Thesis (M.S.)--University of Michigan, 1996.

Objetivos: Determinar los factores asociados a complicaciones de la histerectomía vaginal en el Hospital Nacional Docente Madre Niño San Bartolomé en el periodo comprendido de Enero del 2008 a Mayo del 2013. Material y métodos: Se realizó un estudio observacional, analítico, de casos (pacientes que presentaron complicaciones) y controles (pacientes que no presentaron complicaciones). Se revisaron 104 historias clínicas de pacientes atendidas en el Hospital San Bartolomé en el servicio de Ginecología y Obstetricia sometidas a histerectomía vaginal, en el periodo que correspondió al estudio. Resultados: La media de la edad de las pacientes en estudio fue de 55.7+/-11.58 años, con una mínima de 36 años y una máxima de 76 años. Hubo complicaciones postoperatorias en el 56.7% de los casos. Al 69.2% se les realizo histerectomía vaginal y al 30.8% histerectomía vaginal asistida por laparoscopia. El 84.6% eran desempleadas y el 76.9% tenían secundaria completa. El 53.8% consulto por la sensación de bulto, el 46.2% tenían el antecedente de aborto, el 53.8% tuvo como diagnóstico prequirúrgico el de distopia genital III, y el 23.1% tuvo dolor pélvico e hipertensión arterial como antecedente clínico de importancia. La complicación de mayor frecuencia es la anemia en el 41.4% de los casos y la fiebre se presentó en el 4,8% de las pacientes postoperadas. La mayoría no tiene estudio anatomopatológico (76.9%), y el 15.4% tuvo leiomioma intramural. Conclusiones: El factor asociado a complicaciones de la histerectomía vaginal fue el dolor pélvico como motivo de consulta, además el factor de mayor estancia hospitalaria (P<0.05). La frecuencia de histerectomía vaginal, fue del 69.2% y la asistida por laparoscopia fue del 30.8%. La mayoría de pacientes eran desempleadas con grado de instrucción secundaria. En cuanto a las características clínicas de las pacientes sometidas a histerectomía vaginal, la mayoría consulto por sensación de bulto, la mayoría tuvieron el diagnóstico de distopia genital, y el antecedente clínico de importancia fue el dolor pélvico e hipertensión arterial. No hubo complicaciones intraoperatorias de importancia de las pacientes sometidas a histerectomía vaginal. La complicación postoperatoria de mayor frecuencia fue la anemia y la fiebre se presentó en el 4,8 % de las pacientes postoperadas. La mayoría no tuvo diagnóstico anatomopatológico. / Tesis

No description available.

Most research evaluating the effects of the reproductive tract microbiota on reproductive performance has been done in humans, thus far. In bovids, reproductive microbiota research is not as advanced, with preliminary conclusions, not supported by contamination checks or repeatability. Our studies concluded that endogenous reproductive hormones, days of gestation, and pregnancy status does not change the overall vaginal microbiota composition. Although, the overall composition did not change there were species level differences. These differences could have implications in reproductive performance and fertility in heifers. Heifers that undergo nutrient restriction have similar vaginal microbiota to adequately fed heifers with no species differences. The most impactful finding is that exogenous supplementation of melatonin was associated with changes in the vaginal microbiota in Brangus heifers during late gestation. The implications of this finding are not yet clear, but to date, this is the first hormone, in bovids, determined to change the composition of the vaginal microbiota.

The vagina is one organ of the body which has not been studied exhaustively. Moreover, most of the studies found in the contemporary literature have been performed on women affected by a variety of genital diseases. In the present study the vaginal epithelium was examined with a histological method, morphometry, whereby cyclical changes related to hormonal variation during the menstrual cycle were demonstrated. Determination of the quantity of estrogen receptors in the vaginal epithelium on two occasions during the menstrual cycle revealed a significantly greater number in the follicular than in the luteal phase. The results of these studies indicate the presence of a menstrual variation in the vaginal epithelium comparable to that in the endometrium. Phenoxymethylpenicillin (pcV) was used as a marker substance to study the dynamics of the transport mechanisms into the vagina. PcV was found to accumulate in the vaginal fluid and high concentrations persisted for a long period of time. In hysterectomized women, the appearance of pcV in the vaginal fluid followed the same pattern. Consequently, the substance is transported through the vaginal wall and need not enter with the secretions from the internal genitalia. The greatest concentration of pcV was in the distal portion of the vagina, possibly due to the specific internal circulation of fluid within the vagina. Bacterial vaginosis as an example of an ‘ecological disease’ has been studied with regard to the formation of endotoxin, a constituent of the cell wall of Gram- negative bacteria. Large amounts of endotoxin were found and the clinical implication of this finding has been pointed out. Furthermore, the influence of pcV on the vaginal microbial flora of healthy women has been investigated. A change from a situation with predominance of lactobacilli to the appearance of Gram-negative rods was observed. In one of the women the lactobacilli disappeared completely and were replaced by E. coliand high levels of endotoxin in the vaginal fluid were found. This study demonstrates the complexity of the ecological balance of the vaginal microbial flora and illustrates the difficulty of defining a ‘normal’ vaginal condition. Is there any unquestionable state of ‘normality’ even in a healthy woman free from symptoms of genital disease? / <p>S. 1-22: sammanfattning, s. 25-64: 6 uppsatser</p> / digitalisering@umu

Thesis (M.S.)--University of Michigan, 1991.

Made available in DSpace on 2015-07-22T20:50:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-27. Added 1 bitstream(s) on 2015-08-11T03:07:21Z : No. of bitstreams: 1 Publico-12807.pdf: 1925667 bytes, checksum: 40f94a2382fcb5e9e0c7155532f0079a (MD5) / Objetivo: Apresentar e avaliar os resultados histológicos, anatômicos e funcionais do procedimento de McIndoe modificado, utilizando a celulose oxidada (Surgicel®). Métodos: Onze mulheres com agenesia vaginal se submeteram à neovaginoplastia com ou sem canalização útero-vaginal utilizando um molde revestido com celulose oxidada. As cirurgias foram realizadas entre janeiro de 2009 e dezembro de 2010. Oito dessas pacientes tiveram o diagnóstico de Síndrome de Mayer-Rokitansky-Kuster-Hauser (MRKH), e as outras três tiveram o diagnóstico de Agenesia Cervico-vaginal (CVA). O tempo médio de seguimento foi 14 meses (variando de 6 a 24 meses), e incluiu exame físico e avaliação do questionário sexual (Female Sexual Function Index-FSFI). Amostras teciduais foram obtidas no momento da cirurgia e 1 a 12 meses após o procedimento. Biópsias vaginais para controle foram obtidas de um grupo de pacientes com doenças ginecológicas benignas. Avaliou-se a epitelização escamosa do tecido da neovagina, e a quantidade total de colágeno das neovaginas, e comparou-se com o grupo controle. Para análise estatística utilizou-se o teste ANOVA e o t-test. Resultados: Seis meses após a cirurgia, o sucesso anatômico foi encontrado em 100% das pacientes com síndrome MRKH (comprimento vaginal > 6 cm), e sucesso funcional em todas as pacientes que iniciaram atividade sexual (Score FSFI > 30). As biópsias mostraram epitelização da neovagina após 6 meses em todas as amostras, e o conteúdo total de colágeno foi comparável ao de uma vagina normal. Uma complicação maior ocorreu em uma paciente com CVA, que culminou em morte. O procedimento de canalização útero vaginal não foi bem sucedido em criar um pertuito para menstruações regulares mensais em nenhum dos casos. Nenhuma das pacientes com CVA obtiveram sucesso anatômico ou funcional. Conclusão: A neovaginoplastia com a técnica de McIndoe modificada, utilizando a celulose oxidada (Surgicel®), procedimento simples e de baixo custo, permite a formação de canal vaginal com epitelização e conteúdo de colágeno similar ao de uma vagina normal. É uma potencial alternativa terapêutica para síndrome de MRKH. / Objective: To present and evaluate the histological, anatomical and functional results of the McIndoe procedure, as modified by the application of oxidized cellulose (SurgicelTM) in women with vaginal agenesis. Study design: Eleven patients with vaginal agenesis underwent vaginoplasty with or without uterovaginal cannulation using a mold that had been wrapped with oxidized cellulose. The surgeries were performed between January 2009 and January 2010. Eight of the patients had been diagnosed with Mayer-Rokitansky- Kuster-Hauser (MRKH) syndrome, and the remaining three had been diagnosed with cervicovaginal agenesis (CVA). The mean follow-up time was 14 months (range, 6-24 months), and it included clinical examinations and evaluation of the Female Sexual Function Index (FSFI). Neovaginal biopsies were taken from the patients with MRKH syndrome at the time of surgery and 1-12 months after surgery. Control tissues were taken from a group of patients without vaginal disease. The histology of the samples was evaluated to determine squamous epithelialization of the neovaginal tissue over time, and the total collagen content of the neovaginas were compared with normal control subjects. For statistical analysis we employed the ANOVA test and the t-test. Results: At 6 months, anatomical success was achieved in 100% of the MRKH syndrome patients (neovaginal length . 6 cm), and functional success was achieved in 100% of the patients who started their sexual life (FSFI score . 30). Biopsy results showed complete epithelialization of the neovagina after 5 monthsin all samples, and the amount of collagen content in the neovaginas progressively increased. After 6 months, the collagen content was comparable to that of a normal vagina. One major postoperative complication occurred in a patient with CVA, which culminated in death. The uterovaginal canalization procedure was unsuccessful at creating an outflow tract for regular menses in all cases. None of patients with CVA achieved anatomical or functional success. Conclusions: The procedure described here offers patients a functional vagina by means of a simple and low-cost procedure that elicits squamous epithelialization of the neovaginal vault, with total collagen content similar to that of normal vaginal tissue. It is a potential alternative therapeutic approach for MRKH syndrome but not applicable to cases of CVA. / TEDE

Made available in DSpace on 2014-06-11T19:26:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-07Bitstream added on 2014-06-13T20:54:35Z : No. of bitstreams: 1 delmanto_a_me_botfm_prot.pdf: 1594635 bytes, checksum: 59b8850497a3a71e0f5ae2ec36c4ccb0 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Analisar o efeito do raloxifeno sobre o epitélio vaginal de mulheres pós-menopausa. Métodos: Estudaram-se prospectivamente entre novembro de 2004 a fevereiro de 2006, 80 mulheres na pós-menopausa. Quarenta pacientes receberam 6Omg/dia de raloxifeno (GR) e 40 mulheres compuseram o grupo não tratado (grupo controle, GC), pareado por idade e tempo de menopausa. O grupo tratado foi composto por pacientes com osteoporose de coluna lombar e/ou colo do fêmur. Foram excluídos aquelas com sinais e/ou sintomas de infecção do trato genital inferior e usuárias de terapia hormonal (TH) até seis meses prévios ao estudo. Os esfregaços vaginais foram coletados em dois momentos: inicial (MO) e após seis meses de seguimento (Ml). Para avaliação do epitélio vaginal foi utilizado o valor de maturação, com a contagem de células superficias, intermediárias e parabasais. Os esfregaços foram analisados por único citopatologista, sem conhecimento dos dados das pacientes. Para análise estatística empregou- se o teste t de Student, teste Wilcoxon Mann-Witney e o teste Qui-Quadrado. Resultados: Na comparação estatística inicial os grupos foram homogêneos. Comparando os momentos inicial e final, não foram observadas diferenças estatisticamente sígnífícativas nos valores medianos de maturação do epitélio vaginal e na porcentagem de células superficiais, intermediárias e parabasais entre os grupos. Não foi constatada correlação linear significativa entre o valor de maturação e a idade, o tempo de menopausa, o uso ou não de TH prévia, tabagismo e o índice de massa corpórea, em ambos os grupos. Conclusão: O tratamento com raloxifeno por seis meses não alterou o valor de maturação do epitélio vaginal em mulheres na pós-menopausa. / To analyze the effect of raloxifene on the vaginal epithelium of postmenopausal women. Methods: Eighty postmenopausal women were studied prospectively between November of 2004 and February of 2006. Forty patients received 6omglday of raloxifene (GR), and 40 women comprised the non-treated group (control group, CG), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar column and / or femur. Those with signs and / or symptoms of infection of the inferior genital tract and users of hormonal therapies (HT) up to six months prior to the study were excluded. Vaginal smears were collected at two moments: initial (MO) and after six months of follow-up (Ml). To evaluate the vaginal epithelium, the maturation value was determined, along with counts of superficial, intermediate and parabasal cells. Smears were analyzed by only one cytopathologist, without knowledge of patient data. For statistical analysis Student's t test, Wilcoxon Mann Witney test and Chi-Squared test were employed. Results: In the initial statistical comparison the groups were homogeneous. Comparing the initial and final moments, no statistically significant differences were observed in median values of vaginal epithelial maturation or in percentage of superficial, intermediate and parabasal cells between the groups. There was no significant linear correlation between value of vaginal epithelial maturation and age, time of menopause, use or not of previous HT, smoking or body mass index, in both groups. Conclusion: Treatment with raloxifene for six months did not alter the maturation value of vaginal epithelium in postmenopausal women.

No description available.

En el Instituto Materno Perinatal durante el año 2002 se realizó un estudio observacional analítico de tipo cohorte con el objetivo de determinar el valor en la predicción del parto pretérmino espontáneo de la longitud cervical medida por ecografía transvaginal entre las 22 – 24 semanas de gestación. Un total de 1218 pacientes cumplieron los criterios de inclusión, de las cuales 18 se perdieron al seguimiento. La incidencia de parto pretérmino fue 11,8%. La longitud cervical estuvo normalmente distribuida. La longitud cervical media fue 35,1 +/-8,5 mm (rango, 11 – 72 mm). La longitud cervical, el antecedente de parto pretérmino, la multiparidad y el riesgo social alto se asociaron significativamente con parto pretérmino. El riesgo relativo de parto pretérmino espontáneo (_ 37 semanas de gestación) para pacientes con longitud cervical _ 15 mm y _ 25 mm fue 10,9 (IC 95% 8,3 – 14,2; P _ 0,0001) y 9,0 (IC 95% 7,7 – 10,6; P _ 0,0001); respectivamente. Para parto pretérmino espontáneo una longitud cervical _ 14,5 mm tuvo un valor predictivo positivo de 100%, un valor predictivo negativo de 100%, una sensibilidad de 6,4% y una especificidad de 97%. Concluimos que un cérvix corto medido por ultrasonografía transvaginal entre las 22- 24 semanas de gestación fue un importante predictor de parto pretérmino espontáneo.