scholarly journals Pessaries in clinical practice

2015 ◽  
Vol 64 (2) ◽  
pp. 97-107
Author(s):  
Olesya Nikolaevna Bespalova ◽  
Gabriel Spartakovich Sargsyan
Keyword(s):  
Pregnancy Termination ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Cervical Incompetence ◽  
Treatment And Prevention ◽  
History Of ◽  
Ancient Times ◽  
Selection Of Patients ◽  
Selection Of ◽  
Main Strategy

Pessaries were used in medicine since ancient times, history of their use goes back thousands of years. Throughout its history, pessaries have not changed significantly, so modern products do not differ from the ancients. In modern obstetrics pessaries are used for treatment of cervical incompetence and prevention of premature birth. Transvaginal ultrasound is the gold standard for the evaluation of the cervix during pregnancy and allows a selection of patients with cervical length ≤25 mm for pessary installation. To date, the installation of pessary may be the main strategy for the treatment and prevention of threatened pregnancy termination in the II and III trimester of pregnancy.

The comparison of USG measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion

2019 ◽  
Vol 8 (10) ◽  
pp. 4024
Author(s):  
Harshita Naidu ◽  
Nivedita Hegde ◽  
Anjali M. ◽  
Rohini Kanniga ◽  
Akhila Vasudeva
Keyword(s):  
Pregnant Women ◽  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Induced Abortion ◽  
Cervical Length ◽  
Care Hospital ◽  
Spontaneous Preterm Delivery ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of

Background: The majority of women who undergo induced abortion are young and of low parity. Hence, it is desirable to look for any association effects of induced abortion with future reproductive outcomes. In this study, we aim to compare ultrasound measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion.Methods: This was a prospective observational study performed at tertiary care hospital. Total of 400 patients were recruited, divided into two groups. Patients with an induced abortion in previous pregnancy were included as cases and those with no history were taken as controls. Cervical length was measured by transvaginal ultrasound in all participants at 11-14, 18-22 and 28-32 weeks. Pregnancies were followed up to note incidence of spontaneous preterm delivery, preterm pre labour rupture of membranes (PPROM), threatened preterm, and second trimester miscarriage.Results: Authors have found that there was no significant difference in the cervical length of pregnant patients with or without a history of prior induced abortions.  In our study authors found that mean cervical length at 11-14weeks, 18-22 weeks, and 28-32 weeks was 3.47±0.126cm and 3.48±0.195cm; 3.44±0.296cm and 3.49±0.182cm; 3.36±0.477cm and 3.42±0.310cm respectively among cases and controls. However, there was a demonstrably increased risk of spontaneous preterm delivery, PPROM and threatened preterm in patients with a history of prior induced abortion.Conclusions: Authors conclude that previous induced abortion increases the risk of threatened preterm, PPROM, spontaneous preterm delivery in the subsequent pregnancy. But, this risk is not predictable by measuring cervical length as the mean cervical length remained the same in both the groups.

scholarly journals Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

2012 ◽  
Vol 8 (3) ◽  
pp. 321-324
Author(s):  
S R Tamrakur ◽  
C D Chawla
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Cervical Length ◽  
University Teaching ◽  
Third Trimester ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Cervical Incompetence ◽  
History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district.  All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation.  33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases.  All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24 

scholarly journals The modern significant of the bronchial asthma

2020 ◽  
Vol 22 (2) ◽  
pp. 227-234
Author(s):  
V. V. Salukhov ◽  
M. A. Kharitonov ◽  
A. A. Zaycev ◽  
K. A. Ramazanova ◽  
K. V. Asyamov
Keyword(s):  
Bronchial Asthma ◽  
Diagnostic Algorithm ◽  
Detailed Examination ◽  
Phenotypic Characteristics ◽  
Treatment And Prevention ◽  
Flexible Dosing ◽  
Mechanisms Of Development ◽  
Prophylactic Method ◽  
Selection Of Patients ◽  
Selection Of

A review of modern literature on the diagnostic algorithm of bronchial asthma and a detailed examination of all its stages is presented. It is known that bronchial asthma is the most common form of the disease, prone to progression to more severe forms, but fraught with the development of exacerbations, even fatal. Often, general practitioners perceive bronchial asthma as a manageable, understandable disease, for the successful treatment of which it is enough to identify and isolate the allergen, as well as prescribe therapy. Understanding the mechanisms of development of bronchial asthma helps to increase the effectiveness of the diagnosis and treatment of asthma, preferably taking into account the phenotype. Determining the phenotypic characteristics of bronchial asthma is a requirement of the time, because personalized medicine does not yet require the creation of a separate drug, diagnostic or prophylactic method for each individual patient, but it requires the selection of patients (allocation of subpopulations / clusters / phenotypes of bronchial asthma) that are most responsive to a particular drug, a method for diagnosing or preventing a disease. The essence of phenotyping in medicine is the optimization of diagnosis, treatment and prevention. The central and most studied links of the pathogenetic mechanism and its variants of development are described, phenotypes of bronchial asthma are discussed, as well as options for basic and targeted therapy of bronchial asthma. The necessity of studying personalized therapy and flexible dosing of drugs used in the treatment of bronchial asthma is emphasized.

scholarly journals Selection of the method for correction of cervical incompetence

2017 ◽  
Vol 66 (3) ◽  
pp. 157-168 ◽  
Author(s):  
Olesya N. Bespalova ◽  
Gabriel S. Sargsyan
Keyword(s):  
High Risk ◽  
Transvaginal Ultrasound ◽  
Perinatal Outcomes ◽  
Termination Of Pregnancy ◽  
Short Cervix ◽  
Simple Method ◽  
Cervical Incompetence ◽  
Gynecological Examination ◽  
Surgical Methods ◽  
Selection Of

Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy during pregnancy can be reached with transvaginal ultrasound of the cervix. The ultrasound scale proposed by Salomon LJ allows to measure the length of the cervix depending on the gestational age and assists in making the right choice for the correction of short cervix. The selection of the method of correction of CI depends on the clinical situation, history, timing of gestation, the number of fetuses, cervicometry data, gynecological examination, the threat of abortion, and the doctor’s experience. There are two main methods of correction of CI: conservative and surgical. Surgical methods include transvaginal and transabdominal cerclage, while conservative includes adherence to bed rest, tocolytics, hormonal therapy, and the use of obstetric pessaries. Insertion of obstetric pessaries is a promising, safe, simple method of treatment and prevention of CI and for threatening termination of pregnancy in the II and III trimesters. The strategy of widespread use of pessaries in pregnant women from high-risk groups can reduce the frequency of preterm labor and improve perinatal outcomes.

Effectiveness of early diagnosis for prostate cancer based on PSA and multiparametric MRI: A simulation study.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 224-224
Author(s):  
Marc-Olivier Timsit ◽  
Giulia Baciarello ◽  
Christophe Hennequin ◽  
Francois Kleinclauss ◽  
Marie Laure Bazil ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Diagnosis ◽  
Patient Selection ◽  
Epidemiological Data ◽  
History Of ◽  
Clinically Significant ◽  
The Impact ◽  
Selection Of Patients ◽  
Related Mortality ◽  
Selection Of

224 Background: Multiparametric magnetic resonance imaging (mpMRI) detects ISUP grade≥ 2 prostate cancer (PC) with a sensitivity over 90%. mpMRI can be used for early detection in patients with a risk of clinically significant PC (csPC) either in combination with systematic biopsy (SB) to increase the detection rate of csPC, or to reduce the number of biopsy procedures by performing biopsies only in positive mpMRI patients. Methods: We estimated the numbers of PC diagnosed, PC deaths averted, and biopsy procedures performed with early diagnosis in a simulated population of men beginning at age 50 using a microsimulation model. The model simulates the natural history of PC and the impact of early diagnosis using epidemiological data from a systematic review of literature. Early diagnosis started at age 55 years, with a PSA threshold of 4 ng/mL. The strategies included (S1) SB alone, (S2) SB combined with mpMRI-targeted biopsy (SB/mpMRI-TB), and (S3) SB/mpMRI-TB following selection of patients based on positive mpMRI (PIRAD3-5) or PSA density (PSAd) < 0.15. A sensitivity of 0.92 and specificity of 0.48 for detecting ISUP grade ≥ 2 PC was used for mpMRI. Results: Compared to no early diagnosis, early diagnosis with SB alone (S1) was estimated to avoid 647 PC-related deaths per 100,000 men over their lifetimes. Using mpMRI was estimated to result in an additional 126 and 118 fewer deaths per 100,000 if mpMRI was used in conjunction with SB (S2) or with SB following patient selection for biopsy by mpMRI or PSAd (S3). To avoid a PC-related death was estimated to require screening of 145 men with SB alone, 121 with SB/mpMRI-TB, and 122 with mpMRI or PSAd followed by SB/mpMRI-TB. Adding mpMRI to SB was also found to reduce the predicted number of biopsies performed (21,821 for SB alone versus 16,510 for SB/mpMRI-TB and 15,385 for SB/mpMRI-TB following selection with mpMRI or PSAd). Conclusions: The results indicate that using mpMRI as a detection method will improve the effectiveness of early diagnosis. Compared to SB alone, using mpMRI through the SB/mpMRI-TB approach, with or without prior patient selection based on mpMRI or PSAd assessments, would result in a reduction in PC-related mortality and in the number of biopsies performed. [Table: see text]

scholarly journals CLINICAL TRIAL ON CHEMOPROPHYLAXIS OF BREAST CANCER WITH AROMATASE INHIBITOR LETROZOLE IN WOMEN WITH A HIGH RISK OF DEVELOPING BREAST CANCER. PART I: SELECTION OF PATIENTS, THE FREQUENCY OF PRECANCEROUS STATES

2018 ◽  
Vol 23 (1) ◽  
pp. 10-13
Author(s):  
Andrey A. Meshcheryakov
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Mammary Gland ◽  
High Risk ◽  
Atypical Hyperplasia ◽  
National Medical ◽  
History Of ◽  
Slow Recruitment ◽  
Selection Of Patients ◽  
Selection Of

In 2004 - 2010, in the Research Institute of Clinical Oncology of the N.N. Blokhin National Medical Research Center of Oncology there was implemented a prospective randomized clinical trial on chemoprophylaxis of breast cancer with letrozole in women with precancerous states of the breast epithelium. The hypothesis of the study supposed letrozole to be capable to eliminate or at least halt the progression of breast precancerous changes, represented by atypical hyperplasia or hyperplasia without atypia. The study included women with a potentially high risk of developing breast cancer: female patients with validated risk factors for the disease or a risk of contralateral breast cancer with a personal history of the disease. The ultimate goal of the examination was to identify patients with morphologically proven precancerous changes in the mammary gland with positive expression of estrogen receptors. To obtain a morphological material, periareolar fine-needle puncture of the mammary gland was performed. The effectiveness of the developed method of sampling happened to be high, allowing the diagnosis in 172 (96.6%) of 178 patients. Hyperplasia without atypia was detected in 69 (38.8%) women, atypical hyperplasia - in 81 (45.5%) patients, in 22 (12.3%) women no pathological changes in the epithelium were detected. The study has failed to be completed due to the slow recruitment of patients. Despite the incompleteness of the study, new data on the prevalence of breast precancerous changes in the postmenopausal women in the Russian population and significant experience in the organization and implementation of studies on chemoprophylaxis of breast cancer have been obtained.

scholarly journals Problemy lecheniya patsientov s morbidnym ozhireniem

2011 ◽  
Vol 8 (1) ◽  
pp. 57-66 ◽  
Author(s):  
E G Starostina
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Surgical Intervention ◽  
Surgical Interventions ◽  
Patient Dissatisfaction ◽  
Treatment And Prevention ◽  
High Prevalence ◽  
Selection Of Patients ◽  
Selection Of

The article describes evidence-based approaches to treatment of morbid obesity, including surgical interventions designated for bodyweight reduction and provides comparative analysis of efficacy and safety of lifestyle interventions, medical treatment and various types of bariatric surgery. Detailed description of diagnosis, treatment and prevention of post-surgical vitamin and mineral deficiencies is given. Special attention is paid to high prevalence of mental disorders in patients with morbid obesity, their role in its development, their influence on outcomes of surgical intervention and potential patient dissatisfaction with its results. Necessity of thorough selection of patients for bariatric surgery is emphasized, with assessment of their mental state and proper organization of subsequent life-long follow-up after operation

Cervical Cerclage versus Vaginal Progesterone for Management of Short Cervix in Low-Risk Women

2018 ◽  
Vol 36 (02) ◽  
pp. 111-117 ◽  
Author(s):  
Sarah Dotters-Katz ◽  
Brenna Hughes ◽  
Amber Wood
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Low Risk ◽  
Prior History ◽  
Short Cervix ◽  
Vaginal Progesterone ◽  
History Of ◽  
Secondary Outcomes ◽  
Low Risk Women

Objective To evaluate the risk of preterm birth in low-risk women with cervical length (CL) ≤25 mm on transvaginal ultrasound (TVUS) managed with vaginal progesterone (VagP) therapy versus cerclage. Study Design This is a retrospective cohort of women with no prior history of preterm birth or cervical insufficiency and CL ≤ 25 mm on TVUS, managed with either VagP therapy alone or cerclage (with or without VagP). The primary outcome was rate of preterm delivery < 37 weeks gestational age (GA). Secondary outcomes included delivery at ≤ 32 or ≤ 28 weeks GA, premature preterm rupture of membranes, pregnancy latency, GA at delivery, and composite neonatal outcome. Results Women undergoing cerclage placement (n = 31) were older and had an earlier GA at the time of diagnosis of short cervix compared with women receiving VagP (n = 62). Delivery at < 37 weeks occurred in 21/62 (33.9%) in the VagP group and 14/31 (45.2%) in the cerclage group (adjusted odds ratio: 1.72, 95% confidence interval: 0.52, 5.66). There were no differences in secondary outcomes. Conclusion Cerclage compared with VagP therapy did not decrease risk of preterm birth in women with CL ≤ 25 mm. Further research is needed to determine optimal management in such women given a residual 40% risk of preterm birth despite optimal therapy.

Abstract 2226: Predictors Of tPA Non-responders According To Location Of Vessel Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nuno Mendonça ◽  
David Rodríguez-Luna ◽  
Sandra Boned-Riera ◽  
Marta Rubiera ◽  
Marc Ribó ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
History Of ◽  
Hemodynamic Profile ◽  
Ica Stenosis ◽  
Selection Of Patients ◽  
Iv Tpa ◽  
Selection Of

Background and purpose: Information on the clinical and hemodynamic profile of IV tPA non-responders, at different location of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aimed to investigate predictors of failing IV tPA therapy according to occluded vessel and location of clot. Methods: We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred and forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal MCA occlusion (n=251), distal MCA occlusion (n=194), ICA T occlusion (n=61) and BA occlusion (n=42). Recanalization was assessed on TCD at 1 hour of tPA bolus. Results: Among patients with proximal MCA occlusion, the presence of severe extracranial ICA stenosis or occlusion (OR 2.36, 95% CI 1.15-4.84, p=0.02) and age >74 years (OR 1.84, 95% CI 1.02-3.31, p=0.04) independently predicted no recanalization (NR). No independent predictors of NR were identified in patients with distal MCA occlusion. In patients with ICA T occlusion, history of hypertension (OR 12.77, 95% CI 2.12-76.88, p=0.05) and absence of atrial fibrillation (OR 0.12, 95% CI 0.02-0.71, p=0.02) emerged as independent predictors of NR. Similarly, among patients with BA occlusion, atrial fibrillation was as an independent predictor of NR (OR 0.13, 95% CI 0.03-0.72, p=0.02). Conclusions: Absence of atrial fibrillation independently predicts persistent occlusion at 1-h after tPA bolus in patients with ICA T and BA occlusions. The use of relevant predictors of NR and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.

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