Experience with vaginal reconstruction utilizing the modified Singapore flap.

Many types of vaginal reconstruction have been described, and we have employed several with varying degrees of success. All we have used seem to have drawbacks. In April 1989 Wee and Joseph from Singapore described a technique using neurovascular pudendal-thigh flaps as islands. Initially we used the procedure as described. Later we modified the approach by releasing the labia majora, allowing them to retract somewhat anteriorly, and rotating the flap into position. This procedure has been used in eight patients, in some instances under the most adverse circumstances in patients who have undergone multiple procedures and heavy irradiation (including intraoperative radiation) besides experiencing postoperative leakage of urine. Though we have had dehiscence and problems with infection and drainage in some of our patients, no flap has failed, contour is exceptionally good, and potential for function is satisfactory. The procedure requires less time and produces better results than any other technique employed by us in the more than 30 vaginal reconstructions we have carried out. The technique will be illustrated and clinical cases will be presented.     

Isolation of the equilibrium solution from a west soil or clay paste

Summary A technique is described for the isolation of the equalibrium solution of very small amounts of soil. The technique is a combination of the filter-paper and centrifugation techniques. The new technique has been compared with the saturation-extract method with good results.     

Immediate postnatal decontamination as a means of obtaining axenic animals and human infants.

A technique not involving surgery is described for obtaining axenic (germ-free) newborn animals and human infants by decontamination immediately after birth. Three steps are involved: cleansing ther perineal region of the mother with an iodinated bactericidal solution, washing the newborn with the same solution, and after the newborn has been placed in a sterile isolater, administering a single oral dose of an antibiotic mixture previously determined to be active against the fecal and vaginal flora of the mother. All of the newborn obtained by means of this technique, including 13 piglets, 2 lambs, and 4 human infants, were found to be axenic throughout their stay in the isolators. Four piglets obtained by the same technique, but without adminstration of antibiotic mixture, were found not to be anenic. This technique, as compared with methods of surgical delivery of axenic young, embodies a number of advantages. It is harmless to the mother and to the newborn, it is relatively inexpensive, and it obviates the risk of prematurity involved in elective surgical delivery before term.     

Detection of Australia antigen in Grenoble]

The reverse passive hemaggluatination (RPH) technique for HB ag. detection is presently used at the Grenoble Blood Center; this technique has been slightly modified with a view to lowering the cost. A microtechnique which gave preliminary good results, is also described.     

Nested polymerase chain reaction on vaginal smears of tuberculous cervicitis. A case report

BACKGROUND: Tuberculous cervicitis (TC) is a rare disease the diagnosis of which is based on the microscopic and/or cultural recognition of mycobacteria. In recent years, the polymerase chain reaction (PCR), especially with double-round amplification ("nested" PCR [nPCR]), has been increasingly used for rapid detection of mycobacteria in clinical samples. CASE: The present case is the first example of tuberculosis diagnosed with the aid of nPCR amplification of mycobacterial DNA fragments on smeared and Papanicolaou-stained cytologic material. First detected on vaginal smears, the amplicon IS6110 was subsequently identified also on paraffin-embedded tissue sections. CONCLUSION: The technique described here could also be applied to aspiration cytology smears to give rapid and accurate information on mycobacterial infections.     

Microwave irradiation-stimulated in situ hybridization procedure with biotinylated DNA probe.

A microwave-stimulated in situ hybridization technique using biotin-labeled DNA probe is described. Both hybridization reaction and the detection of the biotin label (with a alkaline phosphatase or immunofluorescence method) has been performed in the microwave oven. All procedures are completed within one hour. The described method was applied for identification of nucleic acid sequences of human immunodeficiency virus in human cell lines. The resolution and the intensity of the signal are as good as from a standard technique with overnight incubation of the probe. Because of the simplicity and speed of the technique, this procedure can be used in a number of other applications.     

Pharmacokinetics of the progesterone-containing vaginal tablet and its use in assisted reproduction

Natural progesterone, which is devoid of androgenic activity, is widely used in assisted reproduction for luteal and pregnancy support. The vaginal route has become the most established way to deliver natural progesterone because it is easily administered, avoids liver first-pass metabolism, and has no systemic side-effects. The vagina has a large potential for absorption, and through the 'uterine first-pass effect' vaginal administration results in higher uterine progesterone concentrations. We have investigated the pharmacokinetics of natural progesterone in the form of a vaginal tablet. A single dose of 100 mg resulted in a mean C(max) of 31.53 +/- 9.15 nmol/l with a T(max) of 6.92 +/- 3.12 h. The terminal half-life was 16.39 +/- 5.25 h. The pharmacokinetic data are discussed in relation to dose, age, and estrogen priming. Single-dose pharmacokinetics of 100 mg of progesterone vaginal tablets and gelatin capsules were evaluated over 24 h. Results indicated a similar mean T(max) of 6.92 +/- 3.12 and 6.23 +/- 6.57 h, respectively. However, a significantly higher C(max) was achieved by the vaginal tablet (31.95 +/- 9.15 and 23.85 +/- 9.57 nmol/l, respectively, P < 0.05). Continuous use of vaginal progesterone did not influence the hormonal, liver, or lipid profiles evaluated. There was no case of endometrial hyperplasia. The vaginal tablet was found to be well-tolerated, safe, and easily administered. In conclusion, progesterone-containing vaginal tablets have good pharmacokinetic properties and should be used for progesterone supplementation in IVF.     

A Method for the Rapid Isolation of Listeria monocytogenes from Infected Material

Two media, one for enrichment and the other for differentiation of Listeria monocytogenes , are described and a method is proposed for the selective isolation of this bacterium from material containing a mixed bacterial flora such as faeces, vaginal swabs etc. Addition of potassium dichromate, chromium trioxide, thionin, nalidixic acid and amphotericin B to Todd-Hewitt Broth (BBL) made a satisfactory enrichment broth in which good selective growth of L. monocytogenes was obtained without notable damage to cells. The differentiation agar was Trypticase Soy Agar (BBL) supplemented with gallocyanin, pyronin and nalidixic acid. On this medium L. monocytogenes colonies, when viewed by the Henry's oblique transillumination technique, were blue in contrast to colonies of other bacterial species which were pink or red. Trials with experimentally infected materials showed that L. monocytogenes could be recovered from faeces infected with as few as 20 L. monocytogenes cells/g. All common contaminants, with the exception of a few strains of Streptococcus faecalis , were inhibited.     

The cytology of vaginal, cervical and endometrial smears obtained at the time of embryo transfer during in vitro fertilization

Seventy-four women enrolled in an in vitro fertilization (IVF) program had cytologic smears of the vagina, cervix and endometrium obtained at the time of embryo transfer (ET). Of these, 68 vaginal, 46 cervical and 25 endometrial smears were available for cytologic examination. Of the 68 vaginal smears, 4% showed a proliferative pattern, 40% were early secretory and 56% were advanced secretory. The 46 cervical smears demonstrated a delayed hormonal effect, with 70% showing a proliferative pattern, 23% early secretory and 7% advanced secretory cytology. Endometrial cells were obtained only when the Jones catheter, which has a side opening, was used. Twenty-two patients had both vaginal smears and suitable endometrial smears. Of these, 8 of the 9 patients with early secretory vaginal cytology had secretory endometrium while 10 of the 12 patients with mid-secretory vaginal cytology had secretory endometrium. The value of endometrial cytology in predicting conception following IVF-ET is unknown. It seems, however, that a good correlation exists between endometrial and vaginal cytology and that the latter may be of value as an additional, noninvasive tool for the evaluation of endometrial development.     

Precocious puberty with congenital hypothyroidism

Precocious puberty associated with profound hypothyroidism is a rare condition. It is usually characterized by breast development, vaginal bleeding, lack of pubic hair and delayed bone age. Multicystic ovaries in profound hypothyroid patients with precocious puberty have been rarely described. Vaginal bleeding in adolescent girls should be considered as a clinical significance particularly when it is prolonged or heavy, whereas vaginal bleeding in younger girls, regardless of its duration and quantity is always of clinical importance. Bleeding in such patients could be caused by local causes such as vulvar or vaginal lesions, or it could be from the endometrium, which is usually a sign of systemic hormonal disturbance [1]. In this report a rare case of vaginal bleeding, large, multicystic ovaries, precocious puberty and delayed bone age in a 7 years old girl with profound hypothyroidism is described.     

Vaginal and pelvic reconstruction with distally based rectus abdominis myocutaneous flaps

This report introduces a new method of vaginal reconstruction using a single rectus abdominis myocutaneous flap based distally. Applications of this flap in reconstruction of major abdominal wall and pelvic defects, such as hemipelvectomies, are also described. The flap is designed to carry a paddle of upper abdominal skin on a distally based muscle and vascular pedicle. Advantages of this flap design are (1) the technique is straightforward and rapid, (2) flap viability is reliable, (3) the epigastric skin-fascial donor defect preserves the anterior rectus fascia distal to the linea semicircularis, which prevents hernia, (4) a large arc of rotation is provided, and (5) the epigastric donor site does not interfere with colostomy and urinary conduit stomas in the pelvic exenteration patient. We have done 11 vaginal reconstructions and 9 major pelvic defect reconstructions with this flap during the last 3 1/2 years. In these 20 patients, the only complications were two partial flap losses. No major flap losses or ventral hernias occurred.     

定君生联合甲硝唑治疗滴虫性阴道病的临床疗效观察

目的 通过定君生联合甲硝唑以及单独用药治疗滴虫性阴道病的临床疗效观察,探讨联合用药对滴虫性阴道病的疗效.方法 选择诊断明确的滴虫性阴道病患者150例,随机分为3组,试验组采用甲硝唑联合定君生的治疗,对照组Ⅰ采用定君生单独用药,对照组Ⅱ采用甲硝唑治疗,观察治疗后的症状、体征、滴虫和阴道的pH的变化.结果 3组患者有效率差异有统计学意义(P＜0.05),起效时间和复发率差异有统计学意义(P＜0.01).结论 定君生联合甲硝唑治疗滴虫性阴道病,疗效好,有利于快速恢复阴道的微生物环境的平衡,降低复发率.     

阴式全子宫切除术和腹腔镜下全子宫切除术的临床对比分析

目的:比较阴式全子宫切除术与腹腔镜下全子宫切除术的临床治疗效果。方法:回顾性分析2014年6月-2015年6月我院收治的137例子宫良性病变患者的临床病历资料,按照手术方式将其分为阴式组(行阴式全子宫切除术)和腹腔镜组(行腹腔镜下全子宫切除术),比较两组患者的术中、术后临床指标及术后并发症情况。结果:阴式组手术时间及术中出血量均少于腹腔镜组,差异有统计学意义(P0.05)。阴式组肛门排气时间、下床活动时间以及住院时间均短于腹腔镜组,住院总费用低于腹腔镜组,差异有统计学意义(P0.05)。两组患者并发症发生情况差异无统计学意义(P0.05)。结论:阴式全子宫切除术较腹腔镜下全子宫切除术而言,具有手术创伤小、术后恢复快的特点,值得临床推广。     

Surgical treatment of erythroplasia of Queyrat.

An operative technique is described for the treatment of large lesions of erythroplasia of the penis. The defect on the glans and on the coronary sulcus is covered by a flap prepared from the external part of the prepuce. This therapy has been effective and has given a good functional result.     

"Apron" flap and re-creation of the inframammary fold following TRAM flap breast reconstruction

To the best of our knowledge, the recreation of an inframammary fold after TRAM flap breast reconstruction has not yet been described. This article offers a technique for the creation of an inframammary fold as a secondary procedure. The technique has been performed thus far in two patients with good aesthetic outcomes and no postoperative complications. It may also be suitable for adding bulk to the TRAM flap, especially in bilateral breast reconstruction, and for other minor chest deformities.     

Prevention of Urinary Tract Infections After Vaginal Surgery

The technique of care of the bladder and indwelling catheter during the postoperative period was altered to determine whether the incidence of urinary tract infections following vaginal surgery could be reduced. Sixty-nine patients undergoing various types of vaginal reparative surgery were studied. Irrigation of the bladder was carried out with a closed system, four times daily, using chlorhexidine diacetate 1:20,000. Only 12 of the 69 patients showed urinary infection after removal of the catheter, a marked reduction in the usual incidence. It is suggested, therefore, that this technique is helpful in preventing urinary infection after vaginal surgery. It was noted, however, that a further 12 patients who were free of infection at the time of removal of the catheter subsequently developed infection as a result of catherization for residual urine. It is recommended that routine catheterization for residual urine be abandoned.     

Microflora of the penile skin-lined neovagina of transsexual women

Background  

The microflora of the penile skin-lined neovagina in male-to-female transsexuals is a recently created microbial niche which thus far has been characterized only to a very limited extent. Yet the knowledge of this microflora can be considered as essential to the follow-up of transsexual women. The primary objective of this study was to map the neo-vaginal microflora in a group of 50 transsexual women for whom a neovagina was constructed by means of the inverted penile skin flap technique. Secondary objectives were to describe possible correlations of this microflora with multiple patients' characteristics, such as sexual orientation, the incidence of vaginal irritation and malodorous vaginal discharge.     

Studies on the differentiation pattern and hormonal sensitivity of an antigenic material specific for the cervicovaginal epithelium in fetal and neonatal mice.

By use of an indirect mixed haemagglutination method for tissue sections, the Müllerian cervicovaginal epithelium of fetal and neonatal mice has been shown to contain a material (CVA) with antigenic properties specific for this epithelium. The method is highly sensitive and permits a semiquantitative estimation of CVA in the epithelium. The studies showed that the cervicovaginal epithelium undergoes a multiphasic differentiation pattern. An estradiol injection 1 day prior to killing the animals strongly increased the amount of demonstrable CVA. The quantitative response to estradiol varied with the age of the animals. Notably, estradiol given as early as the day of birth stimulated CVA accumulation in the vaginal epithelium. Differences between the cervical epithelium and the vaginal epithelium regarding the response to estradiol are described.     

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

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).     

壳聚糖治疗阴道感染的临床疗效及观察

目的分析壳聚糖治疗阴道感染的临床疗效及观察。方法对随机抽取的320例患者进行壳聚糖治疗前和治疗后的比较。结果在320例阴道感染中,治疗效果显效245例（占受检人数的76．56％）,治疗效果有效67例（占受检人数的20．94％）,治疗无效8例（占受检人数的2．5％）。结论分析壳聚糖对各种阴道感染都有较好的疗效,有利于阴道微感染的治疗,而且治疗过程中,无一例患者发生副反应,表明壳聚糖治疗阴道感染的安全性。