Relationships between cerebrospinal fluid characteristics, injury severity, and functional outcome in dogs with and without intervertebral disk herniation.

BACKGROUND: Cerebrospinal fluid (CSF) is commonly acquired in dogs with intervertebral disk herniation (IVDH) and is a common method to assess inflammatory responses following spinal cord injury (SCI). OBJECTIVES: The purpose of the study was to describe relationships between cisternal CSF characteristics, behavioral measures of SCI, T2- weighted (T2W) hyperintensity on magnetic resonance imaging (MRI), and long-term outcome in dogs with IVDH. Diagnostic accuracy of CSF for differentiating IVDH from other myelopathies was also assessed. METHODS: The retrospective case series included 727 dogs, 443 with thoracolumbar IVDH, 103 with cervical IVDH, and 181 with other spinal cord diseases. Signalment, initial neurologic function, ambulatory function at long-term follow-up, T2W MRI, and CSF variables were recorded for dogs with IVDH. Signalment, etiology, and CSF data were retrieved for dogs with other myelopathies. Associations between CSF predictors, diagnosis, and outcomes were assessed. RESULTS: CSF total nucleated cell count (TNCC) increased with SCI severity (rho -0.256, P < .001) in dogs with IVDH, TNCC was significantly higher in the presence of T2W hyperintensity (P = .001) in dogs with thoracolumbar IVDH, but TNCC, RBC count, microprotein, and percent neutrophils decreased with increasing injury duration (rho -0.253, P < .001; rho -0.269, P < .001; rho -0.141, P = .004, and rho -0.356, P < .001, respectively). CSF characteristics were not accurate for differentiating IVDH from other spinal cord diseases. CONCLUSIONS: In dogs with IVDH, CSF TNCC, RBC count, microprotein, and percent neutrophils are correlated with clinical aspects of SCI such as injury severity and duration, but cannot differentiate IVDH from other etiologies.

Gender role models in fictional novels for emerging adult lesbians.

Novels provide role models for young adult lesbians and thus may influence their identity development. This study focused on 16 lesbian protagonists identified in 11 young adult novels that received 2011 Lambda Literary Award nominations. Content analyses revealed six themes. Three themes defied traditional gender stereotypes: Asserting Oneself, Pursuing Intimacy with Another Woman, and Breaking Free of Constraints to Authentic Self-Expression. Three themes reinforced gender stereotypes: Negative Emotional Experiences Associated with Lesbian Identity, Traditional Masculine Gender Expression, and Traditional Gender Role-Based Sexual Scripts. Each theme is discussed in light of its possible contribution to lesbian identity development.

Mesenteric cryptococcal granuloma in a dog caused by Cryptococcus neoformans var. grubii.

Although cryptococcosis is usually associated with respiratory and neurologic signs in domestic species (such as sneeze, cough, nasal discharge, seizures, ataxia), clinical manifestations of the disease may be more subtle and nonspecific. A 3-year-old male castrated Boxer dog presented with a history of chronic vomiting, diarrhea, weight loss, and lethargy. At no time had respiratory or neurologic signs been noted by the owners or the primary care veterinarian. Palpation of an abdominal mass revealed an atypical lesion location: a large (16 × 9 × 7 cm) mass at the root of the mesentery. Diagnosis was achieved through cytology of this mass and a positive serologic Cryptococcus capsular antigen titer; polymerase chain reaction was utilized for speciation of the abdominal isolate as Cryptococcus neoformans variety grubii. The animal was euthanized due to poor prognosis. After necropsy and histopathologic analysis, the mesenteric mass and associated lymph nodes were identified as large fungal granulomas. This is a rare manifestation of cryptococcosis, involving several visceral organs, with no remaining evidence of the route of entry of the organism. As prompt diagnosis of mycotic illness is paramount to successful management, this case indicates that cryptococcal infection should be considered as a differential diagnosis in dogs with gastrointestinal signs and lymphadenopathy. The protean nature of cryptococcosis is discussed within the context of a brief review of emerging and unresolved issues in pathogenesis.

Laparoscopic paravaginal repair of anterior compartment prolapse.

STUDY OBJECTIVE: To assess the results of laparovaginal repair of anterior vaginal prolapse in terms of perioperative morbidity and repair durability. DESIGN: Longitudinal study of a consecutive series of women assessed with the pelvic organ prolapse quantification (POPQ) system before and after laparoscopic paravaginal repair of anterior vaginal prolapse (Canadian Task Force classification II-2). SETTING: University hospital in South Australia. PATIENTS: Two hundred twelve women undergoing laparoscopic paravaginal repair for anterior compartment prolapse, with average follow-up of 14.2 months and 10 (4.7%) lost to follow-up. INTERVENTIONS: All women underwent bilateral laparoscopic paravaginal repair that was combined with uterosacral hysteropexy or colpopexy in women with concomitant level I defects (n = 42) and supralevator repair in those with posterior fascia defects (n = 47). Recurrences were treated with graft-reinforced anterior colporrhaphy (n = 18). MEASUREMENTS AND MAIN RESULTS: Nine women (4.2%) had major complications, and there were 61 minor complications. The POPQ assessment on follow-up (mean 14.2 months) gave a prolapse cure of the laparoscopic repair of 76% (95% CI 70.7%-82.1%). Eighteen of 23 women with a residual central defect subsequently had a graft-reinforced anterior colporrhaphy, after a mean interval of 14 months, which increased the cure rate to 84% (95% CI 79.6%-89.3%). CONCLUSION: Laparoscopic paravaginal repair followed by graft-reinforced anterior colporrhaphy for central defects, when necessary, is associated with a low morbidity rate and achieves an anatomic cure rate greater than 80%.

Laparovaginal hysterectomy: a decade of evolution.

OBJECTIVE: To compare surgical outcomes for laparoscopically-assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH. SAMPLE: Seven hundred and ninety-four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH. METHODS: Retrospective review of case history notes and manual extraction of data. MAIN OUTCOME MEASURES: Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non-autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re-admission rates were also recorded. RESULTS: There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non-significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non-autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group. CONCLUSION: The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.

Laparoscopic treatment of enterocele: a 3-year evaluation.

OBJECTIVE: To report the morbidity associated with the laparoscopic treatment of enteroceles and assess the durability of the repair. DESIGN: Prospective observational study. SETTING: University Teaching Hospital. POPULATION: Forty-five consecutive women with symptomatic enteroceles who underwent laparoscopic treatment of an enterocele. MAIN OUTCOME MEASURES: Objective urogynaecological assessment using the pelvic organ prolapse quantification system. RESULTS: The 11% incidence of anterior wall prolapse is lower than that associated with previous reports of surgical procedures to treat enterocele. There is a 4.4% incidence of major complications. The procedure has been demonstrated to have a 93% success rate at 3 years in treating enterocele. CONCLUSION: The laparoscopic enterocele sac excision and vaginal vault suspension fulfils Richardson's requirements for surgical correction of enterocele and provides an anatomic solution to the long-standing surgical dilemma of enterocele.

Pregnancy following endometrial ablation: case history and literature review.

UNLABELLED: A total of 43 pregnancies that occurred subsequent to endometrial ablation were reported to July 2002. Only 17 of these pregnancies had progressed beyond 20 weeks. We report a successful planned pregnancy following endometrial ablation and sterilization reversal, culminating in vaginal birth after a previous Caesarean section. The English literature has been reviewed to ascertain family planning practices, uterine cavity assessment and pregnancy outcomes after endometrial ablation/resection. Pregnancy management recommendations are provided. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the various pregnancy complications associated with a history of endometrial ablation, and to describe the changes in the endometrial cavity following endometrial ablation.

Two-year experience with laparoscopic pelvic floor repair.

STUDY OBJECTIVE: To evaluate the cumulative experience at our institution of laparoscopic pelvic floor repair to treat genital prolapse and associated symptoms. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Seventy-three consecutive women treated surgically for symptomatic genital prolapse. INTERVENTION: Surgical treatment was site specific depending on findings on physical examination. Anterior compartment defects were treated by laparoscopic paravaginal repair, laparoscopic Burch colposuspension, or transvaginal anterior vaginal repair. Defects in the posterior compartment were treated by a combination of laparoscopic supralevator repair, laparoscopic vaginal vault suspension, enterocele sac invagination or excision, and transvaginal posterior vaginal repair. Anatomic defects in the apical compartment were primarily treated by laparoscopic vaginal vault suspension and enterocele sac excision. Patients whose anatomic anomalies contained elements of anterior, posterior, and apical compartments were classified in a global group. MEASUREMENTS AND MAIN RESULTS: Preoperatively, prolapse was considered as an attachment or fascial defect at DeLancey level I, II, or III. Each was then quantified by the pelvic organ prolapse quantification (POPQ) system and compartmentalized according to site of the major defect. Women were assessed by physical examination and repeat POPQ staging 6 weeks postoperatively and every 6 months thereafter. A standard interview was administered to assess functional status. Major complications occurred in 4.1% of women. Objective and subjective cure rates were 90% at 2 years. CONCLUSIONS: Laparoscopic pelvic floor repair is an effective procedure with low morbidity. It should play a primary role in surgical management of DeLancey levels I and II attachment defects. For fascial defects, in particular DeLancey level II anteriorly and posteriorly, it should be complemented with vaginal repair.

Total laparoscopic hysterectomy: a new option for removal of the large myomatous uterus.

This is the first report of a series of women who underwent total laparoscopic hysterectomy (TLH) to remove a large myomatous uterus weighing more than 390 g. The case history notes of 21 women undergoing TLH in both the private and public sectors of Flinders Endogynaecology were studied. The mean uterine weight was 534.7 g (390-1,022 g). The mean operating time was 155.0 +/- 56.1 minutes and mean blood loss was 297.6 mL (50-1,000 mL). The mean hospital stay was 3.2 +/- 1.0 days. The two complications were a post-operative deep venous thrombosis (DVT) and an estimated blood loss of 1000 mL in separate cases. Total laparoscopic hysterectomy is a low morbidity procedure offering a new option for the removal of the large myomatous uterus and avoidance of abdominal hysterectomy