Vaginal Device Research Articles

État des lieux des pratiques de déclenchement en France

ObjectiveTo describe induction of labor practices in France and to identify factors associated with the use of different methods. MethodsThe data came from the French prospective population-based cohort MEDIP (MEthodes de Déclenchement et Issues Périnatales), including consecutively during one month in 2015 all women with induction of labor and a live fetus in 7 perinatal networks. The characteristics of women, maternity units, gestational age, Bishop's score, decision mode, indication and methods of labor induction were described. Factors associated with the use of different methods were sought in univariate analyzes. ResultsThe rate of induction of labor during the study was 21% and 3042 women were included (95.9% participation rate). The two main indications were prolonged pregnancy (28.7%) and premature rupture of the membranes (25.4%). More than one-third of women received intravenous oxytocin in first method, 57.3% prostaglandins, 4.5% balloon catheter and 1.4% another method. Among the prostaglandins, the vaginal device of dinoprostone was the most used (71.6%) then the gel (20.7%) and the vaginal misoprostol (6.7%). Women with a balloon were more often of higher body mass index and multiparous with scarred uterus. The balloon and misoprostol were mainly used in university public hospitals. ConclusionsThe evolution of induction of labor methods, due to new data from the literature and the development of new drugs or devices, invites to regularly repeat population-based studies on induction of labor.

Clinical value of new rapid pathological diagnosis technique in the examination of cervical lesions in primary medical institution

Objective To explore the clinical value of new rapid pathological diagnosis technology in the examination of cervical lesions in primary medical institution. Methods In the Affiliated Hospital of Yangzhou University, 25 cases of cervical scraping and 22 cases of cervical biopsy were selected.Twenty-five cases of cervical scraping scraped two wipers during operation, the results were compared with conventional pathological techniques and new rapid pathological diagnosis techniques.Twenty-two cases of cervical biopsy used a new rapid pathological diagnosis technique to perform cytological diagnosis of biopsy tissue rolls in biopsy operation.According to the results of rapid pathological diagnosis, the biopsy operation plan was adjusted to analyze the clinical value of the new rapid pathological diagnosis technique in cervical lesions in primary medical institution. Results The new rapid pathological diagnosis technology required less space and no pollution, and the diagnosis took about 2-3 min, which did not affect the normal inspection operation.Twenty-five cases of cervical scraping were produced with new rapid pathological diagnosis technique, and the quality of cervical scraping produced with conventional pathological technique was consistent, which could satisfy the needs of pathological cytological diagnosis; twenty-two cases of cervical biopsy under the vaginal device were assisted by this technology and it could increase the positive rate of the first biopsy. Conclusion Cervical scraping and cervical biopsy are still the main methods for cervical lesions examination in primary hospitals.The new rapid pathological diagnosis technology can provide the real-time pathological diagnosis of cervical scraping, improve the positive detection rate of the first biopsy of cervical biopsy, and the cost is low, suitable for promotion in primary medical institution. Key words: Uterine cervical diseases; Pathology, clinical; Biopsy, needle; Cervical biopsy; Real-time; Base layer; Positive rate

Development of a Vaginal Immobilization Device: A Treatment-planning Study of Carbon-ion Radiotherapy and Intensity-modulated Radiation Therapy for Uterine Cervical Cancer.

We developed a vaginal immobilization device for external radiotherapy in gynaecological malignancies and evaluated its bowel dose-reduction effect during carbon-ion radiotherapy (CIRT) and intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. Computed tomographic images obtained with and without the device in seven patients with cervical cancer were assessed. Treatment plans for CIRT and IMRT were generated, and dose-volume parameters (V20, V25, V35, and D2cc) of the rectum, sigmoidal colon, and bladder were evaluated. The mean±standard deviation of the rectal volume in CIRT for V35 with and without the device were 2.1±2.1 and 13.6±4.4 ml, respectively, and those in IMRT were 2.0±2.2 and 13.7±3.8 ml, respectively; these values were significantly lower in CIRT and IMRT using this device. Using our novel vaginal immobilization device, high rectal doses were largely reduced in CIRT and IMRT.

“Vaginal Delivery”: A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty

Background: To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods: After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results: The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions: This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.

Modern methods of assessing function and strength ofpelvic muscles in women

Objective: to provide an overview of modern methods for assessing the function and strength of the pelvic floor muscles in women available for clinical practice. The main provisions. Foreign and domestic sources found in free access Internet databases were analyzed. Visual observation, palpation, perineometry, electromyography, ultrasound and magnetic resonance imaging measure various aspects of the function and strength of the pelvic floor muscles. Perineometry allows you to accurately measure the force of contractions of the pelvic floor muscles and is an easy and affordable way. Oxford vaginal palpation technologies, biofeedback devices, and ultrasound can be important clinical tools in the practice of a physician to quantify dysfunction of the pelvic floor. Conclusion. The obtained data on methods for assessing the function and strength of the pelvic floor muscles indicate the need for perineometry in clinical practice for the timely diagnosis of pelvic floor insufficiency, which will allow choosing the right rehabilitation method for women of different age groups.

Revitalizing research in genitourinary syndrome of menopause

Genitourinary syndrome of menopause is defined as the collection of signs and symptoms of the genitourinary tract from menopause, previously known as vulvovaginal atrophy. The Food and Drug Administration has approved select hormonal and nonhormonal treatment for vaginal atrophy, including systemic estrogen, vaginal estrogen, estrogen receptor modulators, and dehydroepiandrosterone. These medications can increase the risk of thromboembolic disease and malignancy; furthermore, the cost of the medications have been increasing. Energy-based therapy such as the fractional CO2 laser energy or nonablative photothermal Erbium:YAG-laser has emerged as an alternative treatment option for genitourinary syndrome of menopause. However, in July of 2018, the Food and Drug Administration released a statement cautioning women against vaginal rejuvenation devices and highlighted the paucity of long-term clinical research in this field. This statement may result in patients' hesitation to seek care for genitourinary syndrome of menopause. These recent events should be a call to action to urge physicians to address the barriers that exist in the treatment of genitourinary syndrome of menopause because of limited clinical research, cost of treatment, and fear.

IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity.

This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.

198 Superovulatory response in cows undergoing aromatase inhibitor treatment

The aromatase inhibitor letrozole has been used in the treatment of infertility in women by inducing mild ovarian superstimulation or augmenting the ovarian response to FSH treatment. The effect has been attributed to an apparent up-regulation of FSH receptors on granulosa cells as a result of increased androgens (Weil et al. 1999 J. Clin. Endocrinol. Metab. 84, 2951-2956). The objective of this study was to determine whether letrozole will augment the superstimulatory response in FSH-treated cattle. Mature, non-lactating Holstein cows (n=30) were given 2 luteolytic doses of PGF2α 12h apart and scanned daily by transrectal ultrasonography to detect ovulation. Transvaginal ultrasound-guided ablation of follicles ≥5mm was performed in all cows as a group, at 5 to 8 days after ovulation. On the day of ablation, cows were assigned randomly to 2 groups (n=15 per group) and given either an intravaginal letrozole-releasing device or a blank device for 5 days. Coinciding with expected wave emergence (Day 0), cows in both groups were given 8 doses of 50mg of pFSH (Folltropin; Vetoquinol, Lure, France) IM at 12-h intervals, and PGF2α on Days 3 and 3.5. At the time of the second PGF2α, vaginal devices were removed and paint was applied to the tailhead to facilitate detection of oestrus. On Day 5, cows were given gonadotropin-releasing hormone (100mg gonadorelin) IM and artificially inseminated 12 and 24h later. Ova/embryos were collected by transcervical uterine flush on Day 12. The ovaries were examined by ultrasonography on Day 0, 3.5, 5, 6.5, and 12 to record the follicular and luteal response. Nominal data were compared between groups by t-test and by ANOVA for repeated-measures and are expressed as mean±s.e.m. Binomial data were compared by chi-squared test. The number of follicles at wave emergence did not differ between letrozole and control groups (24.6±3.1 and 26.5±3.3 respectively; P=0.68). There was no treatment effect or treatment×day interaction in the number of follicles >8mm on Day 3.5, 5, and 6.5. Letrozole-treated cows exhibited oestrus later than controls (50.3±1.1h v. 40.7±2.0h after first PGF2α; P<0.001) and had less variance in interval to oestrus (residuals, 3.1±0.48h v. 6.7±0.87 h; P<0.01). The number of CL on Day 6.5 was lower in the letrozole group than in the control group (9.1±1.1v. 12.3±1.1; P=0.05). The proportion of ovulations (number of CL on Day 12 over number of follicles ≥3mm on Day 0) was lower in the letrozole group than in the control group (0.65±0.05v. 0.82±0.08; P=0.02). The total number of ova/embryos collected per cow did not differ between letrozole and control groups (5.0±1.9v. 5.4±1.8; P=0.75), nor did the number of transferable embryos differ (3.0±1.2v. 4.3±1.5; P=0.56). In conclusion, treatment with a letrozole-releasing device during ovarian superstimulation did not improve the superovulatory response or embryo collection rate in mature Holstein cows, but letrozole treatment resulted in more synchronous oestrus, which may be used in the design of a fixed-time AI protocol following superstimulatory treatment in cattle. This research was supported by the Alberta Livestock and Meat Agency.

Vaginal natural oxygenation device (VNOD) for concomitant administration of hyaluronic acid and topical hyperbaric oxygen to treat vulvo-vaginal atrophy: a pilot study.

This is a pilot study to evaluate the effectiveness of concomitant administration of hyaluronic acid and topical hyperbaric oxygen therapy (THOT) by a specifically designed medical device (vaginal natural oxygenation device, VNOD) in improving the symptomatology of postmenopausal patients with vulvo-vaginal atrophy (VVA). Women with diagnosis of severe VVA from September 2017 to May 2018 were included. Five biweekly administration of THOT and concomitant of hyaluronic acid were performed with a specifically designed medical device. In each occasion, the intensity of patient's symptoms (well-being such as absence of dyspareunia, vaginal dryness, vulvar and/or vaginal itching; vaginal burning; presence of fluid) was determined with a graduated scale from 1 to 6 and the vaginal elasticity and the vaginal wall epithelium appearance were also determined with a graduated scale from 1 to 5. The change in all parameters from baseline to end of therapy was evaluated. Twenty-five patients were considered for the final analysis. A significant improvement in well-being (0.3 vs. 5.1, p < 0.001), vaginal burning (0.2 vs. 5.1, p < 0.001), presence of fluid (0.6 vs. 4.9, p < 0.001), vaginal epithelium appearance (1.8 vs. 4.7, p < 0.001), and vaginal elasticity (1.1 vs. 3.8, p < 0.001) was observed between the first and the last therapy session. All the patients reported a recovery of their sexuality at the end of the five treatment sessions. In this pilot study, the use of VNOD seems to be a valid treatment of VVA, resulting in a completely natural type of therapy well accepted by patients with immediate therapeutic effects and without side effects; these findings must be confirmed in a well-designed randomized controlled trial.

Chlamydia trachomatis infection in women living in remote areas in Amazonas, Brazil-a self-collection screening experience.

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection among women. In Brazil, there is no organized screening program for C. trachomatis, and the actual prevalence of infection is unknown. This study aimed to determine the prevalence of C. trachomatis infection in women living in riverside communities in the Amazon, using self-collection employing the Evalyn® Brush and polymerase chain reaction. A total of 299 riverine women aged 18-81 years, mean age 35.7 (±12.8) years, predominantly agricultural workers, with low schooling and living with a partner, participated in this study. The prevalence of C. trachomatis infection was found to be 3.7% (95% CI 1.8-6.5), most of them being symptomatic. The mean age of the first sexual intercourse reported by women was 15.2 (±2.3) years, and the majority reported having had none or only one partner in the last 12 months, with very low adherence to consistent condom use (15.4%). Most women (98.3%) reported having approved using the vaginal self-collecting brush, and only 4.7% reported having difficulty in handling the brush. We consider that a vaginal self-collecting device is adequate for diagnosing C. trachomatis infection in women living in remote, hard-to-reach areas.

Immune and metabolic responses of beef heifers supplemented with Saccharomyces cerevisiae to a combined viral-bacterial respiratory disease challenge.

Two treatments were evaluated in heifers to determine the effects of a yeast supplement on immune and metabolic responses to a combined (tandem viral-bacterial) respiratory disease challenge. Thirty-two beef heifers (325 ± 20.1 kg BW) were selected from a larger population previously assigned to one of two treatments: Control (CON), receiving no yeast supplement in the diet, or yeast (YST), CON diet plus a combination live yeast (2.5 g·heifer-1·d-1) and yeast cell wall (2.5 g·heifer-1·d-1) supplement (Phileo Lesaffre Animal Care, Milwaukee, WI). Heifers were maintained on treatments for 31 d prior to the challenge. On day -3 all heifers were fitted with an indwelling vaginal temperature recording device, received an intranasal challenge with 2 × 108 plaque-forming units of bovine herpesvirus-1 (BHV-1), and placed in outdoor pens. On day 0, all heifers were fitted with an indwelling jugular catheter, challenged intratracheally with an average dose of 3.0 × 107 colony-forming units (cfu) of Mannheimia haemolytica in 100 mL media, and were transferred into individual stanchions in an enclosed, environmentally controlled barn. Whole blood samples were collected at -72 h and at 0, 2, 4, 6, 8, 12, 24, 36, 48, 60, and 72 h (hematology) and at 0, 1, 2, 3, 4, 5, 6, 7, 8, 12, 24, 36, 48, 60, and 72 h (serum isolation) relative to M. haemolytica challenge (0 h). Data were analyzed using the MIXED procedure of SAS specific for repeated measures with fixed effects of treatment, time, and the treatment × time interaction. Vaginal temperature and cortisol concentrations were similar between treatments (P ≥ 0.39). Although total leukocyte count following BHV-1 challenge was similar between treatments (P = 0.21), there was a tendency (P = 0.07) for CON heifers to have greater neutrophil counts than YST heifers. Serum haptoglobin concentration was similar between treatments (P = 0.13). Heifers in the YST treatment had similar serum glucose concentrations (P = 0.25) and decreased serum concentrations of urea nitrogen compared to CON (P = 0.03). Dietary treatment did not affect serum nonesterified fatty acid concentrations (P = 0.37). Nasal lesion score severity (0-4) tended (P = 0.07) to be decreased in YST compared to CON (2.5 vs. 3.19 ± 0.26), while water intake tended to be increased in YST (P = 0.06). Feeding a yeast supplement had little effect on the acute-phase response but improved metabolic outcomes in heifers during a respiratory disease challenge.

Assessing risk by analogy: a case study of us medical device risk management policy

Medical devices occupy an increasingly important place in global medical care, and yet the risk management systems that govern them are largely overlooked in academic literatures. In the US, home to the largest medical devices market, Food and Drug Administration (FDA) regulation allows most medical devices to enter the market based on analogy, or substantial equivalence, with previously marketed devices. Thus, risk assessment is administered without premarket clinical trials for safety and efficacy. This system represents a permissive regulatory regime based in neoliberal tenets, where risk, in the form of adverse events, is inherently tolerated within governance structures, evidencing risk colonisation. This paper employs a case study approach, examining market clearances of vaginal mesh surgical devices, which have been the subject of US multi-district litigation. We identified 266 devices cleared before 31 December 2017 and analysed the complicated web of device ‘ancestry’ whereby devices as disparate as cardiac patches and hernia mesh allowed clearance of surgical devices for urogynecology. Perhaps of greatest concern, 10 recalled or withdrawn devices influenced new device clearances for up to 17 years after their market-removal. While the FDA must balance its dual mandate to safeguard patients and promote innovation, we find that medical device regulation structurally favours innovation over safety. ‘Light touch’ risk assessment is not counterbalanced with postmarket mechanisms to safeguard against residual and developmental risks that are associated with medical devices, particularly permanent implants. The proportionality principle associated with a precautionary approach should inform medical device risk management.

Solid state 13C NMR spectroscopy provides direct evidence for reaction between ethinyl estradiol and a silicone elastomer vaginal ring drug delivery system

Steroid molecules have a long history of incorporation into silicone elastomer materials for controlled release drug delivery applications. Previously, based on in vitro release testing and drug content analysis, we demonstrated indirectly that the contraceptive progestin levonorgestrel (LNG) chemically and irreversibly binds to addition cure silicone elastomers, presumably via a hydrosilylation reaction between the levonorgestrel ethynyl group and the hydrosilane groups in the poly(dimethylsiloxane-co-methylhydrosiloxane) crosslinker of the silicone elastomer. Here, for the first time, we report that solid state 13C nuclear magnetic resonance (NMR) spectroscopy provides direct evidence for the irreversible binding of ethinyl estradiol (EE) – an estrogenic steroid molecule also containing an ethynyl functional group – to an addition cure silicone elastomer. By preparing silicone elastomer samples containing 13C-labelled EE, signals in the NMR spectra could readily be assigned to both the free and bound EE. Additional depolymerisation studies, performed on an addition cure silicone elastomer system from which the unbound EE fraction was completely extracted, further confirmed the presence of bound EE through the formation of coloured reaction mixtures resulting from the reaction of bound EE and trifluoroacetic acid (TFA). These methods will be particularly useful in the ongoing development of new steroid-releasing silicone drug delivery devices, including various vaginal ring devices for contraception, HIV prevention and multipurpose prevention technology applications.

Preliminary Results of Brachytherapy Using a Modified MIAMI Brachytherapy Applicator for Treatment of Upper/Apical Vaginal Tumors

Standard intracavitary vaginal brachytherapy devices are limited in the ability to deliver radiation dosage to the upper/apical vagina. Our institution modified the commercially available MIAMI™ applicator (Mick Radio Nuclear Instruments, New York, NY, USA) to allow for extension of needles through seven channels (one central and six peripheral) into the proximal vaginal cuff. This study examines the outcome of brachytherapy using this device through evaluation of acute/chronic toxicities, dosages to organs-at-risk, and tumor control.

Characterization of the LH peak after short and long fixed‐time artificial insemination protocols in sheep raised in the tropics

The aim of this study was to evaluate the peak in luteinizing hormone (LH) and the pregnancy rate of sheep (Texel×Santa Inês) in the tropics using short- (6days) and long-term (12days) progesterone protocols followed by artificial insemination (AI) both in and out of the breeding season. Experiment 1 was conducted within (IN) the breeding season (autumn, n=36), and experiment 2 was conducted outside (OUT) of the breeding season (spring, n=43). In each experiment, the sheep were divided into two groups (6 or 12days) according to the duration of treatment with a single-use progesterone release vaginal device (CIDR® , Pfizer, São Paulo, SP, Brazil), and blood samples were collected from 10 animals per group every 4hr to measure the LH and progesterone concentrations. In the spring, the characteristics of the LH peak did not differ between groups; but in the autumn, there were differences between groups at the beginning (G-6 IN: 36.44±5.46hr; G-12 IN: 26.57±4.99hr) and end of the LH peak (G-6 IN: 46.22±7.51hr; G-12 IN: 34.86±8.86hr). The results showed alterations in the LH peak during the breeding season only in the sheep undergoing the short-term protocol.

Acetato de deslorelina como agente inductor de ovulación en yeguas

The mares are seasonal reproductive animals, being influenced by the changes in the daily relation of luminosity during the year, presenting a greater difficulty in the control of the estrous cycle when compared to the cattle. The use of ovulation inducers can improve reproductive efficiency by synchronizing the time of ovulation and reducing the period of estrus. The objectives of this paper were to evaluate the use of progesterone-device for cow estrous induction and ovulation time in mares using deslorelin acetate as an ovulation inducer. Five mares of reproductive age were used, which had their estrus induced twice each. In one of them it was administered with 750 mg of deslorelin acetate. For estrous induction, a 5mg dose was administered via IM of prostaglandin F2alpha at the D0 and an intravaginal device was inserted, which was removed at D8, and a dose of prostaglandin was administered concomitantly. After removal of the vaginal devices follicular growth was evaluated at 12 / 12h intervals until ovulation. All animals showed estrus behavior. Mares treated with deslorelin acetate had a mean ovulation time of 43.2 ± 6.57 while the untreated group was 84.0 ± 14.70, with a significant difference. It can be concluded that the intra-vaginal device use for cattle induces the manifestation of estrus in mares; The administration of deslorelin acetate anticipates the time of ovulation contributing to a better reproductive management in mares.

Association between preterm labour and pelvic floor muscle function

We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour.Impact statementWhat is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor’s function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial.What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour.What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce the risk of a spontaneous preterm birth.

Diagnosis and Management of Fecal Incontinence.

The purpose of this review is to highlight current and newer therapeutic approaches to treat fecal incontinence in patients who do not respond to conservative measures. Neurostimulation techniques, injection of bulking agents, and radiofrequency energy delivery to the anal canal have been proposed and tested for fecal incontinence over the last decade. Sacral stimulation is both effective and durable and is now the most popular of the invasive techniques whereas percutaneous tibial stimulation, radiofrequency energy, and bulking agents are either less effective or their evaluation has been handicapped by suboptimal study designs. The precise indications for the new vaginal control device and anal plugs remain to be established. The magnetic anal sphincter is disappointing. Stem cell therapy is a potentially exciting approach, which is in its infancy. There continues to be an unmet need for innovative approaches to patients with fecal incontinence who do not respond to conservative measures. The efficacy of current and future therapies should be assessed using criteria more stringent than has been used in the past to provide a more realistic assessment of meaningful efficacy.

Electrical Storms after Levonorgestrel (Synthetic Progestin)-Releasing Intra-Vaginal Device Insertion. A Case Report and a Short Review of Literature

We report a case of arrhythmic storm in a patient with recent vaginal insertion of a device with release of levonorgestrel (synthetic progestin). A woman of 60 years was hospitalized for runs of monomorphic sustained ventricular tachycardia. She received a vaginal device levonorgestrel-releasing 2 days before admission. No history of associated cardiovascular or thyroid disease or risk factors was reported. Laboratory parameters as well as ECG and echocardiogram were normal. After 48 hours from removal of the vaginal device, the patient was asymptomatic and showed only single ectopic beats, sometimes in pairs. The subsequent coronary angiography, electrophysiological study and cardiac magnetic resonance resulted negative.

Physical Properties and Ionic Concentration of the Bovine Cervical Mucus at the Moment of Inseminating: Spontaneous Estrous and Induced Estrous

Objective of the investigation was to characterize biochemically the cervical mucus collected prior to the artificial insemination of Holstein heifers comparing spontaneous oestrus with induced oestrus. The concentration of sodium and potassium was determined through flame photometry, chlorine ions by Schoenfeld reaction, magnesium and calcium was determined through colorimetry in micro plates. pH (reactive tape) and degree of crystallization (optical microscope) were also evaluated. Natural estrous was detected by observing the behavior of the heifers twice a day and by observing the characteristics of the vulva. In order to induce oestrous, an intra vaginal device was placed with 1 gm of progesterone and 2 mg of estradiol benzoate were injected (Day 0). On day 8 the device was withdrawn and 0-150 mg of D-Cloprostenol and 1 mg of Estradiol Cypionate were provided. 56 hours after withdrawal, the device was inseminated and at 60 days of pregnancy determined. The cervical mucus of heifers with spontaneous oestrus showed lower content of sodium and potassium, higher magnesium and chlorine, and bigger proportion of sodium/potassium from that obtained by induce oestrus. When comparing the pregnant with the empty heifers, it was discovered that at the moment of insemination, the pH value and the degree of crystallization of pregnant heifers was significantly lower, same as the concentrations of potassium and magnesium. Sodium was higher in this group. Pregnancy was always related to high ionic level generating an osmotic force that draws water to the cervical mucus, characteristic fundamental in transport of sperms.