Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review

With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.

Primary extragastrointestinal stromal tumor arising in the vaginal wall: significant clinicopathological characteristics of a rare aggressive soft tissue neoplasm

Gastrointestinal(GI)stromal tumor is the most common mesenchymal neoplasm of the GI tract but also occurs with a lower frequency in extragastrointestinal regions and is called extragastrointestinal stromal tumor(EGIST).We report an unusual case of EGIST presenting as a vaginal mass.A 41-year-old woman presented with a gradually enlarging vaginal mass for the last2 years.Physical examination revealed an elliptical,non-tender mass about 7.5 cm×7 cm in size in the posterior vaginal wall and was resected completely.Under histological examination,the tumor showed a spindle cell type with coagulation necrosis,hemorrhage and high mitotic count.Immunohistochemical analysis revealed tumor cells were positive for DOG1,CD117,CD34 and p53 protein.Ki-67 labeling was 8%.Genetic analysis showed a deletion of exon 11 of the c-kit gene at codons 557-558.EGISTs should be kept in mind in the differential diagnosis in patients presenting with solid mass of the vaginal wall.

Atopobium vaginae与细菌性阴道病关系的研究

目的:应用非培养方法研究Atopobium vaginae与细菌性阴道病的关系。方法:根据Nugent评分标准从15例健康妇女及17例BV患者的其阴道分泌物中提取细菌总DNA。分别选择健康妇女及BV患者样本各3例,构建16S rRNA基因克隆文库并进行测序分析。应用Atopobium vaginae16S rRNA基因的特异性引物对32例样本进行PCR扩增。结果:Atopobium vaginae是BV患者阴道菌群中的优势菌种,它存在于大部分(14/17)BV患者阴道中,健康妇女阴道中(1/15)则很罕见。结论:Atopobium vaginae与细菌性阴道病的发生有一定的相关性。

In Bangla There Is No Word for Vagina —Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries

Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.

Unusual primary location of the malignant melanoma, the cervico-vaginal region: 3 cases and literature review

Introduction: Malignant melanoma (MM) represents 1% of all cancers and has an incidence of 3% - 7% in the female genital tract, the majority of cases being reported in the vulva. The cervico-vaginal region is an unsual primary location of the malignant mela-noma. Case report: The clinical and morphologic findings of 3 MM patients with cervico-vaginal tumours mimicking cervical polyp in third case. Histologically, the neoplasia was formed by nodules of broad cytoplasmic cells with poorly defined borders with pleomorphic nuclei with prominent nucleolae. Tumor cells were positive for S-100 protein, Melan A, HMB 45 and CD117. The authors discuss three cases of cervico-vaginal melanoma and analyze clinical and prognostic aspects of this disease. Conclusion: Primary MM of the cervix should be considered in the differential diagnosis of cervical malignancies. Early diagnosis is essential in order to warrant a better prognosis, although there are no cases of cure described.

Comparison of Electro Ejaculator and Artificial Vagina on Semen Collection from South African Indigenous Goat Following Assessment by Computer Aided Sperm Analysis

South African indigenous bucks are raised under extensive conditions and are more likely to reject artificial vagina (AV) due to their limited contact with human beings, as they are less handled. The purpose of the study was to compare goat semen collection techniques used for goats based on semen traits of South African indigenous bucks during the natural breeding season. A total of eight South African indigenous bucks were used, four bucks per semen collection technique due to their scarcity. Before semen collection with AV group, ten bucks were trained and exposed to AV. Semen was then collected from both groups over a period of six weeks per individual buck. Semen volume, pH and sperm concentration were evaluated immediately. The Computer Aided Sperm Analysis (CASA) assessed the sperm motility rates. Sperm morphology was evaluated using a fluorescence microscope with the aid of eosin-nigrosin staining. Analysis of variance was used to test the differences among the semen collection groups following assessment by CASA. Semen collected with EE resulted in higher semen volume (1.1 mL) compared with AV (0.5 mL) technique. However, AV technique resulted in higher total sperm motility and rapid movement (91.9% and 48.7%), live sperm (72%) and sperm concentration (635.6 × 106 sperm/mL) compared with EE (86.3% and 30.4%;69% and 463.7 × 106 sperm/mL, respectively). There were no significant differences observed in pH and sperm morphology characteristics between two semen collection techniques. Moreover, EE had higher sperm moving in a progressive (53.6%) and medium rate compared with AV (41.1% and 21.9%) technique. It was concluded that the AV yielded higher total sperm motility rate, sperm concentration and rapid sperm movement compared with EE. Therefore, AV was more suitable for semen collection of South African indigenous bucks, even though training was problematic to such indigenous bucks.

Primary Melanoma of the Vagina Treated by Imatinib: Case Report

Melanoma of the vagina is a rare lesion. It results from the malignant transformation of ectopic melanocytes occurring in post-menopause. The CKIT is expressed in 36% of cases in addition to melanoma markers. Prognosis is poor especially for inoperable and disseminated forms despite systemic therapy. Treatment with Imatinib is an option in cases of metastatic mucosal melanoma with CKIT mutation or amplification. We report the case of post-menopausal women, treated at Hassan II University Hospital, diagnosed with metastatic melanoma of the vagina, that didn’t respond to first line of chemotherapy, and received Imatinib as second line of treatment, with good clinical response and durable stability at radiological assessment.

Predictors of Outcome after Transvaginal Mesh for Pelvic Organ Prolapse

Introduction: We aim to report outcomes and predictors of outcome of transvaginal mesh (TVM) for pelvic organ prolapse (POP). We also report frequency, severity, risk factors, and management of mesh-related complications after TVM. Materials and methods: We performed retrospective chart review of TVM performed from 2005 to 2010. There were 67 patients followed for a mean duration of eighteen months. Complications were reported using the International Continence Society and International Urogynecological Association classification system for prosthesis/graft complication. Results: Success rate was 88% (97% for anterior repair, 100% for posterior repair and 71% for combined repair) and complications occurred in 13 patients (19%), including vaginal hematoma, pelvic pain, urinary retention, dyspareunia and vaginal mesh exposure (in 9 patients). On multivariable logistic regression, recurrence was significantly higher with combined repair (P = 0.021), overall complication was significantly associated with younger age (P = 0.019), and mesh exposure was significantly associated with age and combined repair. All mesh-related complications were vaginal exposures occurring at median of 6 months postoperatively. Two patients were managed conservatively with vaginal estrogen cream, while seven patients elected surgical excision of exposed mesh with primary re-approximation of the vaginal epithelium. There were no excision-related complications, and in no case was the defect large enough to require closure with graft or secondary material. Conclusion: Combined anterior and posterior repair using TVM is associated with failure, younger age is associated with higher rate of complication, and combined repair and younger age are associated with mesh-related complication specifically.

Isolation and Screening of Lactic Acid Bacterial Strains with Antibacterial Properties from the Vaginas of Healthy Cows

In the present study, eight strains were isolated from 20 cow vagina samples and identified using phenotype, biochemical analysis, sugar fermentation tests, and 16S rRNA sequence analysis. Among eight strains, only SQ0048 was identified as Lactobacillus johnsonii based on a series of biochemical testing (including the adhesion test, catalase test, bacteriocin production test, antibacterial test, and pH value), suggesting that its biological activity was superior to the other seven strains. Furthermore, SQ0048 had the lowest pH value (4.32) and the shortest fermentation time (8 h) compared with the other strains. The adhesion rate of SQ0048 was significantly higher than that of Lactobacillus delbrueckii, with an average adhesion number of 304 ± 2.67. The hydrogen peroxide production testing in SQ0048 was positive;in addition, bacteriocin gene of SQ0048, encoding an approximately 10-kDa product, was successfully cloned, expressed, and detected using the SDS-PAGE method. Meanwhile, SQ0048 had a weak inhibitory effect on Staphylococcus aureus and Escherichia coli. However, the expression products of the bacteriocin gene of SQ0048 had a very strong inhibitory effect on S. aureus and E. coli, with inhibition zone sizes of 18 ± 0.45 mm and 15 ± 0.60 mm, respectively. These data showed that SQ0048 has excellent antibacterial properties compared with other isolated strains and is a potential probiotic candidate to improve the health of the vaginas of cows by inhibiting pathogenic microorganisms.

显微外科技术一期修复指屈肌腱损伤

目的探讨显微技术修复指屈肌腱损伤,预防肌腱粘连的有效方法.方法对2001年9月～2004年3月间43例81指指屈肌腱损伤应用显微外科技术一期修复指屈肌健以及腱鞘或健周组织,术后早期进行保护性功能锻炼.结果术后随访5～24个月,按TAM评价法评定疗效,优42指良30指可9指,优良率88.9%.结论新鲜的指屈肌腱损伤,注意微创操作,一期缝合,保护肌腱的血运和营养,结合早期系统康复训练能有效防止肌腱粘连.

PRIMARY MALIGNANT MELANOMA OF THE VAGINA:CLINICAL, PATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDIES OF 9 CASES

Nine cases of vaginal primary malignant melanoma were diagnosed and treaed in Zhejiang Cancer Hospital from 1964 to 1990. The mean age of patients was 48. 6 years. Abnormal vaginal bleeding was the Incipient symptom in 6 patients. Five cases of malignant melanoma located in the lower one-third of the vagina. Five patients had the tumor in size larger than or equal to 4 cm In diameter. All of them were of the cauliflower-like, nodular configuration grossly. The surface of the mass demonstrated in a variable degree of black or grey- blackish in 7 patients. The htstological appearances were similar to those in the skin. Sections of 4 cases Indicated only few or no melanin under microscope. The covering epithelial changes of 3 vaginal primary malignant melanoma resembled that of malignant melanoma in situ. All sections of 9 cases showed positive reaction to S-100 protein and negative to CEA immunohistochemically. This article laid emphasis on the origin, diagnosis and treatment of this tumor, and make discussion in conjunction with the literature.

直肠移动瓣修补先天性直肠阴道瘘

目的探讨直肠移动瓣修补先天性直肠阴道瘘的临床治疗效果。方法设计直肠移动瓣,充分游离移动瓣直肠粘膜,无张力修补直肠瘘口,且直肠壁缺损与阴道壁缺损分别关闭,缝合不在同一水平面上。结果12例患者经手术治疗均治愈,随访1年～9年,无复发、肛门失禁并发症。结论对于低位先天性直肠阴道瘘,直肠移动瓣修补术疗效确切,值得推广,术前充分肠道准备、术中规范操作对保证手术成功至关重要。

龙胆泻肝汤联合西药治疗阴道炎(肝胆湿热)随机平行对照研究

[目的]观察龙胆泻肝汤联合西药治疗阴道炎(肝胆湿热)疗效。[方法]使用随机平行对照方法,将128例患者按就诊顺序号方法随机分为两组。对照组64例甲硝唑,200mg/次,3次/d,高锰酸钾溶液(1∶5000),坐浴,1次/d;甲硝唑栓,1枚/次,睡前阴道置入。治疗组64龙胆泻肝汤:泽泻、龙胆草、柴胡、黄芩、栀子、当归各10g,车前子、生地黄各15g,木通8g,甘草6g,阴痒阴肿严重加白鲜皮10g,地肤子15g;带下黄浊臭秽加土荆皮8g,黄柏10g;热甚加白花蛇舌草、穿心莲、半枝莲各10g,七叶一枝花6g;白带量增多、色黄,味臭加蒲公英10g,土茯苓15g。水煎500mL,1剂/d,早晚分服;西药治疗同对照组。连续治疗5d为1疗程。观测临床症状、尿频、尿痛、阴道瘙痒、阴道分泌物、氨试验、阴道pH、阴道黏膜、不良反应。连续治疗4疗程(20d),判定疗效。随访6个月,观测复发率。[结果]治疗组痊愈34例,显效28例,无效2例,总有效率96.88%;对照组痊愈30例,显效24例,无效10例,总有效率84.88%;治疗组疗效优于对照组(P<0.05)。不良反应治疗组发生率4.96%低于对照组17.19%(P<0.05)。随访6个月,对照组复发8例(8/30,26.67%)高于治疗组1例(1/34,2.94%)(χ~2=5.133,P=0.015<0.05)。[结论]龙胆泻肝汤联合西药治疗阴道炎(肝胆湿热),疗效满意,无严重不良反应,值得推广。

EXPERIENCE WITH VAGINAL RECONSTRUCTION USING PUDENDAL-THIGH FLAPS-REPORT OF 9 CASES

Objective To review our eoperience of vaginal reconstruction using pudendal- thigh flap.Methods In the past 4 years, 9 patients suffering from the congenital vaginal agenesis underwent vaginalreconstruction using the pudendal- thigh flaps. The modilications of the surgical technique were de-tailed. Results All patients recovered satisfactorily from surgery and have been lollowed - up for a mean of 1.5years. There were no instances of flap loss, penetration of rectum and urethra. On final examination, all patientswere recorded as having a satislactory result, complete flap take, adequate dimensions and depth of neovagina andthe external appearance of the perineum and vagina was satisfactory. All married patients reported a satisfactoryintercourse. Conclusion The result proves that neurovascular pudendal- thigh flaps provide excellent tissue forvaginal reconstruction with low complication rate and good results. This operation does not cause an ugly donorsite scar and can be completed in single stage, without need of loparotomy and postoperative daily dilation. It isbelieved that this method can serve as a reliable alternative in vaginal reconstruction, which is one of the mostchallenging subjects of plastic surgery.

原发性子宫和阴道非霍奇金淋巴瘤

目的 探讨原发性子宫和阴道非霍奇金淋巴瘤临床病理特点及治疗。方法 回顾性分析 1996年 8月～ 2 0 0 3年 9月北京协和医院和江西省妇幼保健院收治的 10例原发性子宫和阴道非霍奇金淋巴瘤患者的临床表现、病理特征和治疗结果。结果 10例原发性子宫和阴道非霍奇金淋巴瘤患者平均发病年龄为 4 3 5岁 ,分期均为IEa,发生部位 :子宫颈 8例、子宫底部和阴道壁各 1例。临床表现为阴道分泌物增多和血性分泌物 ,4例患者有明确占位病变。组织病理均为B细胞淋巴瘤 (CD2 0 + )。 4例为粘膜相关淋巴瘤 (MALT) ,4例弥漫大B细胞淋巴瘤 (DLBCL)。手术治疗 6例 ,手术方式为全子宫、双附件切除及盆腔淋巴结清扫术 ,其中手术 +化疗 5例 ,手术 +化疗 +放疗 1例 ,单纯化疗 3例 ,化疗 +放疗 1例。化疗多为CHOP方案。死亡 1例 ,存活 9例 ,最长生存期已 84个月。结论 原发性子宫和阴道非霍奇金淋巴瘤极为少见 ,临床表现无特异 ,组织病理B细胞淋巴瘤为主 ,根治性手术切除和联合化疗是有效的治疗方法 。

令肤适洗液皮肤和阴道局部毒性研究

目的评价令肤适皮肤和阴道局部使用的安全性。方法采用皮肤急性毒性、皮肤刺激、皮肤过敏、阴道急性毒性和阴道刺激等试验方法。结果未见令肤适具有皮肤毒性、皮肤刺激作用和明显的阴道急性毒性反应；在阴道刺激试验中低剂量未引起阴道明显的刺激反应，高剂量可引起阴道粘膜炎细胞浸润、淤血、出血及溃疡等病理变化。结论令肤适皮肤使用较安全，阴道使用浓度不宜过高。

沧州市已婚育龄妇女生殖卫生状况的调查

目的 了解沧州市已婚育龄妇女生殖卫生状况。方法 按妇科操作规程 ,取已婚育龄妇女后穹窿处分泌物涂片 ,革兰 (G)染色后用光学显微镜观察各种微生物的形态、数量和种类 ,判断清洁度。结果 已婚育龄妇女阴道分泌物的清洁度异常率为 4 2 3% ,其中混合感染占 81 5 %。阴道分泌物的清洁度异常率生育组和已婚未生育组分别为 4 8 5 %、 2 8 0 % ;郊区农民、企业职工、机关公务员已婚育龄妇女阴道分泌物清洁度异常率分别为 6 7 7%、 4 6 0 %、2 9 0 %。滴虫、霉菌、G+ 球菌、G-球菌、G-双球菌、G-杆菌、加德纳氏菌的感染率分别为 3 0 %、 2 0 7%、 6 2 1%、17 9%、1 7%、 7 6 %、 6 6 5 %。结论 已婚育龄妇女阴道分泌物的清洁度异常与生育状况密切相关 ,生育妇女阴道分泌物的清洁度异常率最高。已婚育龄妇女阴道分泌物的清洁度异常与职业有关 ,郊区农民阴道分泌物的清洁度异常率最高。加德纳氏菌、G+ 球菌的感染率最高 。

过表达人抗菌肽LL37腺病毒构建及转染阴道上皮细胞

背景:LL-37作为唯一存在人体的抗微生物肽,不仅能促内皮细胞增殖,而且具有较强的促进血管生成能力,在组织修复初期的血管生成中起重要作用。目的:构建过表达人抗菌肽LL37基因的重组腺病毒,体外转染犬阴道上皮细胞,检测抗菌肽LL37的表达和分泌情况。方法:PCR法扩增LL37基因片段,构建融合绿色荧光蛋白(EGFP)和LL37的重组腺病毒表达质粒,限制性内切酶酶切和测序法鉴定构建的重组腺病毒表达质粒,采用HEK293包装后反复冻融扩增、纯化过表达LL37的腺病毒,终点稀释法检测腺病毒滴度。体外分离培养犬阴道上皮细胞,转染过表达LL37腺病毒,分别于转染后1,2,3,5和7 d采用荧光显微镜观察细胞转染情况,ELISA法测定细胞培养上清液中LL37的分泌表达情况。结果与结论:1限制性内切酶酶切鉴定与DNA测序证实成功构建了GV314-LL37腺病毒表达载体,包装纯化后腺病毒滴度达到3×109 pfu/m L;2犬阴道上皮细胞可在体外成功分离培养并稳定传代;3过表达LL37腺病毒可高效转染阴道上皮细胞,转染24 h后荧光显微镜下即可见绿色荧光蛋白表达,随时间延长表达逐渐增强,转染72 h时表达最强,转染效率达89%;4ELISA证实阴道上皮细胞转染过表达LL37腺病毒后表达分泌LL37,转染后细胞培养上清中LL37表达量显著高于空白组,表达呈时间依赖性,转染3 d表达最强,转染后7 d仍持续分泌表达;5结果说明,成功构建了过表达人抗菌肽LL37基因的重组腺病毒,转染犬阴道上皮细胞后高效表达分泌LL37,为构建具有抗感染能力和促血管生成的功能性组织工程化阴道奠定了基础。

正常女孩子宫颈及阴道壁厚度的测量

目的 探讨正常女孩子宫颈及阴道壁厚度的正常值 ,以评估其与子宫发育的关系。方法 用超声测量 3 2 0例正常女孩并与 5 7例性早熟女孩作比较。结果 子宫颈及与阴道壁厚度随年龄而变化 ,青春期前后及青春期前与性早熟之间比较有高度显著性差异 (P <0 .0 1)。提议青春期前正常值为 :子宫颈前后径 <8mm ,阴道前后壁厚度 <4mm。结论 子宫颈与阴道壁厚度可提示子宫的形态 ,三者呈同步改变 ,进而为了解体内性激素水平提供了一简便方法。

基质金属蛋白酶在分娩中的表达及其意义

目的探讨基质金属蛋白酶在分娩机制中的作用。方法采用蛋白电泳法测定40例(自然分娩和剖宫产各20例)血清基质金属蛋白酶!2(MMP!2)、基质金属蛋白酶!9(MMP!9)蛋白的活性变化及表达情况。结果自然分娩组和剖宫产组MMP!9酶原形式的表达分别为14970.33±1891.20和11626.80±2161.75,MMP!9活性形式分别为35523.17±6820.10和25972.13±4615.03;MMP!2酶原形式分别为19858.40±4030.78和12542.33±1607.20,MMP!2的活性形式分别为26909.33±2976.38和15120.50±2421.03。自然分娩组和剖宫产组比较均具有显著性差异(P<0.05)。结论MMP!9和MMP!2蛋白在自然分娩中表达高于剖宫产,提示自然分娩MMP!9和MMP!2蛋白使宫颈的胶原分解,并促使宫颈成熟和扩张。