Anchoring device to prevent membrane detachment and preterm premature rupture of membranes after fetal intervention.

OBJECTIVE: Anchoring the fetal membrane to the uterine wall via a novel suture delivery system could reduce the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery. This study assesses the feasibility of using a novel device designed for minimally invasive suturing to anchor fetal membranes to the uterine wall and to close surgical defects after fetoscopy. METHODS: We tested the suturing device both ex vivo and in vivo. In the ex vivo studies, 12-French trocar defects were created with a fetoscope in five specimens of human uterine tissue with fetal membranes attached. Specimens were examined for integrity of the anchoring stitch. For in vivo studies, trocar defects were created in the two uterine horns of three pregnant ewes, each carrying twins at ~79-90 days gestation. One trocar defect in each ewe was repaired using the suture device, and the other was left unrepaired as a control. The repair sites were examined for membrane anchoring integrity when the defect was created and at delivery. RESULTS: Fetal membranes were successfully anchored to the uterine myometrium using this device in all five trials performed ex vivo. The in vivo trials also revealed successful membrane anchoring compared with controls both at the time of device deployment and five-to-eight weeks after the procedure. CONCLUSIONS: We successfully anchored amniotic membranes to the underlying myometrium via suturing device both ex vivo and in vivo. Further studies are needed to evaluate the efficacy of the device and to determine whether it can successfully anchor fetal membranes percutaneously in human subjects. This article is protected by copyright. All rights reserved.

Thecaloscopy: the endoscopy of the lumbar subarachnoid space, part I: historical review and own cadaver studies.

Since 1931 only a few efforts have been made for direct visualization of the neural structures of the spinal canal. Given current technologies and minimally invasive techniques it is now possible to effectively view these structures. We describe here a new technique for inspection of the subarachnoid space of the lumbar spinal canal by using a flexible endoscope in ten fresh post-mortem adult human cadavers. According to the anatomical structures, namely the thecal sac and its anatomical position, the procedure is called thecaloscopy and the instrument is a thecaloscope. It was proven that the procedure is safe and easy to perform.

Cultural determinants in the treatment of Arab Americans: a primer for mainstream therapists.

As the population of Arab Americans grows, so does their presence among mental health clientele, creating a need among clinicians for information about these clients. The broad lines of Arab culture are delineated: its roots, language, religion, and political history; patterns of immigration to the United States; and the salient differences between Arab culture and the dominant U.S. culture. The effects of negative stereotyping and discrimination against Arab Americans are examined, as are specific clinical issues in treating them. Recommendations for more culturally sensitive treatment are enumerated.

Imidazoles for vaginitis.

Vaginal candidiasis is a common infection in women for which several effective therapeutic agents are currently available. Clotrimazole and miconazole were introduced in 1975, and both recently became available over the counter. These imidazole agents have largely replaced nystatin as primary therapy because of greater antifungal activity and shorter treatment regimens, thereby enhancing patient compliance. The cost for these OTC regimens ranges from $12.00 to $24.00 for the patient.