Laparoscopic management of recurrent vesicovaginal fistula.

Vesicovaginal fistula repair is most commonly undertaken via a transvaginal approach. We report a recurrent case of vesicovaginal fistula which was ultimately repaired using a laparoscopic approach. The fistula followed a hysterectomy and persisted despite two operations using the Latzko partial colpocleisis and prolonged catheterization. The fistulous tract was ultimately repaired by closing the vagina and bladder with an interposing omental flap utilizing a laparoscopic approach.

Cardiac metastasis from carcinoma of the cervix: report of two cases.

BACKGROUND: The presence of cardiac metastasis from cervical carcinoma is extremely rare. The diagnosis is made almost exclusively postmortem. There are few cases of premortem diagnosis, and it is believed that when cardiac metastasis are found in vivo, the prognosis is extremely poor. Due to the rarity of this condition it is very difficult to standardize care for these patients. Considering the evidence provided by the cases in this report, it is possible that aggressive therapy may lengthen patients survival and quality of life. CASE: We present two cases of cervical carcinoma with metastasis to the heart. Both patients presented with symptomatology of cardiac tamponade. Both patients had invasion of the myocardium from presumed endomyocardial metastasis where the prognosis is even worse. We took an aggressive therapeutic approach to our patients and had excellent results in one. Our report includes the longest survival reported for a patient to date with premortem diagnosis of intramyocardial metastasis from cervical carcinoma. CONCLUSION: We concluded that the prognosis for cardiac metastasis from cervical carcinoma is extremely poor. The stage of the disease at initial presentation does not predict the future development of cardiac metastasis. Taking an aggressive therapeutic approach, including thoracentesis, chemotherapy, and radiation therapy to the heart, survival and quality of life can be improved.

The emergence of lesbian sexuality and identity cross-culturally: Brazil, Peru, the Philippines, and the United States.

Questionnaire data were collected from 205 lesbians and 224 heterosexual women in Brazil, Peru, the Philippines, and the United States between 1981 and 1988. Items include direction of childhood sexual interests, age of first awareness of sexual attraction, cross-attractions, age of first sexual contact, sex of partner in first sexual contact, age of awareness that sexual attractions were serious, and age of realization of adult sexual orientation. In general, similarities in the development of lesbian sexuality and differences between lesbians and heterosexual women were found, regardless of culture. Findings include: Lesbians were more sexually active as children and displayed more sexual interest in girls than heterosexuals did in boys; lesbians tended to become aware of their attractions to women later than heterosexuals realized attractions to men; lesbians reported considerably more early attraction to men than heterosexuals did to women; lesbians reported earlier sexual contact than did heterosexual women; the sex of the partner of first sexual contact for lesbians was split roughly equally between males and females whereas heterosexuals reported contact with males almost exclusively; childhood awareness that sexual attractions were serious were similar in lesbians and heterosexuals; lesbians defined themselves as homosexual later than heterosexuals defined themselves as heterosexual. We conclude that norms for heterosexual behavior impact the development of lesbian sexuality and identity, impeding, but not obliterating, their development. Lesbian sexuality and identity eventually emerge regardless of culture.

A novel nucleosome assembly procedure (with a little help from pectin).

The acidic polysaccharide pectin (alpha-1,4-polygalacturonic acid) has been introduced as a nucleosome assembly facilitator as a substitute for polyglutamic acid. The pectin-assembled nucleosomes were indistinguishable from polyglutamic acid-assembled nucleosomes by thermal denaturation and DNAse I digestion. Pectin had two major advantages over polyglutamic acid-the yield of assembled cores was approximately 50% higher and the pectin could be easily removed after completion of the reassembly procedure by dialysis following pectinase cleavage.