941 resultados para bis-insertion
Resumo:
BACKGROUND: Suburethral slings are commonly used for the surgical treatment of female stress incontinence; occasionally they can cause erosion and dyspareunia. OBJECTIVES: The primary aim of this study is to determine the outcome after reclosure of the vaginal epithelium for suburethral sling erosion. Sexual function was assessed before and after intervention using the Female Sexual Function Index (FSFI) questionnaire. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective case-controlled study in which, between December 2005 and December 2007, we included patients who were referred to the Department of Urogynaecology because of vaginal erosion after suburethral sling insertion for urinary stress incontinence. For evaluation of sexual function, all patients filled in an FSFI questionnaire before intervention and at follow-up. All patients underwent gynaecological examination including colposcopy, and the site and size of the defect were noted. INTERVENTION: The edge of the vaginal epithelium was trimmed, mobilized, and closed with interrupted vertical Vicryl mattress sutures in a single layer. MEASUREMENTS: FSFI questionnaire and clinical findings. RESULTS AND LIMITATIONS: Twenty-one patients were included in the study. Eighteen patients with larger defects were operated on, and three defects healed after topical application of estrogen cream. In 16 patients, the defect had healed at follow-up; two patients with persisting defects were brought back to surgery and the procedure was repeated, paying particular attention to tension-free adaptation of vaginal tissue. In one patient, partial sling removal was performed after the second failed intervention. The domains of desire (p<0.0001), arousal (p<0.0003), lubrication (p<0.0001), satisfaction (p<0.0130), and pain (p<0.0001) improved significantly. Orgasm remained unchanged (p=0.4130; all two-tailed t-test). CONCLUSION: Suburethral erosion can be treated effectively by resuturing. Sexual function is improved in regard to desire, arousal, lubrication, satisfaction, and pain, but not orgasm. In septic patients and patients with a history of radiation, grossly infected tissue, or severe pain, excision of the mesh needs to be considered.
Resumo:
The work presented in this dissertation deals with the coordination chemistry of the bis(benzyl)phosphinate ligand with vanadium, tungsten and cobalt. The long term goal of this project was to produce and physically characterize high oxidation state transition metal oxide phosphinate compounds with potential catalytic applications. The reaction of bis(benzyl)phosphinic acid with VO(acac)2 in the presence of water or pyridine leads to the synthesis of trimeric vanadium(IV) clusters (V3(µ3-O)O2)(µ2-O2P(CH2C6H5)2)6(H2O) and (V3(µ3-O)O2)(µ2-O2P(CH2C6H5)2)6(py). In contrast, when diphenylphosphinic acid or 2-hydroxyisophosphindoline-2-oxide were reacted with VO(acac)2, insoluble polymeric compounds were produced. The trimeric clusters were characterized using FTIR, elemental analysis, single crystal diffraction, room temperature magnetic susceptibility, thermogravimetric analysis and differential scanning calorimetry. The variable-temperature, solid-state magnetic susceptibility was measured on (V3(µ3-O)O2)(µ2-O2P(CH2C6H5)2)6(py). The polymeric compounds were characterized using FTIR, powder diffraction and elemental analysis. Two different cubane clusters made of tungsten(V) and vanadium(V) were stabilized using bis(benzyl)phosphinate. The oxidation of (V3(µ3-O)O2)(µ2-O2P(CH2C6H5)2)6(H2O) with tBuOOH led to the formation of V4(µ3-O)4(µ2-O2P(Bn)2)4(O4). W4(µ3-O)4(µ2-O2P(Bn)2)4(O4) was produced by heating W(CO)6 in a 1:1 mixture of EtOH/THF at 120 ˚C. Both compounds were characterized using single crystal diffraction, FTIR, 31P-NMR, 1H-NMR and elemental analysis. W4(µ3-O)4(µ2-O2P(Bn)2)4(O4) was also characterized using UV-vis. Cobalt(II) reacted with bis(benzyl)phosphinate to produce three different dinuclear complexes. [(py)3Co(µ2-O2P(Bn)2)3Co(py)][ClO4], (py)3Co(µ2-O2P(Bn)2)3Co(Cl) and (py)(µ2-NO3)Co(µ2-O2P(Bn)2)3Co(py) were all characterized using single crystal diffraction, elemental analysis and FTIR. Room temperature magnetic susceptibility measurements were performed on [(py)3Co(µ2-O2P(Bn)2)3Co(py)][ClO4] and (py)3Co(µ2-O2P(Bn)2)3Co(Cl). The variable-temperature, solid-state magnetic susceptibility was also measured on [(py)3Co(µ2-O2P(Bn)2)3Co(py)][ClO4].
