Michal Yaron

Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients.

STUDY OBJECTIVE To evaluate the efficacy of laparoscopic lateral suspension using mesh in patients with pelvic organ prolapse (POP). DESIGN A prospective cohort study (Canadian Task Force classification II-2). SETTING A tertiary referral center for operative laparoscopy. PATIENTS In all, 73 patients with POP were assessed in the preoperative and postoperative stages. The assessment included a description of their functional symptoms and the degree of their POP condition, established according to the Baden-Walker prolapse classification system. The patients were followed in the postoperative stage for a median of 19 (range 12-41) months. INTERVENTIONS Laparoscopic lateral suspension of pelvic organs using mesh carried out from January 2004 through September 2006. MEASUREMENTS AND MAIN RESULTS Satisfactory anatomic results were obtained in 64 (87.7%) patients. Neither major complications, nor postoperative pelvic infection were reported. None of the operations required laparotomy. CONCLUSION Laparoscopic lateral suspension using mesh effectively treats POP with low morbidity.

Missed opportunities for diagnosis of female genital mutilation

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center

To study the obstetric outcomes of women attending a specialized clinic for women with female genital mutilation (FGM).

An Exploration of Sexual Desire and Sexual Activities of Women with Psychosis

Abstract Sexual disturbances in patients with severe mental disorders can be related to medication, to psychological issues such as self-stigma and anhedonia, but also to the social context. This research aims to gain knowledge of desire and sexual practices in women suffering from schizophrenia. Women outpatients suffering from schizophrenia were compared with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. Keeping into account the fact that most clinicians avoid this topic, this finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.Sexual disturbances in patients with severe mental disorders can be related to medication, to psychological issues such as self-stigma and anhedonia, but also to the social context. This research aims to gain knowledge of desire and sexual practices in women suffering from schizophrenia. Women outpatients suffering from schizophrenia were compared with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. Keeping into account the fact that most clinicians avoid this topic, this finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.

Adolescent Pregnancy in Switzerland

The number of live births before the age of 20 in Switzerland is approximately 4 per 1,000 adolescent girls aged 15–19. Starting in about 1970, the adolescent birth rate among 15–19-year-old girls began to decline, from a high rate of 16 live births per 1,000. The influence of major social changes like sexual liberation, increase of the adolescent population, and women empowerment during these years may partly explain this decline. Cultural changes such as independence, education, and professional activity available for young women may have resulted in the older mean age at marriage. Swiss adolescents have one of the lowest birth and abortion rate in the world. Rate is described as, “safe, legal, and rare”. Access to contraception plays a major role in reducing the rate of adolescent pregnancy in Switzerland. Switzerland pioneered contraception and family planning centers in Europe. In cantons, where Protestantism was regarded as the principle religion, sex education and contraception were available in most clinics. Oral contraceptives in Switzerland have been on the market since the early 1960s, and condom use has been promoted through the national campaigns for AIDS prevention since the 1980s. Additionally, when young women and girls become sexually active, it is standard practice for them to visit a gynecologist to determine the best contraception. Subsequently, most youth (75 % among 16–20 year old) use at least a condom during first intercourse and the vast majority of youth (87 %) use oral and/or condom contraception. Although unplanned adolescent pregnancy will never disappear, Swiss medical and social service providers will continue to try and improve contraceptive prevalence and efficacy as well as improve care for adolescent females facing crisis pregnancies.

The retroperitoneal approach in minimally invasive pelvic surgery.

Abstract:  The retroperitoneal approach is a minimally invasive surgery than can be performed through direct access or through indirect access, with abdominal penetration. The choice of indirect transabdominal approach is appropriate when additional abdominal surgery is indicated (radical hysterectomy, pelviabdominal exploration). The advantages of the direct retroperitoneal access are the absence of risk of creating intra‐abdominal adhesions associated with those of intraperitoneal operative laparoscopy.

Effect of estetrol on Beta-Endorphin level in female rats

INTRODUCTION Estetrol (E4), a naturally occurring estrogen produced exclusively by human fetal liver, is currently being evaluated for potential use in contraception and menopausal care in humans. The present study was designed to profile E4 effects on the central nervous system, to assess the in vivo effects of E4 administration on Beta-Endorphin (β-END) release in specific brain structures and to evaluate whether E4 has synergic or antagonistic effects on estradiol-mediated β-END synthesis. EXPERIMENTAL Intact female adult rats received different doses of E4 and ovariectomized (OVX) rats received different doses of E4 or E2V or combinations of both drugs. The concentrations of β-END were assessed in the frontal and parietal cortex, hippocampus, hypothalamus, neurointermediate lobe, anterior pituitary and plasma. RESULTS E4 at the dose of 1mg/kg/day did not alter β-END content in most brain areas, as well as, plasma levels of intact animals E4 administered at a dose of 5mg/kg/day decreased β-END content in the hippocampus, hypothalamus, and in the neurointermediate lobe, as well as, plasma levels, compared to intact animals receiving vehicle. E4 increased β-END values in the frontal cortex, but not in the plasma, following the administration of 1mg/kg/day in OVX rats, whereas treatment with 5mg/kg/day in OVX rats induced a significant increase in β-END levels in most brain areas and in the plasma. However, in the presence of estradiol, E4 showed an estrogen-antagonistic effect in selected brain structures at the dose of 5mg/kg/day and in plasma levels of β-END at the dose of 1mg/kg/day and 5mg/kg/day. CONCLUSION In OVX rats, E4 increases CNS and peripheral levels of β-END, behaving as a weak estrogen-agonist. The antagonistic effect observed after combined estradiol and E4 administration further profiles E4 as a natural SERM.

Chronic tubal ectopic pregnancy: a rare but challenging diagnosis

A 34-year-old woman without any medical history presented to our hospital emergency unit with a history of 4 days of progressively increasing pain in the left iliac fossa, fever and vaginal bleeding for the past 3 weeks. Urine pregnancy test and serum bhCG were negative. CT scan showed a left pelvic mass compatible with a tubo-ovarian abscess. After transfer to our gynaecology unit, transvaginal ultrasound revealed an empty uterus with a heterogeneous mass in the left adnexal area. We performed a laparoscopy, which revealed an enlarged left haematosalpinx with firm adhesions to the surrounding organs, but no abscess. A total left salpingectomy was undertaken and the histopathological examination revealed the presence of chorionic villi, suggesting the diagnosis of chronic ectopic tubal pregnancy. The postoperative course was uneventful.