Zeev Goldik

Predicting the outcome of surgical treatment of vulvar vestibulitis

Objective To identify predictive factors for success or failure of perineoplasty for severe vulvar vestibulitis. Methods Seventy-nine women with severe vulvar vestibulitis underwent perineoplasty by a single surgeon during 1992–1994. Sixty (76%) who experienced a complete response were compared with 19 (24%) who had an incomplete response. Using univariate and then multivariate (logistic regression) analysis, the two groups were compared with regard to preoperative demographic, social, and medical variables, as well as physical findings in the vestibule. Results The complete- and incomplete-response groups were similar in all comparisons except for constant vulvar pain of vestibular origin (in addition to dyspareunia) and the presence of symptoms since first coitus. On multiple logistic regression, these characteristics had odds ratios (and 95% confidence intervals) of 4.97 (1.49, 16.63) and 5.83 (1.74, 19.55), respectively. Conclusion An incomplete response to perineoplasty may be anticipated in women with vulvar vestibulitis associated with dyspareunia since their first episode of inter-course and in those with associated persistent vulvar pain. Treatment approaches other than surgery should be considered for such patients.

Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis

Objective To evaluate the efficacy of vestibuloplasty (vestibular undercutting without excision) to treat severe vulvar vestibulitis.

Vulvar vestibulitis: physical or psychosexual problem?

OBJECTIVE To examine whether vestibulitis has a physical or a psychosexual etiology. DATA SOURCES MEDLINE was searched to retrieve publications dating from January 1981 through June 1998 that evaluated the outcomes of surgical treatment and the psychosexual theory of the origin of vestibulitis. INTEGRATION: Articles were analyzed for methods of subject selection and surgery, surgical outcome, and length of follow-up. RESULTS A significant decrease in symptoms (complete responses + partial responses) was reported by 89% of 646 women who had perineoplasty for vulvar vestibulitis. Complete resolution of dyspareunia with surgical treatment was reported in 72% of 512 women whose cases were reviewed in studies in which complete responses and partial responses were evaluated separately. Women with vestibulitis did not differ from the normal population with respect to marital satisfaction, psychologic distress, or psychopathology. A suggestion that childhood sexual abuse caused vestibulitis has not been confirmed. The findings of somatization and shyness might be explained as results rather than causes of vulvar vestibulitis. CONCLUSION We do not agree that vestibulitis is a psychosexual problem and one that should not be treated surgically. A high rate of success can be achieved with proper surgical treatment.

Airway management by physicians wearing anti-chemical warfare gear: comparison between laryngeal mask airway and endotracheal intubation.

BACKGROUND AND OBJECTIVE To evaluate the ease with which successful insertion of a laryngeal mask airway can be performed in comparison with endotracheal intubation by medical personnel wearing chemical protective equipment. METHODS Anaesthetists and non-anaesthetists (each n = 20) participated in the prospective comparative trial in an animal laboratory. The time and success rates of laryngeal mask airway vs. endotracheal tube insertions were measured as performed on anaesthetized monkeys. RESULTS The results showed that the laryngeal mask airway was inserted more rapidly than the endotracheal tube by both groups (3.6 s and 28.6 s, P < 0.0001). Failed intubation occurred in 35% (anaesthetists) vs. 55% (non-anaesthetists) (P = 0.17). CONCLUSIONS In view of the 100% success rate of insertion even in unfavourable conditions, the possible role of the laryngeal mask airway in the scenario of a toxic mass casualty event should be considered.

Quality and safety guidelines of postanaesthesia care: Working Party on Post Anaesthesia Care (approved by the European Board and Section of Anaesthesiology, Union Européenne des Médecins Spécialistes).

Postanaesthesia care units are standard parts of hospital care in most European Union countries. Their main purpose is to identify and immediately treat early complications of surgery or anaesthesia, before they develop into deleterious problems. This review, prepared by the Working Party on Post Anaesthesia Care of the European Board of Anaesthesiology. European Union of Medical Specialists (Union Européenne des Médecins Spécialistes) and approved by the European Board and Section of Anaesthesiology, gives recommendations on relevant aspects of organization, responsibilities, methods, safety and quality control of postanaesthesia care.

Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome

Abstract OBJECTIVE: Our purpose was to assess the prevalence of infections by human papillomavirus, herpes simplex virus, and cytomegalovirus among women with severe vulvar vestibulitis. STUDY DESIGN: Eighty-six women referred for dyspareunia and diagnosed as having severe vestibulitis underwent perineoplasty, including surgical removal of the sensitive vestibule. Controls included 25 age-matched patients without dyspareunia undergoing vaginal operations for various benign causes or undergoing repair of an episiotomy. Polymerase chain reaction analysis was carried out to determine the presence of viral genes. RESULTS: The prevalence of herpes simplex virus and cytomegalovirus among the subjects tested was nil, whereas human papillomavirus was detected in 46 cases (54%). The human papillomavirus present was not of types 6, 11, 16, 18, or 33. Only one woman of the 25 asymptomatic controls (4%) had human papillomavirus deoxyribonucleic acid in the vestibule ( p CONCLUSION: Our data provide support for the idea that vulvar vestibulitis is associated with human papillomavirus deoxyribonucleic acid in more than half of cases. (Am J Obstet Gynecol 1996;175:139-44.)

Persistent vulvar vestibulitis: the continuing challenge.

A continuing challenge in the management of women with vulvar vestibulitis is the patient who has not responded to surgical treatment. The main reason for persistent dyspareunia is failure to excise the sensitive periurethral tissue in the primary operation. In other cases, the Bartholins glands may be the source of the pain. A low oxalate diet, the administration of interferon, and biofeedback training of the lower pelvic muscles-treatments that are used as a first-choice approach for vulvar vestibulitis, may all work in the postoperative patient. The management of a patient with residual vestibulitis should be conservative, and only when medical measures fail, do we consider additional surgical methods such as Bartholins gland resection or repeat perineoplasty.

Postgraduate training in anaesthesiology, resuscitation and intensive care: state-of-the-art for trainee evaluation and assessment in Europe

In the last decade, competency-based curricula in anaesthesiology, resuscitation and intensive care have been slowly implemented in Europe, based mainly on the Canadian Medical Education Directions for Specialists (CanMEDS) framework for doctor competencies, which requires that a competent doctor should be proficient in seven distinct roles. This framework is an outcomebased education model spanning a large range of domains of activities and associated competencies to be acquired. Learning outcomes have been defined that underpin these competencies and should permit appropriate trainee evaluation and assessment.

WHO Needs High FIO2

World Health Organization and the United States Center for Disease Control have recently recommended the use of 0.8 FIO2 in all adult surgical patients undergoing general anaesthesia, to prevent surgical site infections. This recommendation has arisen several discussions: As a matter of fact, there are numerous studies with different results about the effect of FIO2 on surgical site infection. Moreover, the clinical effects of FIO2 are not limited to infection control. We asked some prominent authors about their comments regarding the recent recommendations.

Abandoning negative marking

The European Diploma of Anesthesiology and Intensive Care was created in 1984. It has matured and developed over the last 24 yr into a multilingual examination, which takes place today in more than 20 centres in Europe. It consists of two parts – Part 1 (the primary examination) and Part 2 (the final examination). The primary examination takes place in the form of a written multiple-choice examination. The ‘True/ False/ Don’t Know’ format is used, where every candidate can mark one of three boxes on the computerreadable mark sheet corresponding to one of these three decisions. If none of the three boxes are marked for an individual question, the choice of ‘Don’t Know’ is assumed. The number of correct responses is counted and each is given a score of 11. Likewise, each incorrect response is given a score of 21. A response of ‘Don’t Know’ receives a score of 0. Subtracting the number of incorrect responses from the number of correct responses gives the candidate’s score. Until 1969, in the UK, the Part I of the Membership Examination of the Royal College of Physicians was scored by the above method (11, 21 and 0) described by the Study Group of The London College in 1967 and modified in 1969 [1]. This method was called Formula Scoring, defined by the formula