tethered cord and spinal cord swelling with dilated perimedullary veins. Embolization of the spinal dural AVF was successfully performed, and is an optional treatment for coexisting spinal dural AVF and lipomyelocele in adults. PMID:23438662

Sato, Masayuki; Takigawa, Tomoji; Shiigai, Masanari; Tamura, Goichiro; Masumoto, Tomohiko; Nakai, Yasunobu; Zaboronok, Alexander; Tsurushima, Hideo; Matsumura, Akira

2013-01-01

225

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

226

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

227

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

228

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

229

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

230

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

231

Spontaneous cholecystocutaneous fistula presenting in the gluteal region.  

PubMed

The complication of cholecystocutaneous fistula secondary to calculus cholelithiasis is an extremely rare occurrence. The incidence has further decreased with the advent of broad-spectrum antibiotics, ultrasonography, and safe and early surgical treatment of biliary tract disease. We are reporting a rare cholecystocutaneous fistula presenting in the right-side gluteal region below the iliac crest. PMID:10192624

Nicholson, T; Born, M W; Garber, E

1999-04-01

232

Acute cervical radiculopathy due to vertebral AV fistula  

Microsoft Academic Search

We report the case of a 28 year old woman with acute, mainly motor, radiculopathy at C5-C6 on the right side secondary to a congenital vertebral arteriovenous fistula. The finding of a bruit at the side of the neck lent weight to the CT and MRI findings. Angiography was diagnostic. The fistula was embolized successfully.

F. Morello; G. Moro; M. Tibaldo; G. Siringo; W. Faggin; A. Franciosi

1992-01-01

233

Evidence of calcium phosphate depositions in stenotic arteriovenous fistulas.  

PubMed

This study investigates vascular samples from patients with and without end-stage renal disease (ESRD) to determine the occurrence of calcium depositions. Findings in stenotic arteriovenous (AV)-fistula veins were compared with those of nonstenotic AV-fistula veins, non-AV-fistula veins, and atherosclerotic vessels. Calcium and phosphorus content was measured by means of scanning electron microscopy and its built-in method of energy-dispersive spectrometry (EDS) X-ray analysis. We found calcium and phosphorus in samples from AV fistulas with stenotic areas with a calcium/phosphorus molar ratio of 1. Based on EDS analysis and crystal shape comparison, we conclude that calcium phosphate precipitations in stenotic AV fistulas are brushites with the composition CaHPO(4)*2H(2)O. This specific calcium phosphate deposition was found solely in stenotic AV fistulas, not in nonstenotic AV-fistula veins or non-AV-fistula veins regardless of whether the patient had ESRD. Moreover, this calcium phosphate deposition was different from calcium compounds found in atherosclerotic samples. Whether the precipitation of brushite is primarily involved in the development of vascular-access stenosis or represents a secondary consequence cannot be determined from the present study. PMID:11479165

Olsson, L F; Odselius, R; Ribbe, E; Hegbrant, J

2001-08-01

234

Esophagobronchial fistula - A rare complication of aluminum phosphide poisoning  

PubMed Central

Aluminum phosphide is a systemic lethal poison. Fistulous communication between esophagus and airway tract (esophagorespiratory fistula) has rarely been reported in the survivors of aluminum phosphide poisoning. We report a case of benign esophagobronchial fistula secondary to aluminum phosphide poisoning, which to best of our knowledge has not been reported in the medical literature. PMID:21264171

Bhargava, Sumeet; Rastogi, Rajul; Agarwal, Ajay; Jindal, Gaurav

2011-01-01

235

[Nutrition therapy in enterocutaneous fistula; from physiology to individualized treatment].  

PubMed

Enterocutaneous fistula is the most common of all intestinal fistulas. Is a condition that requires prolonged hospital stay due to complications such as electrolyte imbalance, malnutrition, metabolic disorders and sepsis. Nutritional support is an essential part of the management; it favors intestinal and immune function, promotes wound healing and decreases catabolism. Despite the recognition of the importance of nutrition support, there is no strong evidence on its comprehensive management, which can be limiting when establishing specific strategies. The metabolic imbalance that a fistula causes is unknown. For low-output fistulas, energy needs should be based on resting energy expenditure, and provide 1.0 to 1.5 g/kg/d of protein, while in high-output fistulas energy requirement may increase up to 1.5 times, and provide 1.5 to 2.5 g/kg of protein. It is suggested to provide twice the requirement of vitamins and trace elements, and between 5 and 10 times that of Vitamin C and Zinc, especially for high-output fistulas. A complete nutritional assessment, including type and location of the fistula, are factors to consider when selecting nutrition support, whether is enteral or parenteral nutrition. The enteral route should be preferred whenever possible, and combined with parenteral nutrition when the requirements cannot be met. Nutritional treatment strategies in fistulas may include the use of immunomodulators and even stress management. PMID:24483960

Rodríguez Cano, Ameyalli Mariana

2014-01-01

236

[Aorto-esophageal fistula. Apropos of a case].  

PubMed

One case of aortoesophageal fistula is presented. This pathology is rare: most of aortoenteric fistulas are in the duodenojujunum. Clinical presentation is rarely as clear as the Chiari triad describes it: mild thoracic pain, sentinel arterial hemorrhage and exsanguination. Esophagoscopy, computed tomography and arteriography are helpful for diagnosis. Issue is fatal without surgery but patients are often too old to tolerate it. PMID:7860674

Willemin, B; Simon, F; Briche, L; Chaira, A; Mugel, J L; Duchene, R

1994-10-01

237

A cure with successful staged treatment of aortoesophageal fistula.  

PubMed

Aortoesophageal fistula is a fatal disease which needs immediate control of bleeding and infection. We report a case of aortoesophageal fistula successfully treated with extra-anatomical bypass and complete resection of infected aorta and esophagus following endovascular repair. He was discharged after reconstruction of esophagus and recurrence of infection has not been observed for the past 5 years. PMID:24293247

Tanaka, Akiko; Sakamoto, Toshihito; Matsumori, Masamichi; Imanishi, Tatsuya; Nakamura, Tetsu; Okada, Kenji; Okita, Yutaka

2013-11-29

238

Ileocolic Arteriovenous Fistula with Superior Mesenteric Vein Aneurism: Endovascular Treatment  

SciTech Connect

We report a case of a venous aneurysm secondary to an acquired ileocolic arteriovenous fistula in a 64-year-old woman with recurrent abdominal pain and history of appendectomy. The aneurysm was diagnosed by ultrasound and computed tomography. Angiography showed an arteriovenous fistula between ileocolic branches of the superior mesenteric artery and vein. This vascular abnormality was successfully treated with coil embolization.

Gregorio, Miguel Angel de; Gimeno, Maria Jose; Medrano, Joaquin [Interventional Radiology, Clinico Universitario Lozano Blesa (Spain); Schoenholz, Caudio; Rodriguez, Juan; D'Agostino, Horacio [Interventional Radiology, State University Health Sciences Center (United States)

2004-09-15

239

Limits of Normal for Pressure Sensitivity in the Fistula Test  

Microsoft Academic Search

In patients with perilymphatic fistula (PLF), nystagmus may sometimes be elicited by application of pressure to the external ear canal. The extent to which the normal population also exhibits such ‘pressure sensitivity’ is presently unknown. Our goal was to determine the limits of normal pressure sensitivity and to quantify the performance of the fistula test. Our subjects consisted of 13

Timothy C. Hain; Vincent B. Ostrowski

1997-01-01

240

CT-Demonstrated Transcalvarial Channels Diagnostic of Dural Arteriovenous Fistula  

Microsoft Academic Search

Summary: MR imaging-evident intraosseous channels as- sociated with the presence of a dural arteriovenous fistula have been described in the literature. We describe these channels in relation to a case of dural arteriovenous fistula seen on CT. The presence of this subtle sign should be sought, and the area reviewed in all CT evaluations of patients with pulsatile tinnitus. Dural

Steven Alatakis; George Koulouris; Stephen Stuckey

241

Surgical management of rectourethral fistula in different situations.  

PubMed

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair. PMID:24584377

Alam, M M; Awal, M A; Rasul, M A; Rahman, M M; Naser, M F; Salam, M A; Rahman, M A

2014-01-01

242

Multiple coronary fistulae to left ventricle, with acute myocardial infarction.  

PubMed

A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect. PMID:24585292

Uyar, Ihsan Sami; Akpinar, Besir; Senarslan, Omer; Sahin, Veysel; Uc, Halil

2014-01-30

243

Transforming growth factor ?1 genotype polymorphisms determine AV fistula patency in hemodialysis patients  

Microsoft Academic Search

Transforming growth factor ?1 genotype polymorphisms determine AV fistula patency in hemodialysis patients.BackgroundIn hemodialysis patients with an arteriovenous (AV) fistula, access failure is primarily due to fistula stenosis, which predisposes to thrombosis and subsequent access loss. The risk for access failure differs interindividually, an observation that is independent from vascular anatomy in a significant number of patients. Fistula stenosis is

Gunnar H. Heine; Christof Ulrich; Urban Sester; Martina Sester; Hans Köhler; Matthias Girndt

2003-01-01

244

Malignant colo-duodenal fistula; case report and review of the literature  

Microsoft Academic Search

BACKGROUND: Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease. Cases with malignant colo-duodenal fistulae can present with symptoms from the primary, from the fistula or from metastatic disease. The fistula often results in diarrhoea and vomiting with dramatic weight loss. Upper abdominal pain is usually present as is general malaise both from the presence of the

Ruth Soulsby; Edmund Leung; Nigel Williams

2006-01-01

245

Intracranial pial arteriovenous fistula caused by dural tenting: case report.  

PubMed

We describe a rare case where a patient developed intracranial pial arteriovenous (AV) fistula due to dural tenting. The patient was a 63-year-old woman who had undergone neck clipping for an unruptured middle cerebral artery (MCA) aneurysm. The surgery was performed without any problems and her postoperative course was uneventful. Two weeks after cerebral angiography operation revealed a pial AV fistula fed by the right MCA and drained into the vein of Trolard through the Sylvian vein which had not existed before surgery. Being diagnosed as de novo pial AV fistula, surgical repair was performed. The AV fistula was located just beneath the dural tenting. The fistulous point was confirmed with fluorescein video angiography and obliterated using a clip. Although rare, we should pay attention to the AV fistula due to dural tenting as the complications of cranial surgery. PMID:24097086

Nishiyama, Yoshihisa; Kanemaru, Kazuya; Yoshioka, Hideyuki; Hanihara, Mitsuto; Horikoshi, Toru; Kniouchi, Hiroyuki

2014-01-01

246

Basilic vein transposition in the forearm for secondary arteriovenous fistula.  

PubMed

Radiocephalic (RC) fistulae remain the first choice access for hemodialysis. The antecubital fossa is recommended as the next site. However, for some patients a basilic vein can be used to create an arteriovenous (av) fistula. We report a series of patients where the forearm basilic vein served as an alternative conduit for secondary procedures. Over an 8-year period, 30 patients who had a failed RC fistula underwent a basilic vein transposition. The immediate results were satisfactory. All fistulas were successfully cannulated. Cumulative patency was 93% after 1 year, 78% after 2 years, and 55% after 3 years. No ischemic or infectious complications were noted during the study period. The use of the forearm basilic vein to create a native av fistula appears to be a good alternative to procedures in the antecubital fossa or upper arm, thus preserving more proximal veins for future use. PMID:23599505

Glowinski, Jerzy; Glowinska, Irena; Malyszko, Jolanta; Gacko, Marek

2014-04-01

247

Robotic-Assisted Laparoscopic Repair of a Vesicouterine Fistula  

PubMed Central

Background: As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. Case: A healthy 34-year-old woman who underwent 4 cesarean deliveries presented with a persistent vesicouterine fistula. Conservative management with bladder decompression and amenorrhea-inducing agents failed. Results: Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. Conclusion: Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process. PMID:21985720

Chang-Jackson, Shao-Chun R.; Acholonu, Uchenna C.

2011-01-01

248

Pharyngeal perforation and tracheopharyngeal fistula caused by foreign body impaction.  

PubMed

Development of a tracheopharyngeal fistula after pharyngeal perforation is an uncommon occurrence. As a result, published guidance for management of this rare type of aerodigestive tract fistula is limited. We describe the workup and management of a traumatic tracheopharyngeal fistula caused by foreign body impaction. A conservative, endoscopic treatment strategy with broad-spectrum antibiotics, transnasal drainage, and covered tracheal stent placement was used. The stent was removed after 4 weeks, and complete closure of the fistula tract was confirmed by endoscopy and contrast esophagram. Although tracheopharyngeal fistulae are rare and operative treatment can be complex, this case demonstrates that conservative management with antibiotics, drainage, and endoscopic stenting can be successful in select patients. PMID:25639441

Macke, Ryan A; Foxwell, Tyler; Luketich, James D; Nason, Katie S

2015-02-01

249

Incidental cholecystojejunal fistula treated with successful laparoscopic management  

PubMed Central

Internal biliary fistula (IBF) is occurred spontaneously due to the biliary disease in most cases. Bilioenteric, biliobiliary, bronchobiliary, and vasculobiliary type of IBF have been reported in the literature. We herein describe our experience with an incidental cholecystojejunal fistula, a very rare type of bilioenteric fistula in laparoscopic cholecystectomy. A 61-year-old woman with several years' history of intermittent right upper abdominal pain was admitted to Soonchunhyang University Cheonan Hospital. Abdominal CT scan showed the pneumobilia in gallbladder with common bile duct dilatation. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were done. On operative findings, there was a cholecystojejunal fistula. We performed laparoscopic cholecystectomy and fistulectomy with jejunal partial resection. To our knowledge, this is the first report on incidental cholecystojejunal fistula uncombined with any other disease and was treated with laparoscopic procedure. PMID:25368855

Jung, Hae Il; Ahn, Taesung; Cho, Sung Woo; Lee, Moon Soo; Kim, Chang Ho

2014-01-01

250

Superficial temporal arteriovenous fistula as a complication of rhytidectomy.  

PubMed

A 67-year-old woman who had undergone rhytidectomy 5 years before her presentation experienced increasing pulsatile tinnitus on the left side that had begun 2 years earlier. Angiography revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in front of her left ear. There was a scar from the earlier cosmetic surgery at the site. The fistula was embolized with N-butyl cyanoacrylate, and her tinnitus disappeared. We posit that the fistula was a complication of rhytidectomy and that a small arteriovenous fistula formed at the time of surgery and enlarged over time. This case indicates that arteriovenous fistulae can occur as a delayed complication of cosmetic surgery. PMID:22446426

Kominami, Shushi; Watanabe, Akira; Akimoto, Masahiro; Kobayashi, Shiro; Teramoto, Akira

2012-03-01

251

[A case of gallbladder carcinoma following cholecystogastric fistula].  

PubMed

A 79-year-old woman with pneumobilia and liver dysfunction was admitted to our hospital. ERCP and gastrointestinal endoscopy revealed choledochal stones and a cholecystogastric fistula at the greater curvature of the gastric antrum. The risk of cholecystectomy and fistulectomy appeared to be extremely high for this patient because of her advanced age and low respiratory function due to interstitial pneumonia. Therefore, only an endoscopic lithotomy was performed, and the cholecystogastric fistula remained. However, after 2 years of follow-up, she developed an advanced gallbladder carcinoma. This finding suggests that cholecystogastric fistula is a risk factor for gallbladder carcinoma. Because of the difficulty of early detection of gallbladder carcinoma associated with cholecystogastric fistula, both fistulectomy and cholecystectomy are necessary when cholecystogastric fistula is diagnosed. PMID:24806240

Kimura, Yoshito; Yamashita, Yukimasa; Itai, Ryosuke; Maruo, Masayuki; Son, Eiki; Ono, Hiroshi; Ikeda, Eiji; Takada, Mariko; Mikami, Sakae; Sumitomo, Yasuhiko

2014-05-01

252

The association of carotid cavernous fistula with Graves’ ophthalmopathy  

PubMed Central

Graves’ ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature. PMID:23571267

Celik, Ozlem; Buyuktas, Deram; Islak, Civan; Sarici, A Murat; Gundogdu, A Sadi

2013-01-01

253

The association of carotid cavernous fistula with Graves' ophthalmopathy.  

PubMed

Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature. PMID:23571267

Celik, Ozlem; Buyuktas, Deram; Islak, Civan; Sarici, A Murat; Gundogdu, A Sadi

2013-07-01

254

A Case of Pyriform Sinus Fistula Infection with Double Tracts  

PubMed Central

Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid. PMID:25405046

Shino, Masato; Yasuoka, Yoshihito; Nakajima, Kyoko; Chikamatsu, Kazuaki

2014-01-01

255

The medical ethics of the 'father of gynaecology', Dr J Marion Sims.  

PubMed Central

Vesico-vaginal fistula (VVF) was a common ailment among American women in the 19th century. Prior to that time, no successful surgery had been developed for the cure of this condition until Dr J Marion Sims perfected a successful surgical technique in 1849. Dr Sims used female slaves as research subjects over a four-year period of experimentation (1845-1849). This paper discusses the controversy surrounding his use of powerless women and whether his actions were acceptable during that historical period. PMID:8459435

Ojanuga, D

1993-01-01

256

Implications and Management of Pancreatic Fistulas Following Pancreaticoduodenectomy  

PubMed Central

Objective To describe the management and impact of pancreatic fistulas in a high-volume center. Design Retrospective case series. Setting Tertiary academic center. Patients Five hundred eighty-one consecutive patients who underwent pancreaticoduodenectomy from January 2001 through June 2006. Main Outcome Measures Development of a pancreatic fistula (defined as > 30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality. Results Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual withdrawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula- related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage. Conclusions More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality. PMID:18490557

Veillette, Gregory; Dominguez, Ismael; Ferrone, Cristina; Thayer, Sarah P.; McGrath, Deborah; Warshaw, Andrew L.; Fernández-del Castillo, Carlos

2013-01-01

257

Why do we have so much trouble treating anal fistula?  

PubMed Central

Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn’s disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an “ideal” procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient. PMID:21876616

Dudukgian, Haig; Abcarian, Herand

2011-01-01

258

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

259

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

260

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

261

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

262

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

263

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

264

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

265

[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

266

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

267

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

268

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

269

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

270

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

271

Spontaneous scrotal faecal fistula in infants.  

PubMed

Two infants aged 29 and 43 days, respectively, presented with a spontaneous scrotal faecal fistula from a strangulated inguinal hernia. There was associated necrotising fasciitis of the scrotum in both patients, but the testes were spared. Resection and anastomosis along with debridement of the scrotal fasciitis was successful in both cases. This complication is rare: only three other cases have been reported in the world literature. The complication appears to occur mainly in developing countries, and is the result of late presentation. The principle of early referral and repair of childhood inguinal hernias should reduce this complication and the attendant morbidity and mortality. PMID:12415400

Ameh, Emmanuel A; Awotula, Oluwole P; Amoah, Juliana N

2002-09-01

272

Isolated arterioportal fistula presenting with variceal hemorrhage  

PubMed Central

We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization. PMID:23674881

Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi

2013-01-01

273

Carotico-cavernous fistula: An educational case?  

PubMed Central

INTRODUCTION We present a case of direct carotico-cavernous fistula (CCF) and its successful treatment. PRESENTATION OF CASE A 55-year-old male presented with left eye discomfort, diplopia and pulsatile tinnitus. He had a recent history of head injury. Examination showed proptosis, chemosis, orbital bruit, and abducens nerve palsy. Digital subtraction angiography confirmed CCF, which was managed endovascularly. The patient recovered fully after treatment. DISCUSSION CCF has a variety of presenting clinical signs, imaging manifestations, and treatment options available. CONCLUSION CCF is a rare and dangerous neurological disorder that should be promptly diagnosed and treated. PMID:23959420

Martin, Sean; Teo, Mario; Bhattacharya, Jo; Alakandy, Likhith

2013-01-01

274

The challenging management of hepatopulmonary fistulas  

PubMed Central

Hepatopulmonary fistula although benign in nature carries an unacceptable mortality risk up to 10.3% in some case series mainly due to surgical complications. From the first description by Ferguson and Burford in 1967 till present different approaches have been applied and with the introduction of less invasive techniques the results have significantly improved. Interestingly the prevalence of the different etiological factors has changed over the years especially with the advance of liver ablating techniques and surgery. A step by step approach to this entity, from diagnosis to treatment has to be reestablished in order to identify the role of interventional modalities and to develop a management algorithm. PMID:25276379

Kontoravdis, Nikolaos; Lawrence, David

2014-01-01

275

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

276

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

277

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

278

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

279

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

280

Surgical management of spinal dural arteriovenous fistulas.  

PubMed

Spinal dural arteriovenous fistulas are the most common type of spinal arteriovenous malformations. Treatment options consist of microsurgical exclusion and/or endovascular embolization. We retrospectively identified all patients who benefited from surgical treatment at our tertiary center between January 2001 and December 2008. Clinical and imaging data were collected from patient files, including pre- and post-operative formal neurological examination, complete spine MRI and spinal digital subtraction angiography. Of our 30 patients, 25 were men and five were women with a median age of 62years (range 24-76). The average delay between symptom onset and clinical diagnosis was 27months (range 1-90). Complete cure of the fistula was obtained in all patients in a single surgical session with no procedural complications and no surgical morbidity. After a mean follow-up period of 32months (range 14-128), 25 patients (83%) had improved, four were stable and one worsened. Despite recent advances in endovascular techniques and materials, there is a subgroup of patients for which surgery remains the best treatment option. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications. PMID:25304440

Chibbaro, Salvatore; Gory, Benjamin; Marsella, Marco; Tigan, Leonardo; Herbrecht, Anne; Orabi, Mikael; Bresson, Damien; Baumann, Fabian; Saint-Maurice, Jean Pierre; George, Bernard; Kehrli, Pierre; Houdart, Emmanuel; Manisor, Monica; Pop, Raoul

2015-01-01

281

Urethrocutaneous fistula post-Al-Ghorab shunt  

PubMed Central

Priapism is a rare event that may be induced by clinical conditions and medications. Ischemic priapism (IP) is a compartment syndrome of the penis, and it constitutes a medical emergency that may cause significant morbidity on the erectile function in particular. We report a case of a 30-year-old male in his fourth episode of priapism. The aspiration and washing of the corpora cavernosa with saline solution were performed, followed by washing with adrenaline solution without resolution of the condition. Treatment was followed by the performance of the Al-Ghorab shunt procedure with dorsal incision of the glans. During follow-up, an area of necrosis distal to the incision was detected, and after the catheter removal on postoperative day 14, the patient developed a glandular dorsal urethrocutaneous fistula and meatal stenosis. The meatal stenosis was corrected by Johanson urethroplasty with a neo-meatus at the coronal sulcus, along with resection and debridement of the fistula tract and a three-layer closure. PMID:25210568

Paladino, João Roberto; Wroclawski, Marcelo; Den Julio, Alexandre; Teixeira, Gabriel Kushyama; Glina, Sidney; Lima Pompeo, Antonio Carlos

2014-01-01

282

Cutaneous Bronchobiliary Fistula Treated with Tissucol Sealant  

SciTech Connect

Bronchobiliary fistula is a rare and is an uncommon but severe complication of hydatid disease of the liver. Treatment has traditionally been surgical resection, but embolization and stent placement have been described. The invasive method seems to be a key component of patient treatment. We describe a case of a 58-year-old woman who, 25 years before, had undergone surgery for a hydatid cyst. A total cystectomy without previous puncture or parasite extraction was carried out. The lower aspect of the cyst was found to be completely perforated over the biliary duct. During the postoperative course, the patient had subphrenic right-sided pleural effusion and biliary fistula that subsided with medical treatment. Afterward, the patient came to the outpatient area of our hospital complaining of leakage of purulent exudate through the cutaneous opening, pain located on the right hypochondrium radiating to the right hemithorax, malaise, fever, chronic cough, and occasional vomiting of bile. Fistulography revealed an anfractuous cavity communicating with a residual cystic cavity on the right hepatic lobe. We observed communication with the intrahepatic canaliculi. Computed tomographic scan revealed a fistulous tract on the anterior liver border through the abdominal wall. There were no posttreatment complications. The patient is asymptomatic.

Prieto-Nieto, M. I., E-mail: iprieto@intermic.com; Perez-Robledo, J. P., E-mail: jperezrob@yahoo.es [La Paz Teaching Hospital, Department of General and Digestive Surgery (Spain); Alvarez-Luque, A., E-mail: luque600@hotmail.com; Suz, J. I. Acitores, E-mail: radisuzser@terra.es; Torres, J. Novo, E-mail: Joan-novo-t@ono.com [La Paz Teaching Hospital, Department of Interventional Radiology (Spain)

2011-02-15

283

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

284

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

285

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

286

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

287

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

288

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

289

Managing complications II: conduit failure and conduit airway fistulas  

PubMed Central

Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence. PMID:24876943

Mehta, Christopher K.

2014-01-01

290

The missing foley catheter: an unusual finding in vesicouterine fistula  

PubMed Central

A 28-year-old G1P1 presented complaining of urine leakage per vaginum following caesarean delivery, accompanied by amenorrhoea, cyclic haematuria and cyclic pelvic pain. Examination findings were suggestive of vesicouterine fistula and the patient was taken for exploratory laparotomy, during which the foley catheter could not be identified within the bladder. During separation of the bladder from the uterus, the catheter was found to be traversing the fistulous tract into the uterine cavity. Vesicouterine fistula is a fairly uncommon type of urogenital fistula that is frequently associated with caesarean section. Surgical treatment remains the mainstay and successfully cured this patient. PMID:24968444

Shephard, Steven N.; Lengmang, Sunday J.

2013-01-01

291

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

292

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

293

[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

294

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

295

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

296

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

297

Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning.  

PubMed

This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future. PMID:24057599

Atsumi, Naotaka; Matsubara, Muneaki; Kimura, Naritaka; Terada, Masatsugu

2013-09-21

298

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

299

Closure of oroantral fistula with the septal cartilage graft.  

PubMed

For the closure of oroantral fistula, many techniques have been described. There are advantages and disadvantages of all these techniques. We present a technique in which nasoseptal cartilage graft is used for the closure of the oroantral communication. PMID:20644947

Kansu, Leyla; Akman, Hakan; Uckan, Sina

2010-11-01

300

Transcatheter brachial fistula creation for treatment of pulmonary arteriovenous malformations.  

PubMed

Pulmonary arteriovenous malformations (PAVMs) are thought to form as a result of exclusion of hepatic venous blood from part of the pulmonary circulation. Surgical arteriovenous (AV) fistula creation has demonstrated therapeutic potential to reverse PAVM formation. We sought to demonstrate the feasibility and safety of transcatheter AV fistula creation for this indication. Fluoroscopically guided puncture from the basilic vein into the brachial artery using a Brockenbrough needle and sharpened 0.014" wire created a tract between these vessels. After balloon dilation of the tract, a covered stent was deployed, resulting in a functioning brachial AV fistula. The procedure was technically successful, with no clinical complications at 4 months follow-up. Repeat diagnostic catheterization revealed marked improvement in systemic saturation and near-resolution of PAVMs in the pilot patient. This report suggests that transcatheter brachial arteriovenous fistula formation is technically feasible, and may be effective in managing PAVMs in select single-ventricle patients. PMID:23765690

Esch, Jesse J; Marshall, Audrey C; Porras, Diego

2014-04-01

301

Novel multimodality endoscopic closure of postoperative esophageal fistula  

PubMed Central

INTRODUCTION Esophageal fistula following esophagectomy is associated with significant morbidity and mortality. PRESENTATION OF CASE We present the case of a 71-year-old man who underwent salvage Ivor-Lewis esophagectomy, following definitive chemoradiotherapy 1 year previously. On postoperative day 9 the patient complained of chest pain, and a CT scan demonstrated extravasation of oral contrast from the gastric conduit into the right chest. A right chest drain and fully covered esophageal stent were placed at this time. Despite these measures, after 8 weeks, the esophageal fistula persisted. Ultimately, fistula closure was achieved using an interventional radiology-guided, endoscopically placed over-the-scope clip (OTSC). The patient had no further complications and was well at 3 months follow-up. DISCUSSION The case reported herein describes this novel, combined-modality approach to esophageal fistula closure. CONCLUSION This case report demonstrates a novel, minimally invasive, multidisciplinary approach to the closure of a post-esophagectomy anastamotic leak. PMID:22943885

Markar, Sheraz R.; Koehler, Richard; Low, Donald E.; Ross, Andrew

2012-01-01

302

Treatment of peri-anal fistula in Crohn's disease  

PubMed Central

Anal fistulas are a common manifestation of Crohn’s disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence. PMID:25309057

Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia

2014-01-01

303

Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula  

SciTech Connect

We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

Barley, Fay L.; Kessel, David, E-mail: david.kessel@leedsth.nhs.uk; Nicholson, Tony [St. James University Hospital, Department of Radiology (United Kingdom); Robertson, Iain [Gartnaval Hospital, Department of Radiology (United Kingdom)

2006-12-15

304

Complex dural arteriovenous fistula in Bannayan-Riley-Ruvalcaba syndrome.  

PubMed

In this paper the authors report the case of a complex dural arteriovenous fistula (dAVF) with high-risk features in a 14-year-old girl with Bannayan-Riley-Ruvalcaba syndrome (BRRS), a phosphatase and tensin homolog-associated syndrome, presenting with signs and symptoms of increased intracranial pressure (ICP) that had previously been attributed to pseudotumor cerebri. This fistula was obliterated following 2 stages of embolization, and the patient experienced immediate symptomatic improvement. At the 2-month follow-up evaluation, the fistula remained angiographically occluded, and her symptoms continue to improve. This is the third reported case of an intracranial dAVF in a patient with BRRS. Because high-risk dAVFs can result in devastating morbidity, early detection with vascular imaging is crucial for patients with BRRS presenting with signs of increased ICP. Goals of treatment should include complete fistula obliteration whenever possible. PMID:23662932

Moon, Karam; Ducruet, Andrew F; Crowley, R Webster; Klas, Kathleen; Bristol, Ruth; Albuquerque, Felipe C

2013-07-01

305

Fatal aortoesophageal fistula in two cases of tight vascular ring.  

PubMed

Vascular rings are rare vascular congenital anomalies causing oesophageal and tracheal compression. An aortoesophageal fistula is a devastating, in part iatrogenic, complication of vascular rings. It is seen with increasing frequency, and can be misleading, since differential diagnosis with other causes of haematemesis and melaena is often difficult, especially in infants. We report two infants with aortoesophageal fistulas secondary to double aortic arches forming a vascular ring. In both, the diagnosis was missed, and massive haemorrhage led to death. In both cases, the fissuration on the oesophageal and aortic sides of the fistula had sharp edges, highly suggestive of an iatrogenic laceration caused by manipulation of nasogastric tubes. The key for the diagnosis of vascular rings is, therefore, clinical suspicion and awareness of this condition. Prompt identification in infants with stridor, wheezing, or respiratory distress can prevent prolonged intubation, thus avoiding the formation of an aortoesophageal fistula and hopefully preventing a fatal outcome. PMID:12018723

Angelini, Annalisa; Dimopoulos, Konstantinos; Frescura, Carla; Gamba, Piergiorgio; Lo Piccolo, Roberto; Stellin, Giovanni; Thiene, Gaetano

2002-03-01

306

Aortoesophageal fistula associated with tuberculous mediastinitis, mimicking esophageal Dieulafoy's disease.  

PubMed

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication. PMID:11961316

Lee, Ok Jae; Kim, Sung Ho

2002-04-01

307

Aortoesophageal fistula associated with tuberculous mediastinitis, mimicking esophageal Dieulafoy's disease.  

PubMed Central

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication. PMID:11961316

Lee, Ok Jae; Kim, Sung Ho

2002-01-01

308

Aortoesophageal fistula as a complication of Montgomery salivary bypass tube.  

PubMed

The authors describe a 2-year-old girl with a right-sided aortic arch who developed a sudden, fatal aortoesophageal fistula after prolonged placement of Montgomery salivary bypass tubes in the distal esophagus. PMID:15852296

McWhorter, Valerie; Dunn, James C Y; Teitell, Michael A

2005-04-01

309

Fatal aorto-esophageal fistula in child: a case report.  

PubMed

Esophageal foreign body ingestion is especially frequent in childhood and may cause fatal complications in case of late diagnosis and delayed treatment. We present a case of 2-year old girl who was admitted to emergency department with massive bleeding. However, she died due to an unrecognized foreign body resulted an aorto-esophageal fistula. At autopsy an aorto-esophageal fistula was detected by gross examination. Tissue samples were obtained from the organs and fistula region. In histopathological examination, a calcified body with multinucleated giant cell and surrounding granulation tissue was detected at the bleeding site. An ulcerated fistula tract ran from the intima to the adventitia, passing through layers of esophageal wall was also noticed. The mortality rate for foreign body ingestion is less than 1%, except in cases of perforation. Therefore the presented case is among rare examples of fatal foreign body ingestions. PMID:24485434

Pehlivan, Sultan; Kara, Dogus Ozdemir; Turkkan, Dilhan; Akçan, Ramazan; Gokmen, Asude; Akduman, Baris; Karapirli, Mustafa

2014-02-01

310

Refractory acute suppurative thyroiditis secondary to pyriform sinus fistula  

PubMed Central

Acute suppurative thyroiditis is a rare disease because the thyroid gland is remarkably resistant to infection. We present a 2-year-old girl with refractory acute suppurative thyroiditis due to a pyriform sinus fistula (PSF). She complained of fever and painful anterior neck swelling. Her condition did not completely improved by multiple parenteral antibiotics along with incision and drainage. Barium esophagogram to detect PSF demonstrated no specific finding. Computed tomography scan showed air bubble superior to the left thyroid gland which indicated a possible fistula connected to the pyriform sinus. An intraoperative laryngoscopy revealed a 2-mm-sized fistula opening. The fistula was successfully treated by chemocauterization with trichloroacetic acid. PMID:25077095

Seo, Jee Hyue; Yang, Sei Won; Kim, Hyun Young

2014-01-01

311

Comparative Analysis of the Antioxidant Activity of Cassia fistula Extracts  

PubMed Central

Antioxidant potential of various extracts of Cassia fistula was determined by the DPPH, FRAP, Fe3+ reducing power, and hydrogen peroxide scavenging assay. Methanolic extracts of Cassia fistula showed the highest amount of phenolic and flavonoid content and reducing capacity, whereas hexane extracts exhibited the lowest level of reducing capacity. The order of antioxidant activity in Cassia fistula extracts displayed from higher to lower level as methanolic extracts of pulp, methanolic extracts of seed, hexane extracts of pulp, and hexane extracts of seed. The antioxidant potential of Cassia fistula extracts significantly correlated (P < 0.02) with the phenolic content of the methanolic extracts. Ascorbic acid taken as control showed highest antioxidant power in the present study. PMID:25374682

Irshad, Md.; Zafaryab, Md.; Singh, Man; Rizvi, M. Moshahid A.

2012-01-01

312

The mechanism of pneumocephalus formation in patients with CSF fistulas.  

PubMed Central

A novel but simple explanation of how pneumocephalus develops across CSF fistulas is presented and applied to an unusual case of pneumocephalus. Preexisting models of pneumocephalus formation are discussed and a substitute model is suggested. Images PMID:3950639

Walker, F O; Vern, B A

1986-01-01

313

Hepatogastric fistula: a rare complication of pyogenic liver abscess.  

PubMed

Hepatogastric fistula is very rare. We report a case of hepatogastric fistula as a complication of pyogenic liver abscess. A 40-year-old man presented with upper abdominal pain and high-grade fever of 2?weeks. Evaluation revealed multiple liver abscesses. On an empirical diagnosis of pyogenic liver abscess, he was treated with antibiotics. During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. As expectant management failed to resolve the abscess, endoscopic retrograde papillotomy and stenting of common bile duct was performed. After endoscopic stenting, symptoms subsided. Imaging repeated after 2 weeks of endoscopic stenting showed resolving abscess. He was discharged and is doing well on regular follow-ups. We conclude that hepatogastric fistula can be managed by endoscopic stenting as bile flow through the stent hastens resolution and healing of the fistula. PMID:25035445

Gandham, Venkata Srinivas; Pottakkat, Biju; Panicker, Lakshmi C; Hari, Ranjit Vijaya

2014-01-01

314

Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa  

PubMed Central

Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign™ (Surgisis®) graft. PMID:23956521

Rajaian, Shanmugasundaram; Rajadoss, Muthukrishna Pandian; Nayak, Sukriya; Kekre, Nitin S.

2013-01-01

315

Targeted transgastric drainage of isolated pancreatic duct segments to cure persistent pancreaticocutaneous fistulas from pancreatitis.  

PubMed

Chronic pancreaticocutaneous fistulas can be difficult to treat. This article presents a snare-target technique for draining a nondilated pancreatic duct into the stomach, diverting pancreatic fluid away from the pancreaticocutaneous fistula to allow it to heal. Internal or internal/external transgastric pancreatic duct or fistula drains were placed in six patients. After an average of 4 months of drainage, all six patients experienced resolution of the cutaneous fistula. Two patients developed a pseudocyst but no recurrent fistula after drain removal, and the other four patients had no pseudocyst or fistula after an average 27-month follow-up (range, 6-74 mo). PMID:25645413

Boas, F Edward; Kadivar, Fatemeh; Kelly, Peter D; Drebin, Jeffrey A; Vollmer, Charles M; Shlansky-Goldberg, Richard D

2015-02-01

316

Tentorial artery embolization in tentorial dural arteriovenous fistulas  

Microsoft Academic Search

Introduction  The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles.Methods  Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the

Willem Jan van Rooij; Menno Sluzewski; Guus N. Beute

2006-01-01

317

Dementia caused by dural arteriovenous fistulas reversed following endovascular therapy  

PubMed Central

We describe two patients who presented with dementia as the primary neurological manifestation of their dural arteriovenous fistula (dAVF). Although dementia is not the most common presentation for a dAVF, these cases show that obliterating the fistula can eliminate this dreadful manifestation. This awareness may facilitate the diagnosis of dementia in cases caused by dAVF and allow for a minimally invasive treatment that restores cognitive function back to baseline. PMID:23077381

Henderson, James B.; Hise, Joseph H.; Opatowsky, Michael J.; Layton, Kennith F.

2012-01-01

318

Isolated Congenital Urethrocutaneous Fistula of the Anterior Urethra  

PubMed Central

Isolated congenital urethrocutaneous fistula of the anterior urethra is an extremely rare anomaly in which, along with a normal urethra and meatus, a fistula is present. These cases usually present in the pediatric age group. To date, only one such case has been described in the adult population. We describe one such case in an adult and discuss the management of this uncommon anomaly. PMID:21687400

Kamal, Mir Reza; Mandal, Soumendra Nath; Karmakar, Dilip

2011-01-01

319

Management of incurable urinary fistulas by percutaneous ureteral occlusion.  

PubMed

Women with large urinary tract fistulas in the presence of advanced incurable gynecologic cancer are a difficult problem. In the past, treatment has usually been either inadequate or highly morbid. We have palliated three women with large incurable urinary tract fistulas by occluding the distal ureters with isobutyl-2-cyanoacrylate (Bucrylate) and implanting permanent bilateral percutaneous nephrostomies. This technique is easily performed and effective, and has few complications. PMID:3684136

Stern, J L; Maroney, T P; Lacey, C G

1987-12-01

320

Is Repeat PTA of a Failing Hemodialysis Fistula Durable?  

PubMed

Purpose. Our objective was to evaluate the outcome of percutaneous transluminal angioplasty (PTA) and particularly rePTA in a failing arteriovenous fistula (AV-fistula). Are multiple redilations worthwhile? Patients and Methods. All 159 stenoses of AV fistulas that were treated with PTA, with or without stenting, during 2008 and 2009, were included. Occluded fistulas that were dilated after successful thrombolysis were also included. Median age was 68 (interquartile range 61.5-78.5) years and 75% were male. Results. Seventy-nine (50%) of the primary PTAs required no further reintervention. The primary patency was 61% at 6 months and 42% at 12 months. Eighty (50%) of the stenoses needed at least one reintervention. Primary assisted patency (defined as patency after subsequent reinterventions) was 89% at 6 months and 85% at 12 months. The durability of repeated PTAs was similar to the durability of the primary PTA. However, an early primary PTA carried a higher risk for subsequent reinterventions. Successful dialysis was achieved after 98% of treatments. Nine percent of the stenoses eventually required surgical revision and 13% of the fistulas failed permanently. Conclusion. The present study suggests that most failing AV-fistulas can be salvaged endovascularly. Repeated PTA seems similarly durable as the primary PTA. PMID:24587906

Bountouris, Ioannis; Kristmundsson, Thorarinn; Dias, Nuno; Zdanowski, Zbigniew; Malina, Martin

2014-01-01

321

Elevated Shear Stress in Arteriovenous Fistulae: Is There Mechanical Homeostasis?  

NASA Astrophysics Data System (ADS)

Arteriovenous fistulae are created surgically to provide access for dialysis in patients with renal failure. The current hypothesis is that the rapid remodeling occurring after the fistula creation is in part a process to restore the mechanical stresses to some preferred level (i.e. mechanical homeostasis). Given that nearly 50% of fistulae require an intervention after one year, understanding the altered hemodynamic stress is important in improving clinical outcomes. We perform numerical simulations of four patient-specific models of functioning fistulae reconstructed from 3D Doppler ultrasound scans. Our results show that the vessels are subjected to `normal' shear stresses away from the anastomosis; about 1 Pa in the veins and about 2.5 Pa in the arteries. However, simulations show that part of the anastomoses are consistently subjected to very high shear stress (>10Pa) over the cardiac cycle. These elevated values shear stresses are caused by the transitional flows at the anastomoses including flow separation and quasiperiodic vortex shedding. This suggests that the remodeling process lowers shear stress in the fistula but that it is limited as evidenced by the elevated shear at the anastomoses. This constant insult on the arterialized venous wall may explain the process of late fistula failure in which the dialysis access become occluded after years of use.

McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto

2011-11-01

322

Objective parameters aid the prediction of fistulas in pancreatic surgery  

PubMed Central

Insufficiency of pancreatic anastomosis with leakage from the pancreatic stump and the development of fistulas account for the majority of surgical complications following pancreatic resection, which are often life threatening. The cause of pancreatic fistulas of the remnant tissue on a molecular level remains unclear. Thus, the aim of the present study was to investigate risk factors associated with postoperative pancreatic fistula (POPF) formation and to define parameters that may predict the resection outcome. Pancreatic resection margins were selected from 31 patients, including 16 individuals without and 15 patients with POPF, to analyze the degree of fibrosis, lipomatous atrophy, inflammatory activity and infiltration. Wound healing factors were assessed by luminex technology using tissue homogenates, while the distribution in situ was assessed using immunohistochemistry. Increased chronic inflammatory infiltration, a higher degree of fibrosis and a reduction in lipomatous atrophy were observed in the samples without anastomotic fistulas. Multiplex analysis of 38 wound healing factors demonstrated significantly higher levels of interleukin (IL)-6, -8 and -12, glucagon-like peptide-1 and matrix metalloproteinase (MMP)-1, -2, -3 and -12 in the group without fistulas, while lower concentrations of IL-10, IL-17 and gastric inhibitory polypeptide were observed. Therefore, the observations of the present study indicated that increased inflammatory infiltration and inflammatory activity, as well as higher concentrations of proinflammatory cytokines and higher MMP levels at the resection margins, predisposed individuals to a lower fistula incidence rate following pancreatic resection. PMID:25120588

FELIX, KLAUS; SCHUCK, ANNA; GAIDA, MATTHIAS M.; HINZ, ULF; DOVZHANSKIY, DMITRIY; WERNER, JENS

2014-01-01

323

Current Diagnosis and Management of Gastrojejunocolic Fistula  

PubMed Central

We herein report the case of a 51-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. The main clinical presentation of this condition is chronic abdominal pain, weight loss, diarrhea, gastrointestinal bleeding and fecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal tomography for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2–3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favored to minimize mortality. PMID:20805940

Kece, Can; Dalgic, Tahsin; Nadir, Is?lay; Baydar, Behlul; Nessar, Gurel; Ozdil, Burhan; Bostanci, E. Birol

2010-01-01

324

Perilimphatic fistula test: a video clip demonstration.  

PubMed

Perilymphatic fistula (PLF) is an abnormal condition in which a communication is present between the perilymphatic space of the inner ear and the middle ear or mastoid, secondary to a dehiscence in the otic capsule, oval or round window. LF may induce hearing loss, tinnitus, aural fullness, vertigo, disequilibrium, or a combination of these symptoms; the vagueness of symptoms caused by PLF and the lack of specificity of clinical signs and symptoms make the diagnosis elusive. We report a video of a positive PLF test induced by the application of pressure on the tragus, just anterior to the left external auditory canal in a patient with cholesteatoma and PLF of lateral semicircular canal confirmed by CT scan imaging. https://www.youtube.com/watch?v=x5MhSILF9O4. PMID:25535121

Casale, M; Errante, Y; Sabatino, L; Incammisa, A; Salvinelli, F; Quattrocchi, C C

2014-12-01

325

Pericardioesophageal fistula following left atrial ablation procedure.  

PubMed

We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation. PMID:25426222

Bailey, Christopher W; Tallaksen, Robert J

2014-10-01

326

Aortoesophageal fistula: congenital and acquired causes.  

PubMed

Aortoesophageal fistula (AEF) is a rare but frequently lethal cause of upper gastrointestinal bleeding. This is a report of the authors' experience with four cases--two from congenital and two from acquired causes. A review of the pediatric cases reported in the literature is included. The mortality from AEF is high, and can be decreased in two ways. AEF can be prevented by avoiding prolonged nasogastric intubation in patients with known vascular rings, and by promptly removing esophageal foreign bodies and promptly treating periesophageal abscesses. Once an AEF occurs, it presents with typical large-herald upper gastrointestinal bleeding of bright red blood, and cardiovascular collapse. Recognition of this pattern, with vigorous resuscitation and aggressive surgical management, will improve the survival rate. PMID:7807347

Sigalet, D L; Laberge, J M; DiLorenzo, M; Adolph, V; Nguyen, L T; Youssef, S; Guttman, F M

1994-09-01

327

Pericardioesophageal Fistula Following Left Atrial Ablation Procedure  

PubMed Central

We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation. PMID:25426222

Bailey, Christopher W.; Tallaksen, Robert J.

2014-01-01

328

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

329

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

330

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

331

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

332

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

333

Ureteric Embolization for Lower Urinary Tract Fistulae: Use of Two Amplatzer Vascular Plugs and N-Butyl Cyanoacrylate Employing the 'Sandwich' Technique  

SciTech Connect

PurposeThis study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N-butyl cyanoacrylate.MaterialsThis is a retrospective study (January 2007-December 2010) of patients with urinary-vaginal fistulae undergoing distal ureter embolization utilizing an Amplatzer- N-butyl cyanoacrylate-Amplatzer sandwich technique. An 8-12-mm type-I or type-II Amplatzer vascular plug was delivered using the sheath and deployed in the ureter distal to the pelvic brim. Instillation of 0.8-1.5 cc of N-butyl cyanoacrylate into ureter proximal to the Amplatzer plug was performed. This was followed by another set of 8-12-mm type-I or type-II Amplatzer vascular plugs in a technique referred to as the 'sandwich technique.'ResultsFive ureters in three patients were occluded utilizing the above-described technique during the 4-year study period. Mean maximum size Amplatzer used per ureter was 10.8 mm (range, 8-12). One ureter required three Amplatzer plugs and the rest required two. Two patients (3 ureters) were clinically successful with complete resolution of symptoms in 36-48 h. The third patient (2 ureters) was partly successful and required a second Amplatzer- N-butyl cyanoacrylate sandwich technique embolization. The mean clinical follow-up was 11.3 months (range, 1.7-29.2).ConclusionsThe Amplatzer- N-butyl cyanoacrylate-Amplatzer sandwich technique for occluding the distal ureter is safe and effective with a quick (probably due to the N-butyl cyanoacrylate) and durable (probably due to the Amplatzer plugs) clinical response.

Saad, Wael E. A., E-mail: ws6r@virginia.edu; Kalagher, S.; Turba, U. C.; Sabri, S. S.; Park, A.-W.; Stone, J.; Angle, J. F.; Matsumoto, A. H. [University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Vascular Interventional Radiology (United States)

2013-08-01

334

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

335

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

336

Gastropericardial fistula, purulent pericarditis, and cardiac tamponade after laparoscopic Nissen fundoplication.  

PubMed

Gastropericardial fistula, purulent pericarditis, and cardiac tamponade developed 7 years after laparoscopic Nissen fundoplication. The patient was successfully managed through a thoracotomy by open drainage of the pericardium, excision and closure of the fistula, and an omentum flap. PMID:16368406

Sihvo, Eero I T; Räsänen, Jari V; Hynninen, Marja; Rantanen, Tuomo K; Salo, Jarmo A

2006-01-01

337

Arterio-venous fistulae: A possible complication of transradial approach with a possible non invasive management  

PubMed Central

Arteriovenous fistulae is rarely reported as a complication of percutaneous coronary interventions with trans-radial approach. We report herein a case of radial arteriovenous fistulae that was treated conservatively by applying manual compression and avoiding surgical intervention. PMID:24954993

Dahdouh, Ziad; Abdel-Massih, Tony; Dahdouh, Houaida; Sarkis, Antoine; Grollier, Gilles

2014-01-01

338

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

339

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

340

A case of mucinous adenocarcinoma arising in long-standing multiple perianal and presacral fistulas  

Microsoft Academic Search

Chronic anal fistulas are not rare; however, the development of a carcinoma in long-standing, perianal fistulas is rare. We describe a case of an 85-year-old man with multiple, recurring, perianal fistulas, extending to the natal cleft. The patient underwent en bloc resection of the fistulas which were in direct continuity with the middle rectum. Histological examination revealed a mucinous colonic

C. Papapolychroniadis; D. Kaimakis; K. Giannoulis; P. Berovalis; E. Karamanlis; A. Haritanti; A. Leukopoulos; G. Kokkonis; O. M. Masoura; A. Dimitriadis; M. Giala; N. Harlaftis

2004-01-01

341

Giant right coronary artery aneurysm with a fistula to the left ventricle.  

PubMed

A right coronary artery (RCA) aneurysm with a fistula to the left ventricle is rare. In general, the draining site of the RCA fistula may be the right ventricle, right atrium, or pulmonary veins, whereas drainage to the left ventricle occurs less frequently. We report a patient with a RCA aneurysm with a fistula to the left ventricle. He was treated successfully by resection of the RCA aneurysm and closure of the fistula. PMID:23176958

Zheng, Jubing; Dong, Ran; Liu, Taoshuai; Li, Yang; Zhou, Qiwen

2012-12-01

342

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma.  

PubMed

Significant hemobilia due to arterio-biliary fistula is a very rare complication of chemoradiation therapy (CRT) for unresectable intrahepatic cholangiocarcinoma (ICC). Here we report a case of arterio-biliary fistula after CRT for unresectable ICC demonstrated by angiographic examinations. This fistula was successfully treated by endovascular embolization. Hemobilia is a rare complication, but arterio-biliary fistula should be considered after CRT of ICC. PMID:21160700

Hayano, Koichi; Miura, Fumihiko; Amano, Hodaka; Toyota, Naoyuki; Wada, Keita; Kato, Kenichiro; Takada, Tadahiro; Asano, Takehide

2010-09-28

343

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

344

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

345

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

346

Etiology of vaginal infections in Ouagadougou (Burkina Faso).  

PubMed

to determine the specific antimicrobial activity of the drugs proposed in the national algorithm for treatment of vaginal infections. Over a three-month period, the bacteriological laboratory of the Yalgado-Ouédraogo University Hospital in Ouagadougou analyzed vaginal swabs from women seen at 5 health-care facilities in that city. The study included 404 women with a mean age of 29 years. The microbes with the highest incidence rates were various species of Candida (20%), Gardnerella and/or Mobiluncus (18.8%), and Ureaplasma/Mycoplasma (10.9%). The agents isolated were highly susceptible to ciprofloxacin, erythromycin, fluconazole, miconazole, and nystatin. This study demonstrated the continuing efficacy of the drugs in the national algorithm for treatment of vaginal infections, which is associated with compliance with the recommended diagnostic procedure and therapeutic protocol. PMID:24919210

Sanou, I; Millogo-Traoré, F; Bicaba, I; Touré, B; Soudré, F

2014-06-11

347

A vaginal cyst causing dysuria and dyschezia in a bitch.  

PubMed

A 9-year-old female dog was referred to Azabu University Veterinary Teaching Hospital for dysuria and dyschezia after ovariohysterectomy. After a series of diagnostic imaging, vaginal obstruction was suspected by vaginal fluid retention. Surgical repair was attempted three times to establish patency through the vagina and the vestibule by episiotomy and laparotomy. Another laparotomy was performed to remove the entire vaginal mucosal layer to prevent recurrence, which resulted in favorable outcome. Histopathological examination revealed that the resected tissue was a cyst originated from mesonephric duct remnant. In the present case, the cyst was curable by the entire resection of the cyst lining membrane, which could eradicate all the secretory cells with least damage to the urethral vasculature and innervation. PMID:24646603

Watanabe, Toshifumi; Mishina, Mika; Sakurai, Yohei

2014-07-01

348

Morbidity associated with failed vaginal birth after cesarean section.  

PubMed

We investigated morbidity and factors associated with failed vaginal birth after cesarean delivery (VBAC). In a retrospective cohort study maternal and neonatal outcomes of women who underwent VBAC in three Nigerian University Teaching Hospitals were reviewed. Univariate, followed by multivariate analyses, were conducted. VBAC was successful in 683 of 1,013 women (67.4%), whereas 330 (32.6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities. Younger age, lack of previous vaginal delivery, induction of labor and fetal weight >4,000 g were risk factors for failed VBAC. A majority of women who try VBAC achieve a vaginal delivery. Failed VBAC is associated with increased maternal and neonatal morbidity and is somewhat predictable. PMID:20804350

Oboro, Victor; Adewunmi, Adeniyi; Ande, Anibaba; Olagbuji, Biodun; Ezeanochie, Michael; Oyeniran, Ayodeji

2010-09-01

349

Sustained release of proteins from a modified vaginal ring device  

PubMed Central

A new vaginal ring technology, the insert vaginal ring (InVR), is presented. The InVR overcomes the current shortfall of conventional vaginal rings (VRs) that are generally ineffectual for the delivery of hydrophilic and/or macromolecular actives, including peptides, proteins and antibodies, due to their poor permeation characteristics in the hydrophobic polymeric elastomers from which VRs are usually fabricated. Release of the model protein BSA from a variety of insert matrices for the InVR is demonstrated, including modified silicone rods, directly compressed tablets and lyophilised gels, which collectively provided controlled release profiles from several hours to beyond 4 weeks. Furthermore, the InVR was shown to deliver over 1 mg of the monoclonal antibody 2F5 from a single device, offering a potential means of protecting women against the transmission of HIV. PMID:21055465

Morrow, Ryan J.; Woolfson, A. David; Donnelly, Louise; Curran, Rhonda; Andrews, Gavin; Katinger, Dietmar; Malcolm, R. Karl

2013-01-01

350

A Case of Vaginal Cancer with Uterine Prolapse  

PubMed Central

Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 × 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis. PMID:25371880

Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin

2013-01-01

351

A functional ectopic vaginal anus: a rare clinical entity.  

PubMed

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises.She improved within a month with Wexner score of zero. PMID:23058153

Mehboob, Mukhtar; Naz, Samina; Tabassum, Shahina; Khan, Jamil Ahmed

2012-10-01

352

Effects of feminine hygiene products on the vaginal mucosal biome  

PubMed Central

Background Over-the-counter (OTC) feminine hygiene products come with little warning about possible side effects. This study evaluates in-vitro their effects on Lactobacillus crispatus, which is dominant in the normal vaginal microbiota and helps maintain a healthy mucosal barrier essential for normal reproductive function and prevention of sexually transmitted infections and gynecologic cancer. Methods A feminine moisturizer (Vagisil), personal lubricant, and douche were purchased OTC. A topical spermicide (nonoxynol-9) known to alter the vaginal immune barrier was used as a control. L. crispatus was incubated with each product for 2 and 24h and then seeded on agar for colony forming units (CFU). Human vaginal epithelial cells were exposed to products in the presence or absence of L. crispatus for 24h, followed by epithelium-associated CFU enumeration. Interleukin-8 was immunoassayed and ANOVA was used for statistical evaluation. Results Nonoxynol-9 and Vagisil suppressed Lactobacillus growth at 2h and killed all bacteria at 24h. The lubricant decreased bacterial growth insignificantly at 2h but killed all at 24h. The douche did not have a significant effect. At full strength, all products suppressed epithelial viability and all, except the douche, suppressed epithelial-associated CFU. When applied at non-toxic dose in the absence of bacteria, the douche and moisturizer induced an increase of IL-8, suggesting a potential to initiate inflammatory reaction. In the presence of L. crispatus, the proinflammatory effects of the douche and moisturizer were countered, and IL-8 production was inhibited in the presence of the other products. Conclusion Some OTC vaginal products may be harmful to L. crispatus and alter the vaginal immune environment. Illustrated through these results, L. crispatus is essential in the preservation of the function of vaginal epithelial cells in the presence of some feminine hygiene products. More research should be invested toward these products before they are placed on the market. PMID:24009546

Fashemi, Bisiayo; Delaney, Mary L.; Onderdonk, Andrew B.; Fichorova, Raina N.

2013-01-01

353

Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas  

Microsoft Academic Search

ObjectivesPreoperative duplex scanning of arm and forearm veins has increased the creation of autogenous arteriovenous (AV) fistulas. However, the cumulative functional patency and durability of transposed AV fistulas (TAVF) compared with nontransposed AV fistulas (AVF) and prosthetic bridging grafts (AVG) remains ill-defined.

Hung Michael Choi; Brajesh K Lal; Joaquim J Cerveira; Frank T Padberg; Michael B Silva; Robert W Hobson; Peter J Pappas

2003-01-01

354

Increasing the Use of Arteriovenous Fistula in Hemodialysis: Economic Benefits and Economic Barriers  

Microsoft Academic Search

The Fistula First Initiative set a goal of 66% arteriovenous (AV) fistula-based access among US hemodialysis patients. This study modeled the impact of achieving the target AV fistula placement rate on Medicare expenditures and on dialysis patient survival and also reviewed economic disincentives for providers that will inhibit achieving this target. The model projects lifetime costs and survival in the

Donald Schon; Steven W. Blume; Kimberly Niebauer; Christopher S. Hollenbeak; Gregory de Lissovoy

2007-01-01

355

Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance  

Microsoft Academic Search

Purpose: The purpose of this study was to evaluate the impact of secondary procedures to facilitate maturation of autogenous arteriovenous (AV) fistulas and optimize their use for hemodialysis access. Methods: The records of patients undergoing new autogenous AV fistulas were reviewed. Analyses of fistula maturation, subsequent interventions, access function, and patency were performed. Results: From July 1998 through June 2000,

Scott S. Berman; Andrew T. Gentile

2001-01-01

356

A New Animal Model to Study Intimal Hyperplasia in Arteriovenous Fistulas  

Microsoft Academic Search

Background. Intimal hyperplasia (IH) plays a key role in the failure of arteriovenous (AV) fistulas. The animal models available to study IH in AV fistulas are expensive and do not mimic the development of truly stenotic IH. In this study we examined whether goats are a more suitable model to study IH in AV fistulas.Materials and Methods. Thirteen direct and

M. S. Lemson; M. J. A. P. Daemen; J. H. M. Tordoir

1999-01-01

357

Endovascular exclusion of iliac artery to iliac vein fistula after lumbar disk surgery  

Microsoft Academic Search

Iliac arteriovenous (AV) fistula is rare after lumbar disk surgery. Traditionally, open repair through the arterial lumen was performed. We report endovascular exclusion of an iliac AV fistula in a 41-year-old woman 8 years after lumbar diskectomy. An angiogram showed an AV fistula connecting the right common iliac artery and vein. This was repaired with placement of two covered wall

J. P. Hart; F. Wallis; B. Kenny; B. O'Sullivan; P. E. Burke; P. A. Grace

2003-01-01

358

Congenital coronary artery fistulae: a rare cause of heart failure in adults  

PubMed Central

Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status. PMID:24886594

2014-01-01

359

Autologous fibrin glue in the treatment of rectovaginal and complex fistulas  

Microsoft Academic Search

This nonrandomized series reports the use of autologous fibrin glue to treat complex rectovaginal and anorectal fistulas. The use of an autologous source to prepare fibrin glue eliminates the risk of disease transmission. Ten patients, six women and four men, with complex fistulas were treated with autologous fibrin glue application. Five patients had rectovaginal fistulas; one of them had Crohn's

Michael E. Abel; Yanek S. Y. Chiu; Thomas R. Russell; Peter A. Volpe

1993-01-01

360

The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas  

Microsoft Academic Search

Objectives: Esophageal strictures and esophagorespiratory fistulas are complications of malignant esophageal tumors, which are difficult to manage. The efficacy of self-expanding metal stents (SEMS) for palliation of malignant esophageal strictures and fistulas was investigated prospectively. Methods: Forty-three SEMS were inserted in 41 patients with malignant esophageal stricture or fistula. Our series included 32 men and nine women, of whom median

Alpay Sarper; Necdet Oz; Cemalettin Cihangir; Abid Demircan; Erol Isin

2003-01-01

361

Ten-Year Experience With Transvaginal Vesicovaginal Fistula Repair Using Tissue Interposition  

Microsoft Academic Search

PurposeThe success rate of vesicovaginal fistula repair is improved by tissue interposition. The Martius flap produces reliable results but it has increased morbidity. A peritoneal flap is easily created with minimal morbidity and it can be used for proximal fistulas. We describe our 10-year experience with tissue interposition for transvaginal repair of vesicovaginal fistulas.

KARYN SCHLUNT EILBER; ELIZABETH KAVALER; LARISSA V. RODRÍGUEZ; NIRIT ROSENBLUM; SHLOMO RAZ

2003-01-01

362

Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease  

Microsoft Academic Search

During the period 1955 to 1974 inclusive, 826 patients developed Crohn's disease and were registered citizens of Stockholm County at the time of definite diagnosis. These patients were followed up and investigated with reference to the occurrence of and outcome after treatment for anal fistulae. These fistulae were recorded in 184 patients (23%). The incidence of anal fistulae increased the

G Hellers; O Bergstrand; S Ewerth; B Holmström

1980-01-01

363

Assessment of Sexual Functioning, Mental Health, and Life Goals in Women with Vaginal Agenesis  

Microsoft Academic Search

Vaginal agenesis is a congenital disorder defined by the incomplete formation of the vagina and other reproductive organs, often including the cervix, uterus, and fallopian tubes. For the patient, this frequently means infertility and an underdeveloped vagina with the subsequent difficulty to have vaginal intercourse. The patient with vaginal agenesis and her family then encounter a variety of psychological concerns

Elizabeth M. Morgan; Elisabeth H. Quint

2006-01-01

364

Efficacy of a new ketoconazole bioadhesive vaginal tablet on Candida albicans  

Microsoft Academic Search

To develop more effective treatment for vaginal candidasis, ketoconazole (KTZ) was formulated in bioadhesive tablet formulations that increase the time of contact of drug with the vaginal mucosa. The bioadhesive vaginal tablets delivery of KTZ was prepared by direct compression of sodium carboxymethyl cellulose or polyvinylpyrrolidone or hydroxypropylmethyl cellulose (HPMC-E50). Dissolution studies of bioadhesive tablets and commercial ovules were carried

H. Ye?im Karasulu; Süleyha Hilmio?lu; Dilek Y Metin; Tamer Güneri

2004-01-01

365

76 FR 17444 - In the Matter of Certain Vaginal Ring Birth Control Devices; Notice of Investigation  

Federal Register 2010, 2011, 2012, 2013, 2014

...In the Matter of Certain Vaginal Ring Birth Control Devices; Notice of Investigation...after importation of certain vaginal ring birth control devices by reason of infringement...after importation of certain vaginal ring birth control devices that infringe claim 1...

2011-03-29

366

Laser surgery in the treatment of vaginal cysts  

NASA Astrophysics Data System (ADS)

The authors described the results of treatment of vaginal cysts with CO2 laser under colposcopic control in 12 women. In five of them the recurrent Bartholin's, in another five the Gartner's and in tow the endometrial cysts were diagnosed. All laser surgeries were done in the Department of Reproduction, Institute of Gynecology, Karol Marcinkowski School of Medical Sciences, Poznan, Poland between September 1995 and September 1996. In the authors' opinion the use of CO2 laser is the efficient method of treatment of vaginal cysts. The most of laser procedures are doing as the one-day surgery. There are no serious postoperative complications after laser surgery.

Wozniak, Jakub; Dydowicz, Piotr; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Wilczak, Maciej; Pisarski, Tadeusz

1997-10-01

367

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

368

[Cottonseed--a source of vaginal contraceptive (author's transl)].  

PubMed

The antifertility effect of the cottonseed oil, gossypol, had been first observed in China, where it was administered orally to over 40,000 healthy males, with an effectiveness of 99%. The authors of this study have tried gossypol as a vaginal contraceptive. Gossypol acetic acid was dissolved in 0.5 N NaOH, and then diluted. The solution obtained was added to a similar volume of seminal liquid, and sperm motility was carefully measured. The immobilization of spermatozoa was total. The same results were obtained with seminal liquid from rats. One added advantage of vaginal administration of gossypol would be its lubricating quality. PMID:12311573

Tso, W W; Lee, C S

1982-01-01

369

A case of a bleeding benign gastrocolic fistula in 2014  

PubMed Central

INTRODUCTION In the era of proton pump inhibitors in the treatment of peptic ulcer disease, the incidence of a gastrocolic fistula arising from unoperated gastric ulcers is extremely low. PRESENTATION OF CASE We present the case of a 68-year old farmer who presented with melaena and was found to have a benign gastrocolic fistula in the setting of untreated peptic ulcer disease, chronic NSAID ingestion and heavy alcohol intake. The diagnosis was made by gastroscopy. En bloc surgery was undertaken due to the size of the fistula and concomitant significant bleeding of the ulcer which would not have made it amenable to medical management. DISCUSSION The symptoms of a gastrocolic fistula are undifferentiated and the diagnosis can easily be missed in the setting of other complications such as bleeding or perforation of a hollow viscus. Barium enamas are the most accurate for the diagnosis but gastroscopy with biopsy is usually performed to rule out malignancy. The mainstay of treatment is usually surgical, though patients can be medically managed if he/she is not a surgical candidate. CONCLUSION Benign gastrocolic fistulas are rare and its diagnosis is easily missed. PMID:25460443

Winata, Leon Shin-han; Kong, Cherng Huei; Thiruchelvam, Dhan

2014-01-01

370

The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth.  

PubMed

Ascending bacterial infection is implicated in about 40-50% of preterm births. The human vaginal microbiota in most women is dominated by lactobacilli. In women whose vaginal microbiota is not lactobacilli-dominated anti-bacterial defence mechanisms are reduced. The enhanced proliferation of pathogenic bacteria plus degradation of the cervical barrier increase bacterial passage into the endometrium and amniotic cavity and trigger preterm myometrial contractions. Evaluation of protocols to detect the absence of lactobaciili dominance in pregnant women by self-measuring vaginal pH, coupled with measures to promote growth of lactobacilli are novel prevention strategies that may reduce the occurrence of preterm birth in low-resource areas. PMID:25316066

Witkin, Ss

2015-01-01

371

Evaluation of the Effects of a New Intravaginal Gel, Containing Purified Bovine Colostrum, on Vaginal Blood Flow and Vaginal Atrophy in Ovariectomized Rat  

PubMed Central

Introduction Vaginal dryness due to vaginal atrophy is a common complaint of postmenopausal women, interfering with sexual function and quality of life. Hormone replacement therapy is the only effective therapy but with known risks that leave unmet medical needs. A new product, ZP-025 vaginal gel, containing purified (dialyzed lyophilized) bovine colostrum, has been developed for the treatment of vaginal dryness secondary to vaginal atrophy. Aim The study aims to investigate the effects of intravaginal application of ZP-025 on vaginal atrophy using an animal model. Methods Ovariectomized female Sprague-Dawley rats were used. Three weeks after surgery, rats were divided into four groups and treated for 4 weeks (twice a day) with placebo or ZP-025 at low (0.5%) or high (2.3%) concentrations of colostrum; in the control group, rats did not receive any treatment. Changes in vaginal blood flow due to pelvic nerve stimulation were assessed by laser Doppler flowmetry and vaginal tissue was collected for histological assay. Main Outcome Measures The main outcome measures were vaginal blood flow before and after pelvic nerve stimulation and histology of vaginal epithelium. Results Treatment with ZP-025 to ovariectomized rats induced an increase of vaginal blood flow parameters (vascular capacitance, amplitude and area under the curve of the response) in response to pelvic nerve stimulation compared with control group, statistically significant at 2.3%. Vaginal epithelium showed a physiological estrous cycle aspect in treated animals, with at least five cell layers vs. one or two cell layers in control rats. As expected from a topical formulation, systemic effects on body weights and uterine wet weights were not observed with application of ZP-025. Conclusions In this study, the new product ZP-025, containing purified colostrum, was shown to have beneficial effects on vaginal atrophy in ovariectomized rats, improving vaginal hemodynamics and thickness of vaginal epithelium. Vailati S, Melloni E, Riscassi E, Behr Roussel D, and Sardina M. Evaluation of the effects of a new intravaginal gel, containing purified bovine colostrum, on vaginal blood flow and vaginal atrophy in ovariectomized rat. Sex Med 2013;1:35–43. PMID:25356286

Vailati, Silvia; Melloni, Elsa; Riscassi, Ermanno; Behr Roussel, Delphine; Sardina, Marco

2013-01-01

372

How Do Clinicians Manage Vaginal Complaints? An Internet Survey  

PubMed Central

Abstract and Introduction Abstract Introduction Although vaginal symptoms are among the most common presentations in primary care, little is known about how clinicians manage them. Question We undertook an Internet survey to determine how clinicians decided what was normal, how they evaluated vaginal complaints, and what happened when a diagnosis could not be reached. Methods A 27-question anonymous survey was conducted using the Medscape Internet publication platform and Medscape General Medicine, an online, peer-reviewed, open-access general medical journal. The study was targeted at physicians and nurse practitioners. Results There were 556 nurse practitioner and 608 physician respondents. Clinicians generally agreed that a midcycle increase in discharge and discharge seen at the introitus were normal; itching/irritation, odor, and a green discharge were not. There was less agreement concerning the value of a yellow discharge and “self-diagnosis” of abnormality. Eighty-two percent of MDs and 77% of NPs reported examining patients prior to treatment always or often. Only about 30% performed pH testing always or often. Ninety percent of NPs and 92% of MDs reported not making a diagnosis rarely or sometimes. When offered 4 different management strategies for patients in whom no diagnosis was made (watch and wait, symptomatic therapy, empiric antibiotics, referral), there was no clear preference. There was a weak correlation between performance of a wet mount and reports of less non-diagnosis. There was no correlation between pH and whiff testing and reports of less non-diagnosis. Conclusions Clinicians do not always agree about what constitutes a vaginal symptom. Although most providers usually examine patients with vaginal complaints, pH and whiff testing are performed less frequently. Our data suggest the latter 2 maneuvers are not diagnostically helpful. There is no consensus regarding what to do when no diagnosis is made. Our findings suggest that the traditional approach to the evaluation of vaginal symptoms may have limited relevance for clinicians. Introduction The “classic approach” to evaluating vaginal symptoms[1] focuses on the diagnosis of vaginal candidiasis, bacterial vaginosis, and trichomoniasis. The evaluation is based on discharge characteristics, pH testing, the whiff test, and microscopy with both normal saline and KOH.[2,3] The classic approach has been promoted by professional organizations[4] and a clinical literature that emphasizes the importance of making a precise diagnosis before treating the patient.[5,6] Unfortunately, the classic approach presents a number of problems. The diagnostic value of its components is limited.[1,7] Microscopy, the traditional test for trichomoniasis, has a sensitivity of only about two thirds, meaning that one third of patients with this condition will be missed.[7] Not surprisingly, the classic approach often results in no diagnosis. Even after an evaluation far more extensive than that suggested by the classic approach, no cause for vaginal symptoms will be found in about one third of women.[8–10] Problems with the classic approach are compounded by the relatively thin evidence base upon which to determine whether vaginal symptoms are normal.[11] Finally, the classic approach does not include emphasis on the important social dimensions of vaginal symptoms.[12] There is very limited evidence about how clinicians actually manage these symptoms. In 2001, Wiesenfeld and Macio[13] reported on a group of patients referred to a specialty clinic for vaginal symptoms. Using a chart review, they determined that the whiff test and pH testing had been performed only 3% of the time by the referring physician, suggesting that the classic approach is seldom followed. We do not know the reasons for this. Patients may wish to avoid pelvic examination. Providers who perform the wet mount must be certified in accordance with the Clinical Laboratories Improvement Act (CLIA),[14] and this may represent a barrier in some practices. How do clinicians

Anderson, Matthew R.; Karasz, Alison

2005-01-01

373

[Aorto-enteric fistula: an interdisciplinary practical approach].  

PubMed

Aorto-enteric fistulas (AEF) are a rare but often -fatal complication. The primary diagnosis of AEF remains difficult. Computed tomography and FDG-PET?/?CT (fluorodeoxyglucose positron emission computed tomography) are the diagnostic tools of choice. Therapy consists of an urgent individual interdisciplinary surgical approach with primary axillo-femoral bypass and secondary prosthesis explantation or in situ replacement and consecutive bowel resection. Endovascular aortic repair (EVAR) is reserved for primary -aorto-enteric fistulas in patients without signs of infection or in emergency cases as a bridging meth-od. A systematic review of the literature from 1990 to 2009 was performed by medline -research (pubmed) to analyse diagnostic and treatment strategies for aorto-enteric fistulas. A practical, interdisciplinary diagnostic and therapeutic algorithm was created in accordance with the analysed results. PMID:21500147

Hyhlik-Dürr, A; Able, T; Böckler, D; Boeckler, D

2011-06-01

374

Aorto-oesophageal fistula: an unusual complication of oesophageal biopsies  

PubMed Central

The authors report a case of an aorto-oesophageal fistula presenting in a patient undergoing investigation for possible oesophageal malignancy who underwent multiple oesophageal biopsies. A 73-year-old gentleman underwent endoscopic biopsy of an oesophageal lesion. Histology showed only inflammatory changes, endoscopy was repeated and again biopsy showed only inflammatory changes. The patient then presented with severe haematemesis, which was shown by CT angiogram to be due to an aorto-oesophageal fistula. This was treated with endovascular stenting, and the patient recovered well. Sequential imaging has shown gradual resolution of the submucosal swelling and lymphadenopathy, excluding the possibility of underlying oesophageal malignancy. This is the first reported case of aorto-oesophageal fistulation as a complication of endoscopic oesophageal biopsies. Aorto-oesophageal fistula is an uncommon but potentially life-threatening cause of haematemesis. It is a potential complication of endoscopic oesophageal biopsy. PMID:22696721

Wiggins, Tom; Chaudry, Muhammed Asif; Vasas, Peter; Bryant, Catherine; Hughes, Frances

2011-01-01

375

Aortoesophageal fistula following endovascular exclusion of a thoracic aneurysm.  

PubMed

The aim of this study was to report a case of aortoesophageal fistula following endovascular exclusion of a thoracic aneurysm, treated conservatively with fatal outcome. Endovascular exclusion of a thoracic aneurysm was performed in a 64-year-old female patient. Three months later the diagnosis of an aortoesophageal fistula was made and minimal surgery (cervicotomy and jejunostomy) was performed, combined with antibiotherapy and catheter flushing of the infected excluded aneurysm thrombus. The patient died in septic shock 9 weeks later. As reported, following conventional thoracic aortic aneurysm surgery, endovascular stenting of the thoracic aorta can be complicated by aortoesophageal fistula. Management should be surgical, since the outcome under conservative management seems invariably fatal. However, it looks as if the poor condition of these patients may not permit open surgical treatment. PMID:17622215

Martens, K; De Mey, J; Everaert, H; Delvaux, G; Van Den Brande, P

2007-09-01

376

Synovial fistula after tension band plating for genu valgum correction.  

PubMed

Tension band plating is a commonly performed procedure to address angular deformities about the knee in children. We present a case of a synovial fistula formation after tension band plate removal, an unreported complication in the literature. An 11-year-old girl underwent tension band plating for genu valgum. After removal of the plate, she developed a synovial fistula that was confirmed by magnetic resonance imaging. Her knee was immobilized in extension, which allowed the synovial fistula to heal. The unique capsular anatomy in the knee provides a possible etiology. Physicians performing tension band plating should be aware of this complication and consider a brief period of immobilization of 3 to 5 days after hardware removal to allow the capsular rent to heal. PMID:25566555

Momaya, Amit; Ray, Peter; Khoury, Joseph

2015-01-01

377

Reconstruction of an enterocutaneous fistula using a superior gluteal artery perforator flap.  

PubMed

Enterocutaneous fistula is an uncommon complication of surgery for colorectal cancer. However, once a fistula has developed, treatment is complicated by previous treatments. Here, we describe an enterocutaneous fistula that developed after multiple treatments for rectal cancer in a 62-year-old woman. The woman had previously undergone several colorectal surgeries, radiation therapy and five courses of chemotherapy. Four years after the final surgery, an enterocutaneous fistula developed between the small intestine and the sacral skin. The fistula was resected, and the resulting defect was successfully reconstructed with a superior gluteal artery perforator flap. PMID:17959426

Sakuraba, M; Asano, T; Yano, T; Yamamoto, S; Moriya, Y

2009-01-01

378

Conceival, a novel noncontraceptive vaginal vehicle for lipophilic microbicides.  

PubMed

The objective of this study was to develop a nontoxic and noncontraceptive vaginal drug delivery vehicle for lipophilic anti-human immunodeficiency virus (HIV) microbicides. Three representative poorly water-soluble novel broad-spectrum anti-HIV microbicides, PHI-113, PHI-346, and PHI-443, were evaluated in 11 different solvent systems. Based on their solubility profiles, a novel nonspermicidal self-emulsifying gel (viz Conceival) composed of pharmaceutical excipients, sorbitol, polyethylene glycol 400, polysorbate 80, microcrystalline cellulose, xanthan gum, and water was optimized. Conceival enhanced the solubility of these poorly water-soluble (<0.001 mg/mL) anti-HIV drugs by at least 150- to 270-fold. Conceival was evaluated in vivo in the New Zealand white rabbit model for the preservation of sperm function based on pregnancy outcome and the potential for vaginal irritation following single and multiple intravaginal applications, respectively. Conceival administered intravaginally immediately prior to artificial insemination with semen had no adverse effects on subsequent reproductive performance, neonatal survival, or pup development when compared with untreated control group. Histologic evaluation of vaginal tissues of rabbits exposed intravaginally to Conceival for 14 consecutive days revealed lack of epithelial, submucosal, and vascular changes at the gel application site (total irritation score <3 out of a possible 16). These findings indicate that Conceival has potential to become a clinically useful, safe noncontraceptive vaginal vehicle for lipophilic microbicides. PMID:16353964

D'Cruz, Osmond J; Samuel, Peter; Uckun, Fatih M

2005-01-01

379

Vaginal and Oral Microbes, Host Genotype and Preterm Birth  

PubMed Central

Preterm birth (PTB) is a leading cause of infant mortality and morbidity in the U.S. and across the globe. Infection and associated inflammation are important initiators for PTB pathways; an estimated 40% of PTBs are attributed to amniochorionic-decidual or systemic inflammation. Historically, intrauterine infections have been implicated in PTB; recent evidence suggests that infections remote from the fetal site may also be causative. There is strong epidemiological evidence that bacterial vaginosis and periodontitis -- two syndromes characterized by perturbations in the normal vaginal and oral bacterial microflora respectively-- are linked to infection-associated PTB. Oral and vaginal environments are similar in their bacterial microbiology; identical bacterial species have been independently isolated in periodontitis and bacterial vaginosis. Periodontitis and bacterial vaginosis also share many behavioral and sociodemographic risk factors suggesting a possible common pathophysiology. Genetic polymorphisms in host inflammatory responses to infection are shared between bacterial vaginosis, periodontitis and PTB, suggesting common mechanisms through which host genotype modify the effect of abnormal bacterial colonization on preterm birth. We review the state of knowledge regarding the risk of PTB attributable to perturbations in bacterial flora in oral and vaginal sites and the role of host genetics in modifying the risk of infection-related PTB. We posit that bacterial species that are common in perturbed vaginal and oral sites are associated with PTB through their interaction with the host immune system. PMID:19942083

Srinivasan, Usha; Misra, Dawn; Marazita, Mary L.; Foxman, Betsy

2014-01-01

380

Local Production of Chemokines during Experimental Vaginal Candidiasis  

Microsoft Academic Search

Recurrent vulvovaginal candidiasis, caused by Candida albicans, is a significant problem in women of child- bearing age. Although cell-mediated immunity (CMI) due to T cells and cytokines is the predominant host defense mechanism against C. albicans at mucosal tissue sites, host defense mechanisms against C. albicans at the vaginal mucosa are poorly understood. Based on an estrogen-dependent murine model of

MICHAEL SAAVEDRA; BRAD TAYLOR; NICHOLAS LUKACS; PAUL L. FIDEL

1999-01-01

381

Characteristics of women with continued use of vaginal pessaries.  

PubMed

Vaginal pessaries have been shown to be a safe, effective treatment for pelvic organ prolapse, and in some cases, female urinary incontinence. There are limited data that predict long-term pessary use; therefore, the aim of this retrospective, exploratory study was to describe selected characteristics of women using a pessary for 12 months or longer in a nurse-run clinic. PMID:24079114

Lewthwaite, Barbara J; Staley, Doug; Girouard, Lise; Maslow, Ken

2013-01-01

382

Vaginal and oral microbes, host genotype and preterm birth.  

PubMed

Preterm birth (PTB) is a leading cause of infant mortality and morbidity in the US and across the globe. Infection and associated inflammation are important initiators for PTB pathways; an estimated 40% of PTBs are attributed to amniochorionic-decidual or systemic inflammation. Historically, intrauterine infections have been implicated in PTB; recent evidence suggests that infections remote from the fetal site may also be causative. There is strong epidemiological evidence that bacterial vaginosis and periodontitis--two syndromes characterized by perturbations in the normal vaginal and oral bacterial microflora, respectively--are linked to infection-associated PTB. Oral and vaginal environments are similar in their bacterial microbiology; identical bacterial species have been independently isolated in periodontitis and bacterial vaginosis. Periodontitis and bacterial vaginosis also share many behavioral and sociodemographic risk factors suggesting a possible common pathophysiology. Genetic polymorphisms in host inflammatory responses to infection are shared between bacterial vaginosis, periodontitis and PTB, suggesting common mechanisms through which host genotype modify the effect of abnormal bacterial colonization on preterm birth. We review the state of knowledge regarding the risk of PTB attributable to perturbations in bacterial flora in oral and vaginal sites and the role of host genetics in modifying the risk of infection-related PTB. We posit that bacterial species that are common in perturbed vaginal and oral sites are associated with PTB through their interaction with the host immune system. PMID:19942083

Srinivasan, Usha; Misra, Dawn; Marazita, Mary L; Foxman, Betsy

2009-12-01

383

Vaginal infections. How to identify and treat them.  

PubMed

Vaginal infection occurs at some time in the majority of women. Most such infections are caused by Candida albicans, Trichomonas vaginalis, and Gardnerella (Hemophilus) vaginalis. Some less common--but in many cases increasingly prevalent--causes include herpes-virus type 2, papillomavirus, Chlamydia trachomatis, Mycoplasma T strains, and toxic shock syndrome. PMID:6681672

Schneider, G T

1983-02-01

384

Antifungal activity of lectins against yeast of vaginal secretion  

PubMed Central

Lectins are carbohydrate-binding proteins of non-imune origin. This group of proteins is distributed widely in nature and they have been found in viruses, microorganisms, plants and animals. Lectins of plants have been isolated and characterized according to their chemical, physical-chemical, structural and biological properties. Among their biological activities, we can stress its fungicidal action. It has been previously described the effect of the lectins Dviol, DRL, ConBr and LSL obtained from the seeds of leguminous plants on the growth of yeasts isolated from vaginal secretions. In the present work the experiments were carried out in microtiter plates and the results interpreted by both methods: visual observations and a microplate reader at 530nm. The lectin concentrations varied from 0.5 to 256?g/mL, and the inoculum was established between 65-70% of trammitance. All yeast samples isolated from vaginal secretion were evaluated taxonomically, where were observed macroscopic and microscopic characteristics to each species. The LSL lectin did not demonstrate any antifungal activity to any isolate studied. The other lectins DRL, ConBr and DvioL, showed antifungal potential against yeast isolated from vaginal secretion. These findings offering offer a promising field of investigation to develop new therapeutic strategies against vaginal yeast infections, collaborating to improve women's health. PMID:24031889

Gomes, Bruno Severo; Siqueira, Ana Beatriz Sotero; de Cássia Carvalho Maia, Rita; Giampaoli, Viviana; Teixeira, Edson Holanda; Arruda, Francisco Vassiliepe Sousa; do Nascimento, Kyria Santiago; de Lima, Adriana Nunes; Souza-Motta, Cristina Maria; Cavada, Benildo Sousa; Porto, Ana Lúcia Figueiredo

2012-01-01

385

Binding of type 1-piliated Escherichia coli to vaginal mucus.  

PubMed Central

To better understand the interactions involved in bacterial adherence and the role of mucus in the pathogenesis of urinary tract infections, we developed a system to study the binding of a recombinant Escherichia coli strain, HB101/pWRS1-17, expressing type 1 pili, to vaginal mucus collected from 28 women. Bacteria bound to differing extents to all specimens examined, and preincubation of bacteria with mannose inhibited binding by 50 to 89%. Additionally, all mucus samples showed reactivity with anti-mannose antibody, and the levels of reactivity correlated with the levels of bacterial binding, suggesting that the mannose-terminal saccharides present on these glycoproteins are the receptors for the binding of type 1-piliated bacteria. Mucus specimens collected over periods of 5 days and 12 weeks exhibited significant variation in bacterial binding, indicating temporal differences in the ability of vaginal mucus to act as a receptor for type 1-piliated E. coli. The results show that vaginal mucus can bind bacteria and may thus influence the initial attachment and subsequent colonization of the vaginal and urinary tract epithelium by E. coli. PMID:7822005

Venegas, M F; Navas, E L; Gaffney, R A; Duncan, J L; Anderson, B E; Schaeffer, A J

1995-01-01

386

Labial Adhesion with Acute Urinary Retention Secondary to Vaginitis  

PubMed Central

Labial adhesion occurs most often in infants and girls and is usually associated with low estrogen levels. Labial adhesion in the reproductive age group is extremely rare due to abundance of estrogen. Herein we present a case of almost complete labial adhesion with acute urinary retention in a 21-year-old virgin woman secondary to a probable untreated severe vaginitis. PMID:25105038

?entürk, ?enol; Üstüner, Pelin; Bal?k, Gül?ah; Ka??tc?, Mehmet; Ural, Ülkü Mete; ?ahin, Figen K?r

2014-01-01

387

A retrospective comparison of water births and conventional vaginal deliveries  

Microsoft Academic Search

The aim of this study was to document the practice of water births and compare their outcome and safety with normal vaginal deliveries. A retrospective case-control study was conducted over a five year period from 1989 to 1994 at the Maternity Unit, Rochford Hospital, Southend, UK. Three hundred and one women electing for water births were compared with the same

Chineze M. Otigbah; Mandish K. Dhanjal; Gloria Harmsworth; Tim Chard

2000-01-01

388

Incidence of Postpartum Infection after Vaginal Delivery in Viet Nam  

Microsoft Academic Search

This study assessed the incidence of postpartum infection which is rarely clinically evaluated and is probably underestimated in developing countries. This prospective study identified infection after vaginal delivery by clinical and laboratory examinations prior to discharge from hospital and again at six weeks postpartum in Ho Chi Minh City, Viet Nam. Textbook definitions, physicians' diagnoses, symptomatic and verbal autopsy definitions

Nguyen T. N. Ngoc; Nancy L. Sloan; Tran S. Thach; K. B. Liem; Beverly Winikoff

2005-01-01

389

Conservative Management of Placenta Accreta/Increta after Vaginal Birth  

PubMed Central

Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14–100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus. PMID:25308979

Peiffer, S.; Reinhard, J.; Reitter, A.; Louwen, F.

2012-01-01

390

A new vaginal speculum for pelvic organ prolapse quantification (POPQ)  

Microsoft Academic Search

The purposes of this study were to introduce a new vaginal speculum, describe the technique of using the new speculum in identifying and measuring the severity of pelvic organ prolapse (POP), and present results of a pilot study comparing the new speculum to the conventional instruments used in performing POP quantification (POPQ). The new speculum has retractable upper and lower

Ananias C. Diokno; German Borodulin

2005-01-01

391

[Acute urinary retention in primary vaginal carcinoma: therapeutic approach].  

PubMed

Carcinoma of the vagina is a very rare disease. Primary vaginal carcinoma tends to spread by local invasion of the adjacent pelvic organs (without any kind of metastases) and secondarily through lymphatic channels. The aim of this report is to add observations concerning the surgical treatment of this rare occurrence of carcinoma. The 33-year old patient's history began with an acute urinary retention which imposed bladder catheterization. Local examination revealed a hard 3/3 cm large mass on the middle third of the anterior vaginal wall, invasive in the urinary bladder. Cystoscopic examination confirmed the tumor invasion in the trigone. Biopsy specimens of the tumor and histological examination showed carcinoma. Anterior pelvic exenteration with pelvic lymph nodes dissection and total colpectomy was performed and the patient received a continent urinary diversion to the skin (modified Indiana pouch), ovary transposition, vaginal reconstruction with gracilis myocutaneous flaps. Postoperative evolution was uneventful. Organ reconstruction surgery including continent urinary diversion, vaginal reconstruction will significantly improve the quality of life and don't change the body image of the patients after pelvic major surgical procedures such pelvic exenteration. PMID:17687867

Glück, G; Mitulescu, G; Ungureanu, D; Stîngu, C

2007-01-01

392

Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam)  

MedlinePLUS

... service covered? Search Medicare.gov for covered items Cervical & vaginal cancer screenings How often is it covered? Medicare Part ... pay for them. Related resources National Cancer Institute—cervical cancer information CDC—cervical cancer information U.S. Preventive Services ...

393

Quantitation of Secretory Immonoglobulin A in Vaginal Secretions  

ERIC Educational Resources Information Center

The purpose of this study was to attempt to correlate vaginal levels of SIgA with variables including age, day of menstrual cycle, use of oral contraceptives, length of time oral contraceptives had been used, and presence of Candida albicans infection. (Author)

Grant, Tamara Dawn; Mace, Kenneth D.

1977-01-01

394

Human neutrophil peptides in vaginitis/cervicitis of different etiology.  

PubMed

Development of female genito-urinary infections depends on many factors, such as immune system activity, virulence of microorganism and production of factors inhibiting the growth of microorganisms. Taking into account the possibility of relapses or severe complications, it is very important to appropriately diagnose and treat infections. Because of recently observed increase of microbial resistance to antibiotics, researchers are looking for alternatives. In our study we evaluated and compared the concentration of human neutrophil peptides (HNP 1-3) in cervico-vaginal lavages (CVL), obtained from women with vaginitis/cervicitis. Swabs from the posterior vaginal fornix and from the endocervical canal as well as CVL samples were obtained from 32 patients with vaginitis/cervicitis and 29 healthy women (control group). Supernatants of CVL were used for determination of concentration of HNP by ELISA. The difference between concentrations of HNP 1-3 in studied and control groups was statistically significant (p = 0.018). The maximal concentration was determined in patients with mixed infections (28.41 ng/ml), and Group B Streptococci, GBS, (28.06 ng/ml), the minimal concentrations in cases of C. trachomatis (mean concentrations did not differ from those in the control group: 16.93 ng/ml and 16.39 ng/ml, respectively). Maximal correlation was determined for control-studied group with isolation of GBS (r = 0.79), and very high negative correlation for group of GBS - C. trachomatis (r = -0.98). PMID:18062652

Wiechu?a, Barbara E; Friedek, Daniela A; Ekiel, Alicja M; Romanik, Ma?gorzata K; Martirosian, Gayane

2007-01-01

395

Vaginal Practices of HIV-Negative Zimbabwean Women  

PubMed Central

Background. Vaginal practices (VPs) may increase HIV risk by injuring vaginal epithelium or by increasing risk of bacterial vaginosis, an established risk factor for HIV. Methods. HIV-negative Zimbabwean women (n = 2,185) participating in a prospective study on hormonal contraception and HIV risk completed an ancillary questionnaire capturing detailed VP data at quarterly followup visits for two years. Results. Most participants (84%) reported ever cleansing inside the vagina, and at 40% of visits women reported drying the vagina using cloth or paper. Vaginal tightening using cloth/cotton wool, lemon juice, traditional herbs/powders, or other products was reported at 4% of visits. Women with ?15 unprotected sex acts monthly had higher odds of cleansing (adjusted odds ratio (aOR): 1.17, 95% CI: 1.04–1.32). Women with sexually transmitted infections had higher odds of tightening (aOR: 1.42, 95% CI: 1.08–1.86). Conclusion. Because certain vaginal practices were associated with other HIV risk factors, synergism between VPs and other risk factors should be explored. PMID:20871844

Turner, Abigail Norris; Morrison, Charles S.; Munjoma, Marshall W.; Moyo, Precious; Chipato, Tsungai; van de Wijgert, Janneke H.

2010-01-01

396

Mucus-Penetrating Nanoparticles for Vaginal Drug Delivery Protect Against Herpes Simplex Virus  

PubMed Central

Incomplete coverage and short duration of action limit the effectiveness of vaginally administered drugs, including microbicides for preventing sexually transmitted infections. We investigated vaginal distribution, retention, and safety of nanoparticles with surfaces modified to enhance transport through mucus. We show that mucus-penetrating particles (MPPs) provide uniform distribution over the vaginal epithelium, whereas conventional nanoparticles (CPs) that are mucoadhesive are aggregated by mouse vaginal mucus, leading to poor distribution. Moreover, when delivered hypotonically, MPPs were transported advectively (versus diffusively) through mucus deep into vaginal folds (rugae) within minutes. By penetrating into the deepest mucus layers, more MPPs were retained in the vaginal tract after 6 h compared to CPs. 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 developed MPPs composed of acyclovir monophosphate (ACVp). When administered prior to vaginal herpes simplex virus 2 (HSV-2) challenge, ACVp-MPPs protected 53% of mice, compared to only 16% protected by soluble drug. Overall, MPPs improved vaginal drug distribution and retention, provided more effective protection against vaginal viral challenge than soluble drug, and were non-toxic when administered daily for one week. PMID:22700955

Ensign, Laura M.; Tang, Benjamin C.; Wang, Ying-Ying; Tse, Terence A.; Hoen, Timothy; Cone, Richard; Hanes, Justin

2013-01-01

397

Application of the low-level laser therapy for the treatment of vaginitis  

NASA Astrophysics Data System (ADS)

Vaginitis is the most common female infectious disease. Females suffering from this disorder are annually increasing in number. There are a lot of modalities of treatment of vaginitis, but because of drug allergy and microbe's stability to drug the treatment of vaginitis is difficult. Our study compares the efficacy of laser-therapy with drug therapy in the treatment of non-specific vaginitis and vaginal candidiasis. Thirty women reci4eed the LLLT by local action with antiseptic liquid daily during ten days, 20 women received metronidazole and fluconozole and vaginal application of metronidazole. The results suggest that local laser-therapy is able to remove sights of vaginitis more efficiently and faster than drug therapy. Repair of normal vaginal microflora, which is the best indicator of recovery, was significantly at a faster rate in laser-therapy group. There were no report of adverse reaction with vaginal laser- therapy, whereas there were women on drug therapy who reported side effects. In conclusion, vaginal aser-therapy with antiseptic liquid is a suitable, effective, safe and chip alternative to drug therapy in the treatment of vaginitis.

Passeniouk, A. N.; Mikhailov, V. A.

2000-06-01

398

A rare case of congenital complex pulmonary AV fistula.  

PubMed

A 15-year-old boy presented with central cyanosis with clubbing and dyspnoea on exertion. Cardiovascular examination did not reveal any abnormality. ECG was normal. Chest X-ray showed a normal sized heart with rounded opacities of variable size in the left upper lung field. Two-dimensional echocardiographic examination was normal. CT angiography showed a large complex lesion composed of serpiginous tubular structures involving the left upper and lingular lobe, suggestive of racemose tangle of blood vessels. A diagnosis of large complex arteriovenous (AV) fistula involving the left upper and lingular lobe was performed. This case reports a rare case of complex pulmonary AV fistula. PMID:25326563

Pradhan, Akshyaya; Khare, Rashi; Sethi, Rishi

2014-01-01

399

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent  

PubMed Central

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. PMID:22919174

Chawla, Rakesh K.; Madan, Arun; Chawla, Kiran

2012-01-01

400

Pouching a draining duodenal cutaneous fistula: a case study.  

PubMed

Blockage of the mesenteric artery typically causes necrosis to the colon, requiring extensive surgical resection. In severe cases, the necrosis requires removal of the entire colon, creating numerous problems for the WOC nurse when pouching the opening created for effluent. This article describes the management of a draining duodenal fistula in a middle-aged woman, who survived surgery for a blocked mesenteric artery that necessitated the removal of the majority of the small and large intestine. Nutrition, skin management, and pouch options are described over a number of months as the fistula evolved and a stoma was created. PMID:10036421

Zwanziger, P J

1999-01-01

401

Intermittent gaseous bowel distention: atypical sign of congenital tracheoesophageal fistula.  

PubMed

Three girls, 5-, 9-, and 15-year-old, were evaluated for recurrent airway infections and pneumonia. Chest X-rays, which included the upper portion of the abdomen, showed marked gaseous bowels distention, while computed tomography scans of the chest demonstrated the presence of tracheoesophageal fistula (TEF), confirmed by fiberoptic bronchoscopy. Abdominal gaseous distension, a known possible clinical manifestation of TEF in the neonatal period generated by airflow through the fistula into the oesophagus, has not been reported as a clue to the diagnosis in older children. When detected in patients with recurrent respiratory infection, should raise the suspicion of unrecognized TEF. PMID:19205051

Gardella, Chiara; Tomà, Paolo; Sacco, Oliviero; Girosi, Donata; Panigada, Serena; Battistini, Elena; Mattioli, Girolamo; Jasonni, Vincenzo; Rossi, Giovanni A

2009-03-01

402

Primary Aortoesophageal Fistula due to Thoracic Aortic Aneurysm  

PubMed Central

Aortoesophageal fistula is a rare emergency that presents a real challenge for cardiothoracic surgeons. There have been few reports of survivors. We present the case of a 70-year-old man with aortoesophageal fistula, mediastinal abscess, and severe septicemia consequent to esophageal erosion and rupture of a chronic degenerative descending thoracic aortic aneurysm. The patient underwent successful surgical treatment by aorto–aortic bypass and bipolar esophageal exclusion in conjunction with a cervical esophagostomy and a feeding gastrostomy. The pleural cavity was copiously irrigated and drained. Three months later, a retrosternal gastric bypass operation was performed successfully. The patient's 6-month follow-up examination revealed no problems. PMID:20069092

Prokakis, Christos; Charoulis, Nikolaos; Tselikos, Dimitrios; Koletsis, Efstratios N.; Apostolakis, Efstratios; Dougenis, Dimitrios

2009-01-01

403

Congenital bronchial artery to pulmonary artery fistula presenting as hemoptysis.  

PubMed

A 51-year-old male presented with 2 weeks of hemoptysis. Pulmonary angiography was performed and identified a bronchial artery to pulmonary artery fistula of the right upper lobe. Despite angioembolization, the hemoptysis recurred 1 year later. It was hypothesized that the recurrence occurred due to retrograde filling from the pulmonary arterial side of the abnormality. Right upper lobectomy was performed and resulted in resolution of hemoptysis. We present a case report of a rare, congenital bronchial artery to pulmonary artery fistula. PMID:25555983

VanDerPloeg, Daniel G; Strong, William R; Krohmer, Steven J; O'Connor, William N; Martin, Jeremiah T

2015-01-01

404

Gastro cutaneous fistula after laparoscopic cholecystectomy: A case report.  

PubMed

A young lady presented with a nonhealing epigastric sinus after 2 years of laparoscopic cholecystectomy performed outside. Upper gastrointestinal (GI) endoscopy and contrast study confirmed its communication with the stomach. At relaparoscopy, the fistula was identified, dissected, and stapled with endo-GIA stapler. Patient made an uneventful postoperative recovery and she is well after 20 months of surgery. It may be concluded that laparoscopic cholecystectomy can lead to the development of gastrocutaneous fistula that can be managed by relaparoscopy and stapling the tract with endo-GIA devices. PMID:16804460

Verma, Ganga R; Kaman, Lileshwar

2006-06-01

405

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent.  

PubMed

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. PMID:22919174

Chawla, Rakesh K; Madan, Arun; Chawla, Kiran

2012-07-01

406

Endovascular Repair of a Secondary Aorto-Appendiceal Fistula  

SciTech Connect

Aortoenteric fistula (AEF) is an uncommon but serious complication occurring after aortic surgery and may occur at any site in the gastrointestinal tract, with the duodenum being the most common. Conventional surgical repair of secondary AEF has high mortality, whereas endovascular repair has emerged as an alternative treatment despite concerns about persistent or recurrent infection. We report the case of a 91-year old man who was admitted with rectal bleeding from an aorto-appendiceal fistula 9 years after open abdominal aortic aneurysm repair. This rare site for AEF was diagnosed on computed tomography, and we present the first case of endovascular treatment of this uncommon complication.

Tse, Donald M. L., E-mail: donald.tse@gmail.com [John Radcliffe Hospital, Headington, Department of Interventional Radiology (United Kingdom); Thompson, Andrew R. A.; Perkins, Jeremy [John Radcliffe Hospital, Headington, Department of Vasculary Surgery (United Kingdom); Bratby, Mark J.; Anthony, Susan; Uberoi, Raman [John Radcliffe Hospital, Headington, Department of Interventional Radiology (United Kingdom)

2011-10-15

407

A bill of rights for patients with obstetric fistula.  

PubMed

According to the seven categories of vulnerability proposed by Kipnis (cognitive, juridical, deferential, medical, allocational, social, and infrastructural), and the four generally accepted principles of biomedical ethics (respect, beneficence, non-maleficence, and fairness), women with obstetric fistulas are an exceptionally vulnerable population. Therefore, they merit special consideration in both clinical care and research settings. Adoption of a formal bill of rights for patients with fistula similar to the one proposed in the present report should be encouraged at all facilities where these women are treated. Acknowledgment of their rights would help to improve their care and end the abuses they are exposed to in institutional settings. PMID:25194211

Wall, L Lewis

2014-12-01

408

[Renal arteriovenous fistula with a vein aneurysm: a case report].  

PubMed

A 54-year-old woman presented with abdominal distension. Her medical history was unremarkable. Contrast-enhanced computed tomography (CT) revealed a left renal arteriovenous fistula and a large vein aneurysm, and she was diagnosed with aneurismal-type renal arteriovenous fistula. She was successfully treated with transcatheter arterial embolization using steel coils. Although she had pulmonary embolism as a serious post-operative complication, she recovered with anticoagulant therapy using heparin and warfarin. A contrast-enhanced CT scan performed 6 months after transcatheter arterial embolization did not show recanalization. PMID:25142960

Sasaki, Yutaro; Oda, Shinpei; Fujikata, Shiro; Tanimoto, Shuji; Kan, Masaharu

2014-07-01

409

Surgical Treatment of Aortobronchial and Aortoesophageal Fistulae due to Thoracic Aortic Aneurysm  

PubMed Central

We present a review of our single-institution experience, over 19 years, with aortobronchial and aortoesophageal fistulae due to descending thoracic aortic aneurysm. We conducted a retrospective chart review of 10 cases involving surgery for aortobronchial and aortoesophageal fistulae in our clinic from February 1985 through October 2004. Pathologic or predisposing conditions associated with aortobronchial fistula were descending thoracic aortic aneurysm (n = 8), previous aortic surgery (n = 1), and concomitant aortoesophageal fistula (n = 1). Three patients presented emergently with aortobronchial fistula (n = 2) and aortoesophageal fistula (n = 1). Ages of the 10 patients ranged from 42 to 74 years (median, 63 years). The median cross-clamp time was 34 minutes (range, 27–41 min). Repairs, in 9 patients, involved an inlay of prosthetic tube graft using the clamp-and-sew technique, and in 1 patient repair involved patch aortoplasty. The operative mortality rate was 20%: 1 patient had acute concomitant aortoesophageal and aortobronchial fistulae, and another had chronic aortobronchial fistula. There was no embolic stroke or paraplegia. During follow-up (median, 2.5 years), there were no deaths or postoperative morbidity. We conclude that repair of aortobronchial and aortoesophageal fistulae using the clamp-and-sew technique can be performed with acceptable operative mortality and long-term results. However, the mortality rate continues to be highly significant in patients with acute bleeding aortobronchial fistula or with aortoesophageal fistula, despite rapid surgical intervention. PMID:16429896

Eren, Ercan; Keles, Cuneyt; Toker, Mehmet Erdem; Ersahin, Suat; Erentug, Vedat; Guler, Mustafa; Ipek, Gokhan; Akinci, Esat; Balkanay, Mehmet; Yakut, Cevat

2005-01-01

410

Colposcopy and High Resolution Anoscopy in Screening For Anal Dysplasia in Patients With Cervical, Vaginal, or Vulvar Dysplasia or Cancer  

ClinicalTrials.gov

Cervical Intraepithelial Neoplasia Grade 1; Cervical Intraepithelial Neoplasia Grade 2; Cervical Intraepithelial Neoplasia Grade 3; Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Stage 0 Cervical Cancer; Stage 0 Vaginal Cancer; Stage 0 Vulvar Cancer; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IV Vulvar Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer

2012-06-08

411

Guiding the vaginal microbicide trials with biomarkers of inflammation.  

PubMed

This article discusses cytokine patterns as potential biomarkers of vaginal inflammation, which are needed for the safety evaluation of topical microbicide products for the prevention of sexually transmitted HIV-1 infection. In order to be effective, the vaginal anti-HIV-1 microbicides should avoid proinflammatory responses that facilitate transepithelial viral penetration and replication. Pro-inflammatory and anti-inflammatory cytokines play bi-directional roles in HIV-1 pathogenesis, transmission, susceptibility and resistance. Previous research has shown that many of these key mediators of mucosal barrier function (e.g. IL-1, IL-1 receptor antagonist, IL-6, TNF-alpha, TNF-receptor II, transforming growth factor beta, IL-10, IL-12, IL-8, macrophage inhibitory protein 1, etc.) can be detected in the vaginal secretions of healthy or infected individuals using non-invasive sampling techniques. As part of two microbicide trials, we measured IL-lalpha, IL-1beta, IL-1 receptor antagonist, TNF-alpha and IL-8 in 291 cervicovaginal lavage samples obtained before product use and at the seventh and 14th day after product use. We showed that vaginal formulations, temperature and matrix-specific factors in the vaginal fluids may interfere with cytokine detection, and therefore specific protocols must be validated for various collection procedures and cytokine assays. Our results suggest that combined patterns of cytokine dynamics rather than individual measurements might distinguish proinflammatory product-related effects in microbicide safety trials. More research is needed to establish cytokine mucosal baselines and modulation by genetic factors, sexual intercourse, menstrual cycle, exercise, hormones, stress and infections before guidelines can be established for clinical trial enrollment criteria, the prediction of side/adverse events and ultimately microbicide benefit prognostication. PMID:16419271

Fichorova, Raina N

2004-10-01

412

Antibiotic use during pregnancy alters the commensal vaginal microbiota.  

PubMed

Antibiotics may induce alterations in the commensal microbiota of the birth canal in pregnant women. Therefore, we studied the effect of antibiotic administration during pregnancy on commensal vaginal bacterial colonization at gestational week 36. Six hundred and sixty-eight pregnant women from the novel unselected Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2010 ) pregnancy cohort participated in this analysis. Detailed information on oral antibiotic prescriptions during pregnancy filled at the pharmacy was obtained and verified prospectively. Vaginal samples were obtained at pregnancy week 36 and cultured for bacteria. Women who received oral antibiotics during any pregnancy trimester had an increased rate of colonization by Staphylococcus species in the vaginal samples as compared with samples obtained from women without any antibiotic treatment during pregnancy (adjusted OR 1.63, 95% CI 1.06-2.52, p 0.028). Oral antibiotic administration in the third trimester were also associated with increased colonization by Staphylococcus species (adjusted OR 1.98, 95% CI 1.04-3.76, p 0.037). These bacteriological changes were associated with urinary tract infection antibiotics. Women treated in the third trimester of pregnancy were more often colonized by Escherichia coli than women without antibiotic treatment in the third trimester (adjusted OR 1.91, 95% CI 1.04-3.52, p 0.038). This change was associated with respiratory tract infection (RTI) antibiotics. We did not observe any significant changes in vaginal Streptococcus agalactiae (group B streptoccocus) or Staphylococcus aureus colonization following antibiotic treatment in pregnancy. Antibiotic administration during pregnancy leads to alterations in the vaginal microbiological ecology prior to birth, with potential morbidity, and long-term effects on the early microbial colonization of the neonate. PMID:24118384

Stokholm, J; Schjørring, S; Eskildsen, C E; Pedersen, L; Bischoff, A L; Følsgaard, N; Carson, C G; Chawes, B L K; Bønnelykke, K; Mølgaard, A; Jacobsson, B; Krogfelt, K A; Bisgaard, H

2014-07-01

413

Nanoparticle Incorporation of Melittin Reduces Sperm and Vaginal Epithelium Cytotoxicity  

PubMed Central

Melittin is a cytolytic peptide component of bee venom which rapidly integrates into lipid bilayers and forms pores resulting in osmotic lysis. While the therapeutic utility of free melittin is limited by its cytotoxicity, incorporation of melittin into the lipid shell of a perfluorocarbon nanoparticle has been shown to reduce its toxicity in vivo. Our group has previously demonstrated that perfluorocarbon nanoparticles containing melittin at concentrations <10 µM inhibit HIV infectivity in vitro. In the current study, we assessed the impact of blank and melittin-containing perfluorocarbon nanoparticles on sperm motility and the viability of both sperm and vaginal epithelial cells. We found that free melittin was toxic to sperm and vaginal epithelium at concentrations greater than 2 µM (p<0.001). However, melittin nanoparticles were not cytotoxic to sperm (p?=?0.42) or vaginal epithelium (p?=?0.48) at an equivalent melittin concentration of 10 µM. Thus, nanoparticle formulation of melittin reduced melittin cytotoxicity fivefold and prevented melittin toxicity at concentrations previously shown to inhibit HIV infectivity. Melittin nanoparticles were toxic to vaginal epithelium at equivalent melittin concentrations ?20 µM (p<0.001) and were toxic to sperm at equivalent melittin concentrations ?40 µM (p<0.001). Sperm cytotoxicity was enhanced by targeting of the nanoparticles to the sperm surface antigen sperm adhesion molecule 1. While further testing is needed to determine the extent of cytotoxicity in a more physiologically relevant model system, these results suggest that melittin-containing nanoparticles could form the basis of a virucide that is not toxic to sperm and vaginal epithelium. This virucide would be beneficial for HIV serodiscordant couples seeking to achieve natural pregnancy. PMID:24748389

Jallouk, Andrew P.; Moley, Kelle H.; Omurtag, Kenan; Hu, Grace; Lanza, Gregory M.; Wickline, Samuel A.; Hood, Joshua L.

2014-01-01

414

Nanoparticle incorporation of melittin reduces sperm and vaginal epithelium cytotoxicity.  

PubMed

Melittin is a cytolytic peptide component of bee venom which rapidly integrates into lipid bilayers and forms pores resulting in osmotic lysis. While the therapeutic utility of free melittin is limited by its cytotoxicity, incorporation of melittin into the lipid shell of a perfluorocarbon nanoparticle has been shown to reduce its toxicity in vivo. Our group has previously demonstrated that perfluorocarbon nanoparticles containing melittin at concentrations <10 µM inhibit HIV infectivity in vitro. In the current study, we assessed the impact of blank and melittin-containing perfluorocarbon nanoparticles on sperm motility and the viability of both sperm and vaginal epithelial cells. We found that free melittin was toxic to sperm and vaginal epithelium at concentrations greater than 2 µM (p<0.001). However, melittin nanoparticles were not cytotoxic to sperm (p?=?0.42) or vaginal epithelium (p?=?0.48) at an equivalent melittin concentration of 10 µM. Thus, nanoparticle formulation of melittin reduced melittin cytotoxicity fivefold and prevented melittin toxicity at concentrations previously shown to inhibit HIV infectivity. Melittin nanoparticles were toxic to vaginal epithelium at equivalent melittin concentrations ?20 µM (p<0.001) and were toxic to sperm at equivalent melittin concentrations ?40 µM (p<0.001). Sperm cytotoxicity was enhanced by targeting of the nanoparticles to the sperm surface antigen sperm adhesion molecule 1. While further testing is needed to determine the extent of cytotoxicity in a more physiologically relevant model system, these results suggest that melittin-containing nanoparticles could form the basis of a virucide that is not toxic to sperm and vaginal epithelium. This virucide would be beneficial for HIV serodiscordant couples seeking to achieve natural pregnancy. PMID:24748389

Jallouk, Andrew P; Moley, Kelle H; Omurtag, Kenan; Hu, Grace; Lanza, Gregory M; Wickline, Samuel A; Hood, Joshua L

2014-01-01

415

Vaginal chitosan tablets with clotrimazole-design and evaluation of mucoadhesive properties using porcine vaginal mucosa, mucin and gelatine.  

PubMed

Topical administration of clotrimazole represents the common use therapy in the antimycotic genitourinary tract treatment. Due to the fast self-cleaning action of the vagina, commercially available vaginal dosage forms with clotrimazole cannot assure prolonged contact time with mucosa, therefore the main objective of this study was to develop a dosage form for vaginal administration of clotrimazole using chitosan-a biodegradable and biocompatible derivative of chitin. Tablets mucoadhesive properties were examined using texture analyser under the presence of porcine vaginal mucosa and two different models of adhesive layers- mucin gel and gelatine discs. In addition, friability, hardness, swelling behaviour, residence time, surface morphology of the performed tablets, the in vitro release profile of clotrimazole and clotrimazole release kinetics were determined. The release of clotrimazole from formulations with 25 or 40% of chitosan (F2 and F3) followed non Fickian diffusion through chitosan-gel layer and was retarded up to 6 h. Additionally, tablets F2 showed the best results in terms of mucoadhesive properties and appeared to be a good alternative to commercially available antimycotic vaginal dosage forms. PMID:24492586

Szyma?ska, Emilia; Winnicka, Katarzyna; Amelian, Aleksandra; Cwalina, Urszula

2014-01-01

416

Single-dose 500-mg clotrimazole vaginal tablets compared with placebo in the treatment of Candida vaginitis.  

PubMed

In a double-blind controlled clinical trial, 29 practitioners randomized 55 women with culture-proven Candida vaginitis to treatment with single-dose 500-mg clotrimazole vaginal tablets, and 40 to placebo. At a follow-up visit 7 to 10 days after treatment, Candida was present in 21 (38%) of those treated with clotrimazole and in 30 (75%) in the placebo group (P less than .05). Symptoms had improved or disappeared in 38 (69%) treated with clotrimazole, compared with 22 (55%) in the placebo group (P greater than .05). In 10 (23%) of the mycologically cured women, symptoms were unchanged or worse, whereas symptoms had improved or disappeared in 26 (51%) in whom Candida was isolated at the follow-up visit (P = .015). Questionnaires sent to the 95 women 4 weeks after the follow-up visit were returned by 62. Vaginal symptoms were reported by 50% in both groups. Further clinical trials including placebo are needed in general practice in the evaluation of the treatment of Candida vaginitis. PMID:2199599

Bro, F

1990-08-01

417

MTN-001: Randomized Pharmacokinetic Cross-Over Study Comparing Tenofovir Vaginal Gel and Oral Tablets in Vaginal Tissue and Other Compartments  

PubMed Central

Background Oral and vaginal preparations of tenofovir as pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection have demonstrated variable efficacy in men and women prompting assessment of variation in drug concentration as an explanation. Knowledge of tenofovir concentration and its active form, tenofovir diphosphate, at the putative vaginal and rectal site of action and its relationship to concentrations at multiple other anatomic locations may provide key information for both interpreting PrEP study outcomes and planning future PrEP drug development. Objective MTN-001 was designed to directly compare oral to vaginal steady-state tenofovir pharmacokinetics in blood, vaginal tissue, and vaginal and rectal fluid in a paired cross-over design. Methods and Findings We enrolled 144 HIV-uninfected women at 4 US and 3 African clinical research sites in an open label, 3-period crossover study of three different daily tenofovir regimens, each for 6 weeks (oral 300 mg tenofovir disoproxil fumarate, vaginal 1% tenofovir gel [40 mg], or both). Serum concentrations after vaginal dosing were 56-fold lower than after oral dosing (p<0.001). Vaginal tissue tenofovir diphosphate was quantifiable in ?90% of women with vaginal dosing and only 19% of women with oral dosing. Vaginal tissue tenofovir diphosphate was ?130-fold higher with vaginal compared to oral dosing (p<0.001). Rectal fluid tenofovir concentrations in vaginal dosing periods were higher than concentrations measured in the oral only dosing period (p<0.03). Conclusions Compared to oral dosing, vaginal dosing achieved much lower serum concentrations and much higher vaginal tissue concentrations. Even allowing for 100-fold concentration differences due to poor adherence or less frequent prescribed dosing, vaginal dosing of tenofovir should provide higher active site concentrations and theoretically greater PrEP efficacy than oral dosing; randomized topical dosing PrEP trials to the contrary indicates that factors beyond tenofovir’s antiviral effect substantially influence PrEP efficacy. Trial Registration ClinicalTrials.gov NCT00592124 PMID:23383037

Hendrix, Craig W.; Chen, Beatrice A.; Guddera, Vijayanand; Hoesley, Craig; Justman, Jessica; Nakabiito, Clemensia; Salata, Robert; Soto-Torres, Lydia; Patterson, Karen; Minnis, Alexandra M.; Gandham, Sharavi; Gomez, Kailazarid; Richardson, Barbra A.; Bumpus, Namandje N.

2013-01-01

418

Bioadhesive vaginal tablets containing spray dried microspheres loaded with clotrimazole for treatment of vaginal candidiasis.  

PubMed

The aim of the present investigation was to prepare and evaluate novel bioadhesive vaginal tablets containing clotrimazole loaded microspheres in order to provide long-term therapeutic activity at the site of infection. Tablets were prepared by incorporating drug loaded microspheres and using bioadhesive polymers hydroxypropylmethylcellulose, sodium carboxymethylcellulose and Carbopol. Microspheres were prepared by the spray drying technique using Eudragit RS-100 and Eudragit RL-100. Microspheres were characterized by SEM, DSC, FTIR, particle size analysis and evaluated for percentage yield, drug loading, encapsulation efficiency and in vitro drug release. To achieve bioadhesion to the mucosal tissue, optimized microspheres were incorporated into bioadhesive tablets and were evaluated for in vitro drug release, in vitro and in vivo mucoadhesion. FTIR and DSC studies showed that no chemical interaction occurred between the drug and polymers. The sphericity factor indicated that the prepared microspheres were spherical. Formulation Mt6 indicated a controlled in vitro drug release and good bioadhesive strength. The in vivo images confirmed the bioadhesion and retention property of tablets up to 24 h. The results indicated that this drug delivery system can be explored for controlled intravaginal drug release. PMID:24152896

Gupta, Naresh Vishal; Natasha, Shirodker; Getyala, Anil; Bhat, Ramnath Sudeendra

2013-09-01

419

Acute and chronic flow-measurements in experimental arteriovenous fistulas  

Microsoft Academic Search

Summary In 13 dogs a large sized iliac arteriovenous fistula is established following laparotomy. Measurements of local blood flow and of general hemodynamic changes are performed immediately after construction of the shunt as well as 3 (stage II) and 6–12 months (stage III) later. The following results are obtained:1.Arterial pressure drops in the acute phase from 146 to 130 mm

D. Krumhaar; H. D. Schrnidt; U. Schulz

1974-01-01

420

Interventional Radiology in Hemodialysis Fistulae and Grafts: A Multidisciplinary Approach  

SciTech Connect

Purpose: To review the place of interventional radiology in arteriovenous access for hemodialysis. Methods: Prophylactic dilation of stenoses greater than 50% associated with clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. Stents are placed only in selected cases with clearly insufficient results of dilation but they must never overlap major side veins and obviate future access creation. Thrombosed fistulae and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. Results: The success rates are over 90% for dilation, with frequent resort to stents in central veins. Long-term results in the largest series are better in forearm native fistulae compared with grafts (best 1-year primary patency: 51% versus 40%). The success rates for declotting are better in grafts compared with forearm fistulae but early rethrombosis is frequent in grafts so that primary patency rates can be better for native fistulae from the first month's follow-up (best 1-year primary patency: 49% versus 26%). Conclusion: Radiology achieves results comparable with surgery, with minimal invasiveness and better venous preservation. However, wide variations in the results suggest that the degree of commitment of physicians might be as important as the type of technique used.

Turmel-Rodrigues, Luc [Department of Cardiovascular Radiology, Clinique St-Gatien, Place de la Cathedrale, F-37000 Tours (France); Pengloan, Josette [Department ofNephrology-Hemodialysis, Centre Hospitalier Universitaire, 2 boulevard Tonnele, F-37044 Tours cedex (France); Bourquelot, Pierre [Department ofSurgery, Clinique Jouvenet, 6 square Jouvenet, F-75016 Paris (France)

2002-01-15

421

Gallbladder Papillomatosis and Cholecystocolonic Fistula: A Rare Combination  

PubMed Central

Patient: Female, 81 Final Diagnosis: Gallbladder papillomatosis Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Biliary papillomatosis (BP) with sole involvement of the gall bladder or gall bladder papillomatosis (GBP) is very rare. Biliary-enteric fistula, particularly the cholecystocolonic fistula (CCF) type, is also very rare. The combination of both types of lesions in a single patient has never previously been reported in the English literature. Case Report: We report herein the case of an 81-year-old woman who was diagnosed with both disease entities, which occurred in a cause-and-effect relationship. She underwent resection of the gall bladder with closure of the fistula, and was discharged improved afterwards. Conclusions: GBP is a premalignant condition that warrants extensive resection. An absent Murphy’s sign or jaundice on physical examination should not rule out this disease or accompanying biliary tract infection because a biliary-enteric fistula may be present. Thorough review of the radiologic images should be performed, since subtle details could be easily missed or dismissed, thus affecting the postoperative course. A CCF should alert the physician that another disease entity is present. PMID:25351203

Kuo, Jenn-Yuan; Jao, Yeun Tarl Fresner Ng

2014-01-01

422

Hemodynamics in the cephalic arch of a brachiocephalic fistula.  

PubMed

The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year. PMID:24695337

Boghosian, M; Cassel, K; Hammes, M; Funaki, B; Kim, S; Qian, X; Wang, X; Dhar, P; Hines, J

2014-07-01

423

Congenital circumflex coronary artery fistulae; presentation and diagnosis  

PubMed Central

Small fistulae between coronary arteries and the pulmonary artery are common, but abnormal vascular communications between the coronary arteries and other cardiac structures are rare. They were first described by Krause in 1865. We report two cases of fistulous connexions between the circumflex coronary artery and the coronary sinus. PMID:23355554

Ali, Hani Mohamed Mahieldin; Clark, Andrew L; Caplin, John; Bragadeesh, Thanjavur

2013-01-01

424

[Aorto-esophageal fistula caused by foreign body].  

PubMed

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs. PMID:10742898

Cucinotta, E; Barbuscia, M; Calbo, L; Asmundo, A; Palmeri, R; Melita, G; Lazzara, S

1999-01-01

425

Aortoesophageal fistula secondary to thoracic aortic aneurysm repair.  

PubMed

The development of a fistula between the aorta and the oesophagus after graft replacement of the thoracic aorta is extremely rare. We report a case which occurred 3 years and 7 months after repair of an aneurysm of the descending thoracic aorta and review the previous reports of this uniformly fatal condition. PMID:8282742

Graham, A N; McGuigan, J A; Curry, R C

1993-10-01

426

Aorto-esophageal fistula secondary to penetrating atherosclerotic ulcer  

PubMed Central

Aorto-esophageal fistula (AEF) is a rare and life threatening condition, which can be rapidly fatal. More than half of such cases are secondary to aortic aneurysm rupture. There are only two previous reports describing AEF caused by penetrating atherosclerotic ulcer. We present multidetector computed tomography findings in a case of AEF secondary to penetrating atherosclerotic ulcer. PMID:22988408

Gupta, Ranjana; Mittal, Puneet; Mittal, Gaurav

2012-01-01

427

Aortoesophageal fistula: case report and review of the literature.  

PubMed

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. The classic clinical triad consists of midthoracic pain or dysphagia, a sentinel episode of hematemesis, followed by fatal exsanguination. In a patient with hemodynamically significant upper gastrointestinal bleeding of unknown etiology, who has evidence of a tortuous aorta or aneurysm by chest x-ray or who exhibits Chiari's triad, the presence of AEF should be entertained. A prompt and definitive diagnosis at the time of the initial hemorrhage is necessary for a successful surgical outcome. Cautious endoscopy to exclude other causes of bleeding followed by either thoracic CT scan or thoracic aortography are indicated based on circumstances. We report a case of a 76-year-old man who presented with two discrete episodes of hemodynamically significant upper gastrointestinal bleeding. Although there was no radiological evidence of an aneurysm on chest x-ray and no endoscopic evidence of an aortoesophageal fistula, a saccular descending thoracic aorta aneurysm was found by thoracic aortogram. The patient underwent immediate surgical repair of the aorta by graft and esophagectomy, followed by a staged gastric pull-up. Left thoracotomy with fistula repair is the only definitive treatment for AEF. Use of a Sengstaken-Blakemore tube or embolization of the fistula prior to surgery should be considered only if the patient is exsanguinating. Although surgical repairs have high morbidity and mortality, surgery should be undertaken, as untreated cases of AEF are uniformly fatal. PMID:9724148

Amin, S; Luketich, J; Wald, A

1998-08-01

428

Embolisation of spinal dural arteriovenous fistulae with Onyx  

Microsoft Academic Search

Surgery is currently the standard treatment for spinal dural arteriovenous fistulae (DAVF). Endovascular embolisation of these lesions using N-butyl cyanoacrylate (NBCA) has a high success rate. Onyx is a new liquid embolic agent whose viscosity makes it suitable for treatment of spinal DAVF where penetration into the proximal radicular vein is required. It is delivered with greater control than NBCA

D. R. Warakaulle; R. I. Aviv; D. Niemann; A. J. Molyneux; J. V. Byrne; P. Teddy

2003-01-01

429

Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula.  

PubMed

Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant. PMID:24751296

Panagidis, Antonios; Sinopidis, Xenophon; Zachos, Konstantinos; Alexopoulos, Vasileios; Vareli, Anastasia; Varvarigou, Anastasia; Georgiou, George

2014-04-18

430

Cisplatin and Radiation Therapy With or Without Triapine in Treating Patients With Previously Untreated Stage IB-IVA Cervical Cancer or Stage II-IVA Vaginal Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Vaginal Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Vaginal Adenocarcinoma; Vaginal Squamous Cell Carcinoma

2015-01-30

431

Cisplatin and Radiation Therapy With or Without Triapine in Treating Patients With Previously Untreated Stage IB-IVA Cervical Cancer or Stage II-IVA Vaginal Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Vaginal Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Vaginal Adenocarcinoma; Vaginal Squamous Cell Carcinoma

2014-12-19

432

Local treatment of urogenital atrophy with an estradiol-releasing vaginal ring: a comparative and a placebo-controlled multicenter study. Vaginal Ring Study Group.  

PubMed

Local estrogen substitution has been shown to be more appropriate than any systemic application for the treatment of urogenital symptoms of hormone deficiency. The efficacy, safety and acceptability of a new low-dose drug delivery system consisting of an estradiol-releasing silicone vaginal ring was studied in two multicenter trials. In an open-label comparative trial a total of 219 postmenopausal women were randomized to the estradiol-releasing vaginal ring or to estriol suppositories. In terms of efficacy both treatment arms were shown to be equivalent; however, significantly higher rates of acceptability were found for the vaginal ring. In a double-blinded placebo-controlled study a total of 84 patients were randomized to either treatment arm for a period of 24 weeks. The statistically significant improvement of the vaginal epithelial pH and maturation values demonstrated the efficacy of the estradiol-releasing vaginal ring compared to the placebo ring. PMID:10430010

Casper, F; Petri, E

1999-01-01

433

Custom fabricated acrylic vaginal stent as an adjunct to surgical creation of neovagina for a young female with isolated vaginal agenesis  

PubMed Central

Vaginal agenesis is one of the major congenital anomalies of the female genital tract. It may present either as an isolated developmental defect or within a complex of more extensive anomalies. Most commonly it is associated with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. After reconstruction of space for vagina surgically, a long-term vaginal stent use is required to maintain vaginal width and depth and to prevent contraction. In this article is presented a case of nonsyndromic agenesis of vagina in a 14-year-old girl and its surgical management using custom fabricated acrylic vaginal stent.

Rathee, Manu; Boora, Priyanka; Kundu, Renu

2014-01-01

434

On the Biomechanics of Vaginal Birth and Common Sequelae  

PubMed Central

Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a biomechanical perspective. We first review the functional anatomy of the female pelvic floor, the normal loads acting on the pelvic floor in activities of daily living, and the functional capacity of the pelvic floor muscles. Computer models show that the stretch ratio in the pelvic floor muscles can reach an extraordinary 3.26 by the end of the second stage of labor. Magnetic resonance images provide evidence that show that the pelvic floor regions experiencing the most stretch are at the greatest risk for injury, especially in forceps deliveries. A conceptual model suggests how these injuries may lead to the most common form of pelvic organ prolapse, a cystocele. PMID:19591614

Ashton-Miller, James A.; DeLancey, John O.L.

2010-01-01

435

Vaginal infections in human immunodeficiency virus–infected women  

Microsoft Academic Search

Objective: This study was undertaken to compare the frequencies of vaginal infections among human immunodeficiency virus–infected women with those among human immunodeficiency virus–seronegative women. Study Design: Human immunodeficiency virus–seropositive women attending a comprehensive care center for human immunodeficiency virus disease at the outpatient department of an inner-city hospital in Houston underwent rigorous gynecologic evaluation for sexually transmitted diseases, including evidence

Andrew Helfgott; Nancy Eriksen; C. Michael Bundrick; Ronald Lorimor; Barbara Van Eckhout

2000-01-01

436

Urinary Incontinence after Vaginal Delivery or Cesarean Section  

Microsoft Academic Search

background It is uncertain whether women who deliver by cesarean section have an increased risk of urinary incontinence as compared with nulliparous women and whether women who deliver vaginally have an even higher risk. methods We studied 15,307 women enrolled in the Epidemiology of Incontinence in the County of Nord-Trøndelag (EPINCONT) study, which involved a community-based cohort. The data base

Guri Rortveit; Anne Kjersti Daltveit; Yngvild S. Hannestad; Steinar Hunskaar

2003-01-01

437

Induction of labor for vaginal birth after cesarean delivery  

Microsoft Academic Search

A recent population-based study of vaginal birth after cesarean delivery (VBAC) attempts observed uterine rupture rates of 24.5 per 1,000 with prostaglandin-induced labor, while the uterine rupture rates with spontaneous labor and labor induced without prostaglandins were lower (5.2\\/1,000 and 7.7\\/1,000 respectively). The authors did not confirm the diagnoses by examining individual medical records, so the actual incidence of uterine

2002-01-01

438

Clitoral blood flow increases following vaginal pressure stimulation  

Microsoft Academic Search

The vascular responses of clitoral arteries to vaginal pressure stimulation in 10 volunteer women were evaluated by Doppler ultrasonography. Pressure stimulations (20–160 mm Hg) along the lower third of the vagina increased blood velocity and flow into clitoral arteries in 9 of the 10 women. The latency and duration of the Doppler responses ranged from 0.1 to 1.6 sec and

Pierre Lavoisier; Rachild Aloui; Markus H. Schmidt; Antoine Watrelot

1995-01-01

439

Development of dapivirine vaginal ring for HIV prevention.  

PubMed

In the continuing effort to develop effective HIV prevention methods for women, a vaginal ring containing the non-nucleoside reverse transcriptase inhibitor dapivirine is currently being tested in two safety and efficacy trials. This paper reviews dapivirine ring's pipeline development process, including efforts to determine safe and effective dosing levels as well as identify delivery platforms with the greatest likelihood of success for correct and consistent use. Dapivirine gel and other formulations were developed and tested in preclinical and clinical studies. Multiple vaginal ring prototypes were also tested, resulting in the current ring design as well as additional designs under consideration for future testing. Efficacy results from clinical trials are expected in 2015. Through ongoing consultations with national regulatory authorities, licensure requirements for dapivirine vaginal ring approval have been defined. This article is based on a presentation at the "Product Development Workshop 2013: HIV and Multipurpose Prevention Technologies," held in Arlington, Virginia on February 21-22, 2013. It forms part of a special supplement to Antiviral Research. PMID:24188702

Devlin, Bríd; Nuttall, Jeremy; Wilder, Susan; Woodsong, Cynthia; Rosenberg, Zeda

2013-12-01

440

Characterization of Commercially Available Vaginal Lubricants: A Safety Perspective  

PubMed Central

Vaginal lubricants are widely used by women to help solve intercourse difficulties or as enhancers, but recent reports raise questions about their safety. Twelve commercially available gel products were tested for pH value, pH buffering capacity, osmolality and cytotoxicity relevant to vaginal delivery. Obtained data were analyzed in light of the recent Advisory Note by the World Health Organization (WHO) for personal lubricants to be concomitantly used with condoms. Results showed that most products do not comply with pH and osmolality recommended standards, thus posing a potential hazard. Four products presented values of osmolality around three-times higher than the maximum acceptable limit of 1200 mOsm/kg. In vitro cell testing further identified substantial cytotoxicity even at 1:100 dilutions for three products, contrasting with no significant effect of up to at least a 1:5 dilution of a Universal Placebo gel. However, no direct correlation between these last results and pH or osmolality was found, thus suggesting that the individual toxicity of specific formulation components plays an important role in the outcome of a particular product. Although further assessment is required, these results highlight potential safety issues related to the formulation of commercially available vaginal lubricants. PMID:25247884

Cunha, Ana Raquel; Machado, Rita M.; Palmeira-de-Oliveira, Ana; Martinez-de-Oliveira, José; das Neves, José; Palmeira-de-Oliveira, Rita

2014-01-01

441

Three-day clotrimazole therapy for vulvo-vaginal mycosis.  

PubMed

A self-medication therapy with clotrimazole vaginal tablets, application of two tablets at bedtime on 3 consecutive days, was carried out to find out whether vulvo-vaginal mycoses can be treated more effectively and with fewer drop-outs when treatment is simpler and shorter. Our study included forty-one patients, seventeen of whom were in their second or third trimester of pregnancy. There was no significant difference between the efficacy rates in the pregnant (82.4%) and non-pregnant (83.3%) women. In 36 infections caused by various Candida species the cure rate was 91.7%; in 8 infections due to Torulopsis glabrata it was 75%. For thirty-three women with primary infections the cure rate was 84.8% and for eight women with recurrent infections it was 75%. The cure rate for the entire group of patients was 82.9% (thirty-four out of forty-one cases). Failures were seen in six out of thirty cases, i.e. in 16.7%. In one case burning was experienced after the insertion of the vaginal tablet so that treatment was discontinued. PMID:6682063

Higashide, K; Kawaguchi, C; Tomoda, Y

1983-01-01

442

Pelvic floor disorders following vaginal or cesarean delivery  

PubMed Central

Purpose of review Pelvic floor disorders affect women of all ages and are associated with significant economic burden and poor quality of life. Current literature suggests an association between childbirth and these disorders. In this review, we summarize recent advancements in our understanding of this association. Recent findings Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse. There is less evidence to suggest an association between vaginal delivery and overactive bladder symptoms. History of more than one perineal laceration increases the likelihood of developing prolapse. Similar association has not been established for episiotomy. Disruption or denervation of structural components of pelvic floor support system, particularly levator ani muscle complex, is associated with later development of pelvic floor disorders. Imbalance in homeostasis of connective tissue remodeling of the vaginal wall from overstretching during childbirth is another possible mechanism. Summary Pelvic floor disorders represent a significant health problem affecting women of all ages. Identification of potential modifiable risk factors and advancement in understanding of the underlying pathophysiology is crucial for primary and secondary prevention of these disorders and for improvement in treatment strategies. PMID:22907482

Memon, Hafsa; Handa, Victoria L.

2013-01-01

443

Collagen scaffold: a treatment for large mesh exposure following vaginal prolapse repair.  

PubMed

Transvaginal repair with mesh of pelvic organ prolapse (POP) provides women with the durability of a synthetic graft using the less-invasive route of vaginal surgery. However, morbidities such as mesh exposures are common and challenging to manage. Small intestinal submucosa (SIS) is a naturally occurring collagen matrix derived from porcine intestine. It contains growth factors and cytokines that promote healing of damaged tissue. This case report describes a large vaginal mesh exposure due to necrosis of the full thickness of the anterior vaginal wall. A remarkable and rapid regeneration of vaginal tissue over the exposed mesh was achieved with SIS placement after failure of treatment with vaginal estrogen for >6 months. Collagen scaffold is an effective, rapid, and minimally invasive treatment for large vaginal mesh exposures. PMID:24832859

Alperin, Marianna

2014-11-01

444

The importance of the vaginal delivery route for antiretrovirals in HIV prevention  

PubMed Central

The HIV/AIDS pandemic continues to be a global health priority, with high rates of new HIV-1 infections persisting in young women. One HIV prevention strategy is topical pre-exposure prophylactics or microbicides, which are applied vaginally or rectally to protect the user from HIV and possibly other sexually transmitted infections. Vaginal microbicide delivery will be the focus of this review. Multiple nonspecific and specific antiretroviral microbicide products have been clinically evaluated, and many are in preclinical development. The events of HIV mucosal transmission and dynamics of the cervicovaginal environment should be considered for successful vaginal microbicide delivery. Beyond conventional vaginal formulations, intravaginal rings, tablets and films are employed as platforms in the hope to increase the likelihood of microbicide use. Furthermore, combining multiple antiretrovirals within a given formulation, combining a microbicide product with a vaginal device and integrating novel drug-delivery strategies within a microbicide product are approaches to successful vaginal-microbicide delivery. PMID:22468220

Ferguson, Lindsay M; Rohan, Lisa Cencia

2012-01-01

445

A case of mucinous adenocarcinoma arising in long-standing multiple perianal and presacral fistulas.  

PubMed

Chronic anal fistulas are not rare; however, the development of a carcinoma in long-standing, perianal fistulas is rare. We describe a case of an 85-year-old man with multiple, recurring, perianal fistulas, extending to the natal cleft. The patient underwent en bloc resection of the fistulas which were in direct continuity with the middle rectum. Histological examination revealed a mucinous colonic adenocarcinoma. Abdominal CT and colonoscopy revealed an extramural residual rectal mass. The patient refused a radical colorectal operation. Three years later, because of fistula recurrence, he underwent loop sigmoidostomy and radical en bloc excision of the perianal fistula and rectum, with immediate reconstruction by bilateral gluteal flaps. The patient was discharged on the 12th postoperative day, refusing adjuvant radiotherapy. We present this rare malignant entity, successfully treated by staged operations and without any adjuvant therapy. PMID:15655599

Papapolychroniadis, C; Kaimakis, D; Giannoulis, K; Berovalis, P; Karamanlis, E; Haritanti, A; Leukopoulos, A; Kokkonis, G; Masoura, O M; Dimitriadis, A; Giala, M; Harlaftis, N

2004-11-01

446

Pancreaticothoracic Fistula Presenting with Hemoptysis and Pneumothorax in a Chronic Alcoholic Patient  

PubMed Central

Pancreaticothoracic fistula is a rare complication of acute or chronic alcoholic pancreatitis. It may present with various symptoms, like dyspnea, abdominal pain, cough, chest pain, fever, back pain, hemoptysis, fatigue, or orthopnea. Pancreaticothoracic fistula can be detected by magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or computed tomography. MRCP has high sensitivity and fewer side effects, and thus it has recently been recommended as the first choice for the detection of pancreaticothoracic fistula. On the other hand, ERCP enables the detection and treatment of pancreaticothoracic fistula and allows for stent insertion; for this reason it is a commonly used modality in pancreaticothoracic fistula cases. Herein, the authors describe a case of pancreaticothoracic fistula detected by ERCP and MRCP that manifested only respiratory symptoms, namely hemoptysis and pneumothorax without abdominal pain, which commonly accompanies pancreatitis. PMID:24920952

Lee, Si Nae; Lee, Kyung Hee; Chung, Seok; Nam, Hae Sung; Cho, Jae Hwa; Ryu, Jeong Seon

2014-01-01

447

Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy  

PubMed Central

Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to anus. Complications of heterotopic gastric mucosa include dysphagia, upper gastrointestinal bleeding, upper esophageal ring stricture, adenocarcinoma and fistula formation. In this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus. A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial fistula. Microscopic examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic mucosa. We decided to do a non-surgical therapeutic endoscopic procedure. A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results. PMID:21160729

Katsanos, Konstantinos H; Christodoulou, Dimitrios K; Kamina, Sevasti; Maria, Kosmidou; Lambri, Evangelia; Theodorou, Stavroula; Tsampoulas, Konstantinos; Vasiliki, Mitsi; Tsianos, Epameinondas V

2010-01-01

448

Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano.  

PubMed

Forty-two patients with a suspected diagnosis of fistula in ano underwent prospective comparison of digital rectal examination, dynamic contrast enhanced magnetic resonance imaging (DCEMRI) and surgical exploration. There were five discordancies: DCEMRI showed an ischiorectal abscess and track with no enteric connection in one patients who at operation was found to have a well epithelialized primary fistula. Four patients with fistulas on DCEMRI had no enteric opening found at surgery and were treated as having sinuses. Long-term follow-up has shown failure to heal in all patients and further surgery confirmed missed fistula. Compared with final outcome measures DCEMRI had a sensitivity of 97 per cent and specificity of 100 per cent in the detection of fistula. DCEMRI also identified more secondary tracks and was more accurate at identifying complex fistulas than either digital rectal examination alone or surgical exploration. PMID:8944439

Beckingham, I J; Spencer, J A; Ward, J; Dyke, G W; Adams, C; Ambrose, N S

1996-10-01

449

Therapeutic results obtained in vaginal mycoses after single-dose treatment with 500 mg clotrimazole vaginal tablets.  

PubMed

A multicenter, double-blind study of 103 patients with clinically and mycologically documented vulvovaginal candidiasis compared single-dose treatment with a 500 mg clotrimazole vaginal tablet to 3-day treatment with two 100 mg clotrimazole vaginal tablets administered daily. Patients were examined 5 to 10 days (visit 2) and at least 27 days (visit 3) post treatment. At visit 2, mycologic and clinical examinations were negative in 43 of 48 efficacy-evaluable patients receiving clotrimazole, 500 mg (90%), versus 42 of 47 efficacy-evaluable patients receiving clotrimazole, 200 mg (89%). Similarly, at visit 3, 75% of patients receiving clotrimazole, 500 mg, had treatment success versus 72% receiving clotrimazole, 200 mg. There were no significant intergroup treatment differences, indicating that single-dose treatment with clotrimazole, 500 mg, is equipotent to the multidose regimen. PMID:3895963

Fleury, F; Hughes, D; Floyd, R

1985-08-01

450

Esophageal candidiasis in AIDS. Successful therapy with clotrimazole vaginal tablets taken by mouth.  

PubMed

In this paper we describe the results of oral therapy of esophageal candidiasis with clotrimazole vaginal tablets in 25 homosexual men with AIDS, of whom 19 had oral candidiasis and 16 had esophageal symptoms. Therapy with clotrimazole vaginal tablets, 100 mg, taken by mouth cleared the esophageal symptoms, oral candidiasis, and esophageal lesions completely in all 25 men. Clotrimazole vaginal tablets are a useful alternative to other antifungal agents for the treatment of esophageal candidiasis in AIDS patients. PMID:1995261

Lalor, E; Rabeneck, L

1991-03-01

451

In search of sexual pleasure and fidelity: vaginal practices in KwaZulu?Natal, South Africa  

Microsoft Academic Search

Vaginal practices, such as intra?vaginal cleansing, drying and tightening, are suspected of placing women at higher risk of acquiring HIV and STIs. Yet, there is limited understanding of what these practices entail, what motivates women to undertake them and what their socio?cultural and historical meanings are. This paper explores the range of vaginal practices used by women in KwaZulu?Natal, South

Fiona Scorgie; Busisiwe Kunene; Jennifer A. Smit; Ntsiki Manzini; Matthew F. Chersich

2009-01-01

452

Vasculogenic female sexual dysfunction: The hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency  

Microsoft Academic Search

Objective: Organic female sexual dysfunction may be related in part to vasculogenic impairment of the hypogastric-vaginal\\/clitoral arterial bed. The aim was to develop an animal model of vaginal engorgement insufficiency and clitoral erectile insufficiency. Methods: Pelvic nerve stimulated vaginal engorgement and clitoral erection were achieved in control (normal diet, n=8) and atherosclerotic (balloon injury of aorto-iliac arteries and 0.5% cholesterol

I Goldstein; C Andry; MB Siroky; RJ Krane; KM Azadzoi

1997-01-01

453

A Case of Primary Postpartum Bleeding due to Vaginal Laceration after Vaginal Delivery: Successful Management with Transcatheter Arterial Embolization  

PubMed Central

Postpartum hemorrhage is one of the major causes of maternal mortality. There are medical and surgical options to control the bleeding, some of which can impair future fertility. Transcatheter arterial embolization might be a useful option in the management of intractable postpartum bleeding before the consideration of more invasive and radical methods. In this report, we report a 33-year-old patient who presented with primary postpartum hemorrhage due to vaginal laceration and was eventually treated with transcatheter arterial embolization.

Ingec, Metin; Levent, Akin; Delibas, Ilhan Bahri; Pulur, Alparslan; Karaca, Ibrahim

2011-01-01

454

A Case of Large Mucinous Adenocarcinoma Arising in a Long-Standing Fistula-in-Ano  

Microsoft Academic Search

Background: Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. Methods: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. Results: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion

Yamac Erhan; Aslan Sakarya; Hasan Aydede; Akif Demir; Ahmet Seyhan; Emre Atici

2003-01-01

455

Embolization—An optional treatment for intractable hemorrhage from a malignant rectovaginal fistula  

Microsoft Academic Search

PURPOSE: Patients rarely have intractable hemorrhage from rectovaginal fistulas, which usually require surgical intervention. This report presents our experience with nonsurgical treatment of a high-risk patient with uncontrolled hemorrhage originating from a malignant rectovaginal fistula. METHODS: A 74-year-old female developed uncontrolled hemorrhage from a malignant rectovaginal fistula. Because of her poor physical condition, an embolization with metal clips of the

T. Dushnitsky; Y. Ziv; A. Peer; A. Halevy

1999-01-01

456

Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula  

Microsoft Academic Search

The arteriovenous (AV) fistula is the access method of choice for long-term hemodialysis according to DOQI guidelines. Among the recognized complications of upper extremity AV fistulae fashioned for hemodialysis are infection, aneurysm formation, and high-output left ventricular failure. We describe a novel cardiopulmonary complication—secondary pulmonary hypertension resulting from an aneurysmal brachiocephalic AV fistula. The clinical presentation, investigation, management, and pathophysiology

Michael Robert Clarkson; Louise Giblin; Angie Brown; Dillie Little; John Donohoe

2002-01-01

457

Long-term survival of arteriovenous fistulas in home hemodialysis patients  

Microsoft Academic Search

Long-term survival of arteriovenous fistulas in home hemodialysis patients.BackgroundWe report the outcome of arteriovenous (AV) fistulas created and managed by a multidisciplinary team in patients on hemodialysis (HD) over 20 years.MethodsWe analyzed 432 AV fistulas in 301 home HD patients (12% diabetic; median age 47 years) followed for up to 161 months. Observed end points were spontaneous or surgical AV

Kelvin L. Lynn; Adrian L. Buttimore; J. Elisabeth Wells; Judith A. Inkster; Justin A. Roake; John B. Morton

2004-01-01

458

Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis  

PubMed Central

Background Obstetric fistula is a severe condition which has devastating consequences for a woman’s life. The estimation of the burden of fistula at the population level has been impaired by the rarity of diagnosis and the lack of rigorous studies. This study was conducted to determine the prevalence and incidence of fistula in low and middle income countries. Methods Six databases were searched, involving two separate searches: one on fistula specifically and one on broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women. Results Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95% CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95% CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95% CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95% CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women. Conclusions Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula. PMID:24373152

2013-01-01

459

Treatment of Postoperative Enterocutaneous Fistulas by High-Pressure Vacuum with a Normal Oral Diet  

Microsoft Academic Search

Background\\/Aims: Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity\\/mortality, and increased hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula

Aldo Cunha Medeiros; Tertuliano Aires-Neto; Julio Sérgio Marchini; Jose Brandão-Neto; Dione Maria Valença; Eryvaldo Sócrates Tabosa Egito

2004-01-01

460

Factors influencing the outcome of treatment of small bowel cutaneous fistula  

Microsoft Academic Search

A 20-year review of 174 external fistulas of the jejunum and ileum led to the identification of factors affecting morbidity and mortality. The mortality rate for jejunal fistulas was higher as compared to ileal fistulas, whether treated by nonoperative means (41.7% and 29.4%, respectively), conservative surgical means (70% and 21%, respectively) or by radical, i.e., resectional surgical techniques (21.7% and

Victor W. Fazio; Theodore Coutsoftides; Ezra Steiger

1983-01-01