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Peer Reviewed

Title: The management of failed second-trimester termination of pregnancy.
Author: Basu JK; Basu D
Source: Contraception. 2009 Aug;80(2):170-3.
Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 342391 Notification

Peer Reviewed

Title: Group a Streptococcus causing necrotizing fasciitis and toxic shock syndrome after medical termination of pregnancy.
Author: Daif JL; Levie M; Chudnoff S; Kaiser B; Shahabi S
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):504-6.
Abstract: BACKGROUND: Group A Streptococcus is an aerobic gram-positive bacteria known to cause cutaneous infections. Invasive infections can lead to toxic shock syndrome with multiorgan failure and mortality rates of 25-48%. CASE: A healthy, young woman developed necrotizing fasciitis, myonecrosis, and toxic shock syndrome after an elective medical termination of pregnancy. This patient had confirmed group A Streptococcus on blood cultures and underwent surgical debridement. After aggressive surgical treatment, below-the-knee amputation, and antibiotic therapy, the patient survived. CONCLUSION: This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome.
Language: English
Keywords:
NEW YORK | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | HISPANICS | WOMEN | BACTERIAL AND FUNGAL DISEASES | DERMATITIS | TOXIC SHOCK SYNDROME | ABORTION | GYNECOLOGIC SURGERY | SURGERY | ANTIBIOTICS | Developed Countries | United States of America | North America | Americas | Research Methodology | Studies | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Fertility Control, Postconception | Family Planning | Urogenital Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs
Document Number: 330358 Notification

Peer Reviewed

Title: Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy.
Author: Duong TH; Gellasch TL; Adam RA
Source: American Journal of Obstetrics and Gynecology. 2009 Aug 14;
Abstract: OBJECTIVE: We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies. STUDY DESIGN: All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data. RESULTS: A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss. CONCLUSION: Patients with an AAST grade V cystotomy are at increased risk for VVF formation.
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPED COUNTRIES | RESEARCH REPORT | WOMEN | HYSTERECTOMY | FISTULA | RISK FACTORS | North America | Americas | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases
Document Number: 342547

Title: Transvaginal endoscopic tubal sterilization.
Author: Kondo W; Noda RW; Branco AW; Rangel M; Branco Filho AJ
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):59-61.
Abstract: BACKGROUND: Tubal sterilization is one of the most widely used options for female contraception. It can be performed by laparotomy, minilaparotomy, colpotomy, laparoscopy, and hysteroscopy. In this paper, we report the use of the transvaginal endoscopic approach to perform tubal ligation. CASE: The access to the abdomen was obtained by a 1.5-cm colpotomy. The flexible endoscope was introduced into the peritoneal cavity, and carbon dioxide was instilled to get the pneumoperitoneum. Fallopian tubes were identified and electrocauterized with a 40-W coagulation current. Total procedure time was 45 minutes. A single dose of intravenous dypirone was administered for pain. She was discharged 10 hours after the procedure. CONCLUSION: Transvaginal endoscopic tubal ligation is feasible and can be considered an alternative approach to perform female sterilization.
Language: English
Keywords:
BRAZIL | SUMMARY REPORT | CASE HISTORIES | CLIENTS | TUBAL LIGATION | COLPOTOMY | ENDOSCOPY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Female Sterilization | Sterilization, Sexual | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physical Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341431

Peer Reviewed

Title: Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study.
Author: Nelson AL; Chen S; Eden R
Source: Contraception. 2009 Jul;80(1):81-3.
Abstract: BACKGROUND: The purpose of this pilot project was to test the feasibility of a technique designed to place a copper intrauterine device (IUD) through the hysterotomy incision of an elective cesarean delivery to minimize possible contamination and to guarantee that tailstrings were visible in the vagina for easy removal should complications occur. STUDY DESIGN: Women were monitored in the hospital for signs of infection or excessive blood loss. At the time of hospital discharge and at 2 and 6 weeks postpartum, they were examined to determine the status of the tailstrings. The position of the IUD was assessed by ultrasound at week 6. RESULTS: All seven of the subjects had successful placement. The sutures tied to the IUD strings were visible on vaginal examination in each case. The original tailstrings were visible in the vagina at 6 weeks and each IUD was fundally positioned. CONCLUSION: Successful intraoperative placement of Copper T-380A IUDs through incision at the time of cesarean birth is possible.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PILOT PROJECTS | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | HYSTEROTOMY | CESAREAN SECTION | ULTRASONICS | CONTRACEPTIVE REMOVAL | IUD EXPULSION | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Obstetrical Surgery
Document Number: 342788

Peer Reviewed

Title: Second-trimester surgical abortion.
Author: Prager SW; Oyer DJ
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):179-87.
Abstract: Surgical abortion in the second trimester became popularized in the 1970s, and now accounts for the majority of abortion procedures performed in this country. Dilation and evacuation is the most commonly used method in the second trimester, but dilation and curettage can be used with earlier gestations, and intact dilation and extraction accounts for a minority of later procedures. These various procedures will be addressed in detail. Other considerations such as preoperative and intraoperative use of ultrasound, use of uterotonics, pain management, appropriate location for second-trimester abortion provision, and routine postoperative care will also be reviewed.
Language: English
Keywords:
UNITED STATES OF AMERICA | WASHINGTON | RESEARCH REPORT | ABORTION | PREGNANCY, SECOND TRIMESTER | HYSTEROTOMY | GYNECOLOGIC SURGERY | POSTABORTION CARE | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342246 Notification

Peer Reviewed

Title: Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.
Author: Seracchioli R; Mabrouk M; Frasca C; Manuzzi L; Savelli L; Venturoli S
Source: Fertility and Sterility. 2009 May 12;
Abstract: OBJECTIVE: To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive (OC) pills in preventing endometriosis-related pain recurrence. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary care university hospital. PATIENT(S): Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma. INTERVENTION(S): Patients were randomly divided into three groups: nonuser group receiving no therapy, and cyclic user group and continuous user group receiving low-dose, monophasic OC pills for 24 months in either cyclic or continuous administration. MAIN OUTCOME MEASURE(S): Presence and intensity of dysmenorrhea, dyspareunia, and chronic pelvic pain were assessed by a 10-point visual analogue scale (VAS) at 6, 12, 18, and 24 months postoperatively. RESULT(S): A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months, and in cyclic users versus nonusers at 18 months postoperatively. No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups. The increase of VAS scores from 6-24 months during the study period for dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly higher in nonusers than in the other groups. CONCLUSION(S): Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea.
Language: English
Keywords:
ITALY | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | LONGTERM EFFECTS | PAIN | GYNECOLOGIC SURGERY | POSTOPERATIVE PROCEDURES | LAPAROSCOPY | OVARIAN CANCER | ORAL CONTRACEPTIVES, COMBINED | ANALGESIA | ENDOMETRIAL CANCER | ENDOMETRIOSIS | DYSMENORRHEA | Developed Countries | Europe, Southern | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Time Factors | Population Dynamics | Signs and Symptoms | Diseases | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Cancer | Neoplasms | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Menstruation Disorders
Document Number: 341141

Peer Reviewed

Title: Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis.
Author: Seracchioli R; Mabrouk M; Manuzzi L; Vicenzi C; Frasca C; Elmakky A; Venturoli S
Source: Human Reproduction. 2009 Jul 22;
Abstract: BACKGROUND Endometriosis recurrence after conservative surgery is not infrequent. Variable regimens of hormonal therapy have been proposed as adjuvant post-operative measures for prophylaxis against recurrence. Among these, the combined oral contraceptive pills (OCP), represents a valuable option in terms of safety and tolerability for long-term use. The objective of this review is to evaluate the effect of post-operative use of OCP in preventing symptom recurrence, and/or anatomical relapse of endometriosis. METHODS A systematic search of Medline identified seven studies evaluating post-operative OCP treatment on prevention of endometriosis recurrence. RESULTS A reduction in anatomical relapse rate was observed when oral contraceptive therapy was administered for more than 1 year after conservative surgery. Post-operative use of OCP was associated with a reduction in frequency and intensity of dysmenorrhoea recurrence. No association was found between OCP therapy and dyspareunia prevention, although the effect of OCP on chronic pelvic pain was conflicting. CONCLUSION Long-term OCP therapy can be a reliable adjuvant post-operative measure to prevent or reduce frequency/severity of recurrent dysmenorrhoea and anatomical relapse of endometriosis. Since both continuous and cyclic OCP administration regimens seem to have comparable effects, the choice of regimen can be modulated according to patient preferences. The protective effect seems to be related to the duration of treatment.
Language: English
Keywords:
ITALY | LITERATURE REVIEW | CLIENTS | ENDOMETRIOSIS | GYNECOLOGIC SURGERY | POSTOPERATIVE PROCEDURES | SIGNS AND SYMPTOMS | ORAL CONTRACEPTIVES, COMBINED | ADMINISTRATION AND DOSAGE | SAFETY | PAIN | DYSMENORRHEA | Developed Countries | Europe, Southern | Europe | Program Activities | Programs | Organization and Administration | Diseases | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Drugs | Public Health | Menstruation Disorders
Document Number: 342214

10.
Title: [Pharmacotherapy for pelvic endometriosis in women] Farmakoterapia endometriozy narzaadow miednicy u kobiet.
Author: Starczewski A; Brodowska A; Brodowski J
Source: Polski Merkuriusz Lekarski. 2009 Mar;26(153):231-3.
Abstract: Pelvic endometriosis in women is a very common disease. The incidence of this condition in Poland in reproductive age women is about 7-15%, and as much as 50% of cases is diagnosed in patients with co-existing infertility and/or pain and adhesion of a true pelvis. The choice of a therapeutic method depends on the patient's age, stage of the disease, desire for pregnancy, the presence of adhesion, focus localization and a reaction to previous treatment. Currently, the most popular is surgical treatment sometimes followed by pharmacotherapy. Pharmacological treatment includes hormone therapy and symptomatic treatment, also the use of painkillers. Hormonal agents are administered to suppress ovarian activity and cause atrophy of ectopic foci of endometrium. At present, post-surgical pharmacotherapy for endometriosis uses mainly such hormones as: the Combined Oral Contraceptive Pill (COCP), progestagens, danazol, GnRh (gonadotropin-releasing hormone) analogues, aromatase inhibitors and other less common drugs. Also other therapeutic procedures are recommended in endometriosis treatment, procedures which support and in certain clinical situations even replace classical pharmacological methods. Some of them are immunotherapy and a diet rich in isoflavones, organic compounds which modulate estrogen receptor activity. Numerous clinical trials proved that preoperative pharmacotherapy does not improve treatment results and is not applicable to endometriomas in women. On the other hand, postoperative pharmacotherapy still ignites controversy. As maintained by the most recent literature, in the case of mild endometriosis (clinical Stage I and II according to the American Society for Reproductive Medicine) endometrial ablation has better effects than observation only, however postoperative pharmacotherapy does not improve the results of treatment. In more severe cases (clinical Stage III and IV), the best results are achieved by the combined treatment. Nevertheless, no randomized research has been carried out on awide scale in this group of patients.
Language: Polish
Keywords:
POLAND | RESEARCH REPORT | INCIDENCE | WOMEN | PELVIC INFLAMMATORY DISEASE | ENDOMETRIOSIS | GYNECOLOGIC SURGERY | PAIN | TREATMENT | EVALUATION | Developing Countries | Europe, Central | Europe | Measurement | Research Methodology | Demographic Factors | Population | Reproductive Tract Infections | Infections | Diseases | Urogenital Surgery | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms
Document Number: 341113

11.

Peer Reviewed

Title: Scheduled hysterectomy for second-trimester abortion in a patient with placenta accreta.
Author: Tocce K; Thomas VW; Teal S
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):568-70.
Abstract: BACKGROUND: As cesarean deliveries increase, so does placenta accreta. There is little evidence regarding management of patients with known or suspected abnormal placentation seeking abortion. CASE: A medically complicated patient with evidence of placenta increta on magnetic resonance imaging presented for pregnancy termination at 15 weeks of gestation. Scheduled hysterectomy was performed to avoid hemorrhage and subsequent complications. The patient did well postoperatively; her course was complicated only by a wound infection treated as an outpatient. Pathology was consistent with placenta increta. CONCLUSION: Placenta accreta has increased 13-fold in the past 30 years. In select patients with evidence of abnormal placentation, scheduled hysterectomy for termination of pregnancy is an option that may be considered.
Language: English
Keywords:
COLORADO | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | ABORTION | CESAREAN SECTION | PREGNANCY, SECOND TRIMESTER | PREGNANCY COMPLICATIONS | HYSTERECTOMY | INFECTIONS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases | Gynecologic Surgery | Urogenital Surgery
Document Number: 330356 Notification

12.
Title: Ineffective attempt to preserve fertility with a levonorgestrel-releasing intrauterine device in a young woman with endometrioid endometrial carcinoma: a case report and review of the literature.
Author: Vandenput I; Van Eygen K; Moerman P; Vergote I; Amant F
Source: European Journal of Gynaecological Oncology. 2009;30(3):313-6.
Abstract: BACKGROUND: The treatment of endometrial cancer in young women who want to preserve their fertility is challenging. CASE: A 25-year-old woman (A0P0G0) was diagnosed with grade 1 endometrioid endometrial carcinoma (EEC). Imaging studies including transvaginal ultrasound (TVS), computed tomography and magnetic resonance imaging (MRI) could not detect myometrial invasion or metastatic disease. The immunohistochemical expression of the estrogen and progesterone receptor in the tumor was strongly positive, whereas p53 staining was negative. After extensive counseling, we decided to use a levonorgestrel-releasing intrauterine device to preserve her fertility. Follow-up was organized every three months and consisted of serum CA125 levels, TVS, endometrial biopsy and MRI. The tumor regressed after ten months and the intrauterine device was removed. However, nine months later, recurrent EEC was diagnosed and a hysterectomy performed. Pathological examination confirmed Stage Ia EEC. CONCLUSION: Despite the presence of favorable prognostic factors of EEC as determined by grade and immunohistochemistry, the levonorgestrel-releasing intrauterine device was unable to preserve fertility.
Language: English
Keywords:
BELGIUM | SUMMARY REPORT | LITERATURE REVIEW | CASE HISTORIES | CLIENTS | ENDOMETRIAL CANCER | TREATMENT | FECUNDITY | IUD, HORMONE RELEASING | LEVONORGESTREL | ULTRASONICS | HYSTERECTOMY | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Gynecologic Surgery | Urogenital Surgery | Surgery
Document Number: 342780

13.

Title: Oral contraceptives, salpingo-oophorectomy and hormone replacement therapy in BRCA1-2 mutation carriers.
Author: Biglia N; Mariani L; Ponzone R; Sismondi P
Source: Maturitas. 2008 Jun;60(2):71-77.
Abstract: Germline mutations in BRCA1 or BRCA2 genes predispose to hereditary breast and ovarian cancers. The estimated lifetime risk of breast cancer in BRCA1 mutation carriers ranges from 50% to 80%, while the estimated lifetime risk of ovarian cancer ranges from 20% to 65%. Although breast cancer risk is similar in women who inherit BRCA2 mutations, the lifetime risk of ovarian cancer is approximately 20%. In the general population reproductive factors (such as parity, age at menopause, use of exogenous steroid hormones as contraceptives or after menopause) influence the risk of breast and ovarian cancer. In BRCA mutation carriers, these issues are much more complicated and not completely understood. Nonetheless, a growing number of data show that estrogens may modulate the risk of breast cancer in women with BRCA mutations. In these women estrogens may increase the probability of mutation due to enhanced proliferation and direct genotoxic effects of estrogen metabolites. Women carrying BRCA1 and BRCA2 mutations face difficult decisions during the reproductive life. In the younger age period, they may be reluctant to using oral contraceptives (OCs) for the possible influence of these compounds on breast cancer incidence. After completion of childbearing, they may be offered the option of prophylactic oophorectomy, that is associated with a strong reduction of cancer risk, but also with the early onset of menopausal symptoms and the long-term consequences of estrogen deprivation. (excerpt)
Language: English
Keywords:
LITERATURE REVIEW | ORAL CONTRACEPTIVES | BREAST CANCER | OVARIAN CANCER | GENETICS | HEREDITARY DISEASES | OVARIECTOMY | HORMONE REPLACEMENT THERAPY | RISK ASSESSMENT | RISK REDUCTION BEHAVIOR | Contraceptive Methods | Contraception | Family Planning | Cancer | Neoplasms | Diseases | Biology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Behavior
Document Number: 327496

14.

Title: Use of recombinant activated factor VII in massive postpartum haemorrhage.
Author: Bouma LS; Bolte AC; van Geijn HP
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Apr;137(2):172-177.
Abstract: Postpartum haemorrhage (PPH) remains an important cause of maternal morbidity and mortality. With regard to morbidity, preservation of the uterus is of paramount importance in fertile women. The objective of the study was to describe the cumulative experience of a cohort of women that were treated with recombinant factor VIIa. In this retrospective, descriptive study we approached all departments of obstetrics and gynaecology in the Netherlands to find out if they had used rFVIIa for this indication. Twenty-seven cases were reported to us. To evaluate each case, we used a standardized case record form. The main cause of PPH was uterine atony (82%). In 21 cases rFVIIa was explicitly given to prevent a hysterectomy. This was successful in 16 cases (76%). Relevant reduction or complete cessation of bleeding after rFVIIa was noted in 24/27 cases (89%). There was a reduction in blood product requirements following rFVIIa administration. The dose of rFVIIa was variable and ranged from 16 to 128 mg/kg. There appears to be a role for the use of rFVIIa in PPH unresponsive to conventional therapy. Recombinant FVIIa can be helpful and avoid an emergency hysterectomy. (author's)
Language: English
Keywords:
NETHERLANDS | DEVELOPING COUNTRIES | RESEARCH REPORT | COHORT ANALYSIS | POSTPARTUM WOMEN | BLEEDING | HYSTERECTOMY | Developed Countries | Europe, Western | Europe | Research Methodology | Puerperium | Reproduction | Signs and Symptoms | Diseases | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 325919

15.

Peer Reviewed

Title: An historical overview of second trimester abortion methods.
Author: Bygdeman M; Gemzell-Danielsson K
Source: Reproductive Health Matters. 2008 May;16(31 Suppl):196-204.
Abstract: The methods used for abortion in the second trimester have changed considerably in recent years. The surgical procedure dilatation and evacuation (D&E) has replaced hysterotomy. Instead of injecting different compounds, such as hypertonic saline, prostaglandin analogues are administered by non-invasive routes. The most effective medical method is combining a prostaglandin analogue with mifepristone. The consequence of these developments is that abortion in the second trimester can be be performed significantly more effectively and that the currently recommended methods being used are associated with fewer side effects and complications.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | HYSTEROTOMY | ABORTION | PREGNANCY, SECOND TRIMESTER | PROSTAGLANDINS | CHANGES | Europe, Northern | Europe | Developed Countries | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Endocrine System | Physiology | Biology | Social Change | Sociocultural Factors
Document Number: 330090 Notification

16.

Title: Surgical treatment of Peyronie's disease: Choosing the best approach to improve patient satisfaction
Author: Egydio PH
Source: Asian Journal of Andrology. 2008 Jan;10(1):158-166.
Abstract: The aim was to discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie's disease. Recent advances in approaches to Peyronie's disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction (ED), and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years (32-69 years) and the mean angle of curvature 74.2 +or- 22.4 (0-100). Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 +or- 5.9 months (3-22 months). Mean functional penile length gain was 3.40 +or- 0.73 cm (2-5 cm). Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis (length and rigidity). Length and girth restoration is very important for self-esteem and patient satisfaction. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | MEN | CLIENTS | IMPOTENCE | GENITAL EFFECTS, MALE | MALE UROLOGIC SURGERY | SATISFACTION | TREATMENT | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Urogenital Surgery | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Psychological Factors | Behavior
Document Number: 323376

17.

Peer Reviewed

Title: Oral contraceptives and clinical recurrence of human papillomavirus lesions and cervical intraepithelial neoplasia following treatment.
Author: Frega A; Scardamaglia P; Piazze J; Cerekja A; Pacchiarotti A
Source: International Journal of Gynecology and Obstetrics. 2008 Feb;100(2):175-178.
Abstract: The objective was to evaluate the effect of oral contraceptive use on the recurrence rate of human papillomavirus (HPV) lesions and cervical intraepithelial neoplasia (CIN) following ablative or excisional procedures in a long-term follow-up. The study was conducted with 650 oral contraceptive users presenting with HPV lesions and/or CIN, and 670 women who had these lesions but did not use oral contraceptives acted as controls. The participants underwent cytologic evaluations, colposcopy, and direct biopsy, followed by either ablative treatment by laser carbon dioxide vaporization or excision by a loop electrosurgical excision procedure or cold knife conization. They were then followed up for a minimum of 5 years. The recurrence rates did not differ statistically between the case and control groups. Oral contraceptive use was not found to increase the recurrence rate of HPV lesions and/or CIN after ablative or surgical treatment. (author's)
Language: English
Keywords:
ITALY | RESEARCH REPORT | EVALUATION | WOMEN | HPV | ORAL CONTRACEPTIVES | PREVENTION AND CONTROL | TREATMENT | GYNECOLOGIC SURGERY | Europe, Southern | Europe | Developed Countries | Demographic Factors | Population | Viral Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Urogenital Surgery | Surgery
Document Number: 323638

18.

Peer Reviewed

Title: Psychiatric morbidity following hysterectomy in Egypt.
Author: Helmy YA; Hassanin IM; Elraheem TA; Bedaiwy AA; Peterson RS
Source: International Journal of Gynecology and Obstetrics. 2008 Jul;102(1):60-64.
Abstract: The objective of this study was to evaluate psychiatric morbidity in Egyptian women before and after hysterectomy for benign indications. This was a 2-year prospective observational study at Sohag University Hospital, Egypt, in which 96 women scheduled for hysterectomy were assessed for psychiatric comorbidity before and after the operation using the General Health Questionnaire (GHQ-28), Beck Depression Inventory, and Hamilton Anxiety Scale. Of these, 35 (36.5%) had scores of 4 or higher, signifying psychiatric comorbidity (group 1), and 61 (63.5%) had scores less than 4, suggesting no psychiatric comorbidity (group 2). Postoperatively, severe anxiety and depressive symptoms were common in group 1. In group 2, 48 (78.7%) of the 61 women had scores of 4 or higher. In that subgroup, depressive and anxiety symptoms were more common among nulliparas whereas women with a high parity experienced the least psychiatric comorbidity. As women undergoing hysterectomy risk psychiatric morbidity, gynecologists should consider less invasive interventions to treat benign conditions. (author's)
Language: English
Keywords:
EGYPT | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | WOMEN | HYSTERECTOMY | MENTAL HEALTH | ANXIETY DISORDERS | DEPRESSION | Developing Countries | Africa, North | Africa | Research Methodology | Studies | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Psychological Factors | Behavior | Mental Disorders | Diseases
Document Number: 327045

20.
Title: [Dysfunctional uterine bleeding--diagnostics and treatment] Czynnosciowe krwawienia maciczne--diagnostyka i leczenie.
Author: Jakimiuk AJ; Grzybowski W; Beta J
Source: Ginekologia Polska. 2008 Apr;79(4):254-8.
Abstract: Dysfunctional uterine bleeding (DUB) occurs frequently in women at the reproductive age and is unrelated to structural uterine abnormalities. It significantly impairs the quality of life for many otherwise healthy women. Evaluation of patients with abnormal uterine bleeding and identification of those with DUB is based on medical records, physical examination, laboratory tests, uterine imaging and endometrial sampling. Surgical treatment options include hysterectomy and conservative surgery (endometrial resection or ablation). Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. However, there is considerable variation in practice and lack of consensus regarding the most effective therapy.
Language: Polish
Keywords:
BRAZIL | SUMMARY REPORT | WOMEN | BLEEDING | UTERINE EFFECTS | LABORATORY EXAMINATIONS AND DIAGNOSES | REPRODUCTIVE AGE | HYSTERECTOMY | ENDOMETRIAL EFFECTS | SURGERY | TREATMENT | Developing Countries | South America, Eastern | South America | Latin America | Americas | Demographic Factors | Population | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Gynecologic Surgery | Urogenital Surgery | Endometrium
Document Number: 328920

21.

Peer Reviewed

Title: Peripartum hysterectomy in Taiwan.
Author: Jou HJ; Hung HW; Ling PY; Chen SM
Source: International Journal of Gynecology and Obstetrics. 2008 Jun;101(3):269-272.
Abstract: The objective was to investigate the incidence and associated risk factors for peripartum hysterectomy in singleton pregnancies. A retrospective cohort study of all women with singleton pregnancies admitted for delivery in 2002 taken from the National Healthcare Insurance database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and hospital characteristics using logistic regression. There were 287 peripartum hysterectomies in 214 237 singleton pregnancies (0.13%). Cesarean delivery, vaginal birth after cesarean (VBAC), and repeat cesarean delivery had higher hysterectomy rates than vaginal delivery, with adjusted ORs of 12.13 (95% CI 8.30-17.74), 5.12 (95% CI 1.19-21.92), and 3.84 (95% CI 2.52-5.86), respectively. Pregnancies complicated with placenta previa, gestational diabetes mellitus (GDM), and premature labor were associated with significantly increased risks for peripartum hysterectomy (P less than 0.05). Risk factors for peripartum hysterectomy included cesarean delivery, VBAC, repeat cesarean, placenta previa, GDM, and premature labor. VBAC and repeat cesarean had a similar risk. (author's)
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | CHILDBIRTH | HYSTERECTOMY | RISK FACTORS | CESAREAN SECTION | PREGNANCY COMPLICATIONS | PREMATURE LABOR | DIABETES | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Obstetrical Surgery | Diseases
Document Number: 326721

22.

Peer Reviewed

Title: Emergency peripartum hysterectomy in a a tertiary Istanbul hospital.
Author: Kayabasoglu F; Guzin K; Aydogdu S; Sezginsoy S; Turkgeldi L
Source: Archives of Gynecology and Obstetrics. 2008 Sep;278(3):251-256.
Abstract: The objective of this study was to evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries. We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA). The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum hysterectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7. Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | RETROSPECTIVE STUDIES | POSTPARTUM WOMEN | HYSTERECTOMY | CESAREAN SECTION | EMERGENCY SERVICES | RISK FACTORS | COMPLICATIONS | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Puerperium | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Biology | Diseases
Document Number: 327979

23.

Title: Current approaches to optimizing the treatment of endometriosis in adolescents.
Author: Laufer MR
Source: Gynecologic and Obstetric Investigation. 2008;66 Suppl 1:19-27.
Abstract: Endometriosis can occur in adolescents and this patient group presents particular challenges in terms of differential diagnosis, variable presentation and symptoms, and choice of treatment. Early diagnosis is essential in order to decrease pain and hopefully prevent disease progression and preserve future fertility. Endometriosis surgery is generally cytoreductive rather than curative, and postoperative medical therapy should be initiated regardless of disease stage. Menstrual suppressive therapy with the use of continuous combination estrogen/progestin is the main treatment for most adolescents with endometriosis. For those with a persistence of pain on this therapy Gonadotropin-releasing hormone (GnRH) agonists (with add-back therapy) can be effective in relieving symptoms. GnRH agonist therapy requires special consideration in adolescents due to possible adverse effects on bone mineralization--an important consideration in adolescents who are at a critical age for accrual of bone mineral density (BMD). However, potential problems of bone loss may be avoided with the use of 'add back' therapy. A recent clinical study found that most adolescents with endometriosis receiving a GnRH agonist plus add-back therapy with norethindrone acetate (NA) or estrogen plus NA had normal BMD at the hip. Add-back therapy appears to be a promising adjunct to GnRH agonist therapy for the prevention of bone loss and may allow a longer duration of therapy than with a GnRH agonist alone. BMD should continue to be carefully monitored after the initial 6-8 month period of therapy and then approximately every two years in adolescent patients (over age 16) receiving long-term GnRH agonist with add-back therapy.
Language: English
Keywords:
UNITED STATES OF AMERICA | RECOMMENDATIONS | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | ENDOMETRIOSIS | EXAMINATIONS AND DIAGNOSES | PAIN | GYNECOLOGIC SURGERY | SIGNS AND SYMPTOMS | TREATMENT | SKELETAL EFFECTS | OSTEOPOROSIS | ESTROGENS | HORMONE REPLACEMENT THERAPY | TIME FACTORS | Developed Countries | North America | Americas | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Urogenital Surgery | Surgery | Physiology | Biology | Hormones | Endocrine System | Population Dynamics
Document Number: 329069

24.

Peer Reviewed

Title: Goserelin versus leuprolide before hysterectomy for uterine fibroids.
Author: Lim SS; Sockalingam JK; Tan PC
Source: International Journal of Gynecology and Obstetrics. 2008 May;101(2):178-183.
Abstract: The objective was to compare goserelin and leuprolide given before hysterectomy for symptomatic large fibroid uteri. A randomized study of 66 premenopausal women with fibroid uteri at least 14 weeks of gestation in a gravid uterus. Women were randomized to receive either subcutaneous depot 3.6 mg goserelin or 3.75 mg leuprolide every 4 weeks for a total of 3 doses. Hysterectomy was performed within 1 month of the last dose. A total of 34 women randomized to the goserelin group and 31 women to the leuprolide group were available for analysis. Preoperative hemoglobin level (P=0.89), operative blood loss (P=0.72), and operating time (P=0.39) were not different between the 2 groups. Postoperative hemoglobin was higher in the leuprolide group (P=0.003), but blood transfusion requirement was not different between the groups (P=1.0). Other outcomes and side effects of the drugs were similar. Goserelin and leuprolide administered before hysterectomy for uterine fibroids have similar perioperative outcomes. (author's)
Language: English
Keywords:
MALAYSIA | RESEARCH REPORT | WOMEN | UTERINE EFFECTS | FIBROIDS | DRUGS | ADMINISTRATION AND DOSAGE | GONADOTROPINS | HYSTERECTOMY | HEMOGLOBIN LEVEL | SIDE EFFECTS | Developing Countries | Asia, Southeastern | Asia | Demographic Factors | Population | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Neoplasms, Benign | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormones | Endocrine System | Gynecologic Surgery | Urogenital Surgery | Surgery | Hemic System
Document Number: 325981

25.

Peer Reviewed

Title: Relation between vaginal and endocervical pH in patients undergoing cold-knife conization and hysterectomy.
Author: Murta EF; Perfeito PB; Oliveira TM; Michelin MA; Maluf PJ
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):43-46.
Abstract: This study aimed to investigate the influence of endocervical pH on vaginal pH, and also the changes in these pH values following hysterectomy and cold-knife conization. Vaginal pH is important for maintaining the equilibrium of the vaginal microflora. Two groups of women were studied: the first (n = 20, median age 45, range 33-50 years-old), before and after hysterectomy (without ovariectomy) for myomatosis; the second group (n = 18, median age 38.5, range 37-65 years-old), before and after cold-knife conization for cervical intraepithelial neoplasia (CIN) grade II or III. Four samples (before and 90 days after surgery) were collected from the women by means of swabs: (1) anterior vaginal fornix, (2) posterior vaginal fornix, (3) posterior wall of lower vagina, and (4) endocervix (except in cases after hysterectomy). The pH was measured using a digital pH-meter (Sentron). We observed that endocervical pH was less acidic than were all the vaginal locations measured, before both surgeries. After both surgeries, all vaginal pH measurements were higher, but without reaching statistical significance. Endocervical pH correlated with vaginal pH. We concluded that recent hysterectomy does not alter vaginal pH and that vaginal and endocervical pH values are related. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | CERVICAL EFFECTS | VAGINA | HYSTERECTOMY | SURGERY | MENOPAUSE | MENSTRUAL CYCLE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Gynecologic Surgery | Urogenital Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Menstruation
Document Number: 322614

26.

Peer Reviewed

Title: Sexual violence-related fistulas in the Democratic Republic of Congo.
Author: Onsrud M; Sjoveian S; Luhiriri R; Mukwege D
Source: International Journal of Gynecology and Obstetrics. 2008 Sep 22;:[5] p.
Abstract: Objective: To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. Methods: A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Results: Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Conclusion: Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | EXAMINATIONS AND DIAGNOSES | RECORDS | SEXUAL ABUSE | SEX BEHAVIOR | VIOLENCE | VIOLENCE AGAINST WOMEN | RAPE | FISTULA | ABORTION, SPONTANEOUS | HYSTERECTOMY | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Information Processing | Information | Crime | Social Problems | Sociocultural Factors | Behavior | Domestic Violence | Diseases | Pregnancy Complications | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment
Document Number: 328492

27.

Peer Reviewed

Title: Prong sign: a simple measure to enhance safety of laparoscopic sterilization.
Author: Puri M; Pasrija S; Trivedi SS
Source: Tropical Doctor. 2008 Apr;38(2):99.
Abstract: Laparoscopic female sterilization is widely practiced and is very safe. However, mesosalpingeal tears and mesosalpingeal haematomas are common complications especially when performed by an inexperienced surgeon. It was found that the observation of a simple 'prong sign' could prevent these complications and possibly reduce failure rates.
Language: English
Keywords:
INDIA | SUMMARY REPORT | FEMALE STERILIZATION | LAPAROSCOPY | SAFETY | GYNECOLOGIC SURGERY | Developing Countries | Asia, Southern | Asia | Sterilization, Sexual | Family Planning | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Public Health | Urogenital Surgery | Surgery | Treatment
Document Number: 308923

28.

Peer Reviewed

Title: Primary carcinoid tumor of the ovary: A case report.
Author: Somak R; Shramana M; Vijay S; Nita K
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):79-82.
Abstract: Carcinoid tumors commonly occur in the gastrointestinal tract and lungs. However, carcinoid tumors of the ovary are rare, primary carcinoid tumors being even rarer, forming 0.3% of all carcinoid tumors. We present a case of a 55-year-old woman presented with symptoms of abdominal discomfort, weakness and fatigue. Pelvic ultrasound revealed a left-sided lobulated ovarian mass, which was solid with occasional internal scattered fluid areas. No other abnormality was detected on pelvic and abdominal ultrasonography. The findings of biochemical investigations were within normal limits. The patient underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy for a clinical suspicion of ovarian tumor. Gross examination revealed a large tumor completely replacing the ovary, which was predominantly solid with few cystic areas and yellowish in color. Microscopically, the tumor was composed of uniform population of polygonal cells with abundant granular cytoplasm, arranged in small acini, solid sheets, ribbons and trabecular pattern. No teratomatous component was seen either grossly or microscopically. The tumor cells showed the strong expression of Chromogranin A and synaptophysin on immunohistochemistry. On the basis of this, a diagnosis of primary ovarian carcinoid was made. We conclude that it is important to be aware of this entity in the pathological diagnosis of ovarian tumors, even in the absence of any clinical indicator of carcinoid tumor/syndrome, as it carries a markedly better prognosis and clinical outcome in comparison with most other malignant ovarian tumors. (author's)
Language: English
Keywords:
INDIA | SUMMARY REPORT | CASE HISTORIES | NEOPLASMS | OVARIAN CANCER | EXAMINATIONS AND DIAGNOSES | HYSTERECTOMY | HISTOLOGY | ULTRASONICS | Developing Countries | Asia, Southern | Asia | Data Collection | Research Methodology | Diseases | Cancer | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Biology
Document Number: 322618

29.

Title: Local profile of cytokines and nitric oxide in patients with bacterial vaginosis and cervical intraepithelial neoplasia.
Author: Tavares-Murta BM; de Resende AD; Cunha FQ; Murta EF
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 May;138(1):93-99.
Abstract: The objective was to evaluate the local immune response in patients with bacterial vaginosis (BV) and cervical intraepithelial neoplasia (CIN), as assessed by cytokine and nitric oxide (NO) concentrations. Patients attending for routine gynaecological examination were prospectively enrolled in groups: BV (n = 25) diagnosed by clinical criteria, CIN graded I to III (n = 35, 6 CIN I, 8 CIN II and 21 CIN III) by histological analysis, and controls (n = 15) without clinical and cytological findings. Randomly selected patients within CIN group at grades II or III (n = 15) were re-evaluated at 60 days after surgical treatment. Endocervical (EC) and vaginal secretion samples were collected by cytobrush and the levels of cytokines (ELISA) and NO metabolite (Griess reaction) were assayed. NO was assessed in all subjects, and cytokines in all controls, 15 BV and 30 CIN patients. Interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and nitrite levels were higher in EC than in vaginal secretionsin BVand CIN groups. In CIN group, IL-8, IL-10 and nitrite concentrations were greater in EC and/or vaginal secretions than in BV or controls. Surgical treatment reduced IL-8 levels in EC and vaginal secretions. A similar local immune profile was found in BVand CIN groups. The increased local production of IL-8, IL-10 and NO in CIN suggests a role for these mediators in the immune response against tumour or tumour development. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | CASE CONTROL STUDIES | WOMEN IN DEVELOPMENT | VAGINOSIS | BACTERIAL AND FUNGAL DISEASES | CERVICAL CANCER | CYTOLOGIC EFFECTS | PHYSICAL EXAMINATIONS AND DIAGNOSES | LABORATORY EXAMINATIONS AND DIAGNOSES | HISTOCHEMICAL EFFECTS | GYNECOLOGIC SURGERY | IMMUNOLOGIC FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Vaginal Abnormalities | Diseases | Infections | Cancer | Neoplasms | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Urogenital Surgery | Surgery | Treatment | Immunity | Immune System
Document Number: 326443

30.

Peer Reviewed

Title: Endometriosis: Current and future medical therapies.
Author: Vercellini P
Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2008 Apr;22(2):275-306.
Abstract: Endometriosis is a chronic inflammatory disease that responds to steroidal manipulation. Creation of a steady hormonal environment with inhibition of ovulation temporarily suppresses the ectopic implants and reduces the inflammatory status as well as the associated pain symptoms. Pharmacological management of endometriosis must be set within the framework of long-term therapeutic strategies. As the available drugs are not curative, treatments will need to be administered for years or until women desire a pregnancy. The various therapies studied have shown similar efficacy. Consequently, based on a more favourable profile in terms of safety, tolerability and cost, combined oral contraceptives and progestins should be considered as the first-line option, both as an alternative to surgery and as a postoperative adjuvant measure. Gonadotrophin-releasing hormone analogues, danazol and gestrinone should be used when progestins and oral contraceptives fail, are not tolerated or are contra-indicated. Future therapies for endometriosis must compare favourably with existing drugs before hypothesizing their implementation in current practice. Medical treatment is not indicated in women seeking conception because reproductive prognosis is not ameliorated. (author's)
Language: English
Keywords:
ITALY | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | ENDOMETRIOSIS | ANALGESIA | IMMUNOLOGICAL EFFECTS | DRUGS | ANABOLIC STEROIDS | ULTRASONICS | GYNECOLOGIC SURGERY | ORAL CONTRACEPTIVES, COMBINED | PROGESTATIONAL HORMONES | ESTROGENS | ADMINISTRATION AND DOSAGE | Europe, Southern | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System | Physiology | Biology | Androgens | Hormones | Endocrine System | Urogenital Surgery | Surgery | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning
Document Number: 324954


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